Simple urodynamic evaluation ofincontinent elderly female nursing home patients A descriptive analysis

doi:10.1016/0090-4295(91)80220-2

Urology

Volume 37, Issue 2, February 1991, Pages 173-179

https://doi.org/10.1016/0090-4295(91)80220-2 Get rights and content

Abstract

We present a descriptive analysis of the functional, mental, and urodynamic status of a population of incontinent elderly female nursing home patients. One hundred fifty-five intermediate care female patients with a mean age of 85.5 years were identified as being incontinent of urine at least once daily. After urologic evaluation, each patient was classified into one of four categories: incontinence with normal cystometrogram 68 (44 &), detrusor instability (DI) 52 (34 &) stress incontinence (SI) 27 (17 &), or overflow incontinence (01) 7 (4 &). Thirteen weeks later, patients were again studied using simple water cystometry. At follow-up evaluation, 45 patients (33 &) had urodynamic findings which differed from the initial evaluation. Of these women, 10 with DI, 12 with SI, and 2 with OI were found to have normal cystometric parameters at the time of follow-up study, while 19 (14 &) who initially had normal cystometric findings had evidence of DI (11) or SI (3). Strong correlation between urinary incontinence in patients with normal cystometric findings and moderate to severe cognitive impairment was present. Simple urodynamic evaluation did identify patients with SI and 01 who might benefit from specific therapy. Urodynamic evaluation of incontinent elderly female nursing home patients is indicated and may provide direction for planning treatment strategies.

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Cited by (10)

Emptying cystometry: A feasibility and validation pilot study on female patients
2018, Progres en Urologie
Citation Excerpt :
Single channel cystometry, in opposition with multichannel (electronic) cystometry, has been performed for years [5,9]. Single channel filling cystometry was especially used in geriatric population to reconcile the need to improve accuracy of diagnosis with the impracticality or relative inaccessibility in many centers of multichannel cystometry [5,10,11]. In geriatric population, Fonda et al. and Ouslander et al. compared simple cystometry to multichannel cystometry for the diagnosis of detrusor overactivity [10,11].
To assess the feasibility and the accuracy of emptying cystometry in order to simplify the manometric follow-up of overactive detrusor in neurological patients under anticholinergic or botulinum toxin injections.
Female patients with a stable detrusor underwent both a conventional cystometry and sequential measurements of bladder pressure during emptying (emptying cystometry). At the end of the standard cystometry, a CH12 urinary catheter was introduced in the bladder and was connected to a three-way stopcock. The second way of the stopcock permitted the emptying. The third way of the stopcock was connected to a vertical graduated tube to measure the bladder pressure each 50 mL during the bladder emptying.
Eleven female patients were included (mean age: 59.4 years). Nine patients (82%) had neurogenic bladder. Mean cystometric capacity was 439 mL (SD: 35 mL). During the emptying cystometry, 8 to 10 measures were taken (mean: 9.4). The mean detrusor pressure was 1.7 cmH₂O (SD 2.1) for the filling cystometry and 2.3 cmH₂O (SD: 2.7) for the emptying cystometry. The agreement between the detrusor pressure between the two cystometries was good with intra-class correlation coefficient at 0.66 [0.48–0.77] – and the correlation was high (r = 0.7; P < 0.000001).
In a small, selected sample of patients, emptying cystometry provides similar results of detrusor pressure to filling cystometry. This technique could constitute a home monitoring of bladder pressures in a selected population of patients with intermittent catheterization in whom a manometric follow-up of detrusor overactivity is required.
4.
L’objectif de cette étude est d’évaluer la faisabilité et la validité d’une cystomanométrie de vidange afin de simplifier le suivi manométrique des patients neurologiques avec un détrusor hyperactif et traités par anticholinergiques ou injections de toxine botulinique.
Les patientes ayant un détrusor stable ont bénéficié d’une cystomanométrie conventionnelle et de mesures séquentielles de la pression vésicale au cours de la vidange (cystomanométrie de vidange). À la fin de la cystomanométrie standard, une sonde urinaire de CH 12 connectée à un robinet à trois voies, était introduite dans la vessie. La deuxième voie du robinet était connectée à un tube gradué vertical mesurant la pression vésicale tous les 50 mL vidangés.
Onze patientes d’âge moyen 59,4 ans ont été incluses, neuf (82 %) avaient une vessie neurologique. La capacité cystomanométrique moyenne était de 439 mL (SD : 35 mL). Au cours de la cystomanométrie de vidange, 8 à 10 mesures ont été relevées (moyenne : 9,4). La pression détrusorienne moyenne était de 1,7 cmH₂O (SD : 2,1) pour la cystomanométrie conventionnelle et de 2,3 cmH₂O (SD : 2,7) pour la cystomanométrie de vidange. L’accord entre les pressions détrusoriennes au cours des deux cystomanométries était fort avec un coefficient de corrélation intra-classe à 0,66 [0,48–0,77] ainsi que leur corrélation (r = 0,7; p < 0,000001).
Dans un petit échantillon de patients, la cystomanométrie de vidange permet une mesure de pression détrusorienne similaire à la cystomanométrie de remplissage, ce qui pourrait constituer un moyen de contrôle des pressions endovésicales à domicile chez des patients sous autosondages nécessitant un suivi manométrique régulier.
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Physiology of incontinence
2004, Clinics in Geriatric Medicine
Geriatric incontinence
1996, Urologic Clinics of North America
Urinary incontinence in nursing homes for older people
2003, Age and Ageing
Stress urinary incontinence at rest
1999, International Urogynecology Journal
The aging bladder: Morphology and urodynamics
1998, World Journal of Urology

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^*: Supported by National Institute on Aging, National Institutes of Health, and National Center for Nursing Research Grant 5U01 G05268-03.

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UrodynamicSimple urodynamic evaluation ofincontinent elderly female nursing home patients A descriptive analysis*

Abstract

J Psychiatr Res

J Urol

J Urol

Urology

Urinary incontinence in the elderly, Baltimore

AUA Update Series

Urinary incontinence in elderly nursing home patients

JAMA

Urodynamic
Simple urodynamic evaluation ofincontinent elderly female nursing home patients A descriptive analysis*