Urologic Surgery in the Elderly

Most urologists practicing general urology traditionally have taken care of a large number of older adults over the age of 65. As the overall population of the United States age at a rapid pace, the urologists will be entrusted with the care of an increasing number of older adults with comorbidities. Some of the most common urological problems in the elderly which may require surgical intervention include urological cancers such as prostate, bladder and kidney cancer, benign prostatic hyperplasia (BPH) with lower urinary tract symptoms, urinary incontinence, and pelvic floor dysfunction in female. The risks associated with urological surgery in the elderly is not necessarily related with chronological age but rather greatly influenced by the functional capacity and associated comorbidities of the individual patient. The urologist must be familiar with and carefully consider non-surgical or minimally invasive surgical technique when appropriate, perform a thorough pre-operative assessment, and be cognizant of post-operative complications and their management unique to elderly patients. In this chapter we review the surgical management of some of the most common urological problems in the elderly. We have briefly touched on the clinical evaluation of geriatric patients, as this has been discussed in depth in another chapter. Considering the brevity of the space we have limited our discussion of non-surgical treatment options.