263 / 290
Objectives:
Urinary tract infections (UTI) in elderly are frequent and
polymorphic clinical symptoms. This is a public health problem both
in support and cost they generate. The aim of the study is to study the
epidemiological, clinical, paraclinical and therapeutic aspects of UTI
in the elderly.
Methods:
We conducted a retrospective study of 50 cases of UTI in the
elderly collected in the Internal Medicine Department at Habib
Thameur Hospital between January 2011 and December 2015 (Group
I). We compared this group to another group of patients aged below 60
years also explored for UTI in the same service and during the same
period (Group II).
Results:
They were 37 women and 13 men in group I and 41 women
and 9 men in the group II. In group I, the average age was 74.10 ± 6.7
years, in group II 43.58 ± 11.26 years. In group I, 35 patients (70%)
showed no evidence of suspicion of a UTI on admission. 15 patients
(30%) were admitted for suspected UTI. In group II, 36 patients (72%)
showed no evidence of suspicion of a UTI on admission. 14 patients
(28%) were admitted for suspected UTI.
Urological abnormalities underlying the UTI, detected by ultrasound,
were more frequent in Group I (40%) than in Group II (12%).
Second-line antibiotics, due to the likely resistance of the micro-
organism, had to be prescribed in 16% cases in Group I vs. 4% of cases
in Group II. The evolution under antibiotic treatment was marked by
the occurrence of 3 deaths and transition to renal failure in 4 cases for
Group I. In Group II, the outcome was favorable in all cases.
P-864
Penile Cuff Test in old patients: feasibility in real life
D. Carnicelli, G. Fiard, C. Thuillier, G. Gavazzi.
Urology and Renal
Transplant Units and University Clinic of Geriatric Medicine, University
Hospital of Grenoble-Alpes
Introduction:
The aim of this study was to assess the Penile Cuff Test
(PCT) feasibility (non invasive cystomanomety) on a daily practice, for
patients admitted for a treatment of lower Urinary tract symptoms.
Method:
During the first three months of 2014, all patients admitted
at University Hospital of Grenoble for a procedure to relieve prostate
obstruction were included in the study (>50 years). All categories
of limitations to the use of PCT were collected; for patients
who underwent PCT, figures of pressure flow were collected on the
modified nomogram of the ICS.
Results:
Fifty patients were included (mean age 76 y (50
–
92). Out of
50, 16.4% of the patients could perform PCT. 60% were showing an
obstruction (average voided volume 181,8 mL). Limitations to PCT
realizationwere, presence of urethral, or a suprapubic catheter (30,9%),
severe cognitive disorder (12.4%), no urge to urinate (16.4%), technical
problem during the procedure (16,4%), patients had urethral stenosis
(5,4%). The mean prostate volume was 60 g (30
–
120). The mean IPSS
score was 18.8/35 (7
–
31), and the average index of quality of life was
4.78/6 (2
–
6). Procedure duration was 10 minutes. Eligible patients
rated the difficulty to use the PCT 3/10 on an EVA scale (0 = very easy,
10: very difficult).
Key conclusions:
This study highlighted the requirement to select
patients precisely, despite that elderly patients should get the greatest
benefit from PCT. Severe cognitive trouble, frequent preoperative
urinary retentions are the main limitations. patients who underwent
PCT found it simple.
P-865
What patients don
’
t tell and what we do not ask? Continence
service development steering group at district general hospital
A. Jakupaj, C. Martin-Marero.
Luton and Dunstable Hospital NHS Trust
Urinary and faecal incontinence becomes increasingly prevalent with
age. Despite the frequency of the problem, bladder and bowel dysfunc-
tion is not talked about openly. In our Trust in survey questionnaire,
90% of patients complaint of urinary incontinence, 65% complaint
of faecal incontinence. Promoting awareness of continence issues
and development of structured continence pathway may reduce
prevalence of urinary and faecal incontinence in our Trust and
improve patient
’
s quality of life. We introduced Continence Steering
Group and Continence Service to identify and improve the gaps in
continence care. Our project was divided into 3parts: 1. Catheter
Audit 35/103 patients had an indwelling catheter, 24/35 short term
catheter, only 3/24 had TWOC, 2/24 had procedure explained to
them and 2/24 had documented consent, 8/24 had bowel assessment
done prior catheterisation and 1/11 patients had prostate examined.
2. Urinary Continence Audit 64/103 patients with urinary incon-
tinence(UI). 60% of patients had UTI/Urosepsis with the subsequent
morbidity with potential increased mortality. There was also poor
awareness of the importance of concomitant bowel management
and prostate assessment in the care ofUI. 3. Faecal Continence Audit
33/103 patients with faecal incontinence (FI). 40% of FI was asso-
ciated with dementia,faecal loading and poor mobility. 58% of patient
were FI daily. We identified very poor history and examination to look
for cause of FI including basic rectal and abdominal examination.
Urinary and faecal continence is common yet not comprehensively
assessed. Partial assessments are leading to partial management of
the causes of UI and FI with poor implementation of the right
treatments. We have identified important educational and clinical
governance issues to be addressed in different forums. We developed
Continence Steering Group to improve our service and introduce
continence pathways. A prospective study is currently being under-
taken to validate this.
P-866
Kegel exercises in the incontinent older woman
–
is it worth it?
J. Mata
1
, M. Galo
2
, S. Pessoa
2
, I. Calvinho
2
.
1
UCSP Marvila,
2
USF Oriente,
Portugal
Introduction:
Urinary incontinence is a common affliction in women,
especially in the elderly. While some cases might need surgery
to mitigate the symptoms, others will not be eligible for it. Kegel
exercises have shown a beneficial impact in urinary incontinence
progression in younger age groups, so the transposition of these results
to the elderly women would allow an improvement in quality of life
without aggravating the polymedication concern.
Objective:
To evaluate the efficacy of Kegel exercises in urinary
incontinence symptoms in the elderly.
Methods:
We searched PubMed with the terms: incontinence, Kegel
and elderly with a time frame from 01/01/2000 to 30/04/2016.
The Grading of Recommendations, Assessment, Development and
Evaluation (GRADE) system was used to rate the quality of the evi-
dence and recommendations.
Results:
Our systematic search returned 27 papers from which 2
matched the inclusion criteria of women with at least 65 years and
the evaluation of Kegel exercises efficacy. Considering a low quality
of evidence from a randomized controlled trial and a prospective
study, with a total of 87 participants, we could only provide a weak
recommendation for the application of Kegel exercises.
Conclusions:
In both cases the routine of Kegel exercises showed
an improvement (32% and 36.4%) in the PAD test after 8 weeks of
treatment. We can say that the Kegel exercises could be recommended
to selected patients. However, it is necessary to conduct randomized
clinical trials with larger samples and longer follow-ups to determine
the real benefit in the elderly women.
P-867
Prospective study of the impact of urethral catheterization on
geriatric inpatients
J.E. Mateus
1
, C. Silva
1
, O. Oliveira
1
, P. Lopes
1
, J. Fonseca
1
, D. Ferreira
1
,
J. Porto
1
, M. Veríssimo
1
, A. Carvalho
1
.
1
Centro Hospitalar e Universitário
de Coimbra, Portugal
Introduction:
Catheter-Associated Urinary Tract Infection (CAUTI)
remains one of the most common healthcare-associated infections.
International guidelines agree on appropriate indications for the use of
urethral catheterization (UC): acute urinary retention, perioperative
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S257