[Disorders of bladder function in the elderly]

Voiding dysfunction in elderly patients is not a uniform disease entity. Diseases of the cerebrospinal system, metabolic imbalances, detrusor degeneration and bladder outlet obstruction or sphincter impairment can all result in disabilities such as urinary retention and/or urinary incontinence. Although the urodynamic pattern of an uninhibited neuropathic bladder resulting from a poorly functioning corticoreticular system may seem to be normal in these elderly subjects, many of them have lost control of the micturition reflex: the warning to void occurs suddenly at full bladder capacity, and the abrupt sensation that urination is imminent cannot be controlled appropriately. Classifying these symptoms under a simple common denominator, such a detrusor instability can be misleading, because the therapeutic approach in these patients should be more highly differentiate. Detrusor overactivity may be symptomatic and associated with curable diseases of the lower urinary tract, such as bladder outlet obstruction, urinary tract infection or bladder cancer. On the other hand, some of the underlying causes of so-called idiopathic detrusor overactivity have been disclosed recently by Elbadawi et al. (1993), relating detrusor impairment to detrusor degeneration characterized morphologically by a dysjunction pattern. In this setting, it cannot be overemphasized that better knowledge of the underlying disease will result in more successful treatment of the voiding disability in such patients. Urinary incontinence in elderly patients is not always due to an incompetent urinary sphincter, and urinary retention in this age group is not always the result of a bladder outlet obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)