Geriatrics and the bladder: From a neurourological point of view

Background: Bladder problems in older individuals are very common; however, their pathophysiology and management remain poorly understood. Objective: This article examines geriatrics and the bladder from a neurourological perspective. Aging notably impacts the brain. Among octogenarians (over 80 years old), the following estimated prevalences are reported: white matter disease (WMD) at 80%, Alzheimer’s disease (AD) at 33%, and dementia with Lewy bodies (DLB) at 8%. Both isolated and combined pathologies are frequent, with AD+WMD being the most common combination. WMD is considered the primary pathological cause of overactive bladder in the elderly, while AD and DLB also contribute, though to a lesser extent. In advanced dementia cases due to AD or DLB, functional urinary incontinence may occur because of immobility, cognitive impairment, and loss of initiative. Early overactive bladder may be managed with β3 adrenergic receptor agonists and anticholinergics with minimal blood–brain barrier penetration. Advanced functional urinary incontinence may be addressed with behavioral strategies (e.g., prompted/timed voiding), toileting/environmental optimization, gait rehabilitation, and therapies targeting cognition and mobility. These conditions are potentially treatable in geriatric patients. Conclusion: This review highlights the unique integration between aging brain pathology and urodynamic findings, as well as functional urinary incontinence.