Humphrey Atiemo

Advances in geriatric female pelvic surgery.

The body maintains homeostasis among various organ systems and physiological processes. In normal ageing, there is a gradual decline in the functional capacity of almost all organ systems. The term ‘homeostenosis’ is often used in geriatric medicine to refer to the limitations in functional reserve capacity that are part of the ageing process. Surgery is a significant physiological stressor, and the surgeon must be vigilant to help patients regain baseline physiological function within the confines of this limited natural response. Fluctuations from the norm can be more pronounced because of homeostenosis, and the time to return to baseline function can be more prolonged.

V2-11 HIGH UTEROSACRAL HYSTEROPEXY FOR THE MANAGEMENT OF PELVIC ORGAN PROLAPSE

Postoperative, all women had POP-Q stage 0. A 74% continence rate for urinary incontinence was noted. CONCLUSIONS: The LACESA and LAVASA techniques yielded excellent anatomical correction of prolapse. The mesh used is made of PVDF, which cause milder tissue reaction and minimizing the risk of mesh shrinkage/erosions. The unique design of the PVDF structure allows restoration of the USLs with clearly defined surgical steps, making the procedure standardised and reproducible.

MP69-01 ANTIMUSCARINIC USE IN THE ELDERLY: A POISONED APPLE?

INTRODUCTION AND OBJECTIVES: Overactive bladder (OAB) is characterized by urinary urgency, frequency, nocturia, and urinary incontinence (UI). The prevalence of OAB increases significantly with age. The first-line therapy for OAB is antimuscarinic medication, some of which have deleterious side-effects, including cognitive decline. We sought to examine the incidence and prevalence of antimuscarinic prescriptions among elderly persons 1⁄4 age 65. METHODS: The 2006-12 National Ambulatory Medical Care Survey (NAMCS) were queried for patients with newly given or renewed prescriptions for any of 6 antimuscarinics: oxybutynin, tolterodine, fesoterodine, darifenacin, solifenacin, and trospium. Within these cohorts, frequencies of patient/physician attributes and annual trends in drug prescription were determined utilizing drug-mention weighting methodology. RESULTS: A weighted estimate of 47.68 million individuals (unweighted n1⁄41,968) had their antimuscarinics renewed, and 12.77 million patients (unweighted n1⁄4641) received a new prescription (Table 1). The majority of new antimuscarinics were prescribed in elderly (1⁄4 age 65) (55.2%), female (69.2%), white (61.7%), and Medicare insured (84.1%) individuals. Oxybutynin was a frequently prescribed (incidence 27.3%) and continued (prevalence 33.2 %) antimuscarinic among elderly patients. In 2010, there was a sharp decrease in the number of all continued antimuscarinic prescriptions, followed by annual increases in oxybutynin continuation versus continued decline in other antimuscarinic continuation (Figure 1). Figure 1: Continued Antimuscarinic Prescriptions in Patients > 65 Years of Age, NAMCS 2006-2012 CONCLUSIONS: We found alarmingly high prescription rates of oxybutynin (27.3%), pharmacologically the least suitable antimuscarinic, for which studies have consistently demonstrated higher rates of cognitive impairment in the elderly. Frequent oxybutynin prescription is likely driven by tiered Medicare formularies which require patients to trial oxybutynin, a cheaper, generic antimuscarinic, before allowing access to newer, more costly yet safer, antimuscarinics. This work is the first population-based study demonstrating both the alarming rate of oxybutynin prescription and the lack of a proper safety net for a growing and vulnerable elderly population. Our work demands an increased consideration of the possible deleterious effects of unmonitored antimuscarinic use in elderly patients. Source of Funding: none

Evaluation and Management of Disorders of the Female Urethra

Historically, urethral syndrome has been defined as symptoms suggestive of a lower urinary tract infection in the absence of significant bacteruria with a conventional pathogen. In the modern era, components of this term have been separated out into new disease entities such as overactive bladder, functional bladder outlet obstruction, and pelvic pain syndrome including dyspareunia and vulvodynia. Proper treatment is best initiated by correct usage of the terminology that describes the patient’s symptoms and evaluation, followed by symptom-focused treatment.