BERKELEY, CA (UroToday.com) - We conducted a study to evaluate, in a group of female patients with urinary incontinence, the effect of aging on:
- Urodynamic findings
- Incidence of detrusor overactivity (DO)
- Types of urinary incontinence
- Pelvic organ prolapse
- Body mass index (BMI)
- anorectal disorders.
Eighty-four consecutive female patients with urinary incontinence were enrolled in this study. Patients were divided into two groups according to their age: group A: patients with age ≤ 65 years (n° 46 patients, 53.7 years (range 30-65); group B: patients with age > 65 years ( n° 38 patients, 75.4 years (range 66-87). All women underwent a full urogynaecological workup that included detailed history - a 3-day bladder diary, body mass index calculation, clinical examination with assessment of vaginal profile according to Baden and Walker, and a complete urodynamic evaluation.
Statistical analysis was done using the Mann-Whitney test for independent samples for quantitative variables, whereas the hypothesis about a difference in proportions was tested using Pearson's chi square test. A p value of less than 0.05 was considered statistically significant. Methods, definitions and units conform to the standards recommended by the International Continence Society.
The data from the current study reveal age-associated differences in women with urinary incontinence.
Stress incontinence was the most common type of urinary incontinence in younger women whereas urge and mixed incontinence were more frequently found in older patients (p=0.0003).
However, patients with overactive bladder syndrome did not always demonstrate DO in the urodynamic study. Only 16 women out of 46 with the symptoms of urge or mixed incontinence showed a DO on the filling cystometry.
No statistically significant difference was found in pelvic organ prolapse in group A and B both for the degree of prolapse and for the prolapsed vaginal segment. A higher BMI was significantly associated with older patients with mean values of 28.88 versus 23.93 respectively (p<0.0001), but no relation was found between BMI and a specific type of urinary incontinence.
Anorectal disorders did not show a statistically significant difference in the two groups of patients. A normal defecation was more common in women ≤ 65 years whereas constipation was the prevalent disorders in both groups of patients.
In the urodynamic study, no statistically significant difference was found in uroflowmetry parameters even if Qmax and Qave were lower in older patients with a flow time and a PVR that were higher. Maximum urethral closure pressure (MUCP) showed a statistically significant decrease with age, with a mean value of 47.29 in patients > 65 years and a mean value in the youngest women of 68.20 (p<0.0001). Urethral sphincter function declines with aging indicating a decrease in outflow resistance. It is in relation to the structural and functional changes of the urethra. The lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial tropism.
Significant increases in bladder sensation with a decrease in bladder capacity during filling cystometry were found in the older patients. The reduced bladder capacity with age may be related to the increase of DO rather than to structural changes of the bladder wall. Furthermore, a significant increase of the incidence of DO with age was found (p=0.0357).
Finally no statistically significant difference was found in the detrusor pressure in the pressure/flow study, even if the mean value of the detrusor pressure in group B was always lower.
Carlo Vecchioli-Scaldazza,* and Carolina Morosetti ** as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
* Division of Urology, ** Clinical Research, Jesi Hospital, Jesi, Italy