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Management of Bladder Dysfunction in Aging People. Jong Bo Choi M.D., Ph.D. Ajou Unviersity School of Medicine. Change of bladder in aging people. Why is it important?. It is a common health problem with a high prevalence. It is associated with Psychosocial consequences

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management of bladder dysfunction in aging people

Management of Bladder Dysfunction in Aging People

Jong Bo Choi M.D., Ph.D.

Ajou Unviersity School of Medicine

why is it important
Why is it important?
  • It is a common health problem with a high prevalence.
  • It is associated with

Psychosocial consequences

Medical complications

Institutionalization

Significant financial burden

  • It has a huge impact on individuals, their families and society.
age related changes in lut
Age Related Changes in LUT
  • Bladder capacity does not change with age
  • Bladder sensation, contractility :decline
  • Urethral length, maximal closure pressure, striated muscle cells in rhabdosphincter : decline (women)
  • The prostate enlarge : urodynamic obstruction in approximately half
  • Involuntary detrusor contraction increase with aging.
  • Postvoid residual volume ; 50-100ml
  • Excrete most of their fluid intake at night
  • 1-2 episodes of nocturia : sleep disorder
detrusor overactivity
Detrusor Overactivity
  • 25-75% in patients with LUTS
  • Causes – Bladder outlet obstruction

Partial denervation

Alteration of afferent pathway

DHIC

management of do
Management of DO
  • Relief of BOO – Surgical, Medical
  • Avoid possible situation

- Cold weather

- Food and beverage

- Correction of sleep disturbance

  • Behavioral therapy
  • Medication – anticholinergics

alpha-blockers

detrusor underactivity
Detrusor Underactivity
  • Types

- Decreased contractility

(inability of generating sufficient pressure)

- Fading contractions

(Inability of maintaining the contraction)

  • Mechanism

- Bladder muscle degeneration

- Fibrosis

- Axonal degeneration

management of du
Management of DU
  • Remove potential risk factors such as estrogen deficiency or constipation.
  • Perioperative catheterization may decreased the incidence of AUR
  • Medication – Alpha blocker

Cholinergics

  • CIC – PVR greater than 50% of bladder

Optimal in spinal cord injury

management of du1
Management of DU
  • Control UTI

Taylor JA and Kuchel GA. JAGS 2006;54:1920-32

management of dhic
Management of DHIC
  • Do anticholinergics have same activity in patients with DU as well as OAB patients?
  • Do anticholinergics increase the possibility of urinary retention?
  • Is CIC necessary?
  • How can we protect upper urinary tract?
  • How can we meet patients’ need?

UNKNOWN

specific consideration in aging people
Specific consideration in aging people
  • Polypharmacy
  • Co-morbidity
  • Sleep disturbance
  • DIAPPERS
  • Hormonal imbalance
  • Underdiagnosed neurologic disease
take home message
Take Home Message
  • The prevalence of DO is 25-75% in aging people who have LUTS.
  • Avoidance of risk factor should be proceeded to medical treatment.
  • UTI can induce detrusor underactivity.
  • Symptomatic BPH should be treated to prevent bladder dysfunction