Urodynamic analysis of men with lower urinary tract symptoms.

Moideen Abdul Kadhar, J (2014) Urodynamic analysis of men with lower urinary tract symptoms. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : The life span of the present generation is increasing considerably so we are encountering many elderly male patients, seeking treatment for age related urological problems. The complaints of lower urinary tract related pathology also increases with age. They need proper evaluation and management and most important is to differentiate between the various etiology so that the management should be specific, ease for the patient, noninvasive and minimally invasive. Lower urinary tract symptoms (LUTS) is the urological manifestation which increases with age significantly affecting the quality of life. 22–90% of patients presents with urinary incontinence (UI) which is the most troublesome one. Other significant urological morbidities related to aging are the manifestation because of involuntary bladder contractions and increased residual (PVR) volume. Bladder storage and voiding is due to a specialized physiological process. So understanding of those mechanism and that of aging process are important in the evaluation of older men with LUTS. Since many geriatric diseases are multifactorial in origin, we need a wholistic assessment of the functional disturbances of the lower urinary tract and its associated medical illnesses. DO, is becoming more prevalent in elderly and if there is any higher functional disturbance, then DO is almost certain. Urodynamics on such patients is often troublesome for the patient and difficult for the urodynamic staff. But we shall be prepared to do, as the UDS helps in the management of the frail elderly patients. AIM AND OBJECTIVE : The aim of this study is to evaluate the clinical and urodynamic findings of elderly patients with LUTS (Lower Urinary Tract Symptoms) to search for accurate diagnosis and effective management. MATERIALS AND METHODS : Our study population included 100 consecutive men with age more than 50 years with history indicative of lower urinary tract symptoms. Informed consent was obtained from each patient prior to participation in this study. All patients were interviewed in order to obtain detailed personal and medical histories. The patients were divided into irritative and obstructive symptom groups according to their chief complaints. Irritative symptoms are urinary frequency, nocturia urgency and/or urge incontinence; obstructive symptoms included straining,weak stream, intermittency and incomplete emptying. All details were recorded as per the proforma(Appendix). All patients were required to complete 24-hour voiding diary and pad test for 3-day frequency volume chart in order to document urinary volume, incontinence and urgency episodes, and daytime and nighttime frequencies. International Prostate Symptom Score (I-PSS) has been calculated for the cases.Urinalysis, urine culture, noninvasive free flow uroflowmetry, post-void residual urine volume measurement were performed. Inclusion Criteria: The study included all male patients of age older than 50 years with LUTS,with or without urinary retention and with or without co morbid illness. Exclusion Criteria: We exluded men with age less than 50 years with symptoms and all female cases. CONCLUSION : This study supports the use of urodynamic study in the evaluation of elderly men more than 50 years old presenting with LUTS. A significant proportion of elderly patients was found to have urodynamic abnormalities such as detrusor overactivity(DO)or detrusor under activity (DU) or bladder outlet obstruction(BOO) and additionally,the urodynamic abnormalities are widely differing, reflecting the variation in underlying etiologies Detrusor overactivity in patients with LUTS significantly affects their symptom score and perception of quality of life. Moreover, it is strongly affected by the degree of obstruction on uroflowmetry, post -void residual urine estimation as assessed by pressure flow study. So urodynamic study plays an important role in establishing a correct diagnosis in elderly patients with LUTS and deciding on additional treatments.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Urodynamic analysis ; men ; lower urinary tract symptoms.
Subjects: MEDICAL > Urology
Depositing User: Kambaraman B
Date Deposited: 10 Aug 2017 02:25
Last Modified: 10 Aug 2017 06:34
URI: http://repository-tnmgrmu.ac.in/id/eprint/2555

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