Advertisement

Dilemmas in Management of the Geriatric Bladder

  • Siobhan M. Hartigan
  • W. Stuart Reynolds
  • Phillip P. SmithEmail author
Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
  • 16 Downloads
Part of the following topical collections:
  1. Topical Collection on Reconstructed Bladder Function & Dysfunction

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.

Keywords

Geriatric urology Aging bladder Lower urinary tract symptoms Incontinence Voiding dysfunction 

Notes

Compliance with Ethical Standards

Conflict of Interest

SM Hartigan, WS Reynolds, and PP Smith declare that they have no conflict of interest.

Funding Information

Relevant to this publication, PPS reports NIA K76AG054777.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • 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. PubMedCrossRefGoogle Scholar
  2. 2.
    Lowalekar SK, et al. Loss of bladder smooth muscle caveolae in the aging bladder. Neurourol Urodyn. 2012;31(4):586–92.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    Aybek H, et al. Preventive effects of vitamin E against oxidative damage in aged diabetic rat bladders. Urology. 2011;77(2):508 e10-4.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    Saatli B, et al. Alteration of apoptosis-related genes in postmenopausal women with uterine prolapse. Int Urogynecol J. 2014;25(7):971–7.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Strasser H, et al. Urinary incontinence in the elderly and age-dependent apoptosis of rhabdosphincter cells. Lancet. 1999;354(9182):918–9.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.Google Scholar
  14. 14.
    Resnick NM. Urinary incontinence in the elderly. Hosp Pract (Off Ed). 1986;21(11):80C–L 80Q passim.Google Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    Coupland CAC, et al. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Intern Med. 2019.Google Scholar
  17. 17.
    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.PubMedPubMedCentralGoogle Scholar
  18. 18.
    •• 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. PubMedPubMedCentralGoogle Scholar
  19. 19.
    Leitner L, et al. Urodynamic investigation: a valid tool to define normal lower urinary Tract function? PLoS One. 2016;11(10):e0163847.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Griffiths DJ, et al. Urge incontinence and impaired detrusor contractility in the elderly. Neurourol Urodyn. 2002;21(2):126–31.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Abrams P, Andersson KE. Muscarinic receptor antagonists for overactive bladder. BJU Int. 2007;100(5):987–1006.PubMedCrossRefGoogle Scholar
  23. 23.
    Guay DR. Clinical pharmacokinetics of drugs used to treat urge incontinence. Clin Pharmacokinet. 2003;42(14):1243–85.PubMedCrossRefGoogle Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    Pratt TS, Suskind AM. Management of overactive bladder in older women. Curr Urol Rep. 2018;19(11):92.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    • 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. PubMedCrossRefGoogle Scholar
  27. 27.
    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.CrossRefGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    Smith PP, Chalmers DJ, Feinn RS. Does defective volume sensation contribute to detrusor underactivity? Neurourol Urodyn. 2015;34(8):752–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Gaitonde S, et al. Bethanechol: is it still being prescribed for bladder dysfunction in women? Int J Clin Pract. 2018:e13248.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    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.PubMedGoogle Scholar
  33. 33.
    Gross C, et al. Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg. 2010;16(4):249–53.PubMedCrossRefGoogle Scholar
  34. 34.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    Michener A, et al. Infections in older adults: a case-based discussion series emphasizing antibiotic stewardship. MedEdPORTAL. 2018;14:10754.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Finucane TE. "Urinary tract infection"-requiem for a heavyweight. J Am Geriatr Soc. 2017;65(8):1650–5.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Anger J, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU Guideline. J Urol. 2019.  https://doi.org/10.1097/JU.0000000000000296.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Nicolle LE. Resistant pathogens in urinary tract infections. J Am Geriatr Soc. 2002;50(7 Suppl):S230–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Detweiler K, Mayers D, Fletcher SG. bacteruria and urinary tract infections in the Elderly. Urol Clin N Am. 2015;42(4):561–8.CrossRefGoogle Scholar
  42. 42.
    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.PubMedCrossRefGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    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.PubMedCrossRefGoogle Scholar
  45. 45.
    Kershen RT, Azadzoi KM, Siroky MB. blood flow, pressure and compliance in the male human bladder. J Urol. 2002;168(1):121–5.PubMedCrossRefGoogle Scholar
  46. 46.
    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.PubMedCrossRefGoogle Scholar
  47. 47.
    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.PubMedCrossRefGoogle Scholar
  48. 48.
    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.PubMedCrossRefGoogle Scholar
  49. 49.
    • 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. PubMedCrossRefGoogle Scholar
  50. 50.
    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.PubMedCrossRefGoogle Scholar
  51. 51.
    Drach GW. Geriatric urology. In: Hanno PM, et al., editors. Penn clinical manual of urology. Philadelphia: Saunders/Elsevier; 2014.Google Scholar
  52. 52.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Yared JE, Gormley EA. The Role of Urodynamics in Elderly Patients. Clin Geriatr Med. 2015;31(4):567–79.PubMedCrossRefGoogle Scholar
  54. 54.
    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.PubMedCrossRefGoogle Scholar
  55. 55.
    Lin FC, et al. Dynamic Pelvic Magnetic Resonance Imaging Evaluation of Pelvic Organ Prolapse Compared to Physical Examination Findings. Urology. 2018;119:49–54.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Siobhan M. Hartigan
    • 1
  • W. Stuart Reynolds
    • 1
  • Phillip P. Smith
    • 2
    • 3
    Email author
  1. 1.Department of UrologyVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of SurgeryUniversity of Connecticut Health CenterFarmingtonUSA
  3. 3.Center on Aging, UConn Institute for Brain and Cognitive SciencesUConn School of MedicineFarmingtonUSA

Personalised recommendations