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

摘要

Lower urinary tract dysfunction is a major cause of morbidity and decreasedquality of life in older men. Most urinary dysfunctions in the elderly aremultifactorial in origin and associated with a broad spectrum of mental andphysical conditions. In this population, it is essential to have a comprehensiveassessment of the lower urinary tract, functional impairments and concurrentmedical diseases. A holistic and individualized approach to management isimportant. Urodynamic studies (UDS) are objective tests which provide a majorcontribution to our understanding of the pathophysiology of lower urinary tractsymptoms (LUTS). Urodynamic findings in older men may include common diagnosessuch as bladder outlet obstruction and urinary incontinence. However, coexistingconditions such as detrusor overactivity and impaired detrusor contractility arecommon in older men. The identification of these conditions is necessary toappropriately counsel patients regarding treatment options. Simple urodynamictests should be used whenever possible such as uroflowmetry and residual volumeestimation. However, in complicated cases more invasive tests such as pressureflow studies are important to help choose the best treatment.