INTRODUCTION

Urological problems are extremely common in older adults. The prevalence of many urological disorders increases with advancing age in both men and women. Estimates indicate that approximately 20% of all primary care visits include some type of urological complaint. In fact, data from the National Ambulatory Medical Care Survey indicate the specialty of urology ranks third, behind only ophthalmology and cardiology, in the total annual number of outpatient clinical visits by older Medicare recipients in the United States. These trends hold steady even when stratifying for ages older than either 75 or 85 years. This chapter addresses the evaluation and management of many of the common urological conditions seen in older adults. Several topics relevant to urology are also covered in more detail in other chapters including urinary incontinence (Chapter 26), sexuality and sexual health (Chapter 55), and prostate cancer (Chapter 36).

HEMATURIA

Hematuria is a common urological condition seen in people of all ages. The condition may be gross or microscopic, and it may be episodic or persistent. Any episode of gross hematuria should be considered abnormal. On microscopic urinalysis, the generally accepted upper limit of normal is zero to three red blood cells per high-powered field. Because it is a common presenting sign for many types of genitourinary pathology, elderly patients with gross or persistent microhematuria should undergo a thorough evaluation including upper urinary tract imaging and cystourethroscopy. The common sources of hematuria in older adults are summarized in Table 25.1.