Difficult Urination in Elderly Men Case Discussion

I don’t know how to handle this Health & Medical question and need guidance.

Mr. B is a 77-year-old African American man who complains of difficulty urinating.

What could be the underlying cause of these symptoms?
What are his risk factors?
What laboratory tests would be needed to confirm possible differential diagnoses?
What interventions would you expect?

The percentage of the population over age 65 has increased dramatically over the past 100 years and is expected to continue to increase well into the 21st century. Furthermore, the segment of this population with the greatest need for health care, those age 85 and older (the “oldest old” or “frail elderly”), is predicted to undergo a rapid expansion, from 10% to 19% by the year 2040.¹ The lower urinary tract consists of a group of interrelated structures that function in the adult to bring about efficient and low-pressure bladder filling and low-pressure urine storage with perfect continence. In healthy people, periodic voluntary urine expulsion occurs at low pressure. (The definition of low pressure varies widely and differs for men, women, and elderly people.) Urinary dysfunction is the most prevalent problem in the geriatric population, particularly among those admitted to nursing homes (with a prevalence estimated up to 67%). Most urinary dysfunction in the elderly is attributable to lower urinary tract disorders, with incontinence the predominant symptom.

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Incontinence alone has been shown to occur in up to 30% of the community-dwelling and 50% of the institutionalized elderly. ^2,3 Overactive bladder (OAB) has the symptom complex of frequency and urgency, with or without incontinence, and is common, with almost equal incidence in men and women even after controlling for pathologic and metabolic conditions that can cause OAB-like symptoms. This new finding supports the idea that OAB should not be overlooked in men and is not only a women’s health issue. The prevalence of OAB without incontinence in elderly women increases slower than that in men. Conversely, the prevalence of OAB with incontinence increases sharply after age 35 years in women, while it increases gradually with age in men.⁴

The term elderly is ill defined. A 70-year-old community-dwelling, independent individual is in a significantly different category from that of a frail elderly individual of 85 living in a nursing home. There is a whole spectrum in between.

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The majority of the elderly patients having OAB and urinary incontinence (UI) are effectively treated and/or have their symptoms alleviated, provided the type of incontinence present and its cause are determined. Treatment strategies that are effective in the population at large require significant modification in the elderly. Recognizing the problems faced in the treatment of the elderly forms the basis of a successful strategy.