Are cystometric and cystoscopic examinations of any value for disabled incontinent elderly?

According to assessments made by the personnel and patients' own reports 42% of males and 54% of females aged 65 years or over and attending the day hospital in the town of Tampere were found to be incontinent. Incontinence was related to the frequency of urinating in the daytime. All incontinent patients of the day hospital were referred to the urologist at the University Hospital. Only about one third of these patients participated in the cystometric and cystoscopic examinations. The main reasons for non-attendance were unwillingness of the patient, referral of the patient to another place of care and resistant urinary infection. Urinary retention and small bladder capacity were common findings by cystometry and cystoscopy. A surgical management was recommended to seven per cent and conservative management to 93% of the patients. The concordance rates between the classification of the incontinence by anamnestic questions and the classification made by the urologist were not very high: the overall percentage of agreement was 40%. It is concluded, that not all incontinent elderly patients should be sent for cystometric and cystoscopic examination. Residual urine should be measured, if urinary retention is thought to be associated with incontinence. Furthermore, the classification of incontinence cannot be made only by using anamnestic questions.