UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

GERIATRIC UROGYNECOLOGY

Bünyamin Çim

Kovancılar State Hospital, Department of Gynecology and Obstetrics, Elazığ, Türkiye

Çim B. Geriatric Urogynecology. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.365-386.

ABSTRACT

Background: Pelvic floor disorders (PFDs) pose a considerable healthcare challenge among the aging female demographic, impacting 25-45% of women over 65 years of age. As the population ages due to changes in demographics, the number of pelvic floor disorders (PFDs) is expected to rise from 28 million to 44 million over the next forty years, possibly reaching four times that number by 2060.

Pathophysiology: The causes of pelvic floor disorders in older women are complex and include cellular aging, mitochondrial failure, and changes in the composition of the extracellular matrix. Changes that happen with age include lower type I collagen and higher ratios of type III collagen, a buildup of advanced glycation end products, and a breakdown of the function of matrix metalloproteinases. Hormonal fluctuations, especially estrogen deficiency following menopause, lead to vaginal epithelial atrophy, a 30% decrease in collagen synthesis, and a deterioration of the structural integrity of pelvic support tissues.

Clinical manifestations: Clinical manifestations of pelvic floor disorders (PFDs) encompass urinary incontinence (including stress, urge, mixed, and overflow types), pelvic organ prolapse (affecting anterior, posterior, and apical compartments), and associated functional impairments. These issues have a tremendous impact on quality of life, leading to loneliness, hopelessness, and lower self-esteem. 60 to 70% of older women have mixed urine incontinence, but only 15 to 30% have pelvic organ prolapse.

Strategies for management: Treatment modalities are customized based on the assessment of patient frailty, concurrent conditions, and functional capacity. Conservative care includes pelvic floor muscle training, pessary therapy (which works 76.3% to 81.5% of the time), and changes to daily habits. Pharmacological therapies utilize mirabegron and anticholinergics, with mirabegron demonstrating superior safety profiles in geriatric patients. Surgical therapies encompass a spectrum from minimally invasive procedures, like mid-urethral slings for stress incontinence, to reconstructive surgeries, such as sacrocolpopexy for apical prolapse, yielding success rates between 74% and 98%.

Conclusion: To effectively treat pelvic floor disorders in older women, a comprehensive geriatric evaluation, multidisciplinary approaches, and a focus on physiological age rather than chronological age are essential. Best Recovery Postoperative guidelines and delirium prevention strategies are essential for improving outcomes in this vulnerable population.

Keywords: Geriatric urogynecology; Pelvic floor disorders; Elderly women; Pelvic organ prolapse; Geriatric management; Surgical management

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