Genitourinary Problems in the Elderly

  • Frank P. Begun
  • Stephen C. Jacobs
Part of the Contemporary Geriatric Medicine book series (COGM, volume 3)


In this chapter, we would like to introduce the reader to problems that the elderly face with respect to control of the lower urinary tract. The normal anatomy and physiology of the bladder will first be reviewed. Then the two major problems faced by the elderly, incontinence and retention, will be discussed.


Stress Urinary Incontinence Urinary Retention Bladder Neck Stress Incontinence Urge Incontinence 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    McGuire, E., 1979, Urethral sphincter mechanisms,Urol. Clin. North Am. 6:39–49.PubMedGoogle Scholar
  2. 2.
    Wein, A. J. and Raezer, D. M., 1979, Physiology of Micturition, in: Clinical Neuro-Urology (R. J. Krane and M. B. Siroky, eds.), Little, Brown, Boston, pp. 1–33.Google Scholar
  3. 3.
    Anderson, G. F., Pierce, J. M., Fredericks, C. M., Atkinson, S. M., and Goellner, P., 1971, A pharmacologic evaluation of the adrenergic receptors of the rabbit detrusor muscle. Arch. Int. Pharmacodyn. Ther. 191:220–230.PubMedGoogle Scholar
  4. 4.
    Awad, S. A., Bruce, A. W., Carro-Ciampi, G., Downie, J. W., and Lin, M., 1974, Distribution of alpha and beta adrenoreceptors in human urinary bladder, Br. J. Pharmacol. 50:525–529.PubMedGoogle Scholar
  5. 5.
    Benson, G. S., Jacobowitz, D., Raezer, D. M., Corriere, J. N., and Wein, A. J., 1976, Adrenergic innervation and stimulation of canine urethra, Urology 7:337–340.PubMedCrossRefGoogle Scholar
  6. 6.
    Boyarsky, S., Labay, P., Gregg, R., and Levie, B., 1968, Pharmacologic studies of the nature of the sympathetic nerves of the urinary bladder, Paraplegia 6:136–150.PubMedCrossRefGoogle Scholar
  7. 7.
    Donker, P. J., lyanovici, F., and Nooch, E. L., 1972, Analysis of the urethra pressure profile by means of electromyography and the administration of drugs, Br. J. Urol. 44:180–193.PubMedCrossRefGoogle Scholar
  8. 8.
    Edvardsen, P., 1968, Nervous control of the urinary bladder in cats, Acta Physiol Scand. 72:157–234.PubMedCrossRefGoogle Scholar
  9. 9.
    Elmer, M., 1974, Action of drugs on the innervated and denervated urinary bladder of the rat, Acta Physiol. Scand. 91:289–297.PubMedCrossRefGoogle Scholar
  10. 10.
    Leonis, J. V., Wein, A. J., Raezer, D. M., and Schoenberg, H. W., 1973, The effect of β-adrenergic stimulation on the contractile response of canine detrusor muscle.Invest. Urol. 10:419–425.Google Scholar
  11. 11.
    Raezer, D. M., Wein, A. J., Jacobowitz, D., and Corriere, J. N., Jr., 1973, Autonomic innervation of canine urinary bladder: Cholinergic and adrenergic contributions and interaction of sympathetic and parasympathetic systems in bladder function. Urology 2:211–221.CrossRefGoogle Scholar
  12. 12.
    Rohner, T. J., Raezer, D. M., Wein, A. J., and Schoenberg, H. W., 1971, Contractile responses of dog bladder neck muscle to adrenergic drugs, J. Urol. 105:657–661.PubMedGoogle Scholar
  13. 13.
    Gosling, J., 1979, The structure of the bladder and urethra in relation to function, Urol. Clin. North Am. 6:31–38.PubMedGoogle Scholar
  14. 14.
    DeGroat, W. C., 1975, Nervous control of the urinary bladder of the cat. Brain Res. 87:201–211.CrossRefGoogle Scholar
  15. 15.
    DeGroat, W. C. and Saum, W. R., 1972, Sympathetic inhibition of the urinary bladder and of pelvic ganglionic transmission in the cat, J. Physiol. (London), 220:297–314.Google Scholar
  16. 16.
    DeGroat, W. C. and Theobald, R. J., 1976, Reflex activation of sympathetic pathways to vesical smooth muscle and parasympathetic ganglia by electrical stimulation of vesical afferents, J. Physiol. (London) 259:223–237.Google Scholar
  17. 17.
    Bradley, W. E., 1978, Innervation of the male urinary bladder,Urol. Clin. North Am. 5:279–293.PubMedGoogle Scholar
  18. 18.
    Bates, P., Bradley, W. E., Glen, E., Griffiths, D., Melchior, H., Rowan, D., Sterling, A., Zinner, N., and Haid, T., 1979, The standardization of terminology of lower urinary tract function, J. Urol. 121:551–554.PubMedGoogle Scholar
  19. 19.
    Yarnell, J. W. G. and St. Leyer, A. S., 1979, The prevalence, severity and factors associated with urinary incontinence in a random sample of the elderly. Age Aging 8:81–85.CrossRefGoogle Scholar
  20. 20.
    Diokno, A. C., Brock, B. M., Brown, M. B., and Herzog, A. R., 1986, Prevalence of urinary incontinence and other urological symptoms in noninstitu-tionalized elderly, J. Urol. 136:1022–1025.PubMedGoogle Scholar
  21. 21.
    Warshaw, G. A., Moore, J. T., and Friedman, S. W., 1982, Functional disability in the hospitalized elderly, JAMA 248:847–850.PubMedCrossRefGoogle Scholar
  22. 22.
    Milne, J. J., 1976, Prevalence of incontinence in the elderly age groups, in: Incontinence in the Elderly (F. L. Wellington, ed.). Academic Press, New York, pp. 9–21.Google Scholar
  23. 23.
    Jewett, M. A. S., Fernie, G. R., and Holliday, P. J., 1981, Urinary dysfunction in a geriatric long-term care population, J. Am. Geriatr. Soc. 29:211–214.PubMedGoogle Scholar
  24. 24.
    Ouslander, J. G., Kane, R. L., and Abrass, I. B., 1982, Urinary incontinence in elderly nursing home patients, JAMA 248:1194–1198.PubMedCrossRefGoogle Scholar
  25. 25.
    Fernie, G. R., Jewett, M. A. S., Halsall, P., and Zorzitto, M. S., 1983, Urody- namic characterization of incontinence in the elderly by bladder volume, J. Urol. 129:772–774.PubMedGoogle Scholar
  26. 26.
    Issacs, B. and Walkey, F. A., 1964, A survey of incontinence in elderly hospital patients, Gerontol. Clin. 6:367–376.CrossRefGoogle Scholar
  27. 27.
    Brocklehurst, J. C., Dillane, J. B., Griffiths, L., and Fry, J., 1968, The prevalence and symptomatology of urinary infection in an aged population, Gerontol. Clin. 10:242–253.CrossRefGoogle Scholar
  28. 28.
    Feneley, R. C. L., Shepherd, A. M., Powell, P. H., and Blannin, J., 1979, Urinary incontinence: Prevalence and needs, Br. J. Urol. 51:493–596.PubMedCrossRefGoogle Scholar
  29. 29.
    Thomas, T. M., Plymat, K. R., and Blannin, J., 1980, Prevalence of urinary incontinence, Br. Med. J. 281:1243–1245.PubMedCrossRefGoogle Scholar
  30. 30.
    Resnick, N. M. and Diokno, A. C., 1986, Urinary incontinence in the elderly, Urol. Grand Rounds 1:2–7.Google Scholar
  31. 31.
    Hilton, P. and Stanton, S. L., 1981, Algorithmic method for assessing urinary incontinence in elderly women, Br. Med. J. 282:940–942.CrossRefGoogle Scholar
  32. 32.
    Eastwood, H. D. H., 1979, Urodynamic studies in the management of urinary incontinence in the elderly. Age Ageing 8:41–48.PubMedCrossRefGoogle Scholar
  33. 33.
    Casillden, C. M., Duffm, H. M., and Ashner, M. J., 1981, Clinical and urodynamic studies in 100 elderly patients, Br. Med. J. 282:1103–1105.CrossRefGoogle Scholar
  34. 34.
    Overstall, P. W., Rounce, K., and Palmer, J. H., 1980, Experience with an incontinence clinic, J. Am. Geriatr. Soc. 28:535–538.PubMedGoogle Scholar
  35. 35.
    Andersen, J. T., 1976, Detrusor hyperreflexia in benign intravesical obstruction: A cystometric study, J. Urol. 115:532–534.PubMedGoogle Scholar
  36. 36.
    Whiteside, G., 1979, Symptoms of micturition disorders in relation to dynamic function, Urol. Clin. North Am. 6:55–62.PubMedGoogle Scholar
  37. 37.
    Turner-Warwick, R., 1979, Observations on the function and dysfunction of the sphincter and detrusor mechanisms, Urol. Clin. North Am. 6:13–30.Google Scholar
  38. 38.
    Green, T. H., Jr., 1968, The problem of stress urinary incontinence in the female, Obstet. Gynecol. Surv. 23:603–634.PubMedCrossRefGoogle Scholar
  39. 39.
    Jeffcote, T. N. A. and Roberts, H., 1952, Observations on stress incontinence of urine. Am. J. Obstet. Gynecol. 64:721–738.Google Scholar
  40. 40.
    Lapides, J., Ajemian, E. R., Stewart, B. H., Lichtwardt, J. R., and Breakey, B. A., 1960, Physiopathology of stress incontinence,Surg. Gynecol. Obstet. 111:224–231.PubMedGoogle Scholar
  41. 41.
    McGuire, E., Lytton, B., Pepe, V., and Kohorn, E. L., 1976, Stress urinary incontinence,J. Obstet. Gynecol. 47:255–264.PubMedGoogle Scholar
  42. 42.
    Smith, P., 1972, Age changes in the female urethra, Br. J. Urol. 44:667–676.PubMedCrossRefGoogle Scholar
  43. 43.
    Salmon, U. J., Walter, R. I., and Geist, S. H., 1941, The use of estrogens in the treatment of dysuria and incontinence in post menopausal women, J. Obstet. Gynecol. 42:845–851.Google Scholar
  44. 44.
    Caine, M. and Raz, S., 1975, Some clinical implications of adrenergic receptors in the urinary tract. Arch. Surg. 110:247–250.PubMedCrossRefGoogle Scholar
  45. 45.
    Green, T. H., Jr., 1975, Urinary stress incontinence: Differential diagnosis, pathophysiology and management. Am. J. Obstet. Gynecol. 122:368–400.PubMedGoogle Scholar
  46. 46.
    Brocklehurst, J. G., 1978, The bladder. In: Textbook of Geriatric Medicine and Gerontology (J. G. Brocklehurst, ed.), Ghurchill Livingstone, New York, pp. 306–325.Google Scholar
  47. 47.
    Newman, J. L., 1962, Old folks in wet beds, Br. Med. J. 1:1824–1827.PubMedCrossRefGoogle Scholar
  48. 48.
    Bors, E. and Blinn, D. A., 1959, Bulbocavernosus reflex, J. Urol 82:128–130.PubMedGoogle Scholar
  49. 49.
    Bors, E. and Turner, R. D., 1960, History and physical examination in neurological urology, J.Urol 83:759–767.PubMedGoogle Scholar
  50. 50.
    Bradley, W. E., Chou, S., and Markland, C., 1967, Classifying neurologic dysfunction of the urinary bladder, in: The Neurogenic Bladder (S. Boyarsky, ed.), Williams & Wilkins, Baltimore, pp. 136–146.Google Scholar
  51. 51.
    Blaivas, J. G., 1979, A critical appraisal of specific diagnostic techniques, in: Clinical Neuro-urology (R. J. Krane and M. B. Siroky, eds.) Little, Brown, Boston, pp. 69–109.Google Scholar
  52. 52.
    Diokno, A. C., Koff, S. A., and Anderson, W., 1976, Combined cystometry and perineal electromyography in the diagnosis and treatment of neurogenic urinary incontinence, J. Urol 115:161–163.PubMedGoogle Scholar
  53. 53.
    Stanton, S. L., 1978, Preoperative investigation and diagnosis, Clin. Obstet. Gynecol 21:705–724.PubMedCrossRefGoogle Scholar
  54. 54.
    Plante, P. and Sussett, J., 1980, Studies of female urethral pressure profile: Part I. The normal urethral pressure profile, J. Urol 123:64–69.PubMedGoogle Scholar
  55. 55.
    Susett, J. and Plante, P., 1980, Studies of female urethral pressure profile: Part II. Urethral pressure profile in female incontinence, J. Urol 123:70–74.Google Scholar
  56. 56.
    Haubensak, K., Schindler, E., and Rothaar, J., 1975, Dependence of resting urethral pressure on age and sex of healthy subjects and on technical detail, Urol Inl 30:29–32.CrossRefGoogle Scholar
  57. 57.
    Abrams, P. and Torrens, M., 1979, Urine flow studies, Urol Clin. North Am. 6:71–79.PubMedGoogle Scholar
  58. 58.
    Whiteside, G. and Bates, P., 1979, Synchronous video pressure-flow cystourethrography, Urol Clin. North Am. 6:93–102.PubMedGoogle Scholar
  59. 59.
    Jacobs, S. C., Sebern, M., Donnel, R., and Lawson, R. K. 1984, Computer assisted urodynamics, J. Urol 132:716–717.PubMedGoogle Scholar
  60. 60.
    Anderson, J. T. and Bradler, W. E., 1976, Postural detrusor hyperreflexia, J. Urol 116:228–230.Google Scholar
  61. 61.
    Arnold, E. P., 1974, Cystometry: Postural effects in incontinent women, Urol Inl 29:185–186.CrossRefGoogle Scholar
  62. 62.
    Bates, C. P., 1971, A clinical study of the dynamics of voiding and sphincter mechanism, Ann. R. Coll Surg. Engl 49:18–35.PubMedGoogle Scholar
  63. 63.
    Mayo, M. E., 1978, Detrusor hyperreflexia: The effect of posture and pelvic floor activity, J. Urol 119:635–638.PubMedGoogle Scholar
  64. 64.
    Abrams, P. H., 1976, Urodynamic investigation of post-prostatectomy problems, Br. J. Surg. 63:655–656.PubMedCrossRefGoogle Scholar
  65. 65.
    Khanna, O. P., 1976, Disorders of micturition: Neuropharmacologic basis and results of drug therapy. Urology 8:316–328.PubMedCrossRefGoogle Scholar
  66. 66.
    Mahoney, D. T., Laferte, R. O., and Mahoney, J. E., 1973, Observations on sphincter augmenting effect of imipramine in children with urinary incontinence, Urology, 1:317–323.PubMedCrossRefGoogle Scholar
  67. 67.
    Raezer, D. M., Benson, G. S., Wein, A. J., and Duckett, J. W., Jr., 1977, The functional approach to the management of the pediatric neuropathic bladder: A clinical study, J. Urol 117:649–654.PubMedGoogle Scholar
  68. 68.
    Wein, A. J., Raezer, D. M., and Benson, G. S., 1976, Management of neurogenic bladder dysfunction in the adult, Urology 8:432–433.PubMedCrossRefGoogle Scholar
  69. 69.
    Dorflinger, T., Frimodt-Moller, P. C., Bruskewitz, R. C., Jensen, K. M. E., Iversen, P., and Madsen, P. O., 1985, The significance of uninhibited detrusor contractions in prostatism, J. Urol. 133:819–821.PubMedGoogle Scholar
  70. 70.
    Blackford, H. N., Results of transvesical infiltration of the pelvic plexuses with phenol in 116 patients, Br. J. Urol 56:647–649.Google Scholar
  71. 71.
    Pengelly, A., 1979, Effect of prolonged bladder distention on detrusor function, Urol Clin. North Am. 6:279–281.PubMedGoogle Scholar
  72. 72.
    Godec, C. and Cass, A., 1978, Acute electrical stimulation for urinary incontinence, Urology 12:340–342.PubMedCrossRefGoogle Scholar
  73. 73.
    Cardozo, L., Stanton, S. L., Hafner, J., and Allan, U., 1978, Biofeedback in the treatment of detrusor instability, Br. J. Urol. 50:250–254.PubMedCrossRefGoogle Scholar
  74. 74.
    Kegel, A. H., 1956, Stress incontinence of urine in women: Physiologic treatment, J. Int. Coll. Surg. 25:487–499.PubMedGoogle Scholar
  75. 75.
    Kegel, A. H., 1951, Physiologic therapy for urinary stress incontinence, JAMA 146:915–917.CrossRefGoogle Scholar
  76. 76.
    Siegel, I., Zelinger, B. B., and Kanter, A. E., 1962, Estrogen therapy for urogenital conditions in the aged. Am. J. Obstet. Gynecol. 84:505–507.PubMedGoogle Scholar
  77. 77.
    Walter, S., Wolf, H., Barlebo, H., and Jensen, H. K., 1978, Urinary incontinence in postmenopausal women treated with estrogens, Urol. Int. 33:135–143.CrossRefGoogle Scholar
  78. 78.
    Judge, T. G., 1969, The use of quinestradol in elderly incontinent women: Preliminary report, Gerontol. Clin. 11:159–164.CrossRefGoogle Scholar
  79. 79.
    Turner-Warwick, R. and Brown, A. D. G., 1979, A urodynamic evaluation of urinary incontinence in the female and its treatment, Urol. Clin. North Am. 6:203–216.Google Scholar
  80. 80.
    Stamey, T. A., 1980, Endoscopic suspension of the vesical neck for urinary incontinence in females: Report on 203 consecutive patients,Ann. Surg. 192:465–471.PubMedCrossRefGoogle Scholar
  81. 81.
    Lapides, J., Friend, C. R., Ajemian, E. P., and Reus, W. S., 1962, Denervation supersensitivity as a test for neurogenic bladder, Surg. Gynecol. Obstet. 114:241–244.Google Scholar
  82. 82.
    Melzer, M., 1972, The urecholine test, J. Urol. 108:728–730.PubMedGoogle Scholar
  83. 83.
    Merrill, D. C. and Rotta, J., 1974, A clinical evaluation of detrusor denervation supersensitivity using air cystometry, J. Urol. 111:27–30.PubMedGoogle Scholar
  84. 84.
    Kleeman, F. J., 1970, The physiology of the internal urinary sphincter, J. Urol. 104:549–554.PubMedGoogle Scholar
  85. 85.
    Krane, R. J. and Olsson, C. A., 1973, Phenoxybenzamine in neurogenic bladder dysfunction: II. Clinical consideration, J. Urol. 110:653–656.PubMedGoogle Scholar
  86. 86.
    Lapides, J., Diokno, A., Gould, F. R., and Lowe, B. S., 1976, Further observations on self-catheterization, J. Urol. 116:169–171.PubMedGoogle Scholar
  87. 87.
    Kass, E. H. and Sössen, H. S., 1959, Prevention of infection of urinary tract in presence of indwelling catheters, JAMA 169:1181–1183.CrossRefGoogle Scholar
  88. 88.
    Kleeman, G. R., Hewitt, W. L., and Guze, L. B., 1960, Pyelonephritis, Medicine 39:3–116.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • Frank P. Begun
    • 1
  • Stephen C. Jacobs
    • 1
  1. 1.Department of UrologyMedical College of WisconsinMilwaukeeUSA

Personalised recommendations