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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. 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

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  1. Management of Bladder Dysfunction in Aging People Jong Bo Choi M.D., Ph.D. Ajou Unviersity School of Medicine

  2. Change of bladder in aging people

  3. 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.

  4. 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

  5. Prevalence of symptoms

  6. Considerable Bladder Dysfunction in aging people

  7. Detrusor Overactivity • 25-75% in patients with LUTS • Causes – Bladder outlet obstruction Partial denervation Alteration of afferent pathway DHIC

  8. 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

  9. Detrusor Underactivity • Types - Decreased contractility (inability of generating sufficient pressure) - Fading contractions (Inability of maintaining the contraction) • Mechanism - Bladder muscle degeneration - Fibrosis - Axonal degeneration

  10. Potential risk factors for Detrusor Underactivity

  11. Potential risk factors for Detrusor Underactivity

  12. 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

  13. Management of DU • Control UTI Taylor JA and Kuchel GA. JAGS 2006;54:1920-32

  14. 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

  15. Specific consideration in aging people • Polypharmacy • Co-morbidity • Sleep disturbance • DIAPPERS • Hormonal imbalance • Underdiagnosed neurologic disease

  16. 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

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