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Effect of aging on lower urinary tract symptoms and urodynamic parameters in women

2021-05-12 10:58:00

Lower urinary tract symptoms (LUTS) are common among women, and the incidence increases with age. They can be categorized as being related to urine storage or voiding (obstruction), and present themselves as various storage or voiding dysfunctions. Storage dysfunctions include urinary frequency, urgency, nocturia, urgency, and stress urinary incontinence, and emptying dysfunctions may include poor stream, hesitancy, straining, and incomplete bladder emptying. These disturbing symptoms can affect both men and women, especially the elderly.

Generally, the incidence of storage symptoms such as stress urinary incontinence is higher in women due to their weak pelvic floor muscles, while men tend to have voiding symptoms, such as straining and poor stream due to urethral obstruction. However, an observational cohort study by Shin et al. suggested that women with stress urinary incontinence can also have dysuria. According to the study, detrusor contractility and urine flow rate decline with age, especially in women over age 60. This suggests that the urodynamic changes in older women may be the same as in men. Female voiding dysfunction may be due to anatomic outlet obstruction or impaired detrusor contractility. Another report suggested that women may have both storage and voiding problems at the same time, and that voiding problems are sometimes underdiagnosed in women, therefore, urodynamic assessment of female urination parameters should not be ignored among female patients.

Aging may be a risk factor for bladder dysfunction and lower urinary tract symptoms in both men and women. Studies have shown that the increase in lower urinary tract symptoms with age is not sex-specific, but few studies have assessed the effect of age on bladder dysfunction and urodynamic changes in women. The purpose of this study was to investigate the effect of age on lower urinary tract symptoms, urethra and bladder function in women.

Materials and methods: This was an observational cohort study. Women who presented for lower urinary tract symptoms, quality-of-life questionnaires, and urodynamic tests were included in the study. Patients were divided into 4 groups (<50, 50-59, 60-69 and >69). All lower urinary tract symptoms and urodynamic parameters were reviewed and compared between groups.

Results: A total of 364 women were included in the study and analyzed. The urodynamic tests showed that maximal cystometric bladder capacity, the average and maximal urine flow rate, and pressure of detrusor contractility at maximal urine flow rate were all significantly decreased with age. Besides, the voiding time, and post-voiding residual urine volume significantly increased with age.  For urethral competence, the maximal urethral closure pressure deteriorated with age. All storage symptoms did not change with age, except for nocturnal enuresis. However, the effect of age on some voiding symptoms significantly increased with age, including straining to void, hesitancy, and intermittency.

Conclusions: Lower urinary tract symptoms, bladder and urethral functions change with age, particularly voiding function. Physicians should be aware of the aging process when counseling and before implementing management strategies, particularly for older people.

Taiwanese Journal of Obstetrics & Gynecology. IF: 1.704


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Keywords : LUTS urodynamic aging

Source : Taiwan J Obstet Gynecol. 2021;60(3):513-516.doi: 10.1016/j.tjog.2021.03.022.