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RE:
URODYNAMICS IN A COMMUNITY-DWELLING POPULATION OF FEMALES 80 YEARS OR
OLDER. WHICH MOTIVE? WHICH DIAGNOSIS?
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doi: 10.1590/S1677-55382010000300013
FRANÇOISE
A. VALENTINI, GILBERTE ROBAIN, BRIGITTE G. MARTI, PIERRE P. NELSON
ER6, Université
Pierre et Marie Curie (Paris VI), Paris, France and Department of Physical
France
Int Braz
J Urol. 2010; 36: 218-24
To the Editor,
Urinary dysfunctions such as lower urinary tract symptoms increase with
aging (1,2) and the improvement of both diagnosis and treatment may help
recover the functional life of these patients. If we take into account
the syndrome of frailty in patients older than 80 years, defined as sarcopenia,
osteopenia, nutritional changes and factors of illness, a remaining question
would be if urodynamic study may improve the accuracy of the LUT dysfunction
diagnosis.
The authors developed a very interesting
paper where they studied the relation between LUT symptoms and urodynamics
parameters such as free uroflow and intubated flow, cystometry and urethral
pressure profilometry, and final urodynamic diagnosis. They observed that
in community population dwelling oldest old females urodynamic study allows
to find the causes of treatment failure. However, the majority of the
population put forward a decrease in their quality of life often by LUTS
developing. The most common complaint was incontinence urinary, often
associated with urgency which is the main symptom.
The free uroflow obtained in initial moment
was low (44%) compared to the second moment (91%). This may have been
due to lack of confidence and the uncomfortable procedure that involves
this exam. It suggests that in ageing population it is necessary to have
a special preparation and adaptation to the environment in order to obtain
a safe free uroflow. That, in association with a flow rate may be an interesting
tool to evaluate ageing patients with LUTS. Prevalence of DO and DHIC,
and occurrence of RRCs during cystometry in older patients was higher
compared with younger. The urinary symptoms in this special population
may be explained by the oxidative stress in intracellular levels as part
of physiologic aging of people (3). In this way, the urodynamic diagnosis
may help to treat these patients.
REFERENCES
- Martínez
Agulló E, Ruiz Cerdá JL, Gómez Pérez L,
Ramírez Backhaus M, Delgado Oliva F, Rebollo P, et al.: Prevalence
of urinary incontinence and hyperactive bladder in the Spanish population:
results of the EPICC study. Actas Urol Esp. 2009; 33: 159-66.
- Amaro
JL, Macharelli CA, Yamamoto H, Kawano PR, Padovani CV, Agostinho AD:
Prevalence and risk factors for urinary and fecal incontinence in Brazilian
women. Int Braz J Urol. 2009; 35: 592-7; discussion 598.
- Ohnishi
N, Liu SP, Horan P, Levin RM: Effect of repetitive stimulation on the
contractile response of rabbit urinary bladder subjected to in vitro
hypoxia or in vitro ischemia followed by reoxygenation. Pharmacology.
1998; 57: 139-47.
Dr.
João Luiz Amaro
Paulista University, UNESP
Botucatu, Sao Paulo, Brazil
E-mail: jamaro@fmb.unesp.br
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