Der Urologe

, Volume 52, Issue 6, pp 805–812 | Cite as

Inkontinenz im Alter

Was kann und soll man tun?
  • B. Amend
  • S. Kruck
  • J. Bedke
  • R. Ritter
  • L. Arenas da Silva
  • C. Chapple
  • A. Stenzl
  • K.-D. Sievert
Leitthema

Zusammenfassung

Die demographische Entwicklung unserer Gesellschaft zeigt einen deutlichen Anstieg der älteren Bevölkerung in den nächsten Jahrzehnten und damit dem Kollektiv mit einer hohen Prävalenz der Harninkontinenz. Unterschiedliche Gründe führen dazu, dass eine Diagnostik und Therapie nicht erfolgt und somit die Inkontinenzversorgung unzureichend ist. Die sorgfältige Anamnese stellt die Basis eines Erkennens des Problems dar und ist Grundlage für die weiteren diagnostischen und therapeutischen Schritte. Hierbei gelten die Algorithmen entsprechend der Leitlinien der Fachgesellschaften, wobei altersspezifische Besonderheiten bedacht werden sollten. Im Vordergrund stehen konservative Untersuchungen und Maßnahmen. In wenigen Fällen kann aber auch im Alter eine invasive Diagnostik mittels Urodynamik oder Zystoskopie sinnvoll und indiziert sein. Die im Alter vielfältige Einnahme von Medikamenten bedarf sowohl aus ätiologischer als auch therapeutischer Sicht im Hinblick auf Interaktionen besondere Beachtung. Vor allem kognitive Einschränkungen durch pharmakologische Ansätze sollten vermieden werden. Wenngleich Inkontinenzchirurgie mit steigendem Alter der Patienten weniger häufig Anwendung findet, so hat diese dennoch bei entsprechender Diagnostik und Auswahl ihren erfolgreichen Stellenwert.

Schlüsselwörter

Belastungsharninkontinenz Drangharninkontinenz Prävention Anticholinergika Botulinumtoxin 

Urinary incontinence in the elderly

What can and should be done?

Abstract

The demographic development of society shows a clear increase in the elderly population in the coming decades, which will result in an increasing prevalence of urinary incontinence. Diagnosis and treatment of many patients is not carried out for a myriad of reasons and thus incontinence care is often inadequate. A detailed medical history is the basis of identification of the problem and underpins the effective diagnostic and therapeutic management of the problem. In this context, the algorithms based on the national and international guidelines and age-specific characteristics should be considered. The initial focus should be on conservative management. In a few cases of elderly patients, invasive diagnostics using urodynamics or cystoscopy might be indicated. The increased use of medication in the elderly both from an etiological and therapeutic point of view, especially in terms of drug/drug interactions requires special consideration. In particular cognitive impairment using pharmacological approaches should be avoided. Although incontinence surgery of the patient applies less often with increasing age it still plays a role in the appropriate selection of treatment.

Keywords

Stress incontinence Urge incontinence Prevention Anticholinergic drugs Botulinum toxin 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • B. Amend
    • 1
  • S. Kruck
    • 1
  • J. Bedke
    • 1
  • R. Ritter
    • 1
  • L. Arenas da Silva
    • 1
  • C. Chapple
    • 2
  • A. Stenzl
    • 1
  • K.-D. Sievert
    • 1
  1. 1.Klinik für UrologieUniversitätsklinikum TübingenTübingenDeutschland
  2. 2.Consultant UrologistRoyal Hallamshire HospitalSheffieldEngland

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