Urinary Incontinence, Quality of Life, and Risk Factors in a Geriatric Cohort.

INTRODUCTION: The aim of the study was to evaluate the prevalence of urinary incontinence (UI) and its subtypes, associated clinical factors, and impact on quality of life (QoL) in a geriatric population aged 80 years or older. METHODS: Male and female residents (inclusion criterion: 80 years or older) of three Viennese senior citizen homes were personally interviewed with the aid of a structured questionnaire based on the Bristol Female Lower Urinary Tract Symptom Questionnaire within a 12-month period. UI was defined as any involuntary loss of urine during the past 4 weeks. Several demographic parameters were obtained additionally. RESULTS: 434 participants with a mean age of 86.8 years (women: 87.6 years; men: 86.1 years) were included. UI was present in 52.5% (57% female vs. 23% male, p < 0.001), stress UI affected 36% (41% female vs. 5% male, p < 0.001), urge UI 38% (40.5% female vs. 23% male, p < 0.01), and mixed UI 28% (24% female vs. 5.0% male, p < 0.01). While the overall prevalence of UI remained rather stable in the four age cohorts (80-84 years, 85-89 years, 90-94 years, >94 years), there was a constant decline of SUI paralleled by an increase of UI and - to a lesser extent - of MUI with age. 36.5% (33% female vs. 57% male) participants did not report any negative impact on QoL, while a severe reduction of QoL was present in 31% of cases (35% female vs. 10.0% male). Risk factors for UI and its subtypes included female sex, reduced/no mobility, hysterectomy, and number of births. CONCLUSION: This study provides data on the high prevalence of UI in a low-morbid geriatric cohort and evaluates gender-specific differences in UI prevalence, associated risk factors, and QoL.

Do differences in clinical symptoms and referral patterns contribute to the gender gap in bladder cancer?

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Urothelial carcinoma of the bladder (UCB) is more prevalent in men than women; however, in women the tumour stage is generally more advanced at the time of the diagnosis and the prognosis is worse. Possible explanations include anatomical, genetic and socio-economic factors. The study shows that clinical symptoms before the first-time diagnosis of UCB did not differ between the sexes, while primary care and referral patterns did. Women were more likely to receive symptomatic treatment or therapies for alleged UTIs without further investigation or referral to urological evaluation. The study highlights the fact that there may be a diagnostic delay in women which could contribute to the gender-dependent disparities in stage distribution and prognosis of UCB. OBJECTIVE: To evaluate gender-dependent disparities regarding clinical symptoms, referral patterns or treatments before diagnosis of urothelial carcinoma of the bladder (UCB). PATIENTS AND METHODS: A consecutive series of patients with newly diagnosed UCB completed a questionnaire at the time of admission for elective transurethral resection of a bladder tumour (TURBT). The questionnaire surveyed the presence of haematuria, dysuria, urgency and bladder pain as well as the number of consultations and treatments before urological evaluation. Tumour characteristics, clinical symptoms, treatments and referrals were compared between men and women in the patient series. RESULTS: In men (n = 130) the distribution of tumour stages was pTa 62.3%, pT1 23.1% and pT ≥ 2 12.3%. The respective percentages in women (n = 38) were pTa 57.9%, pT1 23.7% and pT ≥ 2 18.4% (P > 0.05). The prevalence of clinical symptoms in men vs women was as follows: gross haematuria 65 vs 68%, dysuria 32 vs 44%, urgency 61 vs 47%, and nocturia 57 vs 66%, respectively (P > 0.05). A total of 78% of men vs 55% of women directly consulted a urologist (P < 0.05). Symptomatic treatment for voiding disorders/pain was given without further evaluation to 19% of men vs 47% of women 1 year before the diagnosis of UCB (P < 0.05). A total of 3.8% of men vs 15.8% of women received three or more treatments for urinary tract infections (UTIs) within the same time period (P < 0.05). CONCLUSIONS: In the present study there were no gender-related differences in clinical symptoms of UCB, but women were more likely to be treated for voiding complaints or alleged UTIs without further evaluation or referral to urology than men. Gender-dependent disparities in referral patterns exist and might delay definitive diagnosis of UCB in women.

Bladder preservation in octogenarians with invasive bladder cancer.

OBJECTIVES: To analyze mortality and morbidity of octogenarians with newly diagnosed invasive transitional cell cancer (TCC) of the bladder who were managed without cystectomy. METHODS: Retrospective chart review of all patients with newly diagnosed invasive TCC (> or = pT1) in the period of 1997-2007, who were 80 years or older at diagnosis. RESULTS: A total of 71 patients (86 + 4 years, mean + standard deviation [SD], pT1: n = 29; > pT2: n = 42) entered this analysis. In this geriatric population, treatment regimens were highly individualized. After transurethral resection, 61% of pT1-patients received bacillus Calmette-Guerin and 62% of those with > pT2-tumors external beam radiation. Mean overall survival (OS) of the entire cohort (n = 71) was 22 + 26 months for pT1-patients 34 + 33 versus 14 + 15 months for those with > or = pT2-tumors (P = .001). Mean cancer-specific survival was 58 months for pT1-patients and 11 months for > or = pT2-patients (P <.001). OS was correlated to tumor stage and the degree of mobility, to a lesser extent to the American Society of Anesthesiologists (ASA) score, and only marginally to chronologic age. Satisfactorily bladder function was preserved in 73%. pT1-patients spent 16% of their remaining life-span in the hospital compared with 23% for patients with > pT2-tumors. CONCLUSIONS: OS in TCC is dependent on tumor stage, age, mobility, and comorbidities, and a risk-stratified management is necessary. Patients with pT1G3 tumor and low ASA score have satisfying OS with bladder preservation, but in patients with > or = pT2 and ASA 3-4 the prognosis is very bad. It remains questionable whether patients with tumor stages > or = pT2 and ASA 1-2 despite high age would benefit from radical cystectomy.