LUTS in the elderly Flashcards
What is urinary incontinence?
The involuntary loss of urine, this is objectively demonstrable and is a social or hygienic problem.
What ageing changes can contribute to urinary incontinence?
- During ageing, bladder capacity and urethral closure pressure decreases.
- At the same time, post void residue and detrusor overactivity increases.
What are some transient causes of incontinence?
Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceutical/prostate
Psychological, especially depression
Stool impaction
What is stress incontinence?
Involuntary urinary leakage on effort or exertion, sneezing or coughing.
What is urge incontinence?
Involuntary leakage accompanied by or immediately preceded by urgency
What is mixed incontinence?
Involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing.
What is overflow incontinence?
Leakage owing to bladder outflow obstruction of any cause resulting in large post-void residual volume
Clinical features during examination of a patient presenting with incontinence?
General appearance including BMI
Abdominal examination
Pelvic examination
PR examination
Consider urinalysis - only perform if result will change management.
In cases of incontinence, what are the indications for specialist referral?
Microscopic haematuria aged > 50
Frank haematuria
Recurrent or persisting UTI
Suspected or malignant mass
Chronic retention
Men with stress urinary incontinence
Investigations for urinary incontinence?
Post void bladder scanner
Bladder diary
Bloods: consider PSA, U+E’s, glucose
Urodynamic studies: not before starting conservative management
Lifestyle management options for urinary incontinence?
Decrease caffeine intake
Encourage weight loss if appropriate
Physical/behaviour management options for urinary incontinence?
Pelvic floor exercises for stress incontinence
Bladder training for urgency/mixed UI
Exercise beneficial in frail elderly
Prompted and timed voiding programmes
Medical management options for urinary incontinence?
Patients should try 3 month of non-pharmacological management first
First line drug treatment - tolterodine 2mg BD
Second line drug treatment - solifenacin 5mg OD
Third line drug treatment - stop antimuscarinic and change to mirabegron MR 50mg OD
