Torres C, Ciocon J O, Galindo D, Ciocon D G
Florida International University and Miami Veterans Affairs Medical Center, USA.
Int Urol Nephrol. 2001;33(3):549-52. doi: 10.1023/a:1019580322555.
To compare the initial approach and pattern of practice between internists and geriatricians in treating urinary incontinence. A retrospective chart review of 300 consecutive charts of elderly patients over the age of 65, seen by either internists (IM) or Geriatricians (GERI) for urinary incontinence at the Cleveland Clinic Florida was performed. The clinical approaches to the management of urinary incontinence were compared between IM and GERI groups by using a Student's t test. The mean age for these patients was 77 y for the IM group and 79 y for the GERI group. Majority of patients suffered from two chronic illnesses. We found that geriatricians performed more initial work up such as urodynamic testing before referring, while internists obtained more referrals to gynecologist with special interest in urologic disorders (currently called urogynecologist) without initial workup. IM and GERI groups equally prescribed medications for incontinence. However, the GERI group recommended Kegel exercises more frequently. This study showed that geriatricians manage urinary incontinence more extensively by performing more initial work up including urodynamics and providing initial behavioral therapy (Kegel exercise and toilet schedule) before referring to specialists. Perhaps geriatricians feel more comfortable treating urinary incontinence as shown by their lower frequency of referrals and are therefore more comfortable than internists at addressing this medical issue. On the contrary, the internist did the initial evaluation but preferred to get a referral perhaps due to less familiarity with urinary incontinence.
比较内科医生和老年病医生在治疗尿失禁方面的初始治疗方法和实践模式。对佛罗里达州克利夫兰诊所65岁以上老年患者的300份连续病历进行回顾性图表审查，这些患者因尿失禁由内科医生（IM）或老年病医生（GERI）诊治。通过使用学生t检验比较IM组和GERI组在尿失禁管理方面的临床方法。这些患者的平均年龄，IM组为77岁，GERI组为79岁。大多数患者患有两种慢性疾病。我们发现，老年病医生在转诊前会进行更多的初始检查，如尿动力学测试，而内科医生在未进行初始检查的情况下，会更多地转诊至对泌尿系统疾病有特殊兴趣的妇科医生（目前称为泌尿妇科医生）。IM组和GERI组在尿失禁用药方面相同。然而，GERI组更频繁地推荐凯格尔运动。这项研究表明，老年病医生在转诊至专科医生之前，通过进行更多的初始检查，包括尿动力学检查，并提供初始行为治疗（凯格尔运动和排尿时间表），对尿失禁的管理更为广泛。也许老年病医生在治疗尿失禁时感觉更得心应手，这从他们较低的转诊频率可以看出，因此在处理这个医学问题上比内科医生更自在。相反，内科医生进行了初始评估，但可能由于对尿失禁不太熟悉而更倾向于转诊。
