An 82-year-old man with daytime frequency, urinary urgency, occasional incontinence and nocturia is treated with an anticholinergic. His incontinence worsens. Urinalysis is normal. The next step is:
A. PVRAnswer A
LUTS in the elderly may be secondary to a number of medical conditions, including immobility, congestive cardiac failure and diabetes. Antimuscarinic agents may cause or worsen urinary incontinence in elderly patients with poor detrusor contractility. This may present with new or worsened incontinence due to overflow after the initiation of an antimuscarinic agent. This can be diagnosed with the non-invasive measurement of a PVR. Renal ultrasound is not indicated. There is no need at this point to proceed to uroflowmetry, urodynamics or cystoscopy, but these may be useful in further evaluation.