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Published in: Current Bladder Dysfunction Reports 4/2019

01-12-2019 | Voiding Disorder | Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)

Dilemmas in Management of the Geriatric Bladder

Authors: Siobhan M. Hartigan, W. Stuart Reynolds, Phillip P. Smith

Published in: Current Bladder Dysfunction Reports | Issue 4/2019

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Abstract

Purpose of Review

In this article, we will review current dilemmas regarding evaluation and management of the geriatric bladder incorporating concepts of normal changes of aging as well as common lower urinary tract dysfunction.

Recent Findings

Increasing age leads to functional changes in essentially all organ systems including the genitourinary system. Understanding the natural changes with age of the bladder as well as the signs and symptoms of pathologic conditions is paramount to diagnosis and treatment of urologic conditions in the geriatric population.

Summary

There are several conundrums in the diagnosis and evaluation of the geriatric bladder including the ability of the bladder to store, empty, as well as sensitivity disturbances. Diagnostic testing and goals of treatment should be individualized for each patient and personalized to consider patient comorbidities, limitations, and expectations.
Literature
1.
go back to reference • Vaughan CP, et al. Report and research agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: a translational research agenda for a complex geriatric syndrome. J Am Geriatr Soc. 2018;66(4):773–82. This article is a recently published summary report from a rare multidisciplinary meeting to discuss urinary incontinence in a geriatric population. PubMed • Vaughan CP, et al. Report and research agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: a translational research agenda for a complex geriatric syndrome. J Am Geriatr Soc. 2018;66(4):773–82. This article is a recently published summary report from a rare multidisciplinary meeting to discuss urinary incontinence in a geriatric population. PubMed
2.
go back to reference Lowalekar SK, et al. Loss of bladder smooth muscle caveolae in the aging bladder. Neurourol Urodyn. 2012;31(4):586–92.PubMed Lowalekar SK, et al. Loss of bladder smooth muscle caveolae in the aging bladder. Neurourol Urodyn. 2012;31(4):586–92.PubMed
3.
go back to reference Elbadawi A, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. II. Aging detrusor: normal versus impaired contractility. J Urol. 1993;150(5 Pt 2):1657–67.PubMed Elbadawi A, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. II. Aging detrusor: normal versus impaired contractility. J Urol. 1993;150(5 Pt 2):1657–67.PubMed
4.
go back to reference Elbadawi A, et al. Structural basis of geriatric voiding dysfunction. VII. Prospective ultrastructural/urodynamic evaluation of its natural evolution. J Urol. 1997;157(5):1814–22.PubMed Elbadawi A, et al. Structural basis of geriatric voiding dysfunction. VII. Prospective ultrastructural/urodynamic evaluation of its natural evolution. J Urol. 1997;157(5):1814–22.PubMed
5.
go back to reference Pfisterer MH, et al. The effect of age on lower urinary tract function: a study in women. J Am Geriatr Soc. 2006;54(3):405–12.PubMed Pfisterer MH, et al. The effect of age on lower urinary tract function: a study in women. J Am Geriatr Soc. 2006;54(3):405–12.PubMed
6.
go back to reference Pfisterer MH, et al. The impact of detrusor overactivity on bladder function in younger and older women. J Urol. 2006;175(5):1777–83 discussion 1783.PubMed Pfisterer MH, et al. The impact of detrusor overactivity on bladder function in younger and older women. J Urol. 2006;175(5):1777–83 discussion 1783.PubMed
7.
go back to reference Aybek H, et al. Preventive effects of vitamin E against oxidative damage in aged diabetic rat bladders. Urology. 2011;77(2):508 e10-4.PubMed Aybek H, et al. Preventive effects of vitamin E against oxidative damage in aged diabetic rat bladders. Urology. 2011;77(2):508 e10-4.PubMed
8.
go back to reference Betschart C, et al. Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(11):1477–81.PubMed Betschart C, et al. Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(11):1477–81.PubMed
9.
go back to reference Saatli B, et al. Alteration of apoptosis-related genes in postmenopausal women with uterine prolapse. Int Urogynecol J. 2014;25(7):971–7.PubMed Saatli B, et al. Alteration of apoptosis-related genes in postmenopausal women with uterine prolapse. Int Urogynecol J. 2014;25(7):971–7.PubMed
10.
go back to reference Zhou Y, et al. Endoplasmic reticulum stress contributes to the pathogenesis of stress urinary incontinence in postmenopausal women. J Int Med Res. 2018;46(12):5269–77.PubMedPubMedCentral Zhou Y, et al. Endoplasmic reticulum stress contributes to the pathogenesis of stress urinary incontinence in postmenopausal women. J Int Med Res. 2018;46(12):5269–77.PubMedPubMedCentral
11.
go back to reference Strasser H, et al. Urinary incontinence in the elderly and age-dependent apoptosis of rhabdosphincter cells. Lancet. 1999;354(9182):918–9.PubMed Strasser H, et al. Urinary incontinence in the elderly and age-dependent apoptosis of rhabdosphincter cells. Lancet. 1999;354(9182):918–9.PubMed
12.
go back to reference Smith PP, Kuchel GA, Griffiths D. Functional brain imaging and the neural basis for voiding dysfunction in older adults. Clin Geriatr Med. 2015;31(4):549–65.PubMed Smith PP, Kuchel GA, Griffiths D. Functional brain imaging and the neural basis for voiding dysfunction in older adults. Clin Geriatr Med. 2015;31(4):549–65.PubMed
13.
go back to reference Kuchel GA, et al. Localization of brain white matter hyperintensities and urinary Incontinence in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2009:glp037. Kuchel GA, et al. Localization of brain white matter hyperintensities and urinary Incontinence in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2009:glp037.
14.
go back to reference Resnick NM. Urinary incontinence in the elderly. Hosp Pract (Off Ed). 1986;21(11):80C–L 80Q passim. Resnick NM. Urinary incontinence in the elderly. Hosp Pract (Off Ed). 1986;21(11):80C–L 80Q passim.
15.
go back to reference By the American Geriatrics Society Beers Criteria Update Expert, P., American Geriatrics Society 2019. Updated AGS Beers Criteria(R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–94. By the American Geriatrics Society Beers Criteria Update Expert, P., American Geriatrics Society 2019. Updated AGS Beers Criteria(R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–94.
16.
go back to reference Coupland CAC, et al. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Intern Med. 2019. Coupland CAC, et al. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Intern Med. 2019.
17.
go back to reference Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMed Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMed
18.
go back to reference •• Chapple CR, et al. Terminology report from the International Continence Society (ICS) Working Group on Underactive Bladder (UAB). Neurourol Urodyn. 2018;37(8):2928–31. An excellent article outlining the most up to date terminology and definitions related to detrusor underactivity and underactive bladder. PubMed •• Chapple CR, et al. Terminology report from the International Continence Society (ICS) Working Group on Underactive Bladder (UAB). Neurourol Urodyn. 2018;37(8):2928–31. An excellent article outlining the most up to date terminology and definitions related to detrusor underactivity and underactive bladder. PubMed
19.
go back to reference Leitner L, et al. Urodynamic investigation: a valid tool to define normal lower urinary Tract function? PLoS One. 2016;11(10):e0163847.PubMedPubMedCentral Leitner L, et al. Urodynamic investigation: a valid tool to define normal lower urinary Tract function? PLoS One. 2016;11(10):e0163847.PubMedPubMedCentral
20.
go back to reference Griffiths DJ, et al. Urge incontinence and impaired detrusor contractility in the elderly. Neurourol Urodyn. 2002;21(2):126–31.PubMed Griffiths DJ, et al. Urge incontinence and impaired detrusor contractility in the elderly. Neurourol Urodyn. 2002;21(2):126–31.PubMed
21.
go back to reference Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. Jama. 1987;257(22):3076–81.PubMed Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. Jama. 1987;257(22):3076–81.PubMed
22.
go back to reference Abrams P, Andersson KE. Muscarinic receptor antagonists for overactive bladder. BJU Int. 2007;100(5):987–1006.PubMed Abrams P, Andersson KE. Muscarinic receptor antagonists for overactive bladder. BJU Int. 2007;100(5):987–1006.PubMed
23.
go back to reference Guay DR. Clinical pharmacokinetics of drugs used to treat urge incontinence. Clin Pharmacokinet. 2003;42(14):1243–85.PubMed Guay DR. Clinical pharmacokinetics of drugs used to treat urge incontinence. Clin Pharmacokinet. 2003;42(14):1243–85.PubMed
24.
go back to reference Andersson, K.-E. and A.J. Wein, Pharmacologic management of lower urinary tract storage and emptying failure, in Campbell-Walsh Urology, A.J. Wein, et al., Editors. 2016, Elsevier: Philadelphia, PA. Andersson, K.-E. and A.J. Wein, Pharmacologic management of lower urinary tract storage and emptying failure, in Campbell-Walsh Urology, A.J. Wein, et al., Editors. 2016, Elsevier: Philadelphia, PA.
26.
go back to reference • Faris AER, et al. Impact of age and comorbidities on use of sacral neuromodulation. J Urol. 2017;198(1):161–6. A recent study examining the influence of patient age on sacral neuromodulation trial outcomes, device implantation, and treatment durability. PubMed • Faris AER, et al. Impact of age and comorbidities on use of sacral neuromodulation. J Urol. 2017;198(1):161–6. A recent study examining the influence of patient age on sacral neuromodulation trial outcomes, device implantation, and treatment durability. PubMed
27.
go back to reference Komesu YM, et al. Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications. Am J Obstet Gynecol. 2018;218(1):111 e1–9. Komesu YM, et al. Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications. Am J Obstet Gynecol. 2018;218(1):111 e1–9.
28.
go back to reference Liao CH, Kuo HC. Increased risk of large post-void residual urine and decreased long-term success rate after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity. J Urol. 2013;189(5):1804–10.PubMed Liao CH, Kuo HC. Increased risk of large post-void residual urine and decreased long-term success rate after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity. J Urol. 2013;189(5):1804–10.PubMed
29.
go back to reference Smith PP, Chalmers DJ, Feinn RS. Does defective volume sensation contribute to detrusor underactivity? Neurourol Urodyn. 2015;34(8):752–6.PubMed Smith PP, Chalmers DJ, Feinn RS. Does defective volume sensation contribute to detrusor underactivity? Neurourol Urodyn. 2015;34(8):752–6.PubMed
30.
go back to reference Gaitonde S, et al. Bethanechol: is it still being prescribed for bladder dysfunction in women? Int J Clin Pract. 2018:e13248.PubMed Gaitonde S, et al. Bethanechol: is it still being prescribed for bladder dysfunction in women? Int J Clin Pract. 2018:e13248.PubMed
31.
go back to reference Bougas DA, et al. Clinical efficacy of distigmine bromide in the treatment of patients with underactive detrusor. Int Urol Nephrol. 2004;36(4):507–12.PubMed Bougas DA, et al. Clinical efficacy of distigmine bromide in the treatment of patients with underactive detrusor. Int Urol Nephrol. 2004;36(4):507–12.PubMed
32.
go back to reference Sugaya K, et al. Effect of distigmine at 5 mg daily in patients with detrusor underactivity. Nihon Hinyokika Gakkai Zasshi. 2014;105(1):10–6.PubMed Sugaya K, et al. Effect of distigmine at 5 mg daily in patients with detrusor underactivity. Nihon Hinyokika Gakkai Zasshi. 2014;105(1):10–6.PubMed
33.
go back to reference Gross C, et al. Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg. 2010;16(4):249–53.PubMed Gross C, et al. Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg. 2010;16(4):249–53.PubMed
34.
go back to reference May L, Mullins P, Pines J. Demographic and treatment patterns for infections in ambulatory settings in the United States, 2006-2010. Acad Emerg Med. 2014;21(1):17–24.PubMedPubMedCentral May L, Mullins P, Pines J. Demographic and treatment patterns for infections in ambulatory settings in the United States, 2006-2010. Acad Emerg Med. 2014;21(1):17–24.PubMedPubMedCentral
35.
go back to reference Nace DA, Drinka PJ, Crnich CJ. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Assoc. 2014;15(2):133–9.PubMed Nace DA, Drinka PJ, Crnich CJ. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Assoc. 2014;15(2):133–9.PubMed
36.
go back to reference Michener A, et al. Infections in older adults: a case-based discussion series emphasizing antibiotic stewardship. MedEdPORTAL. 2018;14:10754.PubMedPubMedCentral Michener A, et al. Infections in older adults: a case-based discussion series emphasizing antibiotic stewardship. MedEdPORTAL. 2018;14:10754.PubMedPubMedCentral
37.
go back to reference Nicolle LE, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643–54.PubMed Nicolle LE, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643–54.PubMed
38.
go back to reference Finucane TE. "Urinary tract infection"-requiem for a heavyweight. J Am Geriatr Soc. 2017;65(8):1650–5.PubMed Finucane TE. "Urinary tract infection"-requiem for a heavyweight. J Am Geriatr Soc. 2017;65(8):1650–5.PubMed
40.
go back to reference Nicolle LE. Resistant pathogens in urinary tract infections. J Am Geriatr Soc. 2002;50(7 Suppl):S230–5.PubMed Nicolle LE. Resistant pathogens in urinary tract infections. J Am Geriatr Soc. 2002;50(7 Suppl):S230–5.PubMed
41.
go back to reference Detweiler K, Mayers D, Fletcher SG. bacteruria and urinary tract infections in the Elderly. Urol Clin N Am. 2015;42(4):561–8. Detweiler K, Mayers D, Fletcher SG. bacteruria and urinary tract infections in the Elderly. Urol Clin N Am. 2015;42(4):561–8.
42.
go back to reference Koves B, et al. Benefits and harms of treatment of asymptomatic bacteriuria: a systematic review and meta-analysis by the European Association of Urology Urological Infection Guidelines Panel. Eur Urol. 2017;72(6):865–8.PubMed Koves B, et al. Benefits and harms of treatment of asymptomatic bacteriuria: a systematic review and meta-analysis by the European Association of Urology Urological Infection Guidelines Panel. Eur Urol. 2017;72(6):865–8.PubMed
43.
go back to reference D'Ancona C, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2):433–77.PubMed D'Ancona C, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2):433–77.PubMed
44.
go back to reference Rule AD, et al. Longitudinal changes in post-void residual and voided volume among community dwelling men. J Urol. 2005;174(4 Pt 1):1317–21 discussion 1321-2; author reply 1322.PubMed Rule AD, et al. Longitudinal changes in post-void residual and voided volume among community dwelling men. J Urol. 2005;174(4 Pt 1):1317–21 discussion 1321-2; author reply 1322.PubMed
45.
go back to reference Kershen RT, Azadzoi KM, Siroky MB. blood flow, pressure and compliance in the male human bladder. J Urol. 2002;168(1):121–5.PubMed Kershen RT, Azadzoi KM, Siroky MB. blood flow, pressure and compliance in the male human bladder. J Urol. 2002;168(1):121–5.PubMed
46.
go back to reference Chae JY, et al. Points Aa and Ba are factors associated with preoperative voiding dysfunction in patients with cystocele. Eur J Obstet Gynecol Reprod Biol. 2014;174:146–9.PubMed Chae JY, et al. Points Aa and Ba are factors associated with preoperative voiding dysfunction in patients with cystocele. Eur J Obstet Gynecol Reprod Biol. 2014;174:146–9.PubMed
47.
go back to reference Wong KS, et al. The relationship of anterior vaginal and apical position to postvoid residual urine. Female Pelvic Med Reconstr Surg. 2017;23(5):310–4.PubMed Wong KS, et al. The relationship of anterior vaginal and apical position to postvoid residual urine. Female Pelvic Med Reconstr Surg. 2017;23(5):310–4.PubMed
48.
go back to reference Illiano E, et al. Urodynamic findings and functional outcomes after laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse. Int Urogynecol J. 2019;30(4):589–94.PubMed Illiano E, et al. Urodynamic findings and functional outcomes after laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse. Int Urogynecol J. 2019;30(4):589–94.PubMed
49.
go back to reference • Wagg A, et al. Urinary incontinence in frail elderly persons: report from the 5th International Consultation on Incontinence. Neurourol Urodyn. 2015;34(5):398–406. This article provides an authoritative set of recommendations in the management of urinary incontinence in frail older persons. PubMed • Wagg A, et al. Urinary incontinence in frail elderly persons: report from the 5th International Consultation on Incontinence. Neurourol Urodyn. 2015;34(5):398–406. This article provides an authoritative set of recommendations in the management of urinary incontinence in frail older persons. PubMed
50.
go back to reference Rose A, et al. Severity of urinary incontinence of nursing home residents correlates with malnutrition, dementia and loss of mobility. Urol Int. 2013;91(2):165–9.PubMed Rose A, et al. Severity of urinary incontinence of nursing home residents correlates with malnutrition, dementia and loss of mobility. Urol Int. 2013;91(2):165–9.PubMed
51.
go back to reference Drach GW. Geriatric urology. In: Hanno PM, et al., editors. Penn clinical manual of urology. Philadelphia: Saunders/Elsevier; 2014. Drach GW. Geriatric urology. In: Hanno PM, et al., editors. Penn clinical manual of urology. Philadelphia: Saunders/Elsevier; 2014.
52.
go back to reference Stone ND, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012;33(10):965–77.PubMedPubMedCentral Stone ND, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012;33(10):965–77.PubMedPubMedCentral
53.
go back to reference Yared JE, Gormley EA. The Role of Urodynamics in Elderly Patients. Clin Geriatr Med. 2015;31(4):567–79.PubMed Yared JE, Gormley EA. The Role of Urodynamics in Elderly Patients. Clin Geriatr Med. 2015;31(4):567–79.PubMed
54.
go back to reference Pizzoferrato AC, et al. Dynamic magnetic resonance imaging and pelvic floor disorders: how and when? Eur J Obstet Gynecol Reprod Biol. 2014;181:259–66.PubMed Pizzoferrato AC, et al. Dynamic magnetic resonance imaging and pelvic floor disorders: how and when? Eur J Obstet Gynecol Reprod Biol. 2014;181:259–66.PubMed
55.
go back to reference Lin FC, et al. Dynamic Pelvic Magnetic Resonance Imaging Evaluation of Pelvic Organ Prolapse Compared to Physical Examination Findings. Urology. 2018;119:49–54.PubMed Lin FC, et al. Dynamic Pelvic Magnetic Resonance Imaging Evaluation of Pelvic Organ Prolapse Compared to Physical Examination Findings. Urology. 2018;119:49–54.PubMed
Metadata
Title
Dilemmas in Management of the Geriatric Bladder
Authors
Siobhan M. Hartigan
W. Stuart Reynolds
Phillip P. Smith
Publication date
01-12-2019
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports / Issue 4/2019
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-019-00541-8

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