OBJECTIVES: Provide guidelines presented as an algorithm for practical evaluation and first line therapy of urinary incontinence in elderly.
PATIENTS AND METHODS: Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 40 experts quoting proposals, subsequently reviewed by an independent group of multidisciplinary experts (urologist, general practitioner, neurologist, gynecologist, geriatrist, specialist in physical medicine and rehabilitation).
RESULTS: By means of 3 rounds of interrogation of the expert panel, GRAPPPA algorithm was constructed. This algorithm take in account both evaluation and first line therapeutic options in the different type of incontinences observed in this population (urge, stress and mixed incontinence). Initial evaluation consists to track down urinary retention (and subsequently fecal stool impaction, use of anticholinergic or morphinic drugs), urinary tract infection and cognitive impairment. Haematuria, bladder-pelvic pain, history of radiotherapy or recent pelvic surgery, lead to refer the patient to a specialized unit. First line therapy is in all the cases pelvic floor training, use of local oestrogenotherapy and dietetic measures. In urge incontinence, anticholinergic drugs may be used.
CONCLUSIONS: Implementation of this algorithm may promote best practice in management of urinary incontinence in elderly.
Written by:
Amarenco G, Gamé X, Petit AC, Fatton B, Jeandel C, Robain G, Scheiber-Nogueira C, Vetel JM, Mares P. Are you the author?
Service de neuro-urologie, hôpital Tenon, AP-HP, GRC01 UPMC GREEN, 4, rue de la Chine, 75020 Paris, France; Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, 31059 Toulouse, France; Centre de santé, 8, rue Neibecker, 93440 Dugny, France; Service de gynécologie, CHU de Nîmes, place R.-Debré, 30029 Nîmes cedex 9, France; Service de gériatrie, CHU de Montpellier, avenue Charles-Flahault, 34295 Montpellier cedex, France; Service de médecine physique et de réadaptation, hôpital Rothschild, Paris AP-HP, GRC01 UPMC GREEN, 75571 Paris cedex 12, France; 17, place de l'Europe, 69006 Lyon, France; Service de gériatrie, CH Le Mans, 194, avenue Rubillard, 72037 Le Mans cedex, France.
Reference: Prog Urol. 2014 Mar;24(4):215-21.
doi: 10.1016/j.purol.2013.11.016
PubMed Abstract
PMID: 24560289
Article in French.
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