Re: Urinary Incontinence is Strongly Associated with Depression in Middle-Aged and Older Korean Women: Data from the Korean Longitudinal Study of Ageing.

available at http://www.ncbi. nlm.nih. gov/pubmed/29175130 Editorial Comment: Urinary incontinence (UI) has been linked to multiple negative outcomes in older adults, including decreased health related quality of life across multiple domains. This study again demonstrated strong associations between UI and depression using data from the Korean Longitudinal Study of Ageing. Subjects were assessed using computer assisted interviews, and 1,116 women diagnosed with UI by their physician were included in the analysis. Severity of depression as measured by symptom score significantly worsened with increased severity of UI. Depression severity also worsened with increased number of days individuals experienced UI during the prior month for each measured time point in the 2-year study. Results were maintained even after adjusting for age and multiple other potentially predictive variables. There have been several theories suggesting that UI and depression may share neurochemical pathways. Decreased monoamine levels, including serotonin and noradrenaline, have been linked to depression, and animal studies have shown they are linked to urinary urgency, frequency and UI. Functional impairment and social isolation associated with UI may also be associated with depression. The scientific design of the study precluded identification of directionality for these associations but these results emphasize the strong relationship between these conditions in elderly women. Thus, successful treatment for UI may help with affective and mood disorders, and improved mental health status may benefit older women with UI. Tomas L. Griebling, MD, MPH Suggested Reading Thom DH, van den Eeden SK, Ragins AI et al: Differences in prevalence of urinary incontinence by race/ethnicity. J Urol 2006; 175: 259. Re: Natural History of Post-Void Residual Urine Volume over 5 Years in Community-Dwelling Older Men: The Concord Health and Ageing in Men Project N. Noguchi, L. Chan, R. G. Cumming, F. M. Blyth, D. J. Handelsman, L. M. Waite, D. G. Le Couteur and V. Naganathan Centre for Education and Research on Ageing, Ageing and Alzheimer’s Institute, Department of Urology and ANZAC Research Institute, Concord Hospital and School of Public Health, University of Sydney, Sydney, New South Wales, Australia Neurourol Urodyn 2018; 37: 1068e1073. doi: 10.1002/nau.23415 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/28940729available at http://www.ncbi. nlm.nih. gov/pubmed/28940729 Editorial Comment: Post-void residual (PVR) urine volume is considered an important measure of voiding efficiency and overall bladder function. Yet there is no standard volume that is widely accepted as abnormal or clinically concerning in all circumstances. Different clinicians make treatment recommendations based on individual patient characteristics. This study followed the natural history of urological conditions in a community based cohort of 329 men based on PVR urine volumes at enrollment. Measurements were made at baseline, and at 2-year and 5-year followup. Men with established diagnoses thought likely to influence PVR, such as prostate cancer, neurological diseases and prior urological treatment, were excluded. Overall, the authors found that of 101 men who had baseline PVR measures less than 400 ml and who did not undergo subsequent urological therapy none had PVR greater than 400 ml at 2 or 5 years of followup. Only a small number of men (4%) with initially low PVR (less than 200 ml) required surgery for 644 GERIATRICS Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. benign prostatic hyperplasia or treatment with catheterization during the next 5 years. In contrast, 75% of men with baseline PVR greater than 400 ml and 18% of those with PVR 200 to 399 ml required treatment. Their data emphasized the importance of repeated measures due to fluctuations in observed PVR volumes for individual men in short periods of time. Baseline PVR was not predictive of subsequent need for hospitalization due to either acute urinary retention or urinary tract infection. These findings suggest that conservative treatment may be useful in this geriatric population of men with low baseline PVR (less than 200 ml). Tomas L. Griebling, MD, MPH Suggested Reading Rule AD, Jacobson DJ, McGree ME et al: Longitudinal changes in post-void residual and voided volume among community dwelling men. J Urol 2005; 174: 1317. May M, Brookman-Amissah S, Hoschke B et al: Post-void residual urine as a predictor of urinary tract infectiondis there a cutoff value in asymptomatic men? J Urol 2009; 181: 2540. Re: Urinary Tract Infection Surveillance in Residential Aged Care S. Ryan, E. Gillespie and R. L. Stuart Infection Control and Epidemiology Unit, Monash Infectious Diseases, Monash Health and Department of Medicine, Monash University, Clayton and National Centre for Antimicrobial Stewardship, Melbourne, Victoria, Australia Am J Infect Control 2018; 46: 67e72. doi: 10.1016/j.ajic. 2017.07. 002 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/28844374available at http://www.ncbi. nlm.nih. gov/pubmed/28844374 Editorial Comment: Urinary tract infection (UTI) is perhaps the most frequently occurring urological condition in geriatric patients. However, over diagnosis and overtreatment are common and have important consequences, including risk of adverse treatment effects for individuals and increasing antibiotic resistance patterns. Accurate diagnosis includes differentiating UTI from asymptomatic bacteriuria, which does not typically require antibiotics. Diagnosis can be particularly challenging in nursing home residents. This study examined UTI diagnoses in 2 nursing homes compared to established UTI surveillance standards, ie McGeer criteria. These criteria require presence of combinations of specific signs and symptoms (dysuria, fever, leukocytosis, pain, hematuria, incontinence, mental status changes) and microbiological findings (positive urine cultures with 10 cfu bacteria for voided samples or 10 for catheterized samples). Overall, only 5.9% of 119 presumed UTIs diagnosed in 57 elderly nursing home residents actually met McGeer criteria. Of UTIs diagnosed 42% did not meet clinical criteria, 15% did not meet urine culture requirements and 42.9% did not meet either set of criteria. However, nearly all patients were treated with systemic antibiotics. More than 22% of bacteria were resistant to initially prescribed antibiotics but, surprisingly, prescriptions were changed in only 54.5% of cases. Many patients (33%) had communication problems that exacerbated accurate symptom evaluation. Treatment should not be based solely on changes in urine characteristics, dipstick urinalysis tests, or mental status or behavior changes in the absence of localized urinary tract symptoms. This small study in only 2 nursing homes highlights the enormous problems facing improvement in antibiotic stewardship in this clinical setting. Tomas L. Griebling, MD, MPH GERIATRICS 645 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.