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Elderly with urinary obstruction

Matthew G Crockett, Marcus J Drake
PURPOSE OF REVIEW: Benign prostatic obstruction (BPO) is a common cause of lower urinary tract symptoms (LUTS) in elderly men. However, such symptoms are often caused by primary detrusor overactivity or underactivity. Surgical management where BPO is absent or merely incidental has a lower chance of success, and exposes the patient to the potential complications of surgery. This review discusses the diagnostic challenges facing this common presentation. RECENT FINDINGS: Most evidence comes from small, historical prospective cohort studies...
March 9, 2018: Current Opinion in Urology
Carol Emi Bretschneider, Sarah M Share, Marie Fidela R Paraiso
BACKGROUND: Severe labial agglutination can be refractory to outpatient management and can lead to voiding dysfunction in postmenopausal women. Labial agglutination is often a sequela of long-standing inflammatory processes, which include untreated lichen planus, lichen sclerosus, and atrophic vaginitis. CASE: An 82-year-old parous woman presented with severe labial agglutination and complete obstruction of her vaginal introitus, causing obstructive voiding symptoms...
February 27, 2018: Female Pelvic Medicine & Reconstructive Surgery
David W Donnelly, Conan Donnelly, Therese Kearney, David Weller, Linda Sharp, Amy Downing, Sarah Wilding, Penny Wright, Paul Kind, James W F Catto, William R Cross, Malcolm D Mason, Eilis McCaughan, Richard Wagland, Eila Watson, Rebecca Mottram, Majorie Allen, Hugh Butcher, Luke Hounsome, Peter Selby, Dyfed Huws, David H Brewster, Emma McNair, Carol Rivas, Johana Nayoan, Mike Horton, Lauren Matheson, Adam W Glaser, Anna Gavin
OBJECTIVES: To provide intelligence on the prevalence of urinary, bowel and sexual dysfunction in Northern Ireland (NI) to act as a baseline for studies of prostate cancer (PCa) outcomes and to aid service provision within the general population. SUBJECTS AND METHODS: A cross-sectional postal survey of 10,000 men aged 40 and over in NI, age-matched to the distribution of men living with PCa. The EQ-5D-5L and EPIC-26 instruments were used to enable comparisons with PCa outcome studies...
February 28, 2018: BJU International
Leonidas Karapanos, Johannes Salem, Ilgar Akbarov, Axel Heidenreich, Vahudin Zugor
Female pelvic organ prolapse is a widely prevalent condition and is associated with variable morbidity. It encompasses a number of clinical conditions, including subvesical obstruction, overactive bladder symptoms, sexual dysfunction and urinary und fecal incontinence. The prevalence of pelvic insufficiency is estimated to be between 30 and 50 %. As life expectancy is increasing and the elderly population is growing, there will be an increased incidence of the condition and growing demand for pelvic floor treatment in the future...
February 2018: Aktuelle Urologie
Jing Li, Yanxin Tian, Shimeng Guo, Haifeng Gu, Qianting Yuan, Xin Xie
Benign prostatic hyperplasia (BPH) is an age-related disease, affecting a majority of elderly men worldwide. Medical management of BPH is an alternative to surgical treatment of this disease. Currently, α1-adrenergic receptor (α1-AR) antagonists are among the first line drugs to treat BPH by reducing the tension of urinary track and thus the obstructive symptoms in voiding. In drug development, old male dogs with spontaneous BPH are considered the golden standard of the animal models. However, old dogs (>6 years) are expensive and not all old dogs develop BPH...
2018: PloS One
Masahiro Yasunishi, Akihiro Koumura, Yuichi Hayashi, Shohei Nishida, Takashi Inuzuka
A 71-year-old woman with a 9-year history of Parkinson's disease was admitted to our hospital emergently because of consciousness disturbance. Her consciousness level was 200 on the Japan coma scale (JCS), and she presented with tenderness and distension of the lower abdomen. Brain computed tomography showed normal findings. Blood tests showed an increased ammonia level (209 μg/dl) with normal AST and ALT levels. We catheterized the bladder for urinary retention. Five hours after admission, the blood ammonia level decreased to 38 μg/dl, and her consciousness level improved dramatically...
2017: Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Kapil Sethi, Michael Bozin, Tebogo Jabane, Richard McMullin, David Cook, Rob Forsyth, Lachlan Dodds, Lydia Johns Putra
Purpose: To report our outcomes with the use of a thermo-expandable metallic intraprostatic stent (Memokath) for patients with bladder outlet obstruction (BOO) secondary to prostatic obstruction, and to assess it is a feasible option for many frail and elderly men unsuitable for surgery. Materials and Methods: We reviewed patients who underwent insertion of a Memokath stent for BOO over 17 years (January 1999 to December 2015) at one regional center over a long follow-up period (median, 7 years)...
November 2017: Investigative and Clinical Urology
Ali Murat Gokce, Mehmet Remzi Erdem, Ruhi Caglar, Cevdet Kaya, Leyla Ozel, Mesut Izzet Titiz
OBJECTIVES: Benign prostate hyperplasia is frequently diagnosed in elderly chronic renal failure patients. Although it is asymptomatic because urine flow declines in those with chronic renal failure, it may become symptomatic when urine flow increases after renal transplant. Untreated benign prostate hyperplasia may lead to several complications that adversely affect the kidney allograft. MATERIALS AND METHODS: Our retrospective study investigated data from 286 male transplant patients...
October 31, 2017: Experimental and Clinical Transplantation
Ana Karine Brandão Novaes, Wander Barros do Carmo, André Avarese de Figueiredo, Patrícia Cheker Lopes, Zínia Maria Mendes Dias, Leandra Alves Lopes Silva, Marcus Gomes Bastos
INTRODUCTION: Ultrasonography (US) is a rapid, non-invasive and safe procedure that allows the nephrologist to obtain vital information to the bedside, as well as allows to guide the procedures for nephrology practice. CASE REPORT: Male patient, elderly with hypertension, diabetes mellitus and chronic kidney disease presents with infraumbilical protrusion that the Point of Care US (POCUS), performed by the nephrologist, proved to be a large bladder with a diverticulum...
April 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Yasir Bashir, Quart Ul Ain, Muhammad Jouda, Osama Al Sahaf
INTRODUCTION: Percutaneous Suprapubic urinary bladder catheterisation (SPC) is a common procedure performed in cases of urinary retention where attempt to pass urethral catheter has failed. However, the procedure requires meticulous precision, vigilance and sound knowledge of anatomy, to avoid grave complications. We are reporting a very rare complication of Suprapubic catheterisation that is small bowel obstruction. Our case is first Irish and 10th global case of small bowel obstruction secondary to SPC...
October 10, 2017: International Journal of Surgery Case Reports
Mona M Khamis, Darryl J Adamko, Anas El-Aneed
Obstructive airways inflammatory diseases sometimes show overlapping symptoms that hinder their early and correct diagnosis. Current clinical tests are tedious and are of inadequate specificity in special population such as the elderly and children. Therefore, we are developing tandem mass spectrometric (MS/MS) methods for targeted analysis of urine biomarkers. Recently, proton-nuclear magnetic resonance ((1)H-NMR) analysis proposed 50 urinary metabolites as potential diagnostic biomarkers among asthma and chronic obstructive pulmonary disease (COPD) patients...
October 9, 2017: Analytica Chimica Acta
Yuan-Hong Jiang, Hann-Chorng Kuo
Although evidence shows that urodynamic study may not improve outcomes, it can be used to evaluate men with lower urinary tract symptoms (LUTSs) which have not been adequately delineated and treated. In young men with LUTS not responding to treatment based on clinical examination, or elderly men with LUTS and incontinence, a complete urodynamic evaluation is mandatory to understand the pathophysiology underlying LUTS, such as bladder outlet obstruction (BOO), detrusor overactivity, and detrusor underactivity...
April 2017: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
Chun-Hou Liao, Hann-Chorng Kuo
Lower urinary tract symptoms (LUTS) are highly prevalent in men and increase with age. Because LUTS are common among elderly men, they are usually considered synonymous with benign prostatic hyperplasia (BPH). Drugs should be the first-line treatment for BPH and surgical intervention should be performed only when there are complications or LUTS refractory to medical treatment. In addition to medical treatment, several minimally invasive therapies, such as thermal therapy, prostatic lift, laser evaporation, or laser enucleation techniques have been developed...
January 2017: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
Giacomo Verzotti, Vanessa Fenner, Gregory Wirth, Christophe E Iselin
Acute urinary retention is one of the most frequent urologic emergencies. It occurs mostly in elderly males that suffer from prostate enlargement. Very rare in women, it is essentially caused by vaginal prolapse and neurologic disease. Patients with acute urinary retention suffer from lower abdominal pain and cannot void. Medical history is the cornerstone of diagnosis. Rarely palpable on abdominal examination, an overfilled bladder may be revealed by dullness on supra-pubic percussion. Acute urinary retention may lead to a decrease in kidney function, and on the long term to detrusor hypocontractility...
November 30, 2016: Revue Médicale Suisse
Kenjiro Suzuki, Fuminari Hanashima, Suguru Shirotake, Kiichiro Kodaira, Koshiro Nishimoto, Takao Takahashi, Hideki Onishi, Masafumi Oyama
Locally advanced bladder cancer causes unpleasant symptoms such as irritative voiding symptoms, lower abdominal pain, gross hematuria and urinary retention, and lowers the quality of life. Treatment decisions in elderly patients may be difficult, as elderly patients are physically and psychologically different from younger patients. An 89-year-old male was referred to hospital for the treatment of an invasive bladder tumor with right hydronephrosis from tumor obstruction. The patient was elderly and did not have a good performance status; therefore curative radical cystectomy or chemotherapy was not indicated...
June 2017: Molecular and Clinical Oncology
J Kerdraon, B Peyronnet, X Gamé, B Fatton, R Haddad, C Hentzen, C Jeandel, P Mares, M Mezzadri, A-C Petit, G Robain, J-M Vetel, G Amarenco
AIM: The aim of this study was to review the evidence regarding the pathophysiology of detrusor underactivity in the elderly. METHODS: A literature review was conducted in July 2016 using the Medline/Pubmed database limiting the search to works in English or French. RESULTS: The prevalence of detrusor underactivity has been reported to range from 8% to 48% depending on the definition used and the age of the population studied. Current data suggest that aging may itself be a causative factor of detrusor underactivity through myogenic dysfunctions (ultrastructural degeneration of the detrusor muscle) and neurogenic dysfunctions (by degeneration of efferent but mostly afferent innervation mechanisms)...
May 22, 2017: Progrès en Urologie
Min Soo Choo, Changwon Yoo, Sung Yong Cho, Seong Jin Jeong, Chang Wook Jeong, Ja Hyeon Ku, Seung-June Oh
PURPOSE: As the elderly population increases, a growing number of patients have lower urinary tract symptom (LUTS)/benign prostatic hyperplasia (BPH). The aim of this study was to develop decision support formulas and nomograms for the prediction of bladder outlet obstruction (BOO) and for BOO-related surgical decision-making, and to validate them in patients with LUTS/BPH. METHODS: Patient with LUTS/BPH between October 2004 and May 2014 were enrolled as a development cohort...
April 2017: International Neurourology Journal
Yuan-Hong Jiang, Hann-Chorng Kuo
OBJECTIVE: Underactive bladder is frequently encountered in elderly patients. It may result from detrusor underactivity (DU) or low detrusor contractility due to a urethral sphincter inhibitory effect. This study analyzed the video-urodynamic study (VUDS) characteristics of patients with underactive bladder in a large cohort of men with lower urinary tract symptoms (LUTS). METHODS: Male patients with LUTS who had failed the initial treatment were consecutively enrolled...
2017: PloS One
Christopher J Gouveia, John D Cramer, Stanley Yung-Chuan Liu, Robson Capasso
Objective Assess the frequency and nature of postoperative complications following sleep surgery. Examine these issues specifically in elderly patients to provide guidance for their perioperative care. Study Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program. Methods We identified patients with obstructive sleep apnea undergoing sleep surgery procedures from 2006 to 2013 in the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional outcomes program designed to improve surgical quality...
April 2017: Otolaryngology—Head and Neck Surgery
B Katerberg, F Ter Borg
Faecal impaction is a problem which is becoming more prevalent now that the number of elderly patients is increasing. When not detected and treated inadequately, it can lead to symptoms such as diarrhoea, faecal incontinence and other serious problems like anorexia, vomiting and rectal ulcers with bleeding or even a bowel perforation. We describe two patients with serious and less common complications of faecolithiasis. Patient A, a 79-year-old woman with signs of dementia, presented with faecal incontinence and unexplained worsening of her cognitive symptoms leading to a situation where she could no longer live in her own home...
2017: Nederlands Tijdschrift Voor Geneeskunde
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