URGE INCONTINENCE IN ELDERLY PEOPLE - FACTORS PREDICTING THE SEVERITYOF URINE LOSS BEFORE AND AFTER PHARMACOLOGICAL TREATMENT

Geriatric patients with urge incontinence lose different amounts of ur ine and respond differently to treatment. Identification of factors pr edicting the amount of urine loss before or after treatment might help to select therapy. We have sought such factors in 41 elderly patients (23 women and 18 men), mean age 79 years with established urge incont inence that was urodynamically proven to be associated with detrusor h yperreflexia, who were treated with oxybutynin chloride. Urine loss wa s measured by 24-hour monitoring (mean 378 g/24 hour). Demographic, ps ychosocial, behavioral, cortical, circulatory, urodynamic, and urologi cal factors were studied before and after treatment. Multiple regressi on analysis showed that, before intervention, factors predicting the a mount of urine loss were fluid intake, voiding frequency, and impaired orientation on cognitive testing. After intervention, urine loss was significantly smaller (mean 259 g/24 hour). Different factors predicte d the amount of this persistent incontinence: underperfusion of the ce rebral cortex, reduced bladder sensation, and (again) impaired orienta tion. The analysis confirms that the severity of geriatric urge incont inence associated with detrusor hyperreflexia, particularly incontinen ce that is resistant to anticholinergic therapy, depends on cortical f actors, that bladder sensation plays an important role, and that thera peutic manipulation of fluid intake and voiding frequency may offer a modest reduction in urine loss (e.g., about 40 g/day). (C) 1996 Wiley- Liss, Inc.