Senile hyperactive bladder

Specialty: Geriatrics.

• urination urgency syndrome in the elderly
• senile overactive detrusor
• urgency-frequency of urination in old age
• instability of the main detrusor

Why it occurs

• Detrusor hyperactivity with impaired contractility (DHIC), complex and very specific urinary pathology of the frail elderly
• Loss of cortical inhibition mechanisms for micturition due to multiple frontal lacunar infarcts or advanced dementia
• Senile interstitial cystitis or atrophy of the urothelial mucosa induced by extreme estrogen deficiency after menopause
• Chronic infravesical obstruction (benign prostatic hyperplasia in men, severe cystocele in women) with compensatory detrusor hypertrophy
• Chronic use of fast-acting loop diuretics or consumption of bladder irritants in the diet (caffeine, artificial sweeteners)

Initial workup

Kidney, bladder and prostate ultrasound with precise measurement of post-void residual (PVM, values ​​greater than 100 ml contraindicate the use of strong anticholinergic drugs); urine strip and urine culture to rule out active infection; 3-day voiding diary recording volume ingested, volume excreted, and urgency episodes; Non-invasive voiding flowmetry if outflow tract obstruction is suspected.

Standard management

• Mirabegron — 25 mg to 50 mg orally per day, beta-3 adrenergic receptor agonist, of choice in geriatrics because it lacks anticholinergic effects and does not increase the risk of cognitive impairment, requiring blood pressure control due to the risk of hypertension
• Solifenacin — 5 mg orally per day, only if the post-void residue is less than 50 ml and there is no suspicion of dementia or cognitive impairment, monitoring for the appearance of dry mouth, constipation and confusion
• Estriol vaginal cream (local application twice a week in women to improve urothelial trophicity and reduce reflex urinary urgency, without significant systemic effects).