Welche Untersuchungen sind beim alten Menschen mit Harninkontinenz sinnvoll?

Clinical predictors and significance of postvoid residual volume in women with diabetes

AIMS

To identify women with diabetes at risk of increased postvoid residual volume (PVR) and investigate the relationship of increased PVR to urinary symptoms in women with diabetes.

METHODS

PVR was measured by bladder ultrasonography in a cross-sectional cohort of 427 middle-aged and older women with diabetes. Participants completed questionnaires assessing urgency incontinence, stress incontinence, daytime frequency, nocturia, obstructive voiding, and diabetes-related end-organ complications: heart disease, stroke, neuropathy. Serum HbA1c and creatinine were recorded.

RESULTS

75% of participants had a PVR of 0-49, 13% had a PVR of 50-99, and 12% had a PVR ≥ 100 mL. Approximately 59% of women with a PVR < 50 mL reported at least one lower urinary tract symptom. Women with diabetes and a PVR ≥ 100 mL were more likely to report urgency incontinence (OR 2.18, CI 1.08-4.41) and obstructive voiding symptoms (OR 2.47, CI 1.18-5.17) than women with PVR < 50 mL. In multivariable models, poorer glycemic control was associated with an increased likelihood of PVR ≥ 100 mL (OR 1.30, CI 1.06-1.59 per 1.0-U increase in HbA1c).

CONCLUSIONS

PVR volumes ≥ 100 mL may indicate increased risk of urgency incontinence and obstructive voiding. Glycemic control may play a role in preventing increased PVR in women with diabetes.

[Diagnostic radiology of the pelvis. Prostate cancer, bladder cancer, and incontinence]

Prostate cancer, bladder cancer, and pelvic floor weakness are among the most common diseases of the pelvis. Cardinal symptoms include painless macrohematuria in bladder cancer and urinary and fecal incontinence in pelvic floor weakness. Suspicion of prostate cancer currently is most frequently raised when the serum concentration of prostate-specific antigen is pathologically elevated. Besides extensive clinical and invasive diagnosis, clinical imaging is frequently applied for the localization, locoregional staging, and diagnosis of recurrence of prostate cancer and invasive bladder cancer, and in clinically difficult cases of cystocele, enterocele, rectocele, descensus or prolapse of vagina, uterus, and rectum, and rectal intussusception. Magnetic resonance imaging with T2-weighted TSE or FSE images in several planes combined with either axial, T1-weighted images and MR spectroscopy for the prostate, dynamic contrast-enhanced T1-weighted images for the urinary bladder, or dynamic T2-weighted functional images for pelvic floor incontinence are particularly well suited as clinical imaging methods.