Geriatric considerations in the diagnosis and management of lower urinary tract dysfunction

Lower urinary tract dysfunction increases with age. Detrusor overactivity, detrusor underactivity, and detrusor hyperreflexia with impaired contractility are more common in elderly population. The elderly patients usually have cormobidities, comedications, and precipitation factors, which cause or exacerbate urinary symptoms, or aggravate subclinical lower urinary tract dysfunction to overwhelming diseases. Pharmacokinetics and pharmacodynamics changes with age. Older patients may refuse appropriate therapy because they are concerned about adverse effects, and economic burden. Thus strategy for the diagnosis and the management of lower urinary tract dysfunction in elderly might be different from those in young population. The diagnostic evaluation of these patients starts with history taking and non-invasive tests to make a plan to treat patient's symptom. Watchful waiting with lifestyle intervention is a good treatment modality. If pharmacotheraphy is planned, it would be better to start with low dose, then escalate dose. Adverse effects of medications are more common in elderly patients not by old age, but by comorbidity and comedication. First follow up might be in a short period after prescription when adverse effects usually occur.