Urodynamics in women from menopause to oldest age: what motive? what diagnosis?

Abstract

Purpose: To analyze age-associated changes as a motive for urodynamics and urodynamic diagnosis in community-dwelling menopausal women and to discuss the role of menopause and ageing. Materials and Methods: Four hundred and forty nine consecutive menopausal women referred for urodynamic evaluation of lower urinary tract (LUT) symptoms, met the inclusion criteria and were stratified into 3 age groups: 55-64 years (A), 65-74 years (B), and 75-93 years (C). Comprehensive assessment included previous medical history and clinical examination. Studied items were motive for urodynamics, results of uroflows (free flow and intubated flow) and cystometry, urethral pressure profilometry, and final urodynamic diagnosis. Results: The main motive was incontinence (66.3%) with significant increase of mixed incontinence in group C (p = 0.028). Detrusor function significantly deteriorated in the oldest group, mainly in absence of neurological disease (overactivity p = 0.019; impaired contractility p = 0.028). In the entire population, underactivity predominated in group C (p = 0.0024). A progressive decrease of maximum urethral closure pressure occurred with ageing. In subjects with no detrusor overactivity there was a decrease with age of detrusor pressure at opening and at maximum flow, and of maximum flow while post void residual increased only in the C group. Conclusion: In our population of community-dwelling menopausal women, incontinence was the main motive for urodynamics increasing with ageing. A brisk change in LUT function of women older than 75 years underlined deterioration in bladder function with a high incidence of detrusor hyperactivity with or without impaired contractility while change in urethral function was progressive. Effect of ageing appears to be predominant compared to menopause.

Underactive bladder in women

“…Several subsequent studies have evaluated the prevalence of detrusor underactivity in women in the ambulatory setting [10,13,14]. Groutz et al [13] interviewed 206 consecutive women with mean age 62.6 in a urogynecology practice for symptoms of ‘voiding difficulties’, specifically: incomplete emptying, double voiding, intermittent voiding, weak stream, hesitancy, straining to void, positional voiding, and need for prolapse reduction.…”

“…In a study of postmenopausal women age 55 and older, Valentini et al [14] identified detrusor underactivity, defined as ‘impaired detrusor contraction leading to prolonged voiding time and high residual volume,’ in 62/449 (14%) consecutive patients undergoing UDS. The motive for UDS was incontinence in two-thirds of patients.…”

“…It is notable that despite variable definitions for detrusor underactivity, prevalence rates were fairly similar across all three studies in the ambulatory setting [10,13,14]. In a recent population-wide cross-sectional study in Metro Detroit, 20% of the 291 women surveyed reported difficulty emptying their bladder, suggesting UAB is also prevalent outside of the clinical setting [15].…”

Role of Urodynamics in the Evaluation of Elderly Voiding Dysfunction

“…In a study of 449 women, Valentini et al found predominance of impaired detrusor contractility and high PVR in patients 75-93 years old compared to younger age groups [8]. The elderly are more predisposed to fecal impaction, impaired mobility, and use of multiple medications that can affect the detrusor function [9].…”

Therapeutic conduct in postmenopausal women with different forms of urinary incontinence

“…Factors causing and aggravating urinary incontinence include [1,[14][15][16][17] It is believed that women performing advanced endurance sports are at a risk of developing urinary incon-der were the most common diagnoses in the third age group. The urge incontinence was not linked to age in any way [23]. Different perspective comes from a study by Findink et al, who established that urge incontinence is most prevalent among women after menopause [24].…”