LUTS in The Elderly Flashcards
What happens to Bladder capacity and urethral closure pressure as we age?
They both decrease
What happens to post void residue and detrusor overactivity?
They Increase
What are the different classifications of incontinence?
- Stress: involuntary urinary leakage on effort or exertion, sneezing or coughing
- Urge: involuntary leakage accompanied by or immediately preceded by urgency
- Mixed: involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing
- Overflow: leakage owing to bladder outflow obstruction of any cause resulting in large post-void residual volume
What should be examined in a patient with urinary incontinence?
- General appearance including BMI
- General mobility
- General cognitive examination
- Abdominal examination
- Pelvic examination
- Consider urinalysis - only perform if result will change management
- PR examination
What indicates specialist referral for patients with incontinence?
- Symptomatic prolapse at or below intriotus
- Microscopic haematuria aged >50
- Frank haematuria
- Recurrent or persisting UTI
- Suspected or malignant mass
- Chronic retention
- Men with stress UI
- Failure of conservative Rx
What investigations should be done in a patient with Incontinence?
- Post void bladder scanner
- Bladder diary
- Bloods: consider PSA, U+Es, glucose
- Urodynamic studies: not before starting conservative management, consider before surgery/failure of Rx
What are some lifestyle changes used for the management of Incontinence?
Decreased Caffeine Intake
Encourage weight loss
What Physical/Behavioural Tx can be used in Incontinence?
- Pelvic flood exercises
- Bladder retraining
How long should Patients try Non-pharmacological management before moving to medical Tx?
3 months
What is the First Line Drug Tx of Stress incontinence?
Duloxetine, only after non-pharmacological management has failed and px is not a candidate for surgery
What are causes of Transient Urinary incontinence?
DIAPPERS
D - Delirium
I - Infection
A - Atrophic vaginitis or urethritis
P - Pharmaceutical (medications)
P - Psychiatric disorders
E - Endocrine disorders (e.g. diabetes)
R - Restricted mobility
S - Stool impaction
“DIAPPERS”
What is the Gold Standard for Stress incontinence surgical management?
Mid-urethral slings
What Drugs are used in the Tx of Urge incontinence?
Anti-cholinergic medications
- Oxybutynin, Tolterodine, Fesoterodine, Solifenacin.
What can be used in Older patients with urge incontinence?
Mirabegron (beta-3 receptor agonist)
- Be careful of Hypertension tho
What can be tried in men with significant postvoid residue?
- Treat any underlying Constipation
Then - Alpha Blockers or 5-alpha reductase inhibitors.
