Search processing algorithms in a primary care setting, analyzing the specifics of care management for seniors suffering from urinary incontinence (UI), described the recommendations and levels of evidence of treatment.
A literature review carried out via PubMed® and websites of scientific societies with search keywords classified according to an algorithm.
One hundred algorithms have been discovered in the field of evaluation and treatment of UI. Screening for UI risk factors began early on in the treatment of reversible or chronic comorbidities, avoiding iatrogenic. Specific clinical features (red flags) required specialized advice. Non-pharmacological conservative treatment should be offered first in line for seniors: behavioral therapy, changes in lifestyle, walk, treatment of constipation. For women, pelvic floor muscle training combined biofeedback and functional electrical stimulation. After failure and persistence of UI with urgency, the information of the risk of a possible urinary retention or cognitive impairments preceded the prescription of an anticholinergic and the measurement of post-voiding residue done by ultrasounds. Older age is not a cons-indication for surgery UI least invasive. The cough test and Bonney maneuver can confirm a masked stress urinary incontinence and/or an associated prolapse. Cases of failure of UI, doubtful diagnosis or programmed surgery required urodynamic assessment.
Algorithms and recommendations of UI should remain a valuable aid to the clinical assessment, diagnosis and treatment of UI in the elderly.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2017 Mar 09 [Epub]
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