DON’T BLAME THE BLADDER FOR YOUR PATIENTS’ SYMPTOMS

摘要

Bladder symptoms including urinary incontinence, urgency, frequency, and retention are increasingly problematic with advancing age, yet current bladder-centric approaches are often limited to compensatory or palliative measures. The fundamental premise of this workshop is that emphasis on bladder pathology as the cause of impaired urinary control has not yielded adequate therapies especially at the ends of the lifespan. A current enlightened approach to urinary symptoms in the elderly considers the multiplicity of overlapping physiologies of aging and associated morbidities in the context of the less resilient human. An even more effective approach may be to consider urinary control as a manifestation of an adaptive system. Structural and functional changes induced by age and comorbidities may be pathologic or adaptive, but always function within an integrative system. A resilient system provides an adaptive response to physiologic challenge, thereby avoiding symptoms. As system components lose adaptive range, the ability to achieve homeostasis diminishes and the likelihood of dysfunction and symptoms increases. The increase in urinary problems in later life should therefore not be blamed on old patients having old bladders, rather should be considered as an expression of diminishing resilience. In this symposium, Roger Dmochowski, Lori Birder, Adam Klausner, and Phillip Smith will present emerging basic, translational, and clinical concepts of the bladder in aging. These bladder-centered findings will be considered in an integrative, homeostatic model of urinary control. Discussion will be led by a Neil Resnick, a geriatrician/gerontologist with expertise in the diagnosis and management of urinary problems in older adults.