[Urinary incontinence in geriatric patients: pharmacological Therapy]

1/2019 we presented an update of the AWMF guideline 'urinary incontinence in frail elderly - diagnostics and therapy'. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group 'Incontinence' of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about pharmacological therapy.

A profound literature search was done in a structured evaluation process in the context of a 'frail elderly'. Most medical societies define a 'frail elderly' as someone older than 70 years and multimorbide or older than 80y. We focused on randomized, double blind, placebo controlled studies as well as already published guidelines in this field. In the case no studies were available or not feasible other publications such as not randomized studies or case reports were taken into consideration for our guideline. Recommendations resulted from a structured voting process and the results are stated as percentage of members who agreed.

Pharmacological therapy of OAB, stress incontinence and overflow incontinence as well as unspecific treatment with antidiuretics was evaluated with special focus on vulnerable, potentially cognitively impaired frail elderly. We took a closer look on special side effect profile of the above mentioned drugs with regard to the individual multimorbidity and multimedication.

Pharmacological therapy of urinary incontinence in frail elderly needs strict indication. Knowledge about drug metabolization and substance interactions as well as close monitoring of possible side effects are indispensable in this vulnerable group of patients.