Urodynamic profile of patients aged 60 years and above who underwent urodynamics

Buenaseda S1, Ramos M1

Research Type

Clinical

Abstract Category

Geriatrics / Gerontology

Abstract 393
Open Discussion ePosters
Scientific Open Discussion Session 23
Friday 9th September 2022
15:20 - 15:25 (ePoster Station 6)
Exhibition Hall
Incontinence Gerontology Retrospective Study
1. St. Lukes Medical Center
Online
Presenter
Links

Poster

Abstract

Hypothesis / aims of study
To describe the urodynamic profile of patients aged 60 years and above who underwent urodynamics
Study design, materials and methods
This is a retrospective cohort study among patients 60 years old and above who underwent uroflowmetry and cystometry from January to June 2018. Data were collected by patients files review. SPSS regression was used to show correlations between variables.
Results
181 subjects were included. Requests for urodynamics were largely from urologists (70.27%), while geriatricians only comprise 1.66% among them. 54% underwent urodynamics for evaluation of lower urinary tract symptoms (LUTS), most commonly frequency (75.69%). Majority had low flow rates at 82.07%, 13% of them have low voided volumes. 81.38% have prolonged flow times. As age increases, maximum flow rate, average flow rate, and time to maximum flow also increase. In cystometry, 80.77% have small bladder capacity, but majority have good bladder compliance with intact proprioception (92.31%). Uninhibited contractions were present (15.38%) as well as urine leak (13.46%). 73.08% have post-void residual urine and abdominal straining was noted to 34.62%. 63.46% have weak bladder contractility. 34.62% were suspected of having bladder outlet obstruction while 38.89% have obstruction based on bladder outlet obstruction index (BOOI). 13.46% have detrusor-sphincter dyssynergia. As age increases, total bladder capacity, Qmax, and average flow rate also increase.
Interpretation of results
The two most common LUTS among subjects in this study were urinary frequency and nocturia. Normal age-related changes are observed in the structure of both detrusor and urethra.[1] Consequences of these changes are an increased occurrence in storage symptoms (frequency, nocturia, urgency), which are the most common, and in voiding symptoms (hesitancy, complete or incomplete retention, incomplete voiding).[1] 
Among the variety of reasons physicians request for urodynamics, the most common is LUTS evaluation due to its impact on the lives of the patients. Symptoms of voiding dysfunctions such as LUTS may initially be addressed by medications but uroflowmetry may be used as a screening tool which will help the clinician provide a more specific treatment. Another reason is trial voiding for those with indwelling foley catheter and suprapubic catheters. Effects of medications were being assessed and trial voiding is done to aid in the decision if the catheter may be removed or needs to be continued. As part of preoperative evaluation, they look at the flow rates and the possible mechanisms for problems with flow rate to help clinicians decide if they will push through with procedures particularly those involving the prostate gland. Recurrent UTI is also an indication for urodynamics to check for presence of urinary retention and its mechanism. Taking into consideration the high percentage of elderlies with urinary incontinence, the different LUTS present, and the different reasons why clinicians request for urodynamics, very few geriatricians request for urodynamic studies including uroflowmetry as a screening tool.
	Majority of the total number of subjects have low flow rates. This may be due to either a weak detrusor muscle or an outlet obstruction. To exclude those with contracted bladder, those with low voided volumes were excluded. In doing so, 81.38% have prolonged flow times wherein outlet obstruction or elastic obstruction may be suspected. 
Age may be used as a predictor of maximum flow rate, average flow rate, and time to maximum flow. As age increases, maximum flow rate, average flow rate, and time to maximum flow also increase. However, correlation of age with time to maximum flow has negligible correlation but statistically significant. In the study done by Zimmern, et.al., voiding time increased 2.7 seconds for every 10 years of age increment.[2] 
Although majority have intact proprioception and was categorized as having small bladder capacity, mean value is at 316ml. Uninhibited contractions which were present to few subjects indicate premature or unstable bladder activity. This is due to the structural changes in the detrusor muscle with ageing. Very few subjects also experienced urine leak. This reflects a small percentage of subjects with DO incontinence as manifested by a small percentage of those with stress urinary incontinence as well. Post void residual urine was noted to 73.08%, while abdominal straining was noted to 34.62%. Most subjects were found to have weak bladder contractility. The odds of hypocontractility in this age group was nearly 3 times that of the younger age group and found that for every 10 years of age, there is a drop in BCI of 8cmH2O.[2] A study done on rats showed that biological aging significantly decreases bladder smooth muscle caveolae number and morphology with associated selective alteration in caveolin protein expression.[3] Since caveolae are protected membrane regions that regulate signal transduction, age-related alterations in caveolae and its protein expression could alter bladder contractility resulting in bladder dysfunctions of the elderly.[3] Based on detrusor pressure and maximum flow rate, 34.62% were considered of having bladder outlet obstruction, but only 38.89% of them have obstructed bladder outlet obstruction index (BOOI) at 38.89%. There were 28.85% with sphincteric activities by EMG but only 13.46% were found to have detrusor-sphincter dyssynergia. Some increase in sphincter activities are due to abdominal straining.
	Age may be used as a predictor of total bladder capacity, Qmax, and average flow rate. As age increases, total bladder capacity, Qmax, and average flow rate also increase. This time, as opposed to uroflowmetry, negligible correlation between age and time to maximum flow is not significant. In the study done by Zimmern, et.al., for each increase in age by 10 years, there is a decrease in voiding time, decrease in Pdet.Qmax, and no changes in PVR or maximum cystometric capacity (MCC).[2] On women over 65 years with stress incontinence, maximum flow, detrusor pressure at maximum flow (Pdet@Qmax), and valsalva leak point pressure (VLPP) were all significantly lower compared to younger women.[2] Pdet@Qmax decreased 2.1 cm H2O for each 10 year increase in age.[14]
Concluding message
Among increasing number of elderly patients screened to have urinary incontinence during comprehensive geriatric assessment or during visit at the clinic, very few geriatricians request for urodynamics. Geriatric patients present with symptoms that are often multifactorial in origin. Urodynamics is a useful tool to help us rule out other causes that could potentially add more harm to the patient when we do trial medications and when we prolong their symptoms without proper intervention. This study may be used as a basis for development of a clinical pathway. This study may also be used as a precursor for other studies but a larger population is recommended if a similar study will be done. In future studies on profiling, include only those with complete urodynamics procedure and exclude those who underwent uroflowmetry or cystometry alone to get a better and more specific picture of the patient’s condition. A corrected Qmax may be used if the pelvic center permits. A prospective study might give better profiles since subjects may be interviewed with questions specific for the study and subjects may be observed during the urodynamics procedure in order to further explain results better and to observe for any limitations such studies would have. Directly observing the patient will help in better selection among different trials the subjects underwent during the procedure. This will also help in better acquisition of information from subjects involved.
References
  1. Valentini, F.A., et. al., Do urodynamics provide a better understanding of voiding disorders on women over 80?. Prog Urol. 2017.
  2. Zimmern, Philippe, et. al. Effect of Aging on storage and voiding function in women with stress-predominant urinary incontinence. J Urol 192(2): 464-468. 2014.
  3. Lowalekar SK, Cristofaro V, Radisavljevic ZM, Yalla SV, Sullivan MP. Loss of bladder smooth muscle caveolae in the aging bladder. Neurourol Urodyn. Apr; 2012 31(4): 586-92.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd It is a retrospective study involving only patient files review. Helsinki Yes Informed Consent No
15/07/2025 09:13:26