BOOK
Geriatric Urology, An Issue of Clinics in Geriatric Medicine, E-Book
(2016)
Additional Information
Book Details
Abstract
This issue of Clinics in Geriatric Medicine is devoted to Geriatric Urology. Guest Editor Tomas L. Griebling, MD, MPH has assembled a group of expert authors to review the following topics: Non-Surgical Treatment of Urinary Incontinence in Elderly Women; Outcomes of Surgery for Stress Urinary Incontinence in Older Women; Evaluation and Management of Pelvic Organ Prolapse in Elderly Women; Underactive Bladder in Older Adults; Translational Research and Voiding Dysfunction in Older Adults; Functional Brain Imaging and Voiding Dysfunction in Older Adults; The Role of Urodynamics in Elderly Patients; Associations Between Voiding Symptoms and Sexual Health in Older Adults; Asymptomatic Bacteriuria and Urinary Tract Infections in Older Adults; Comorbidity and Surgical Risk in Older Urologic Patients; Small Renal Masses in Older Adults; Prostate Cancer in Elderly Men: Active Surveillance and Other Considerations; Late Onset Hypogonadism and Testosterone Replacement in Elderly Men; and Contemporary Chemotherapy for Urologic Malignancies in Geriatric Patients.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Geriatric Urology | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Urologic Issues in Geriatric Health Care\r | vii | ||
| Nonsurgical Treatment of Urinary Incontinence in Elderly Women \r | vii | ||
| Outcomes of Surgery for Stress Urinary Incontinence in the Older Woman\r | vii | ||
| Evaluation and Management of Pelvic Organ Prolapse in Elderly Women\r | vii | ||
| Underactive Bladder in Older Adults\r | vii | ||
| Translational Research and Functional Changes in Voiding Function in Older Adults\r | viii | ||
| Functional Brain Imaging and the Neural Basis for Voiding Dysfunction in Older Adults\r | viii | ||
| The Role of Urodynamics in Elderly Patient\x0B | viii | ||
| Associations Between Urinary Symptoms and Sexual Health in Older Adults\r | viii | ||
| Surgical Risk and Comorbidity in Older Urologic Patients\r | ix | ||
| Management of Small Renal Masses in the Older Adult\r | ix | ||
| Prostate Cancer in Elderly Men: Screening, Active Surveillance, and Definitive Therapy\r | ix | ||
| Late-Onset Hypogonadism and Testosterone Replacement in Older Men\r | ix | ||
| Contemporary Systemic Therapy for Urologic Malignancies in Geriatric Patients\r | x | ||
| Palliative Care of Urologic Patients at End of Life\r | x | ||
| CLINICS IN GERIATRIC MEDICINE\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| February 2016 | xi | ||
| May 2016 | xi | ||
| August 2016 | xi | ||
| RECENT ISSUES | xi | ||
| August 2015 | xi | ||
| May 2015 | xi | ||
| February 2015 | xi | ||
| Preface: Urologic Issues in Geriatric Health Care \r | xiii | ||
| Nonsurgical Treatment of Urinary Incontinence in Elderly Women | 471 | ||
| Key points | 471 | ||
| INTRODUCTION | 471 | ||
| MANAGEMENT GOALS | 472 | ||
| CLINICAL EVALUATION | 472 | ||
| PHARMACOLOGIC THERAPIES | 473 | ||
| General Principles | 473 | ||
| Urgency Urinary Incontinence | 473 | ||
| Anticholinergic Agents | 473 | ||
| β3-Agonists | 476 | ||
| Estrogen | 476 | ||
| Other Medications | 476 | ||
| Stress Urinary Incontinence | 476 | ||
| NONPHARMACOLOGIC STRATEGIES | 477 | ||
| Pelvic Floor Muscle Training | 477 | ||
| Mechanical Devices | 477 | ||
| Catheters | 478 | ||
| SELF-MANAGEMENT STRATEGIES | 478 | ||
| General Principles | 478 | ||
| Voiding Hygiene | 479 | ||
| Smoking Cessation | 479 | ||
| Dietary Modifications | 479 | ||
| Caffeine | 479 | ||
| Fluid intake | 479 | ||
| Weight loss | 479 | ||
| Bowel habits | 479 | ||
| CLINICAL FOLLOW-UP | 480 | ||
| SUMMARY AND RECOMMENDATIONS | 480 | ||
| REFERENCES | 480 | ||
| Outcomes of Surgery for Stress Urinary Incontinence in the Older Woman | 487 | ||
| Key points | 487 | ||
| CRITICAL NEED FOR AGE-RELATED OUTCOMES | 487 | ||
| Introduction: Context for Understanding Age-Related Surgical Outcomes | 487 | ||
| PERIOPERATIVE CONSIDERATIONS AND EVALUATION IN OLDER WOMEN | 488 | ||
| Pathophysiological Changes to the Lower Urinary Tract | 488 | ||
| Preoperative Evaluation of the Lower Urinary Tract | 489 | ||
| Preoperative Evaluation of the Geriatric Patient | 489 | ||
| SURGICAL INTERVENTIONS AND OUTCOMES | 491 | ||
| Urethral Bulking Agents | 491 | ||
| Burch Colposuspension and Pubovaginal (Autologous Rectus Fascia) Sling | 493 | ||
| Midurethral Sling | 493 | ||
| AGE-RELATED SURGICAL OUTCOMES | 494 | ||
| Treatment Failure After Midurethral Sling | 498 | ||
| Postoperative Complications | 498 | ||
| Geriatric Postoperative Considerations | 499 | ||
| SUMMARY/NEED FOR FURTHER INVESTIGATION | 500 | ||
| REFERENCES | 500 | ||
| Evaluation and Management of Pelvic Organ Prolapse in Elderly Women | 507 | ||
| Key points | 507 | ||
| INTRODUCTION | 507 | ||
| PATIENT EVALUATION | 508 | ||
| Patient History | 508 | ||
| Physical Examination | 509 | ||
| PELVIC ORGAN PROLAPSE TREATMENT OPTIONS | 511 | ||
| Nonpharmacologic Pelvic Organ Prolapse Treatment Options | 511 | ||
| Natural evolution of prolapse | 511 | ||
| Surgical Treatment Options (if Applicable) | 514 | ||
| SUMMARY/DISCUSSION | 518 | ||
| REFERENCES | 518 | ||
| Underactive Bladder in Older Adults | 523 | ||
| Key points | 523 | ||
| INTRODUCTION | 523 | ||
| RED FLAGS OF UNDERACTIVE BLADDER | 524 | ||
| CAUSES OF UNDERACTIVE BLADDER | 525 | ||
| EPIDEMIOLOGY | 525 | ||
| THE UNRECOGNIZED PROBLEM | 526 | ||
| CONTRIBUTING FACTORS AND PATHOPHYSIOLOGY | 526 | ||
| PROGRESSION OF OVERACTIVE BLADDER TO UNDERACTIVE BLADDER | 527 | ||
| CLINICAL EVALUATION | 527 | ||
| EVALUATION OF UNDERACTIVE BLADDER | 528 | ||
| UNDERACTIVE BLADDER QUESTIONNAIRE | 528 | ||
| THERAPEUTIC DIRECTIONS | 529 | ||
| CHOLINESTERASE INHIBITORS | 529 | ||
| PROSTAGLANDIN E2 AND PROSTAGLANDIN RECEPTORS | 530 | ||
| SACRAL NEUROMODULATION | 530 | ||
| STEM CELL THERAPY FOR UNDERACTIVE BLADDER | 530 | ||
| EDUCATION AND NEXT STEP | 531 | ||
| SUMMARY | 531 | ||
| REFERENCES | 531 | ||
| Translational Research and Functional Changes in Voiding Function in Older Adults | 535 | ||
| Key points | 535 | ||
| INTRODUCTION | 536 | ||
| FUNCTIONAL AGING-RELATED VOIDING CHANGES | 536 | ||
| The Overactive Bladder | 536 | ||
| Detrusor Underactivity | 537 | ||
| ANIMAL MODELS OF AGING-RELATED BLADDER DYSFUNCTION | 537 | ||
| In Vivo Studies of Bladder Function | 537 | ||
| In Vitro Studies of Bladder Function | 538 | ||
| Afferent nerves | 538 | ||
| Urothelium/lamina propria | 539 | ||
| Efferent transmission and smooth muscle | 539 | ||
| RISK FACTORS | 540 | ||
| Gender Differences | 540 | ||
| Atherosclerosis and Oxidative Stress | 540 | ||
| SUMMARY | 542 | ||
| REFERENCES | 542 | ||
| Functional Brain Imaging and the Neural Basis for Voiding Dysfunction in Older Adults | 549 | ||
| Key points | 549 | ||
| INTRODUCTION | 550 | ||
| BRAIN IMAGING OF BLADDER CONTROL | 551 | ||
| FUNCTIONAL MRI STUDIES IN HEALTHY SUBJECTS | 555 | ||
| CONNECTIVITY | 557 | ||
| EFFECT OF AGING ON BRAIN ACTIVATION AND CONNECTIVITY | 557 | ||
| SUMMARY | 562 | ||
| REFERENCES | 562 | ||
| The Role of Urodynamics in Elderly Patients | 567 | ||
| Key points | 567 | ||
| INTRODUCTION | 567 | ||
| POSITIONING | 568 | ||
| URODYNAMIC TESTING | 568 | ||
| Postvoid Residual | 568 | ||
| Uroflowmetry | 569 | ||
| Multichannel Urodynamics | 569 | ||
| Cystometry | 569 | ||
| Electromyography | 571 | ||
| Pressure Flow Studies | 571 | ||
| Videourodynamics | 572 | ||
| Abdominal Leak Point Pressure and Valsalva Leak Point Pressure | 572 | ||
| Detrusor Leak Point Pressure | 573 | ||
| Urethral Pressure Profile | 573 | ||
| LOWER URINARY TRACT SYMPTOMS THAT ARE COMMON IN THE GERIATRIC POPULATION | 573 | ||
| Stress Urinary Incontinence in Females | 573 | ||
| Overactive Bladder, Urgency Urinary Incontinence, and Mixed Urinary Incontinence | 574 | ||
| Nocturia | 574 | ||
| Neurogenic Bladder | 574 | ||
| Benign Prostatic Hyperplasia | 575 | ||
| SPECIAL CIRCUMSTANCES IN ELDERLY PATIENTS | 575 | ||
| Parkinson Disease | 575 | ||
| Stroke and Cerebrovascular Accidents | 576 | ||
| Dementia | 576 | ||
| Spinal Stenosis/Disk Herniation | 577 | ||
| SUMMARY | 577 | ||
| REFERENCES | 577 | ||
| Associations Between Urinary Symptoms and Sexual Health in Older Adults | 581 | ||
| Key points | 581 | ||
| SEXUAL HEALTH AMONG OLDER ADULTS | 581 | ||
| PREVALENCE OF SEXUAL DYSFUNCTION | 582 | ||
| THE MULTIFACTORIAL NATURE OF SEXUAL DYSFUNCTION | 582 | ||
| OVERALL HEALTH STATUS AND SEXUAL DYSFUNCTION | 582 | ||
| INTERRELATIONSHIP BETWEEN URINARY DISORDERS AND SEXUAL DYSFUNCTION | 583 | ||
| ASSOCIATION BETWEEN LOWER URINARY TRACT SYMPTOMS AND SEXUAL DYSFUNCTION IN MEN | 583 | ||
| Data from Epidemiologic Studies | 583 | ||
| Men with Prostate Cancer Undergoing Radical Prostatectomy | 585 | ||
| Men with Overactive Bladder and Urgency Incontinence | 586 | ||
| ASSOCIATION BETWEEN LOWER URINARY TRACT SYMPTOMS AND SEXUAL DYSFUNCTION IN WOMEN | 586 | ||
| Data from Epidemiologic Studies | 586 | ||
| Coital Incontinence in Women | 587 | ||
| Sexual Dysfunction and Incontinence After Treatment of Rectal Cancer in Women | 587 | ||
| Improvement of Sexual Function with Treatment of Urinary Symptoms | 587 | ||
| PRACTICE IMPLICATIONS | 588 | ||
| REFERENCES | 588 | ||
| Surgical Risk and Comorbidity in Older Urologic Patients | 591 | ||
| Key points | 591 | ||
| INTRODUCTION | 591 | ||
| PREOPERATIVE RISK ASSESSMENT IN THE OLDER UROLOGIC PATIENT | 592 | ||
| FRAILTY: A SINGLE PREOPERATIVE RISK ASSESSMENT | 592 | ||
| SINGLE-ORGAN SYSTEMS: IMPORTANT RISK ASSESSMENT ADJUNCTS | 596 | ||
| CARDIAC ASSESSMENT | 596 | ||
| NUTRITIONAL ASSESSMENT | 596 | ||
| PULMONARY ASSESSMENT | 597 | ||
| RENAL ASSESSMENT | 597 | ||
| POPULATION-BASED ASSESSMENT | 597 | ||
| WHAT THE UROLOGIST CAN DO | 597 | ||
| FUTURE DIRECTIONS | 598 | ||
| REFERENCES | 598 | ||
| Management of Small Renal Masses in the Older Adult | 603 | ||
| Key points | 603 | ||
| INTRODUCTION | 603 | ||
| EPIDEMIOLOGY | 604 | ||
| DIAGNOSIS | 604 | ||
| Renal Mass Biopsy | 605 | ||
| Evaluation of Comorbidity | 605 | ||
| Nomograms and Risk Assessment Tools | 606 | ||
| TREATMENT | 607 | ||
| Active Surveillance | 607 | ||
| Radical Nephrectomy | 608 | ||
| Partial Nephrectomy | 608 | ||
| Partial Nephrectomy Versus Radical Nephrectomy | 608 | ||
| Thermal Ablative Techniques | 610 | ||
| SUMMARY | 610 | ||
| MAJOR SUMMARY POINTS | 611 | ||
| REFERENCES | 611 | ||
| Prostate Cancer in Elderly Men | 615 | ||
| Key points | 615 | ||
| INTRODUCTION | 615 | ||
| SCREENING | 616 | ||
| LOCALIZED PROSTATE CANCER: MANAGEMENT OPTIONS | 618 | ||
| ACTIVE SURVEILLANCE | 618 | ||
| PROSTATECTOMY | 619 | ||
| RADIOTHERAPY | 620 | ||
| ANDROGEN DEPRIVATION THERAPY | 621 | ||
| CHEMOTHERAPY | 623 | ||
| SUMMARY | 624 | ||
| REFERENCES | 624 | ||
| Late-Onset Hypogonadism and Testosterone Replacement in Older Men | 631 | ||
| Key points | 632 | ||
| INTRODUCTION | 632 | ||
| DEMOGRAPHY | 632 | ||
| EVALUATION | 632 | ||
| PHARMACOLOGIC STRATEGIES | 635 | ||
| Intramuscular Injections | 635 | ||
| Transdermal Delivery | 636 | ||
| Buccal | 636 | ||
| Subdermal Implants | 636 | ||
| EFFECTS OF TESTOSTERONE REPLACEMENT | 636 | ||
| Bone Density | 636 | ||
| Body Composition and Muscle Strength | 637 | ||
| Mood and Quality of Life | 637 | ||
| Cognitive Function | 637 | ||
| Effects on Metabolic Syndrome and Type 2 Diabetes | 637 | ||
| RISK OF TESTOSTERONE REPLACEMENT | 638 | ||
| Cardiovascular Risk | 638 | ||
| Fertility | 639 | ||
| Prostate Cancer | 639 | ||
| Polycythemia | 639 | ||
| Other Potential Effects of Testosterone Replacement | 640 | ||
| MONITORING STRATEGIES | 640 | ||
| SUMMARY/DISCUSSION | 641 | ||
| REFERENCES | 641 | ||
| Contemporary Systemic Therapy for Urologic Malignancies in Geriatric Patients | 645 | ||
| Key points | 645 | ||
| INTRODUCTION | 645 | ||
| PROSTATE CANCER | 646 | ||
| Androgen Deprivation Therapy | 646 | ||
| Abiraterone Acetate and Enzalutamide | 647 | ||
| Chemotherapy | 648 | ||
| Sipuleucel-T | 650 | ||
| Radium-223 | 650 | ||
| BLADDER CANCER | 650 | ||
| Concurrent Chemoradiation | 650 | ||
| Perioperative Chemotherapy | 651 | ||
| Metastatic Disease: Cisplatin-based First-line Therapy | 652 | ||
| Metastatic Disease: Cisplatin-ineligible or Second-line Therapy | 653 | ||
| RENAL CELL CARCINOMA | 655 | ||
| SUMMARY AND FUTURE | 659 | ||
| REFERENCES | 659 | ||
| Palliative Care of Urologic Patients at End of Life | 667 | ||
| Key points | 667 | ||
| INTRODUCTION | 667 | ||
| EPIDEMIOLOGY | 668 | ||
| TREATMENT PLANNING IN ADVANCED ILLNESS: PROGNOSTICATION | 668 | ||
| TREATMENT PLANNING IN ADVANCED ILLNESS: UNDERSTANDING ILLNESS TRAJECTORIES | 668 | ||
| TREATMENT PLANNING IN ADVANCED ILLNESS: DEFINING AND DISCUSSING GOALS OF CARE | 668 | ||
| TREATMENT PLANNING IN ADVANCED ILLNESS: TIMING OF PALLIATIVE CARE | 670 | ||
| SYMPTOM MANAGEMENT | 671 | ||
| Management Goals | 671 | ||
| General Symptoms in Patients with Advanced Urinary Tract Disease | 671 | ||
| Bone Pain/Spinal Cord Compression | 671 | ||
| Pelvic Pain | 672 | ||
| Delirium | 672 | ||
| Hematuria | 672 | ||
| Sudden Urinary Stoppage | 673 | ||
| Fistula | 673 | ||
| Urinary Tract Symptoms in Patients near the End of Life | 673 | ||
| SYMPTOMS | 674 | ||
| Renal Colic and Flank Pain | 674 | ||
| Bladder Pain/Bladder Spasm | 674 | ||
| Polyuria | 674 | ||
| Infection | 674 | ||
| Change in Urine Appearance | 674 | ||
| Catheters | 675 | ||
| Sexual Intimacy at the End of Life | 675 | ||
| Caregiver Burden | 676 | ||
| Integrating Palliative Care into Urologic Practice | 676 | ||
| Professional Coping | 676 | ||
| SUMMARY | 677 | ||
| REFERENCES | 677 | ||
| Index | 679 |