DIAGNOSIS AND TREATMENT OF VOIDING DYSFUNCTION IN THE ELDERLY ON OUT-CLINIC BASIS

Abstract

The present research was carried out on 144 elderly patients complaining of voiding abnormalities, in order to clarify the clinical problems involved in diagnosis and treatment of voiding dysfunciton in the elderly. The patients included in this study were 117 male and 27 female elderly individuals aged over 65, who were followed on out-patient basis for voiding dysfunction but otherwise healthy or with minimum physical disturbance. The patients were divided into 3 diagnostic groups: obstructive prostatism (31%), neurogenic bladder (40%) and unstable bladder (29%). Neurogenic bladder was subdivided into overactive (33%), underactive (39%), normal (14%) and unknown (14%) based upon cystometric findings.
Forty-four out of 89 patients with benign prostatic hyperplasia had normal bladder function, while in the remaining 45 patients neurogenic bladder or unstable bladder was coexistent. Clinical manifestations were discussed in terms of difficulty in urination, diurnal frequency, nocturnal frequency, uregency and incontinence. Difficulty in urination was noted in the majority of every diagnostic group. Nocturnal frequency was more common than diurnal one, and urinary incontinence was found in 44 cases (31%) of all the patients, 93% of which was with uregency incontinence. Since, in general, each clinical manifestation was shared by most groups, it appeared difficult and inappropriate to predict lower urinary tract funciton only from subjective symptoms. Objective urodynamic evaluation by cystometry, uroflowmetry and residual urine measurement was essential. Neurogenic disorders observed in neurogenic bladder patients were highly variable. In overative neurogenic bladder, various neurological diseases affecting supranuclear lesion were noted, cerebrovascular diseases being most prevalent. Underative neurogenic bladder included much more variable disorders. However, the neurological lesions were not always consistent with the type of bladder dysfunction determined by cystometry. In unstable bladder group, 83% were with prostatic hyperplasia, and in the rest of cases no neurological abnormality was found. Cystometry was performed in 83% of all patients and evaluated as to FDV, MCC, uninhibited contraction and compliance. In all groups, MFR and AFR were declined on uroflowmetry, and the ratio of residual urine was significantly increased. Thirty percent of the patients underwent surgical treatment and 70% had conservative therapy. Clean intermittent catheterization was adopted in 32% of the patients treated conservatively, in 47% of which self catheterization was done.