To select the appropriate treatment for an elderly patient with urinary incontinence, the cause of the incontinence needs to be determined. In diabetic patients who are incontinent, the underlying problem has been described in the past as urinary retention secondary to autonomic neuropathy. In cystometric studies conducted on 23 elderly diabetic nursing home patients (mean age, 80 years; 19 women, 4 men), who presented with symptoms of urinary dysfunction, involuntary contractions were demonstrated in 61% of the subjects. Thirteen percent of the patients had normal voluntary contractions of the bladder, 17% had voluntary contractions of a low magnitude, and 9% had no contractions at all. The majority (76%) of the subjects presenting with urinary incontinence had involuntary bladder contractions, while all of the subjects presenting with urinary retention had either voluntary contractions of a low magnitude or no contractions. It cannot be assumed that all elderly diabetic patients presenting with urinary symptoms have poorly contracting bladders (diabetic bladder). Urodynamic studies can be helpful when choosing therapy for the elderly diabetic patient with urinary dysfunction.
(Arch Intern Med. 1990;150:810-813)