Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations
Overactive bladder (OAB) and urgency urinary incontinence (UUI) disproportionately affect older patients and overlap with multiple geriatric syndromes including frailty and cognitive impairment. Given concerns regarding polypharmacy and anticholinergic risks in older patients, there has recently bee...
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Elsevier
2025-03-01
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| Series: | Continence |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772973724010087 |
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| author | Jacqueline Zillioux Amrita Ladwa Parker Holum Howard B. Goldman |
| author_facet | Jacqueline Zillioux Amrita Ladwa Parker Holum Howard B. Goldman |
| author_sort | Jacqueline Zillioux |
| collection | DOAJ |
| description | Overactive bladder (OAB) and urgency urinary incontinence (UUI) disproportionately affect older patients and overlap with multiple geriatric syndromes including frailty and cognitive impairment. Given concerns regarding polypharmacy and anticholinergic risks in older patients, there has recently been a push from multiple societies to eliminate the concept of “step therapy” and offer patients more individualized treatment options. This may involve offering minimally invasive therapies, traditionally referred to as “third line therapies”, without requiring trials of non-invasive or pharmacologic management. This narrative review considers current evidence and recommendations for minimally invasive therapies (onabotulinumtoxin A (BTX), sacral neuromodulation (SNM), percutaneous tibial nerve stimulation (PTNS), and implantable tibial nerve stimulation (ITNS)) in older and frail patients. There are no data to support one minimally invasive therapy over another. BTX and SNM may have slightly lower efficacy compared to younger patients, but the clinical relevance of this difference is unclear. BTX may have a higher risk of UTI and retention in older frail patients. While cognitive impairment alone should not preclude SNM, it is important to consider if planning for SNM. PTNS is the lowest risk option but carries a significant logistical burden that may reduce adherence. ITNS may mitigate this logistical burden; however, there are minimal data specific to this group and older frail patients may not be appropriate candidates. Ultimately, older patients with or without frailty should be considered candidates for minimally invasive therapies for OAB/UUI as available data support their safety and efficacy in these populations. However, there may be unique considerations for this group and treatment decisions should be individualized and based on shared decision making. |
| format | Article |
| id | doaj-art-12e1f74f22c142aa8b37bbd5c6350117 |
| institution | OA Journals |
| issn | 2772-9737 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Continence |
| spelling | doaj-art-12e1f74f22c142aa8b37bbd5c63501172025-08-20T02:19:21ZengElsevierContinence2772-97372025-03-011310173310.1016/j.cont.2024.101733Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendationsJacqueline Zillioux0Amrita Ladwa1Parker Holum2Howard B. Goldman3Department of Urology, University of Virginia Health, Charlottesville, VA, USA; Correspondence to: UVA Health, PO Box 800422, Charlottesville, VA, USA.University of Virginia School of Medicine, Charlottesville, VA, USAUniversity of Virginia School of Medicine, Charlottesville, VA, USAGlickman Urological Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USAOveractive bladder (OAB) and urgency urinary incontinence (UUI) disproportionately affect older patients and overlap with multiple geriatric syndromes including frailty and cognitive impairment. Given concerns regarding polypharmacy and anticholinergic risks in older patients, there has recently been a push from multiple societies to eliminate the concept of “step therapy” and offer patients more individualized treatment options. This may involve offering minimally invasive therapies, traditionally referred to as “third line therapies”, without requiring trials of non-invasive or pharmacologic management. This narrative review considers current evidence and recommendations for minimally invasive therapies (onabotulinumtoxin A (BTX), sacral neuromodulation (SNM), percutaneous tibial nerve stimulation (PTNS), and implantable tibial nerve stimulation (ITNS)) in older and frail patients. There are no data to support one minimally invasive therapy over another. BTX and SNM may have slightly lower efficacy compared to younger patients, but the clinical relevance of this difference is unclear. BTX may have a higher risk of UTI and retention in older frail patients. While cognitive impairment alone should not preclude SNM, it is important to consider if planning for SNM. PTNS is the lowest risk option but carries a significant logistical burden that may reduce adherence. ITNS may mitigate this logistical burden; however, there are minimal data specific to this group and older frail patients may not be appropriate candidates. Ultimately, older patients with or without frailty should be considered candidates for minimally invasive therapies for OAB/UUI as available data support their safety and efficacy in these populations. However, there may be unique considerations for this group and treatment decisions should be individualized and based on shared decision making.http://www.sciencedirect.com/science/article/pii/S2772973724010087Urgency urinary incontinenceOveractive bladderElderlySacral neurostimulationBotulinum toxin |
| spellingShingle | Jacqueline Zillioux Amrita Ladwa Parker Holum Howard B. Goldman Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations Continence Urgency urinary incontinence Overactive bladder Elderly Sacral neurostimulation Botulinum toxin |
| title | Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations |
| title_full | Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations |
| title_fullStr | Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations |
| title_full_unstemmed | Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations |
| title_short | Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations |
| title_sort | minimally invasive therapies for older patients with urgency urinary incontinence current evidence and recommendations |
| topic | Urgency urinary incontinence Overactive bladder Elderly Sacral neurostimulation Botulinum toxin |
| url | http://www.sciencedirect.com/science/article/pii/S2772973724010087 |
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