The first Plenary Session at the 28th Annual EAU Congress focuses on urology for all ages. Young patients grow up with their ailments, and old patients have to deal with the effects of ageing. One of the session’s state-of-the-art lectures covers incontinence and age. We spoke to its presenter, Dr. Adrian Wagg.Q: Is there any new knowledge that can improve our understanding of this condition?
A: There are two pertinent matters here. Firstly, in terms of what might be done to prevent/ameliorate incontinence as an outcome in later life and secondly in terms of treatment for those who have existing continence problems.
In terms of prevention, there is accumulating evidence that diet (in terms of a “heart-healthy” diet), exercise, maintenance of normal weight and blood pressure may be beneficial interventions in middle age. With sufficient exposure over the years, successful attention to these details may preserve brain and bladder health into later life.
For those already afflicted with incontinence, there have been several trials of exercise and drug treatment, conducted on older people and the frail elderly which have shown beneficial results in ameliorating the condition. Likewise, surgical treatment for stress incontinence in the elderly has shown beneficial results in terms of improvement of quality of life.
Q: What do we still need to know or have in order to successfully prevent and manage incontinence in the elderly patient?
A: There is still a dearth of high-quality evidence about conservative treatments for the frail elderly and for those with a diagnosis of dementia, particularly with respects to the minimum “dose” needed to achieve a positive outcome. Much of the existing data shows a benefit, but the interventions are unsustainable due largely to their intensity. There is much to learn about the effects of treating associated comorbidity on the maintenance of an older person’s ability to successfully void.
Q: Personalised medicine is a really hot topic today – how does your subject matter fit within this context?
A: Because for many, urinary incontinence is a chronic disease, individualised management, which engages the individual as a partner in care with a shared understanding of expectations and treatment goals, is very important. The conventional understanding of the term has a limited currency in this area but certainly has some impact upon drug efficacy in certain circumstances.