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Ultrasonography of the Adult Male Urinary Tract for Urinary Functional Testing
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Voiding dysfunction in older men.

Amanda Chung1, Naomi Noguchi, Lewis Chan

  • 1Department of Urology, Concord Repatriation General Hospital, and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

Current Opinion in Urology
|January 15, 2016
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Summary
This summary is machine-generated.

Managing voiding dysfunction in older men requires careful consideration of comorbidities and polypharmacy. Treatment options vary for overactive bladder, underactive bladder, and benign prostatic obstruction, with individualized approaches yielding best outcomes.

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Area of Science:

  • Geriatric Medicine
  • Urology
  • Pharmacology

Background:

  • Voiding dysfunction is a significant health concern in older men, presenting complex management challenges due to comorbidities and polypharmacy.
  • Sparse literature specifically addresses the nuances of voiding dysfunction in this demographic.

Purpose of the Study:

  • To review current understanding and management strategies for voiding dysfunction in older men.
  • To highlight key geriatric voiding syndromes and their treatment considerations.

Main Methods:

  • Literature review focusing on geriatric voiding syndromes, including overactive bladder (OAB) and underactive bladder.
  • Analysis of treatment outcomes and side-effect profiles for various pharmacological and surgical interventions.
  • Consideration of diagnostic challenges and the impact of comorbidities and polypharmacy.

Main Results:

  • Common syndromes include OAB and underactive bladder, with nocturia and incontinence posing fall risks.
  • Combined detrusor overactivity and impaired contractility are challenging to diagnose and treat.
  • Watchful waiting may be suitable for some OAB cases; mirabegron offers a favorable side-effect profile over anticholinergics for OAB in older men.
  • Intravesical onabotulinum toxin A is effective but carries a higher retention risk in older adults.
  • Benign prostatic obstruction (BPO) surgery is a viable option, and combination therapy for BPO and OAB is effective.
  • Stress incontinence in older patients is often iatrogenic, with various treatment options available.

Conclusions:

  • Management necessitates a holistic approach, integrating symptomatic and functional status with cognitive function, comorbidities, and polypharmacy.
  • Further research into the pathophysiology and treatment outcomes of voiding dysfunction in the elderly is crucial.