Lower urinary tract symptoms (LUTS) are prevalent among older adults, a population that faces multiple medical challenges, with frailty being a major concern. Despite the high prevalence of LUTS, current treatment strategies for older adults are often inadequate. This paper aims to address these issues by defining daytime and/or nighttime LUTS and examining the impact of comorbid conditions on these symptoms. We will identify the priorities of older patients regarding LUTS management and propose treatment strategies to improve outcomes in this vulnerable population.
This review is based on discussions at the ICI-RS 2024 meeting in Bristol, UK, alongside an extensive literature review examining LUTS in older adults. The review explores distinctions between daytime and nighttime symptoms, the impact of frailty, patient priorities, treatment strategies and the role of comorbidities.
LUTS in older adults present a complex and multifaceted challenge, with notable differences between daytime and nighttime manifestations, which may coexist. Clear definitions are needed. There is a lack of evidence that treating associated comorbidities will improve LUTS or urinary incontinence. Personalized care approaches, integrated into broader geriatric health strategies, are essential for addressing these symptoms. An ideal treatment strategy is proposed, focusing on daytime, nighttime or combined day- and nighttime LUTS. Further research is needed to refine treatment pathways and optimize outcomes for this population.
A comprehensive, individualized approach is necessary to address LUTS in older adults. Future research should focus on refining diagnostic definitions, exploring the interplay between comorbidities and LUTS, and developing patient-centered treatment strategies that account for both daytime and nighttime (or combined) symptoms.
Neurourology and urodynamics. 2024 Nov 11 [Epub ahead of print]
Andries Van Huele, Karel Everaert, William Gibson, Adrian Wagg, Paul Abrams, Alan Wein, Wendy F Bower
Department of Urology, Ghent University Hospital, Ghent, Belgium., Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada., Department of Urology, University of Bristol, Bristol, UK., Desai-Seth Institute of Urology, University of Miami, Miami, Florida, USA., Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.