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Plenary session 2 report: Incontinence care challenges and management in elderly patients

Drug-drug interactions (DDIs), expert insights on mesh usage, and the patients’ perspective were some of the topics covered today during Plenary Session 2: Optimal management of incontinence in the elderly patient. Renowned experts EAU Secretary General Prof. Chris Chapple (GB), Prof. Jean-Nicolas Cornu (FR) and Prof. Francisco Cruz (PT) spearheaded and moderated the session live.

In his presentation entitled, “Drug interactions to be aware of when using pharmacotherapy for UUI”, Prof. Martin Michel (DE) cited a study that showed that the average 65-year-old uses seven different medications. The use of multiple medications is referred to as polypharmacy. Polypharmacy leads to a major risk of DDIs, which account for 1.2% of all hospital admissions and visits, and 31.7% of all adverse event-related admissions and visits.

According to Prof. Michel, complete medication history is key to the prevention, detection, and management of DDIs. He advised, “Be on alert for sudden changes with regard to the efficacy of or tolerability to medications. One must consult with the co-prescribing physician on how to optimally manage needs arising from DDI. Do not stop the medication prescribed by the other physician without prior consultation.”

In his lecture “Guideline statement: Is mesh for incontinence the same as mesh for prolapse?”, Prof. Chapple stated that current meshes are an effective treatment that needs to be implanted appropriately. “New materials need to be more like fascia-mimetic material made of three layers of polyurethane (PU) electrospun fibres. PU material copes well with repeated distension and is well tolerated in animals, inducing little inflammation in contrast to polypropylene (PP) mesh. In addition, tissue integration is good but can be improved through the incorporation of estradiol into the mesh,” said Prof. Chapple. He also enumerated methods to critically evaluate these new materials such as advanced surface imaging using secondary electron hyperspectral imaging, and oxidative stress on the surface of PP fibres.

“One of the things we often forget is to truly listen to patients,” said Mrs. Mary Lynne Van Poelgeest-Pomfret (NL), President of the World Federation for Incontinence and Pelvic Problems. In her presentation “Treatment goals and evaluation tools: The patient perspective”, she stated that aligning the treatments to the individual patient requires “a lot of talking and listening; explanation and patience, especially with some (elderly) patients who may not be informed, who are mentally and physically vulnerable, and are dealing with comorbidities and/or polypharmacy issues.”

Mrs. Van Poelgeest-Pomfret also underlined the importance of finding the primary cause and the solutions with regard to incontinence care. She said, “The costs of containment products constitute a significant global cost but they do not solve the root cause of the problem. Of course, these products are an essential element in the continence care spectrum but it doesn’t and shouldn’t end there. Imagine what impact can be achieved with accurate diagnosis, timely and effective treatment as opposed to reliance on products for containment without a full assessment and diagnosis.”

Access and/or rewatch these presentations and other Plenary Session 2 lectures in full, including case-based deliberations on the artificial urinary sphincter and stress urinary incontinence, via the On Demand feature of the EAU21 Virtual Platform.