Factors influencing outcome in elderly patients with urinary incontinence and detrusor instability.

The majority of elderly incontinent patients with detrusor instability in whom various medical treatments had been tried and failed, became dry or very significantly improved following attendance at a Continence Clinic. The reason for this was not only because this clinic had access to specialized investigational equipment, but also because patients received individual psychological and practical management of their incontinence. All were given time to discuss their problems, had imipramine titrated against effect, and practised habit-retraining programmes. Treatment was started in hospital if there was any doubt of the patients misunderstanding or not complying with such regimens. Patients did best if they were sensible and mobile. Urodynamic measurements seemed less important individually, although overall final outcome correlated with the severity of the instability.