Meyer P
Service de réadaptation neurologique, centre de médecine physique et de réadaptation de L'ADAPT, 25, avenue de la Paix, 92320 Chatillon, France.
Prog Urol. 2017 Mar;27(3):111-145. doi: 10.1016/j.purol.2017.01.004. Epub 2017 Mar 9.
Search processing algorithms in a primary care setting, analyzing the specifics of care management for seniors suffering from urinary incontinence (UI), described the recommendations and levels of evidence of treatment.
A literature review carried out via PubMed and websites of scientific societies with search keywords classified according to an algorithm.
One hundred algorithms have been discovered in the field of evaluation and treatment of UI. Screening for UI risk factors began early on in the treatment of reversible or chronic comorbidities, avoiding iatrogenic. Specific clinical features (red flags) required specialized advice. Non-pharmacological conservative treatment should be offered first in line for seniors: behavioral therapy, changes in lifestyle, walk, treatment of constipation. For women, pelvic floor muscle training combined biofeedback and functional electrical stimulation. After failure and persistence of UI with urgency, the information of the risk of a possible urinary retention or cognitive impairments preceded the prescription of an anticholinergic and the measurement of post-voiding residue done by ultrasounds. Older age is not a cons-indication for surgery UI least invasive. The cough test and Bonney maneuver can confirm a masked stress urinary incontinence and/or an associated prolapse. Cases of failure of UI, doubtful diagnosis or programmed surgery required urodynamic assessment.
Algorithms and recommendations of UI should remain a valuable aid to the clinical assessment, diagnosis and treatment of UI in the elderly.
在初级保健环境中搜索处理算法，分析老年尿失禁（UI）患者护理管理的具体情况，描述治疗建议和证据水平。
通过PubMed和科学协会网站进行文献综述，根据算法对搜索关键词进行分类。
在UI评估和治疗领域发现了100种算法。在治疗可逆性或慢性合并症时尽早筛查UI风险因素，避免医源性因素。特定的临床特征（警示信号）需要专业建议。应首先为老年人提供非药物保守治疗：行为疗法、生活方式改变、步行、便秘治疗。对于女性，盆底肌肉训练结合生物反馈和功能性电刺激。在UI伴有尿急且治疗失败和持续存在时，在开具抗胆碱能药物之前，应先告知可能存在尿潴留或认知障碍的风险，并通过超声测量排尿后残余尿量。高龄并非UI微创外科手术的禁忌证。咳嗽试验和邦尼手法可确诊隐匿性压力性尿失禁和/或相关脱垂。UI治疗失败、诊断存疑或计划进行手术的病例需要进行尿动力学评估。
UI的算法和建议对于老年人UI的临床评估、诊断和治疗仍将是有价值的辅助工具。
