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As a junior Urology registrar, I read this article with interest. I have often felt that we do our elderly patients a disservice when it comes to continence. Those that get referred to clinics will usually have the appropriate investigations performed: flow studies, post void residuals and even urodynamics. If not surgical candidates they might be started on an anticholinergic or an alpha blocker and discharged back to their GP but are unlikely to be followed up. In the era of the two week rule and over zealous PSA testing clinics are jam-packed and routine follow-up appointments are precious. Sure, we have have specialist incontinence clinics. It is whole subspecialty of its own. But the majority of patients attending these will not be octogenarians, and often these clinics are in tertiary centres only.
Very often these patients will either never cross the path of a Urologist, or will be seen as a ward referral by a weary SpR late in the evening during an on-call, when the patient is asleep and the normal team aren't around to discuss them. Urology is poorly taught at undergraduate level, so most doctors will have had little or no exposure to the management of incontinence and it is often put down to an unfortunate symptom of aging.
But as Dr Oliver rightly says, we shouldn't underestimate the impact this has on a patient's quality of life. So many patients have broken down in front of me when discussing their symptoms. Some have been house bound, some are paranoid about hygiene and many have not discussed it with anyone. Often they wait several months or even years before summoning up the courage to admit their problem to a health care professional.
As Urologists we can be guilty of losing interest once there is no surgical option for us to offer. We are often not best placed to prescribe medication in elderly patients that are on multiple drugs, but we are able to diagnose the cause of the problem. Combined with the Geriatricians we could offer a formidable service. It has worked In Orthopaedics. Maybe we should consider joint clinics to help us tackle incontinence in the elderly, and not just write these patients off.
Re: David Oliver: The forgotten problem of incontinence
As a junior Urology registrar, I read this article with interest. I have often felt that we do our elderly patients a disservice when it comes to continence. Those that get referred to clinics will usually have the appropriate investigations performed: flow studies, post void residuals and even urodynamics. If not surgical candidates they might be started on an anticholinergic or an alpha blocker and discharged back to their GP but are unlikely to be followed up. In the era of the two week rule and over zealous PSA testing clinics are jam-packed and routine follow-up appointments are precious. Sure, we have have specialist incontinence clinics. It is whole subspecialty of its own. But the majority of patients attending these will not be octogenarians, and often these clinics are in tertiary centres only.
Very often these patients will either never cross the path of a Urologist, or will be seen as a ward referral by a weary SpR late in the evening during an on-call, when the patient is asleep and the normal team aren't around to discuss them. Urology is poorly taught at undergraduate level, so most doctors will have had little or no exposure to the management of incontinence and it is often put down to an unfortunate symptom of aging.
But as Dr Oliver rightly says, we shouldn't underestimate the impact this has on a patient's quality of life. So many patients have broken down in front of me when discussing their symptoms. Some have been house bound, some are paranoid about hygiene and many have not discussed it with anyone. Often they wait several months or even years before summoning up the courage to admit their problem to a health care professional.
As Urologists we can be guilty of losing interest once there is no surgical option for us to offer. We are often not best placed to prescribe medication in elderly patients that are on multiple drugs, but we are able to diagnose the cause of the problem. Combined with the Geriatricians we could offer a formidable service. It has worked In Orthopaedics. Maybe we should consider joint clinics to help us tackle incontinence in the elderly, and not just write these patients off.
Competing interests: No competing interests