**9.2.5 Catheterisation**

126 Urinary Incontinence

(moderate or severe), but with several requisites: the physical examination and the lab tests have to be normal. In this sense, the theoretical side effects on cognitive function must not limit its use in the elderly (Wagg et al, 2010). Furthermore, in all the cases, we must analyze the individual risks of this treatment with a close follow-up of the frailest older

Table 9 shows a list of drugs with antimuscarinic action most commonly used in the treatment of incontinent frail older patients, with their level of evidence and grade of

**DRUG LEVEL GRADE** 

**1 1 2** 

Desmopresin is a synthetic vasopressin analogue, with strong anti-diuretic effects. It could be very useful in the treatment of nocturia, but with risk of hyponatremia (between 7.6 to 10%), especially in the frail elderly patients. In addition, desmopresin should not be used in frail elderly due to the high risk of hyponatremia (level 1 of evidence) (DuBeau et al, 2010;

Duloxetin is a relative recent drug, which is useful for moderate to severe stress urinary incontinence. It has a good profile with a positive effect since the start of the treatment. Its side effects are infrequent (with mild or moderate severity), and of a short duration. Nowadays it is considered as a good alternative for the surgery of stress urinary

Other interesting type of drug is the group of alpha-blockers, especially in men with storage lower urinary tract symptoms and urgency, however, they should be used with caution in the frailest men due to the hemodynamic adverse effects (Schröder et al, 2009;

**A A A A A** 

**A A** 

recommendation (Schröder et al, 2009; DuBeau et al, 2010).

*ANTIMUSCARINICS* **Tolterodine Trospium Solifenacin Fesoterodine Darifenacin** 

*MIXED ACTIONS* **Oxybutinin Propiverine Flavoxate** 

incontinence in older females (Robinson & Cardozo, 2010).

Table 9. Antimuscarinics most commonly used in the incontinent frail elderly

patients.

**9.2.2 Desmopresin** 

Abrams et al; 2010).

**9.2.4 Alpha-blockers** 

Verdejo, 2011).

**9.2.3 Duloxetin** 

Unfortunately, in the cases of chronic urinary retention or bladder impaired contractility in which the patient keeps a high PVR, should be considered the insertion of an urethral catheter. Intermittent catheterisation is usually safer and effective but obviously requires the patient or the carers to be able to learn and practice this technique. When intermittent catheterisation can not be possible, urethral catheter should be considered, with the secondary risks of this technique (infection, hematuria, urethral trauma, accidental removal) (Thirugnanasothy, 2010).

The main indications for long term indwelling catheterisation are exposed in the table 10.

**Chronic bladder outlet obstruction and surgery is not appropriate Patients or carers are unable to manage intermittent catheterisation Patients with pressure sores (transient indication) Patients severely affected by the leakages Managing incontinence in end of life situations** 

Table 10. Main recommendations for using a long term indwelling catheter:
