Urinary Problems in the Elderly
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| Urinary Problems in the Elderly ? | * BPH, Atrophic Vaginitis, UTI/Cystitis, and Prostitis
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| Incontinence and aging ? | * NOT a normal part of aging
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| Types of Incontinence ? | * Urge -- Stress -- Overflowing -- Functional -- Mixed
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| Urge Incontinence ? | * Got to go, got to go right now.... * most common over 75 y/o..... * usu due to an idiopathic cause (atrophic, stones, infections, etc.)..... * or from irritants = caffeine, alcohol, chocolate
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| Stress Incontinence ? | * Most common cause in women.... * Loss of urine with increased intra-abdominal pressure...... * Basically, you cough and then pee ...... * can be from child birth or surgery
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| Overflow Incontinence ? | * Over distension of the bladder causing frequent urination and dribbling...... * Most Common in MEN ...... * can be cause by obstruction like fecal impaction or from lumbar stenosis
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| Overflow incontinence special thing ? | * Must be worked-up --> Chronic over distension of the bladder can lead to hydronephrosis, which can lead to renal failure.
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| Functional Incontinence ? | * Not a problem of the lower urinary tract
...* Causes = cognition and physical impairment
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| Mixed Incontinence ? | * Overlap of 2 or more types of incontinence
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| Transient incontinence ? | * DIAPERS : Delirium
Infection (UTI symptomatic) -- Atrophic urethritis/vaginitis -- Pharmaceutical -- Psychological -- Excessive urine output -- Restricted mobility -- Stool impaction
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| Established Incontinence ? | * Detrusor over activity - Urge ..... * Detrusor under activity - Neurogenic ..... * Urethral obstruction - Overflow ...... * Urethral incontinence - Stress
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| Drugs affecting Urinary Function ? | * Sedatives/hypnotics -- Alcohol -- Anticholinergics -- Antipsychotics -- Tricyclic antidepressants -- Antiparkinsons- except L-dopa -- Narcotics -- Alpha blockers -- Diuretics
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| Work-up to get on them ? | * HISTORY .... * Do a good physical .... * Labs: UA on every eldery that comes to ER and electrolytes/BUN/Cr
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| Post Void Measurements ? | * Do within 5 mins of voiding ..... * Then do a bladder scan or cath.... * < 100 cc adequate if over 65 ..... *100-200 cc borderline .... * > 200 cc abnormal needs further evaluation
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| Urge Incontinence-Treatment ? | * 1st = Behavioral .... * 2nd = Drugs /anticholinergic (Oxybutynin and Tolerodine)
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| Side Effects of Anticholinergics ? | * ANTI- DUMBELLS ..... * Dizziness - Sleepiness -Confusion -Dry eyes -Dry mouth -Tachycardia -Palpitation -Dyspepsia -Constipation -Urinary retention
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| Stress Incontinence Treatment ? | * Behavioral (kegals) .... * Drugs (estrogen creams) .... * Surgery (high suc. rate, but fails).... * Pessary
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| Overflow Incontinence Treatment ? | * Treat Obstruction (Surgery or Drugs- alpha blockers) ...... * Catheter
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| Tmt of Functional ? | * Treat the underlying problem with pt. History
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| Indications for a Temporary Catheter ? | * Long surgical procedure -- Monitoring urine during severe illness -- Decompress bladder following prolonged retention. -- Obtain urine specimen -- Protect surgical wound during initial post-op period.
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| Indications for a Premanent Catheter ? | * Neurogenic bladder -- Skin protection for debililated, immobile patient -- Comfort measure during terminal illness -- Non repairable bladder outlet obstruction.
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| Predisposing factors in UTIs in the Elderly ? | * structure issues, post void urine left of over 100cc, BPH, stones, UBx use and Catheters.... * Basically anything that would leave urine trapped in the bladder, which causes bacteria growth
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| Elderly UTI presentation ? | * Fever, dysuria, frequency, and pt comes in of family saying they are acting "Out of the normal"
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| UTI Bacteriology cause ? | * E.Coli = top cause
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| UTI-Emperic Treatment ? | * Independent/Community = Oral quinalone -- Trimethoprim Sulf -- Amoxicillin/Clavulanate -- Cephalexin
....... * LTC = same ..... *Hospital (very sick) = IV Quinalone -- IV Ceftazidime
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| Asymptomatic Bacteruria and Pyuria A Special Problem of the Elderly ? | * Treating does not reduce incidence of symptomatic infection. .... * Treating does increase antibiotic resistance, costs, drug toxicity.
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| Atrophic Vaginitis/ Pro UTI ? | * from decrease estrogen postmenopause..... * Tmt= estrogen cream
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| Elderly and renal function ? | * After 50y/o, GRF goes down 1%... Normal is 60 or above
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| Cr Clearance formula ? | * Creatinine Clearance (ml/min)=
.... (140 – age) x lean body wt. kg. (x .85 for women)
/// Serum Creatinine x 72
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| BPH CxSx ? | * Can be asymptomatic...... * Decreased force of stream , Dribbling -- Hesitancy -- Urgency -- Nocturia -- Can also see Confusion
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| Treatment of BPH/LUTS ? | * Observation and behavior modification
..... * herbals.... * alpha blockers ... * 5-alpha reductase inhibitors.... * Surgery
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| The prostate and bacteria ? | * The prostate serves as a reservoir for bacteria
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| BPH Lab/Tests ? | * Digital rectal exam, UA and culture usu. Positive for E.Coli (for Chronic Bacterial Prostatitis)
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| Treatment = ? | * Antibiotics- 4 weeks to 4 months of FQs (have to longer bc prostate is hard to reach with ABx ) ..... * Low dose supressing drugs and even surgery
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