Urodynamic studies in the evaluation of the older man with lower urinary tract symptoms: when, which ones, and what to do with the results

Abstract

Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in older men. Most urinary dysfunctions in the elderly are multifactorial in origin and associated with a broad spectrum of mental and physical conditions. In this population, it is essential to have a comprehensive assessment of the lower urinary tract, functional impairments and concurrent medical diseases. A holistic and individualized approach to management is important. Urodynamic studies (UDS) are objective tests which provide a major contribution to our understanding of the pathophysiology of lower urinary tract symptoms (LUTS). Urodynamic findings in older men may include common diagnoses such as bladder outlet obstruction and urinary incontinence. However, coexisting conditions such as detrusor overactivity and impaired detrusor contractility are common in older men. The identification of these conditions is necessary to appropriately counsel patients regarding treatment options. Simple urodynamic tests should be used whenever possible such as uroflowmetry and residual volume estimation. However, in complicated cases more invasive tests such as pressure flow studies are important to help choose the best treatment.

Keywords: lower urinary tract symptoms; older men; urodynamic studies.

Figure 1.

Poor flows from an obstructed patient.

Figure 2.

Videocystometrography.

Figure 3.

Management of LUTS in elderly men. LUTS, lower urinary tract symptoms; FVC, frequency volume chart; BOO, bladder outlet obstruction; OAB, overactive bladder.