Primer of Geriatric Urology PDF
Preview Primer of Geriatric Urology
Primer of Geriatric Urology Second Edition Thomas J. Guzzo George W. Drach Alan J. Wein Editors 123 Primer of Geriatric Urology Thomas J. Guzzo (cid:129) George W. Drach Alan J. Wein Editors Primer of Geriatric Urology Second Edition Editors Thomas J. Guzzo Alan J. Wein Department of Urology Department of Urology University of Pennsylvania Perelman School of Medicine Philadelphia University of Pennsylvania PA Philadelphia USA PA USA George W. Drach Department of Urology in Surgery University of Pennsylvania Philadelphia PA USA ISBN 978-1-4939-4926-7 ISBN 978-1-4939-4928-1 (eBook) DOI 10.1007/978-1-4939-4928-1 Library of Congress Control Number: 2016946369 © Springer Science+Business Media New York 2016 T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Science+Business Media LLC New York Pref ace The American population over the age of 65 will grow greatly in the next two decades. The US Census Bureau has estimated that by 2030, 20 % (approximately 72 million people) of the US population will be in this group. Currently, one in every ten individuals in the world is over 60 years of age; by 2050, this number will double to 1 in 5! Additionally, due to improvement in medical care, elderly indi- viduals are living longer. In 2004, the median life expectancy for an individual reaching age 65 reached 17.1 years and age 75, 10.7 years. While many health-care specialists will feel the impact of this growing elderly population, few will be more affected than those in the fi eld of urology. Many urologic disorders have an increased prevalence among the elderly: nearly 50 % of outpatients and over 60 % of surgical/ procedural patients encountered in US urologic practice are over the age of 65 years. A s medical students on our pediatric rotations, we learn early on that children are not “little adults.” The obvious wisdom of this saying is that pediatric patients have a unique physiology and pathophysiology that is not necessarily transferable from what we learn on the adult wards. One can also say the same for our geriatric patient population. Borrowing this phrase from our pediatric colleagues, it is not just as simple as “they are older adults.” The elderly urology patient merits special assess- ment on several fronts. Many nonoperative urologic conditions are treated with medications which can affect cognition and/or interact with other daily medications. Urinary issues, such as incontinence or frequency, can lead to signifi cant morbidity in the functionally impaired, leading to falls. Surgical intervention is common for urologic disease, both oncologic and benign, and must be carefully considered in the geriatric patient. T he second edition of this book is intended to provide a review of the demo- graphics of our aging urologic population and their unique needs. Like the fi rst edition, this book covers medical issues particular to the elderly that must be con- sidered in the initial evaluation of the aging patient, and follows this with practical suggestions in development of the management plan, whether by medication or invasive procedure. Common complications (and their management) encountered in the treatment of elderly inpatients are also covered. Important aspects of continuity of care are also included, such as appropriate use of adjunctive services and the v vi Preface urologic aspects of nursing home care. Finally, specifi c urologic disease processes in the elderly population are reviewed including urologic oncology, lower urinary tract symptoms, and sexual dysfunction. Each chapter has been updated from the initial edition to refl ect the current literature and medical practice. W e believe the second edition of this book will be useful to anyone who is involved in the care of geriatric patients including medical students, residents, gen- eral practitioners, internists, and urologists. This book is not intended to be an exhaustive review of urology or geriatrics but rather an easy to use, practical, and rationale guide to common urologic management problems in the geriatric popula- tion. The chapters are purposefully concise so that health-care providers can use the information contained within the book “on the fl y”: either on rounds or while seeing patients in the offi ce. It is our hope that this book will aid the reader to better address some of the unique needs of this growing patient population. Philadelphia, PA, USA Thomas J. Guzzo , MD, MPH Contents 1 Introduction: Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Abdo E. Kabarriti and George W. Drach 2 Approach to the Elderly Patient: Evaluation . . . . . . . . . . . . . . . . . . . . . . 7 Abdo E. Kabarriti and George W. Drach 3 Urologic Office Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Siobhan M. Hartigan and Ariana L. Smith 4 Medication Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Mary Ann Forciea 5 Perioperative Care of the Geriatric Urology Patient . . . . . . . . . . . . . . . 43 Daniel J. Canter , Eugene J. Pietzak , and Thomas J. Guzzo 6 Complications Particular to the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . 65 Benjamin L. Taylor and Thomas J. Guzzo 7 Urologic Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Amy M. Pearlman , M atthew J. Resnick , and Thomas J. Guzzo 8 Use of Adjunctive Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Mary Ann Forciea 9 Urology in the Nursing Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 George W. Drach and Edna Schwab 10 Lower Urinary Tract Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Amy M. Pearlman , A riana L. Smith , and Alan J. Wein 11 Behavioral Intervention for Lower Urinary Tract Symptoms in Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Alexander Skokan and Diane K. Newman vii viii Contents 12 Geriatric Sexuality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Hailiu Yang , Christina Ho , Philip T. Zhao , Daniel Su , and Allen D. Seftel Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Contributors Daniel J. Canter Benson Cancer Center , Ochsner Clinic , New Orleans , LA , USA George W. Drach , MD Divisions of Urology (GWD) and Geriatrics (ES) , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA Department of Urology in Surgery , University of Pennsylvania , Philadelphia , PA , USA Mary Ann Forciea , MD, MACP Division of Geriatric Medicine, Department of Medicine , University of Pennsylvania Health System , Philadelphia , PA , USA Thomas J. Guzzo , MD, MPH Department of Urology , University of Pennsylvania Health System , Philadelphia , PA , USA Siobhan M. Hartigan , MD Department of Urology , University of Pennsylvania , Philadelphia , PA , USA Christina Ho Division of Urology, Department of Surgery , Cooper University Hospital , Camden , NJ , USA Abdo E. Kabarriti , MD Division of Urology, Department of Surgery , University of Pennsylvania , Philadelphia , PA , USA Diane K. Newman Division of Urology , Penn Center for Continence and Pelvic Health, Penn Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia , PA , USA Amy M. Pearlman Department of Urology, Hospital of the University of Pennsylvania and Pennsylvania, Hospital, Philadelphia, PA, USA Division Urology, Department of Surgery , University of Pennsylvania , Philadelphia , PA , USA Eugene J. Pietzak Division of Urology , University of Pennsylvania Health System , Philadelphia , PA , USA Matthew J. Resnick Vanderbilt University , Philadelphia , PA , USA ix
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