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Geriatric Urogynecology & Reconstructive Urology

Geriatric urogynecology and reconstructive urology addresses pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), urinary incontinence (UI), fecal incontinence (FI), and genitourinary syndrome of menopause (GSM), in older women. POP prevalence is projected to rise by 46% by 2050.[1] Chronological age alone should not determine treatment eligibility; rather, individualized decisions should be guided by frailty status, comorbidity burden, functional capacity, patient goals, and life expectancy.[2][3]

Epidemiology and Impact​

UI affects about 75% of women aged ≥75 years, and at least half of incontinent women do not report it to their physicians.[4] POP prevalence similarly increases with age, and roughly 13% of women undergo prolapse surgery in their lifetime.[5] UI accounts for about 6% of nursing-home admissions for elderly women, and about $19.5 billion was spent on UI care in the U.S. in 2004.[4] Mixed incontinence becomes increasingly common with age, and the distinction between stress and urgency UI is often less clear in older women.[4][6]

Preoperative Geriatric Assessment and Frailty​

Assess frailty and functional reserve before elective pelvic-floor surgery in older adults. Frailty, a multidimensional syndrome of decreased physiologic reserve, is present in 30–50% of older patients presenting for major surgery and independently predicts postoperative morbidity, mortality, loss of independence, and prolonged hospitalization.[7][8]

For the urogynecologic setting:[3][9][7]

  • Timed Up and Go (TUG). A time of ≥15 seconds indicates compromised mobility.
  • Clinical Frailty Scale (CFS-9). It is rapid and picture-based; against the Fried Frailty Index in pelvic-floor patients, AUC was 0.86 for the treating surgeon, 0.91 for a second surgeon and 0.88 for the patient's own score.[9]
  • Mini-Cog. It screens for cognitive impairment (relevant to medication management and self-catheterization capacity).
  • Robinson Frailty Index. It was used in the ASPIRe trial; scores ≥2 indicate prefrail or frail status.[10]
  • Life-Space Assessment. It evaluates mobility and community engagement.

A urogynecology review proposes TUG, Life-Space Assessment and Mini-Cog as a practical battery.[3]

ASPIRe frailty substudy​

In the ASPIRe frailty substudy, 146 women aged ≥65 underwent randomized prolapse surgery (145 analyzed; 41 prefrail and seven frail); 62/145 (43%) had any 30-day complication and 28/137 (20%) had an immediate Clavien–Dindo grade II–V event, with no detected difference in complication or longer-term geriatric outcomes between the combined prefrail/frail and nonfrail groups. The combined prefrail/frail group had earlier composite treatment failure—retreatment, prolapse beyond the hymen, or bulge symptoms—than the nonfrail group (36-month probability 49% versus 28%; aHR 2.1, 95% CI 1.2–3.6). Among women living without assistance before surgery, 7/36 (19%) in the combined prefrail/frail group versus 5/85 (6%) in the nonfrail group reported living with family or assistance immediately after surgery (P = 0.04).[10]

Comprehensive geriatric assessment should also address polypharmacy (particularly anticholinergic burden; see below), nutritional status, depression screening (PHQ-2), goals of care, and advance-care planning.[11][7]

Prehabilitation and ERAS​

Multimodal prehabilitation, combining exercise training, nutritional optimization, and anxiety reduction, may benefit frail older adults; the ASCRS colorectal-surgery guideline gives this Grade 1B, with individualized components and duration. For frail older adults undergoing colorectal surgery, ASCRS recommends individualized prehabilitation (Grade 1B).[12] In the PREPARE randomized trial of 847 adults aged ≥60 with frailty scheduled for elective inpatient noncardiac surgery, 30-day disability did not differ significantly; among 705 who underwent surgery, in-hospital complications occurred in 177/353 (50.1%) assigned home prehabilitation versus 168/352 (47.7%) assigned usual care (aOR 1.05, 97.5% CI 0.73–1.49).[63] The guideline cites 26 heterogeneous major-abdominal-surgery studies with fewer overall (OR 0.61), pulmonary (OR 0.41) and cardiac complications (OR 0.46), but age/frailty were not consistently reported; a separate 110-patient frail colorectal RCT found no advantage over postoperative rehabilitation.[12]

ERAS protocols specifically adapted for transvaginal pelvic-floor reconstruction in older women were evaluated in a 2025 RCT (100 enrolled; 95 analyzed), with a significantly shorter median postoperative length of stay in the ERAS group (65 versus 74 hours, P < 0.01) along with reductions in postoperative pain scores and PONV.[13][14]

Evaluating New or Worsening Incontinence: Transient Causes​

New or acutely worsening incontinence in an older adult should first prompt a search for a transient, often reversible contributor before it is treated as an established storage or outlet problem. The DIAPPERS mnemonic organizes this screen: Delirium, Infection (symptomatic), Atrophic vaginitis or urethritis, Pharmaceuticals, Psychological factors (depression), Excess urine output (heart failure, diabetes, diuretics), Restricted mobility, and Stool impaction. Identifying and correcting one of these can resolve the incontinence without any bladder-specific treatment, and skipping this step risks labeling a reversible problem as chronic.[52]

Nonsurgical Management of UI in Older Women​

Behavioral and conservative therapies are first-line for stress, urgency and mixed UI in older women:[15][4]

  • Pelvic floor physical therapy / PFMT: effective for stress, urgency, and mixed UI; about 50% satisfaction at 1 year for stress-predominant UI.[15]
  • Bladder training: timed voiding, urge-suppression techniques.
  • Fluid management: tailoring intake to thirst, renal/cardiac status and measured urine output, reducing excessive caffeine, and adjusting evening fluids for nocturia without dehydration.[15]
  • Weight loss: for obese women, combined with exercise.

A 2025 systematic review of conservative interventions in frail older adults (12 RCTs, n = 1,580) found an uncertain effect on objective UI measures (six pooled RCTs; g = −0.39, 95% CI −0.832 to 0.060), with very low certainty and substantial heterogeneity.[16] No adverse events were reported.[16]

Pessaries can be useful when fitting is comfortable and reliable follow-up is feasible, including caregiver support when cognition or dexterity is limited.[17][18] The 2026 UK multidisciplinary guideline advises offering an initial review at 4–6 weeks; it recommends no longer than six months between clinic-managed reviews .[45] Inability to maintain follow-up or self-manage makes ongoing use unsafe.[45]

Pharmacotherapy: The Anticholinergic Burden Problem​

Anticholinergic burden is a geriatric-specific consideration in urogynecology. Observational studies associate cumulative OAB anticholinergic exposure with dementia:[19][20][21]

  • A large French nested case-control study (n = 28,860) found an adjusted OR of 1.48 (95% CI 1.22–1.80) for dementia with >365 defined daily doses of OAB anticholinergics. Oxybutynin and solifenacin carried the highest risk, while trospium (with limited blood-brain-barrier penetration) had no detected association in that study.[19]
  • A 2025 meta-analysis of eight studies involving 3.66 million adults with OAB reported higher dementia risk associated with anticholinergics versus no therapy (RR 1.20) and versus mirabegron (RR 1.28; I² = 98% for the active comparison).[21] In a Danish active-comparator cohort of 58,242 bladder-drug initiators aged 60–75 at entry, anticholinergic use was associated with a lower dementia incidence rate than mirabegron (adjusted IRR 0.82, 95% CI 0.74–0.92).[60]
  • A 2026 systematic review found pooled HR of 1.24 (95% CI 1.19–1.30) for cognitive decline / dementia, with additional observational associations for cardiovascular events (OR 1.13) and mortality (OR 1.26).[22] Short RCTs (mean 19.5 days) detected no cognitive difference; the review identified bias concerns.[22]

Society recommendations​

  • The SUFU White Paper states that chronic use (>3 months) of OAB anticholinergics is "likely associated with an increased risk of new-onset dementia" and suggests considering earlier progression to advanced therapies (botulinum toxin, neuromodulation).[20]
  • The 2023 AGS Beers Criteria lists bladder antimuscarinics as strongly anticholinergic, notes the strongest cognitive-harm evidence for oxybutynin, and urges caution with all agents. Consider cognition, falls and the total medication burden.[23]
  • AUA/SUFU 2024 recommends that clinicians discuss the risk of dementia and cognitive impairment with patients taking or prescribed antimuscarinics , and that therapy be chosen through shared decision-making.[43]

Preferred pharmacologic alternatives​

β3-adrenergic agonists (mirabegron, vibegron) have broadly comparable symptom efficacy to anticholinergics for OAB symptoms but do not contribute to anticholinergic burden.[24][25][26] In a network meta-analysis of older adults (≥65 years), mirabegron had:[24]

  • Similar efficacy across all endpoints (micturition frequency, incontinence episodes, urgency).
  • Odds of dry mouth similar to placebo (OR 0.76), versus ORs of 3.78–7.85 with antimuscarinics.[24]
  • No increased odds of adverse-event-related discontinuation (OR 0.99 versus placebo).[24]

Mirabegron can raise blood pressure; check BP periodically, and the label does not recommend use when systolic BP is ≥180 mm Hg and/or diastolic BP is ≥110 mm Hg. The vibegron ambulatory-BP study did not show a clinically significant increase. Both carry urinary-retention risk; mirabegron moderately inhibits CYP2D6 and calls for monitoring digoxin when coadministered, while vibegron calls for digoxin monitoring before, during, and after therapy.[27]

Minimally Invasive Therapies in Older Women​

AUA/SUFU 2024 states that clinicians may offer minimally invasive therapies in the context of shared decision-making without requiring trials of behavioral, non-invasive or pharmacologic management . Consider access, procedural burden, dexterity, cognition and caregiver support.[43]

  • OnabotulinumtoxinA (Botox): FDA-approved for adult OAB after inadequate response to or intolerance of an anticholinergic; the label does not require failure of a β3 agonist. Placebo-controlled OAB studies found comparable effectiveness across age groups; measure PVR before injection, confirm the patient is willing and able to catheterize if retention develops (accounting for dexterity and cognition), and do not inject with active UTI or urinary retention/PVR >200 mL unless the patient routinely performs CIC.[28][43][18]
  • Percutaneous tibial nerve stimulation (PTNS): office-based, minimally invasive; 30-minute weekly sessions for 12 weeks then maintenance.[29][30][43] Adult studies of non-neurogenic lower urinary tract dysfunction and female UI report symptom improvement with few side effects.[29][30][43]
  • Sacral neuromodulation (SNM): more invasive (implanted device); in a review of non-neurogenic lower urinary tract dysfunction studies with at least six months of follow-up, 29–76% achieved ≥50% fewer leakage episodes.[29] Poor response to PTNS does not predict failure of SNM, and a negative PTNS trial should not preclude an SNM trial. The InterStim SNM system is FDA-approved for chronic fecal incontinence in patients who failed or could not tolerate conservative treatment.[31][32][59]

Surgical Management of POP in Geriatric Patients​

Patient selection​

FactorConsideration
Frailty statusAmong ASPIRe participants aged ≥65, the combined prefrail/frail group had higher hazard of composite treatment failure (aHR 2.1, 95% CI 1.2–3.6); plan immediate postoperative living arrangements for patients who previously lived without assistance[10]
Cardiovascular diseaseIndependent risk factor for perioperative complications (blood transfusion, pulmonary edema, CHF); CAD and PVD were independent predictors alongside operative time
Cognitive statusAffects ability to manage pessaries, perform CIC, adhere to postoperative restrictions; screen with Mini-Cog
Sexual activity goalsDetermines whether obliterative vs. reconstructive approach is appropriate
ASA classHigher ASA associated with colpocleisis selection
Life expectancyInfluences whether durable repair (sacrocolpopexy) vs. simpler procedure is warranted

Surgical approaches by geriatric context​

Colpocleisis (obliterative surgery) is an option for patients who do not wish to retain vaginal penetrative sexual function, particularly when comorbidity makes a shorter procedure attractive. Discuss its irreversible vaginal closure and future examination limitations.[17] Outcomes:[33][35]

  • In a 2006–2022 ACS NSQIP retrospective cohort of 5,213 colpocleisis patients, mFI-5 frailty (score ≥2; 93/5,213) was associated with any 30-day complication (aOR 2.04, 95% CI 1.21–3.48).[61]

  • In women ≥75 years, colpocleisis patients are older with more comorbidities than those undergoing reconstructive repair, yet have no detected difference in complication rates and shorter LOS in an observational cohort (1.2 versus 1.7 days, P = 0.03).[33]

  • A 2026 retrospective single-center series (n = 58, mean age 75.6 years) reported 94.8% anatomic success at POP-Q stage ≤2 in its abstract and Table 3, but 89.6% for the same threshold in its Results prose. It reported 77.5% subjective success (PGI-I "much better" or "very much better") and 6.8% general decision regret at mean 2.9-year follow-up. No patients regretted loss of sexual function. In this single-center 58-patient series, blood loss estimated with the Gross formula exceeded 500 mL in 41/58 (70.6%); 12/58 (20.7%) had postoperative UTI, none received a transfusion, and one patient died of myocardial infarction one month after surgery. Significant improvements were seen in all pelvic-symptom domains (PFDI-20 decreased from 78.1 to 16.6, P < 0.001).[35]

In a 2014–2016 ACS NSQIP cohort of 764 women aged ≥75 undergoing prolapse repair, 43.7% underwent transvaginal repair, 42.3% colpocleisis and 14.0% sacrocolpopexy.[33]

In the ASPIRe randomized trial of posthysterectomy vault prolapse, sacrocolpopexy had lower 36-month composite treatment failure than vaginal native-tissue repair (28% versus 43%) among 360 operated women, with a median operative time 90 minutes longer than the vaginal arms.[62] In ASPIRe, which randomized women to native-tissue repair, sacrocolpopexy or transvaginal mesh, frailty was associated with earlier treatment failure.[10]

Complications in the elderly​

A retrospective study of 267 women ≥75 years found a 25.8% significant perioperative complication rate, with the most common being blood transfusion / significant blood loss, pulmonary edema, and postoperative CHF.[34] Within this cohort of women aged ≥75, operative time, coronary artery disease and peripheral vascular disease predicted significant perioperative complications; ASA class and Charlson Comorbidity Index did not.[34] A retrospective single-center study analyzed 720 admissions of women ≥80 years (65% for urogynecologic conditions); intraoperative complications occurred in 1.5% of all procedures, postoperative complications were mainly minor (Clavien-Dindo I–II), and no procedure-related deaths were recorded.[2]

Septuagenarians and older patients have an approximately 3-fold higher risk of mild early postoperative complications (OR 2.86, 95% CI 1.76–4.66) but no detected increase in major complications in the cited retrospective study.[36]

Genitourinary Syndrome of Menopause (GSM)​

GSM is a chronic, progressive condition; in studies cited by Gallo et al., symptoms were present in 45–77% of surveyed postmenopausal women and became more prevalent with age and time since menopause.[37] See GSM for the full framework. Geriatric-specific points:

  • Vaginal estrogen is recommended to reduce recurrent UTIs. The AUA/CUA/SUFU 2025 guideline recommends it for perimenopausal and postmenopausal women with rUTI when there is no contraindication .[49] Recurrent UTIs are a major source of morbidity, hospitalization, and antibiotic use in elderly women.[49][39][40]
  • Vaginal estrogen may improve urinary symptoms. The 2025 AUA/SUFU/AUGS GSM guideline states that clinicians may offer low-dose vaginal estrogen to improve genitourinary symptoms in patients with GSM and comorbid conditions such as overactive bladder .[50] Oral systemic estrogen increased incontinence in the WHI trial.[50][39]
  • Low-dose vaginal estrogen formulations can improve GSM symptoms. Choose according to symptoms, preferences, handling and cost.[37][38]
  • FDA approved revised labeling for an initial six menopausal hormone products, including a vaginal product, in February 2026 after initiating changes in November 2025. Check the specific current label; neither the older universal-boxed-warning claim nor a claim that all products are now warning-free is accurate.[44]
  • Progestogen is not needed for endometrial protection with low-dose vaginal estrogen based on 1-year safety data; a 2019 systematic review found no increased endometrial hyperplasia or cancer risk without progestogen. Postmenopausal bleeding nonetheless requires evaluation.[39][50]
  • Vaginal estrogen is underused in documented GSM: 9.0% of 1,838,732 Medicare beneficiaries with GSM-related diagnoses filled a prescription in the cited cohort.[37]

Other options include moisturizers/lubricants and, for appropriate indications, vaginal prasterone or oral ospemifene. These drugs are not interchangeable with vaginal estrogen for rUTI prevention or OAB. Breast-cancer history and agent-specific warnings inform drug selection. See the linked GSM page.[41][42]

Bacteriuria in Older Women​

Asymptomatic bacteriuria (ASB) is common in older women (10–50% over age 65 in prospective cohorts, many in long-term care) and rises with diabetes.[46] Do not screen for or treat ASB in routine care. Before an endoscopic urologic procedure expected to cause mucosal trauma, IDSA recommends screening for and treating ASB . Reserve cultures and antibiotics for new genitourinary symptoms or systemic signs of infection.[46][47] The EAU 2026 infections guideline reports ASB in 4–19% of otherwise healthy elderly women and men and in 15–50% of institutionalized older adults, and gives a strong recommendation not to screen for or treat ASB in postmenopausal women or elderly institutionalized patients (level 1a).[51] Those recommendations rest on randomized trials, many in nursing-home residents, in which treatment neither reduced symptomatic UTI nor cleared bacteriuria, and a meta-analysis of nine trials found more adverse effects with treatment. The same guideline notes that in older women genitourinary symptoms are not necessarily due to cystitis, states that no evidence supports NSAID symptomatic treatment of cystitis in geriatric patients and that NSAIDs are potentially inappropriate medications at this age, and limits its strong recommendation for non-antibiotic alternatives to non-geriatric patients.[51]

  • Acute mental status change or delirium (for example, after surgery): with bacteriuria but no local genitourinary symptoms and no systemic signs such as fever or hemodynamic instability, look for other causes and observe carefully rather than giving antibiotics.[46]
  • Fever without a localizing source: assess severity and seek urinary and nonurinary causes. In a bacteriuric patient with fever and other systemic signs potentially consistent with sepsis, start empiric broad-spectrum therapy covering both while evaluating the source.[46][47]
  • Why not treat: in a prospective cohort of 343 older delirious medical inpatients, treatment for presumed asymptomatic UTI was associated with poorer functional recovery (RR 1.30, 95% CI 1.14–1.48), without established benefit; C. difficile infection was numerically more frequent (7.5% versus 3.2%; OR 2.45, 95% CI 0.86–6.96).[48]
  • Prevention in women with true recurrent UTI: see Recurrent UTI; vaginal estrogen and other nonantibiotic options avoid repeated antibiotic exposure, whose risks (resistance, C. difficile, adverse drug events) are higher in older adults.[46]

Fecal Incontinence in Older Women​

FI prevalence rises with age, from 2.6% at 20–29 years to 15.3% at 70 years and older in US data, and reaches 40% to 70% in nursing-home residents. Management principles in the elderly:[32]

  • Conservative first: dietary fiber, stool-bulking agents, loperamide, biofeedback.
  • Sacral neuromodulation. ACOG describes it as a surgical option after failed conservative care regardless of sphincter integrity; a 61-study review cited by ACOG reported ≥50% fewer FI episodes in 63% at 6–12 months and 54% at 44–118 months.[32] The 2023 ASCRS guideline conditionally supports SNM as a first surgical option with or without a sphincter defect (low-quality evidence); in one prospective multicenter cohort, 27/76 (35.5%) patients followed for at least five years required revision, replacement or explant.[64]
  • Sphincteroplasty. Considered when EAUS demonstrates a discrete sphincter defect, though outcomes deteriorate over time.
  • PTNS. ACOG finds evidence insufficient for routine use in FI; in an adult RCT of 227 randomized participants, ≥50% fewer weekly FI episodes after 12 weeks occurred in 39/103 (38%) PTNS recipients and 32/102 (31%) sham recipients with complete bowel diaries, without a significant difference.[32][58]

For diagnostic workup, see Anorectal Function & Defecography.

Geriatric Urology in Men​

Comparable age-specific principles apply to older men presenting with voiding dysfunction and incontinence, and they are not otherwise collected on WARWIKI's general (non-age-specific) male SUI and artificial urinary sphincter pages.

  • Prostate-cancer screening context. PSA screening is separate from evaluating voiding symptoms; an unscreened man does not automatically need PSA testing for an incontinence workup. USPSTF advises against screening at age ≥70, whereas AUA/SUO individualizes screening intervals or discontinuation by preference, age, PSA, risk, life expectancy and health ; at age ≥75 with PSA <3 ng/mL, stopping or lengthening the interval may be reasonable.[53][54][57]
  • Evaluation sequence. For bothersome LUTS attributed to BPH, the AUA 2026 initial evaluation includes history, physical examination, standardized symptom scores and urinalysis . PVR and/or uroflowmetry may be added during initial evaluation to assess retention or alternative disorders ; before a BPH procedure, obtain PVR and image prostate size and shape . Frailty and cognition also shape the workup and treatment plan.[54]
  • Medical therapy trade-offs. For LUTS attributed to BPH, the AUA 2026 guideline recommends alfuzosin, silodosin or tamsulosin as uroselective alpha-blocker options ; for symptom relief, the AUA 2026 guideline recommends 5-alpha-reductase inhibitors when estimated prostate volume is >30 cc and/or PSA is >1.5 ng/mL . Alpha-blocker-associated orthostatic hypotension is a fall-risk concern in older men taking antihypertensives; ask about planned cataract surgery, discuss the risk of intraoperative floppy iris syndrome and advise the patient to tell the ophthalmologist about alpha-blocker use. Weigh symptom benefit against these risks when selecting an agent and dose, and reassess symptoms and blood pressure after starting or changing therapy.[55]
  • AUS versus male sling in the older man. An artificial urinary sphincter requires sufficient hand function and cognition to operate. For mild to moderate stress incontinence after prostate treatment, discuss a male sling . The guideline advises against routine sling placement for severe stress incontinence and favors AUS after radiotherapy . In selected nonradiated men unable to operate an AUS, a sling may be considered with counseling about expected efficacy.[56]

Summary of Geriatric-Specific Principles​

DomainKey Geriatric Principle
AssessmentScreen for frailty (TUG, CFS, Mini-Cog) rather than relying on chronological age; comprehensive geriatric assessment before elective surgery
MedicationsDiscuss observational dementia risk; often favor β3 agonists while checking their precautions and total anticholinergic burden
Conservative RxPessaries require comfortable fit and reliable examination/follow-up; tailor PFMT and behavioral care to functional ability
Vaginal estrogenUnderutilized among Medicare beneficiaries with coded GSM[37]; recommended for peri- and postmenopausal women with rUTI without contraindications [49]; improves vaginal GSM symptoms and low-dose treatment generally does not need progestogen; evaluate bleeding and individual contraindications[50]
Surgical selectionOffer colpocleisis when loss of vaginal penetration is acceptable
Perioperative careIn an RCT of 100 enrolled adults aged 60–80 undergoing transvaginal pelvic-floor reconstruction (95 analyzed), ERAS shortened postoperative stay, reduced resting pain at day 7 and reduced PONV at 12 hours[13]; ASCRS states that frail older adults undergoing colorectal surgery may benefit from prehabilitation [12]
Postoperative planningPlan immediate living arrangements before discharge: among ASPIRe participants living without assistance before surgery, 7/36 (19%) in the combined prefrail/frail group versus 5/85 (6%) in the nonfrail group changed to living with family or assistance immediately afterward; the combined prefrail/frail group also had higher composite treatment-failure hazard[10]
Minimally invasive therapiesPTNS is office-based and requires repeated visits. Botox can improve OAB symptoms, but measure PVR and check for active UTI or urinary retention before injection; assess whether catheterization would be feasible if retention develops, especially with limited dexterity or cognition[28][43]
Goals of careShared decision-making incorporating life expectancy, functional goals, sexual-activity preferences, and caregiver capacity

See Also​

References​

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2. Kołodyńska A, Kamińska A, Strużyk A, et al. "Geripausal Women — a New Challenge for Urogynecology in Upcoming Years." J Clin Med. 2026;15(2):530. doi:10.3390/jcm15020530

3. Shaw JS, Erekson E, Richter HE. "The Impact of Frailty in Older Women Undergoing Pelvic Floor Reconstructive Surgery." Menopause. 2020;28(3):332-336. doi:10.1097/GME.0000000000001681

4. Qaseem A, Dallas P, Forciea MA, et al. "Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline From the American College of Physicians." Ann Intern Med. 2014;161(6):429-440. doi:10.7326/M13-2410

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12. Saur NM, Davis BR, Montroni I, et al. "The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery." Dis Colon Rectum. 2022;65(4):473-488. doi:10.1097/DCR.0000000000002410

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19. Malcher MF, Droupy S, Berr C, et al. "Dementia Associated With Anticholinergic Drugs Used for Overactive Bladder: A Nested Case-Control Study Using the French National Medical-Administrative Database." J Urol. 2022;208(4):863-871. doi:10.1097/JU.0000000000002804

20. Zillioux J, Welk B, Suskind AM, Gormley EA, Goldman HB. "SUFU White Paper on Overactive Bladder Anticholinergic Medications and Dementia Risk." Neurourol Urodyn. 2022;41(8):1928-1933. doi:10.1002/nau.25037

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22. Maguire T, Marr C, Barry H, Abdel-Fattah M, McGuinness B. "Antimuscarinic Medication Used for the Treatment of Overactive Bladder in Women and the Risk of Cognitive Decline, Cardiovascular Disease and Mortality: A Systematic Review." Age Ageing. 2026;55(2):afag027. doi:10.1093/ageing/afag027

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