Nursing strategies for managing urological disorders in aging populations: a comprehensive review

Abstract

Urological disorders are increasingly common in aging populations, with conditions such as benign prostatic hyperplasia (BPH), prostate cancer, urinary incontinence (UI), and repeated urinary tract infections (UTIs) affecting a growing number of individuals. Nurses play a central role in managing these conditions, addressing the complex needs of older adults who often face multiple health issues, polypharmacy, and mental health challenges. This review explores how nurses apply evidence-based practices to care for elderly patients with urological disorders, emphasizing patient-centered approaches and interdisciplinary collaboration. Key focus areas include assessing and managing urinary symptoms, implementing behavioral strategies, utilizing technologies like remote urology, and promoting bladder health. The review highlights the importance of patient education, family support, and UTI prevention, particularly regarding catheter use. By synthesizing current research, this review underscores the vital role of nursing in improving outcomes and quality of life for older adults, advocating for the integration of urological nursing into senior healthcare systems and guiding future research and practice.

Background

Urological disorders, including lower urinary tract symptoms (LUTS), benign prostatic hyperplasia (BPH), urinary incontinence (UI), recurrent urinary tract infections (UTIs), and prostate cancer, are highly prevalent among aging populations and significantly impair quality of life, physical function, and psychological well-being [1, 2]. Age-related physiological changes, such as reduced bladder capacity, weakened pelvic floor muscles, and hormonal shifts, contribute to these conditions, which are often compounded by comorbidities like diabetes, cardiovascular disease, and neurological disorders [3]. By 2050, approximately 1.5 billion people worldwide will be aged 65 years or older, necessitating targeted healthcare policies to address these issues [2]. As the elderly population increases, elderly patients are suffering more widespread uro-gynecological conditions, rendering these problems of significant concern to public health. Some of the most prevalent problems include urinary incontinence, which approximately affects half of the older women population, and benign prostatic hyperplasia (BPH) which causes urinary symptoms in men. Urinary incontinence is divided into three subtypes which include stress, urgency and mixed. Stress incontinence is when people leak urine due to increased abdominal pressure. This occurs as a result of physical movement or activity like coughing, and laughing or exercising. This condition has a profound effect on daily living, social life, and in many instances, the person may suffer from emotional issues like depression and social isolation. For that reason, effective treatment and management strategies have become the greatest hope [4]. Modern non-invasive imaging and bladder monitoring devices, as well as other novel treatments, have made managing these disorders easier, which in turn improves the care system, particularly in diagnosis and treatment [5]. Stress urinary incontinence soars among older women, but pelvic floor muscle training can be of great help. The challenge still lies with the older population in that many do not seek help because they feel embarrassed to report their symptoms [6]. The situation is different now due to the advancements made in technology and research. Bladder problems are now treated using electronic bladder devices and robot-assisted surgeries [6]. There is also increased attention given to the urinary microbiome, which plays a crucial role in either guarding or triggering urinary complications [6]. There are still large gaps in the literature. The effectiveness of some nursing strategies, like biofeedback or training programs, is largely absent [6]. So is the case in studying the urinary microbiome’s influence in age-related urological disorders. Additionally, there is a lack of straightforward nursing guidelines concerning postoperative complications following urological surgeries in elderly patients [7].

A targeted, non-systematic (narrative) literature search was undertaken to identify recent and relevant evidence on nursing roles and interventions in geriatric urology. We searched PubMed/MEDLINE, Embase, CINAHL and the Cochrane Library for English-language publications from 2000 through May 2025 using combinations of keywords and MeSH terms such as “geriatric urology”, “nursing interventions”, “urinary incontinence”, “benign prostatic hyperplasia”, “urinary tract infection”, “prostate cancer”, “aged” and “older adults”. Additional citations were identified by hand-searching reference lists and relevant guidelines. Articles were selected purposively for clinical relevance to nursing practice (including randomized trials, systematic reviews, guideline documents and high-quality observational studies). Approximately 150 potentially relevant records were screened and 117 sources were included to inform this narrative synthesis. The emphasis was on extracting practical nursing strategies, implementation issues and identified evidence gaps rather than on exhaustive systematic appraisal. This review addresses these gaps by organizing evidence into epidemiological, pathophysiological, assessment, intervention, and future directions sections, emphasizing nursing’s pivotal role in holistic care.

Main text

Epidemiology of urological disorders in aging populations

Urological disorders increase in prevalence with age due to demographic shifts and comorbidities such as diabetes, obesity, hypertension, and cardiovascular disease. These conditions collectively burden public health systems and diminish quality of life [8]. LUTS/BPH prevalence was also quite high in elderly patients in the study done on a traditional Chinese population, and smoking, as well as depression, further worsened the condition. Interrelation of LUTS and ED has also been observed, with numerous documentation describing the co-occurrence that diminishes life satisfaction [9]. LUTS is now being assessed as a potential predictive risk element for ED across multiple age ranges and co-existing conditions as well.

LUTS and BPH are particularly common in men. LUTS prevalence rises with age, reaching 62.5%–98% in men aged 50 years or older. BPH affects 60%–80% of men aged 65 years or older, with global cases increasing from 50.7 million in 1990 to 112.5 million in 2021 [9–11]. Risk factors include age, obesity, low education, sedentary lifestyle, genetics, and high intake of red meat and saturated fats. In a Chinese cohort, LUTS/BPH prevalence was 11.97% overall but 22.7% in men over 70 years, exacerbated by depression and smoking [9–11].

In Saudi Arabia, BPH prevalence was 12.0%, linked to obesity [12]. Histologically, prostatic hypertrophy occurs in over 50% of men by age 60 and nearly 90% by age 70. LUTS is also associated with erectile dysfunction (ED), with 72.2% of men with ED experiencing LUTS compared to 37.7% without [13, 14].

UI affects both genders but is more prevalent in women, with rates of 37%–40% in those aged 65 years or older and 25%–30% in men [15]. A meta-analysis reported 37.1% prevalence among women aged 55–106 years, highest in Asian populations [16]. In Eastern Turkey, urge UI affected 60% of women over 65 years. In Brazil, UI prevalence was 29.4% among the elderly, higher in women (36.3%) than men (17%) [13]. The risk factors for UI may include age, female sex, diabetes, stroke, physical inactivity, low education, fecal incontinence, chronic cough, polypharmacy, and functional limitations [16, 17].

Recurrent urinary tract infections (UTIs) are common, affecting 20%–30% of adults aged 65 years or older. Incidence increased 60.4% globally from 1990 to 2019, with rates of 2,782.6 per 100,000 in women (3.6 times higher than in men) [17, 18]. In men, BPH-related bladder outlet obstruction (BOO) promotes bacteriuria, with symptomatic UTIs rare (1 per 100 person-years) but often necessitating interventions like transurethral resection of the prostate (TURP) [19].

Prostate cancer adds to the epidemiological burden, with metastatic castration-resistant prostate cancer (mCRPC) common in elderly Medicare populations, influencing treatment patterns and survival and real-world data highlight disparities in outcomes, underscoring the need for tailored nursing strategies [20].

Regardless of the evidence, the link between symptomatic UTI and the residual volume following urination has yet to be determined, highlighting the challenges associated with the management of urological pathologies among older patients. Current protocols recommend surgical intervention only for symptomatic UTIs in elderly patients to mitigate the risk of excessive antibiotic treatment. The Table 1 summarizes the prevalence of various urological disorders reported in studies.

Table 1.

Prevalence of various urological disorders

Disorder	Description	Prevalence	Risk Factors & Key Points
Lower Urinary Tract Symptoms (LUTS)	Includes urgency, frequency, nocturia, weak stream, incomplete voiding, etc.	Men aged ≥ 50: 62.5%–98% Women aged comparable	smoking, depression, diabetes, obesity, erectile dysfunction (ED)
Benign Prostatic Hyperplasia (BPH)	Non-cancerous enlargement of the prostate causing bladder outlet obstruction.	Men aged ≥ 65: 60%–80%	age, obesity, low education, sedentary lifestyle, genetics, and high intake of red meat and saturated fats
Urinary Incontinence (UI)	Involuntary leakage of urine; includes stress, urge, and mixed types.	Men aged ≥ 65: 25%–30% Women aged ≥ 65: 37%–40%	age, sex, diabetes, stroke, physical inactivity, lower education, fecal incontinence, chronic cough, polypharmacy, and functional limitations
Recurrent Urinary Tract Infections (UTIs)	Frequent symptomatic or asymptomatic infections; often due to bladder obstruction or immune decline	Adults aged ≥ 65: 20%–30%	age, immune suppression, comorbidities, catheter use, BPH, residual urine; treat only symptomatic UTIs in elderly to avoid antibiotic overuse
Prostate Cancer	Malignant growth in the prostate, often metastatic in elderly	65% of new prostate cancers in men aged ≥ 65: 25%–30%	Age, family history; real-world survival varies with treatment access

Pathophysiology and age-related changes

Aging induces structural and functional changes in the urinary system, contributing to LUTS, BPH, UI, UTIs, and prostate cancer susceptibility. Comorbidities like diabetes and hypertension exacerbate these via bladder wall remodeling, including collagen deposition, fibrosis, and urothelium collapse, reducing compliance and capacity while increasing frequency and nocturia [21, 22]. Detrusor muscle hypertrophy leads to weakened contractions, incomplete emptying, and post-void residual urine, heightening UTI risk [23, 24]. In women, postmenopausal estrogen decline causes urethral mucosal thinning and reduced closure pressure, promoting stress UI [25, 26]. In men, BPH elevates intrabladder pressure, inducing detrusor overactivity and voiding dysfunction [22].

Functionally, impaired nitric oxide (NO) signaling reduces detrusor relaxation, while reactive oxygen species (ROS)-induced oxidative stress and mitochondrial damage impair contractility [27, 28]. Age-related urethral stiffness and pelvic floor weakness further compromise continence. Neurogenic changes in the brain-bladder axis diminish voiding reflex control, fostering urgency and overactive bladder [29].

Age-related closure pressure and flexibiliy loss in the urethra, particularly in post-menopausal women, can stem from estrogen deficiency induced mucosal thinning, which makes tissue more susceptible to leakage during straining [25, 26]. The synergistic age-related decline in strength and coordination of pelvic floor muscles also underscores these changes, affecting continence and voiding, especially in women [24]. These functional impairments, frequently synergistic, highlight the multifactorial causation of geriatric urological dysfunction.

Aging bring damages to cells and tissue due to oxidative stress, inflammation, and hormonal changes. ROS overproduction impairs contractility of the detrusor, decreases NO bioavailability, and leads to fibrosis. This is made worse by a mitochondrial deficit which further increases ROS while reducing ATP, and increasing tissue damage, cell damage, and accelerating the ROS-overloaded cycle [30].

Cellular mechanisms involve ROS overproduction, NLRP3 inflammasome activation, and cytokine release (e.g., IL-1β), promoting fibrosis and senescence-associated secretory phenotype (SASP)-driven inflammation [21, 31]. Hormonal shifts, including estrogen deficiency in women and androgen imbalances in men, accelerate these processes [10, 25].

Clinically, these processes are responsible for the high incidence of LUTS, which calls for targeted therapy. Conventional treatments, as may be provided with anticholinergics or alpha-blockers, prove to have limited efficacy due to the holistic character of age-related alterations, but novel treatments aimed at decreased oxidative stress, inflammation, and senescence hold promise [31]. Early intervention, comprising lifestyles, pelvic floor therapy, hormone modulation, and pharmacological interventions, is essential to prevent further advancement into end-stage lower urinary tract dysfunction and maintain urinary tract health among the aged [26].

Nursing assessment and diagnosis of urological disorders

With the rising prevalence of urinary disorders among older adults, accurate nursing assessment is essential for effective management. Instruments like the International

Nursing strategies for managing urological disorders (Evidence-Based nursing Interventions)

Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and bladder diaries aid nurses in assessing symptom patterns, their severity, and the impact on patients’ daily activities [32]. Besides these tools, nurses consider vital signs, medical history, and urinary and fluid intake habits for a more comprehensive assessment. The most common nursing diagnoses include urinary retention, urge UI, and risk for infection. Such diagnoses serve as the basis of tailored care plans for patients with urinary issues [33]. Centering the assessment on the patient alongside other relative metrics improves outcomes and decreases complications associated with urinary issues in the elderly population. Comprehensively understanding UI in older adults incorporates several broad concepts.

UI, a “Geriatric Giant,” affects 50%–80% of frail elderly, often underdiagnosed in long-term care (LTC) where prevalence exceeds 70% [33]. Multidisciplinary teams (nurses, physiotherapists, geriatricians) enhance detection. Nurse-led assessments in LTC emphasize reversible causes over absorbent products, supported by education to address knowledge gaps [33, 34] .

UI care among older adults is greatly enhanced by nurse-led initiatives. Nurses trained in advanced practice as well as continence nurse specialists are skilled to deal with the evaluation, treatment as well as prevention of UI. Nurse-led programs, which contains comprehensive care strategies, can be modified based on every older people requirements in various settings, such as residential care facilities. These strategies may range from simple, including encouraging fluids intake, to more complex, and comprehensive programs involving education, behavior therapies, and environmental changes [35, 36].

UI remains a common and challenging issue among older adults, especially those residing in long-term care (LTC) facilities Continuously, evidence indicates that over 50% of LTC residents suffer from some type of UI, which is able to drastically decrease their quality of life. The rates of prevalence among nursing home residents have been found to be over 70% in the United States, an indicator of the magnitude of the issue. While it has high prevalence, UI is usually under-diagnosed and poorly treated in this group [37]. One of the persisting concerns emphasized in the studies is the lack of proper training and awareness among care staff regarding UI. Often, the emphasis is on managing symptoms through the use of absorbent products rather than identifying the essential causes. This reflects a gap in assessment skills and clinical knowledge, to rectify, there is an urgent need for enhanced staff education and training that promotes early detection and personalized continence care [38, 39].

Research has shown that educational programs for nursing staff are an effective strategy to translate evidence-based practices into long-term care settings. These programs improve staff knowledge and behavior, particularly in the assessment and documentation of UI, and support the use of conservative, individualized management approaches. Although the guideline published by the Agency for Healthcare Policy and Research (AHCPR) exists to support evidence-based UI care, it has been noted as a complex for routine practice. As a result, many residents still do not receive the standard level of healthcare that aligns with recommended for evaluation and treatment [40, 41].

Nurse intervention has also been investigated for preventing UTIs, which are common in individuals with UI and can exacerbate the condition. A systematic review of nurse-led interventions in residential aged care settings identified three main approaches: involving advanced practice nurses, specific interventions (such as increasing fluid intake), and using comprehensive programs combining different strategies. While the studies indicate some positive outcomes, such as decreased cases of asymptomatic bacteriuria and lower antibiotic usage, the diversity of study designs made it difficult to determine the most effective approach. Additionally, there was also limited evidence regarding the effectiveness of nurse-led interventions in the prevention of catheter-associated UTIs [42–44].

Interdisciplinary collaboration between professions in UI care system is crucial for improving care as a public health issue. Studies have shown that continence nurse specialists, particularly in long-term care facilities, enhance patient outcomes. They have managed to reduce episodes of incontinence and decrease the incidence of UTIs, pressure ulcers, and falls through the development of personalized continence programs [45, 46]. Despite some progress, there are still challenges in providing good care for people with UI. These challenges include heavy workloads, and the lower prioritization of UI care by nursing staff. Personal beliefs, attitudes toward older adults, and a lack of knowledge about UI among nurses can also affect how well the condition is managed. To improve care, it’s important to offer better education, training, and support for nursing staff. Having regular monitoring and identifying people within the care team who can lead and advocate for better UI care can also help make these programs more effective [39, 47]. Although the sources explain the age-related causes of UI and UTIs, none of them include diagrams showing the changes in the urinary tract of men and women. Adding such diagrams would be helpful for better understanding these changes.

Nursing strategies for managing urological disorders (Evidence-based nursing interventions)

Urinary disorders with special emphasis on UI and UTI, are especially common among the elderly with features of frailty, cognitive impairment, or restriction in mobility. It may lead to serious complications such as bacteremia, urosepsis, increased length of stay, and diminished quality of life (QoL) [33, 48, 49]. The further stigma and loss of autonomy only aggravates the situation. Nurses driven by the absence of these interventions that are considered basic have claimed gaps in education and knowledge by healthcare professionals. Evidence based strategies performed by nurses are fundamental, centered around behavioral modifications aimed at symptom control and mitigation.

Behavioral interventions include bladder training (gradual voiding intervals) and pelvic floor muscle exercises (PFME/Kegels), reducing episodes by 50%–70%. Nurses provide demonstrations and monitor compliance. Prompted voiding in LTC cuts UI by 30%. Pharmacologically, selective antimuscarinics minimize delirium risks versus non-selective agents. Absorbent products are adjuncts, not primaries [50–52].

Medication therapy must be managed with the utmost care because of the susceptibilities of the elderly. Confusion, delirium, and cognitive decline occur readily with non-selective antimuscarinics, so the long-term care use of these speaks to their dangerous prescribing habits as cognitve issues are so common with overactive bladder (OAB). Patients are monitored extremely closely, so every caregiver and the patient along with the prescriber’s attention is drawn to these dangers, and smart prescribing is done such as changing to selective antimuscarinics, or stopping medications altogether, when preferred [53, 54]. For BPH, nurses promote lifestyle changes (e.g., fluid management, timed voiding) and monitor alpha-blocker adherence, with attention to polypharmacy risks such as orthostatic hypotension. In prostate cancer, particularly mCRPC, they provide education on treatment options (e.g., irreversible electroporation) and survivorship issues, including fatigue and sexual dysfunction [20, 55]. Gonadotropin-releasing hormone (GnRH) therapies are associated with cardiovascular events in up to 15% of patients, often linked to metabolic syndrome; nurses play a key role in screening for shared risks such as physical inactivity [56, 57].

For UTIs, antibiotic dosing adjusts according to renal function, measured via estimated glomerular filtration rate (eGFR), to avoid toxicity, with nurses promoting culture-guided therapy to counteract local resistance patterns [53, 54]. Managing UI with absorbent products like pads or briefs tends to be over hygienic but foster greater dependency. Nurses consider UI causes such as detrusor overactivity or sphincter weakness using instruments like the International Consultation on ICIQ-SF and bladder diaries to analyze triggers. The use of catheters, the most common CAUTI risk, is reduced through evidence-based practices of limited use, controlled access, prompt withdrawal, and external catheters. The use of ultrasound bladder scanners for measuring post-void residual volume improves infection control and patient comfort [58]. Infection prevention is a critical priority for nursing personnel, particularly with incontinence associated with long-term care especially when frailty is present. Nurses promote complete perineal hygiene care instruction, particularly effective in front-to-back wiping and daily bathing with mild non-disruptive cleansers aimed at reducing bacterial colonization, especially for incontinent residents. Hydration with sufficient fluid, aimed for 1.5–2 L daily when not contraindicated, flushes bacteria out of the urinary tract, with nurses tracking input through fluid charts and negotiating around obstacles such as dysphagia or cognitive impairment [46, 59, 60]. Nurses actively advocate against inappropriate catheterization while ensuring proper insertion technique. Catheters are removed within 48 h whenever possible, following the CMS criteria ([https://www.cms.gov/regulations-and-guidance], 2024). Among the elderly, asymptomatic bacteriuria does not necessitate antibiotics unless symptoms are present, due to the risks associated with increased antibiotic use and exposure to Chloridoids’ difficile infections. In cases of symptomatic UTIs, the choice of antibiotics is determined by local antibiograms and other existing conditions such as diabetes, which increases the risk of candiduria [61]. These decisions are made collaboratively by nurses, pharmacists, and physicians to ensure optimal therapy.

Scheduling toileting, such as prompt voiding each 2–3 h among cognitively impaired individuals, minimizes episodes of UI, though recent evidence stresses lack of data about long-term efficacy and patient inclusion criteria, identifying an area for further study needing research attention [62]. Through combining these holistic, patient-focused interventions, nurses address the multifaceted effect of disorders of the urinary tract, enhancing continence, forestalling complication, and ensuring QoL among older adults.

Urological disorders can have notable, far-reaching psychological and socio-psychological impacts on older individuals, influencing their confidence, dignity, interaction, and overall well-being [63, 64]. Emotional support, enhancing openness of communication, and restoring psychological distress related to disorders such as UI can be provided by nurses [65, 66]. Incontinence may be embarrassing and cause isolation and nursing intervention can restore dignity and promote control [65, 66]. Educational interventions can be empowered by residents in nursing homes to increase residents’ overall well-being [67]. Multidisciplinary team interaction, comprising nurses, geriatricians, and other health professionals, is vital to provide complete management [68]. In addition, complete and thorough knowledge of treatment presented by nurses can facilitate planning of appropriate care and potentially aid improved psychosocial outcomes [68].

Overall, it can be said that, fully managing urological disorders among older individuals needs complete, evidence-based assessment that incorporates behavioral, drug, and psychosocial interventions [69]. The main personnel providing this kind of care are nurses, using main theoretical concepts like geriatric syndromes, self-care deficit paradigm, and person-centred care to frame practice. Behavioral teaching like bladder training and PFME is crucial in managing UI [66]. Proper drug management with consideration of possible side effects in older individuals is significant [70]. Effective control of incontinence requires proper use of attendant apparatus and routine toileting schemes as well as UTI prevention by emphasizing hygiene, proper fluid intake, and avoiding catheterization [71], and intervention of psychosocial implications of urological disorders by restoring confidence and well-being is an integral feature of practice of nurses [66]. Table 2 outlines the main nursing strategies and their descriptions for managing urological disorders in older adults.

Table 2.

Comparison of nursing strategies for managing urological disorders

Strategy	Description
Behavioral Therapy	Includes pelvic floor muscle training bladder retraining and PFME reduced UI episodes.	[72, 73]
Medication Management	Use of beta-3 agonists and anticholinergics with careful consideration.	[73, 74]
Surgical Interventions	Minimally invasive procedures like sacral neuromodulation and sphincter implants.	[75]
Sensor-Based Interventions	Utilizes smart continence assessment systems to monitor and manage incontinence.	[76]
Digital Interventions	Includes telehealth platforms and mobile apps for bladder control.	[77]
Psychosocial Management	Education and autonomy improved quality of life; reduced complications fostered independence.	[66]

Challenges in geriatric urological nursing

Multiple theories, such as Activity Theory, Disengagement Theory, and Continuity Theory, provide essential frameworks for understanding and addressing the multi-faceted needs of older adults in geriatric urological nursing and developing holistic, patient-centered care models [78]. According to Activity Theory, continued physical and social involvement is crucial to health, and interventions such as mobility exercises and social interactions are advocated to prevent urological complications, such as urinary retention or incontinence, and promote quality of life [79]. According to Disengagement Theory, older adults shift away from social roles during aging and should thus be balanced in maintaining respect for residents’ autonomy and privacy needs with efforts toward keeping residents involved in urological care to minimize isolation and ensure effective control of conditions [80]. Continuity Theory posits the importance of maintaining consistent lifestyle, routines, and settings and advises adherence to accustomed care practices in geriatric urology in order to avoid stress and anxiety related to urological conditions such as urinary incontinence or frequent urinary tract infections [81]. Theories are transformed into practice through health promotion strategies in the form of routine UTI screenings and bladder control programs to support healthy aging [81], patient-centered care that customizes interventions to the cultural, social, and psychological needs of the patient to ensure compliance and comfort [82], and interdisciplinary care that brings nurses, physicians, social workers, and other specialists together in order to ensure holistic care covering the physical, emotional, and social aspects of urological care in older adults [83]. Grounding care in these frameworks enables nurses to better address the multi-faceted needs of aging adults, enhancing clinical outcomes and overall well-being.

According to these theories, the aging population poses specific challenges in geriatric urological nursing, especially in communication, nursing shortages, and cultural adaptation (Fig. 1). These challenges need to be addressed by taking a multi-faceted approach that incorporates advanced communication strategies, workforce and cultural competence training, by adopting these strategies, nurses are able to deliver high-quality, patient-centered care that caters to the specific needs of older persons.

Fig. 1.

Challenges in Geriatric Urological Nursing.

Effective communication is the pillar of high-quality geriatric urological care, but it is severely challenged by cognitive decline in older adults, including those with dementia or Alzheimer’s disease, who may have trouble communicating needs, thus rendering care delivery more complicated. Studies show that care providers use techniques like “compliance-gaining” and “learning the language” to bridge these communication gaps; in most cases, these strategies are ineffective in those with extensive cognitive impairments, and care is instead marked by misunderstandings and suboptimal care [84, 85]. Older adults with low health literacy also struggle with understanding complex medical information on urological conditions, with ensuing non-adherence to treatment and deteriorating health outcomes [86]. The challenge is further complicated in those who are bilingual with dementia, where language loss leads to language incongruity with care providers and contributes to social isolation and lowered well-being, and with evidence emphasizing the importance of culturally and linguistically congruent care [85]. To bridge these barriers, evidence-based practices involve employing extensive training programs to equip care providers with effective communication skills, specifically with cognitively impaired individuals [87], using culturally congruent care to address the needs of variably sourced residents and using visual support and plain language to enhance understanding in those with cognitive impairments [88]. These measures seek to promote patient-centered care, improve adherence to treatment, and enhance the quality of life in older adults with urological conditions.

The growing need for specialist geriatric urology nursing due to the rapidly aging population with complicated urological needs is faced with severe shortages in critically required staff, further fueled by low availability of geriatric nurses and high turnover rates due to the physically and emotionally demanding nature of the work [89, 90]. The main reasons behind the crisis are the aging nursing workforce, with experienced professionals nearing retirement age, resulting in extensive loss of talent and leadership in the discipline [91]. The specialty nature of geriatric urology necessitates specialized knowledge and skills, but there are few nurses who are properly educated in the area, resulting in deficiencies in specialized experts who are able to treat ailments such as incontinence or urinary tract infections in older persons [92]. Stress in the workplace is fueled by the physical and emotional demands of managing frail older adults with complicated, often persistent urological problems and contributes to burnout and attrition in care workers [93]. To address these shortages, evidence-based solutions are to adopt effective recruitment and retention strategies, such as providing competitive compensation, professional growth opportunities, and mentorship programs to retain and attract nurses in geriatric urology [62]. Increasing educational programs to cover specialist training in geriatric urological care is paramount in providing nurses with the necessary skills to address the particular needs of older persons successfully [83]. Promoting cultural and linguistic diversity in the workforce to meet the patient population’s cultural and linguistic diversity is likely to promote care quality, patient satisfaction, and better communication and trust in care environments [94]. These holistic measures are imperative in bridging the care delivery gap and providing high-quality urological care to older persons.

Cultural adaptation is central to effective geriatric urological care, since older adults with variable cultural backgrounds have distinct care needs determined by values, beliefs, and practices, further affecting their healthcare outcomes and adherence to and engagement in urological treatments [95]. Among the main challenges in cultural adaptation is language difference resulting in miscommunication and mismanagement of care practices, especially in the transmission of vital information regarding conditions such as incontinence or urinary tract infections [94]. Cultural practices and beliefs concerning, e.g., diet, regimen, or end-of-life care also play significantly in care variability and need to be incorporated into individually tailored care plans to ensure respect and pertinence but are usually not heeded [96]. Insufficient cultural competence in the nursing staff further enhances these challenges to produce culturally insensitive care that decreases resident satisfaction, trust, and health outcomes [97]. To counter these problems, evidence-based measures consist in ensuring continuous cultural competence training in nursing staff to enhance deeper engagement with cultural influences on care and increase capacities in providing sensitive and effective care [98]. Creating ethno-specific care homes or care units that address cultural and language needs of specific resident subpopulations ensures more customized and supportive care environments [94]. Also, active engagement of family members in care planning is necessary to ensure respect and incorporation of cultural wishes and values, increasing concord among care delivery and values of residents [93]. These measures all work together toward bridging cultural gaps and enhancing compliance and equitable, high-quality urological care in older adults with variable cultural backgrounds.

Innovative approaches and technology in nursing care

The increasing need for specialist geriatric urological nursing, has spurred the advancement of innovative care models and technologies with the objective of enhancing patient outcomes, curtailing healthcare burdens, and raising the quality of life. Sensor technologies and wearable devices have proven to be revolutionary tools, allowing monitoring of vital physiological parameters like urine saturation levels across the day and night, enabling timely intervention in the form of scheduled toilet programs that drastically minimize the use of absorbent pads and restore patient dignity [99]. Smart wearable systems with advanced AI, like those designed to anticipate episodes of incontinences, utilize inferential analytics in innovative ways to extend care from reactive to preventive, eliminating patient distress and maximizing nursing efficiency [100]. Telemedicine and mobile apps further disrupt care by providing remote consultation and expert assistance and empowering older adults, especially those with mobility issues, with agency in managing urological complications by monitoring symptoms and communicating with healthcare professionals in real-time, as demonstrated in successful urogynecology and paediatric urology uses [101]. Digital care platforms like the SMART system used in home care and the RO-Smart-Ageing system combine multi-faceted geriatric assessments, real-time care provider collaboration, and rehab programs to impose a coordinated care model on addressing urologic diseases with many aspects [102]. The technologies have shown tangible outcomes in the form of lowered emergency room visits and hospitalizations through initiatives like the CareWell program and better control of concurrent chronic ailments like diabetes and hypeension, further boosting overall health outcomes and patient autonomy [103, 104].

Innovative models of care, like the Systems for Person-centered Elder Care (SPEC), reflect the convergence of interdisciplinary practice, cloud-based information and communication technology (ICT) platforms, and principles of person-centered care to meet the holistic needs of older adults with urological conditions through improvements in care quality, such as extensive reductions in absorbable product usage and adoption of evidence-based toilet programs [105]. Technologically enhanced care models, based on the incorporation of sensors, AI-based decision support systems like the NeuroPredict platform, and automated data analysis, optimize care delivery by providing early detection of health decline and targeted individualized intervention, thus easing caregiver workload while ensuring better clinical outcomes [102, 105]. Care models in home care settings, facilitated by platforms like the SMART system, empower patient autonomy by embedding wearables and mobile apps in remote monitoring, with high usability and acceptability by older adults and timely and personalized intervention [106]. Nevertheless, these technologies have major barriers toward adoption, such as the unavailability of standardized guidelines on technology-based continence care and performance, limiting scalability and high-stakes data privacy with resultant security measures required to foster patient trust, as experienced in the SMART system’s design [100, 106]. Ethical concerns, like addressing AI bias and ensuring fair access to advanced technology, need close consideration to avoid differential care delivery [102, 107]. Sustained commitment is also required in implementation, with significant investment in educating healthcare professionals in digital tool use and providing infrastructural support, including hardware like laptops and tablets, for easy incorporation in long-term care environments [108]. Conquering these challenges in regulation, ethics, and usability will allow healthcare systems to optimally harness these innovative strategies to ensure patient-centered high-quality urological care and ultimately revolutionize the care of geriatric urological conditions and improve older adults’ well-being. Figure 2 showed the Technologies, Policies and improve outcome of Aging Populations Nursing Care.

Fig. 2.

Technologies and their challenges and Impacts in Aging Populations Nursing Care

Future considerations and research directions in nursing

The widening scope of urological disorders among ageing communities requires a holistic approach to nursing practice that incorporates advanced clinician interventions, strong education frameworks, and system policy reforms to enhance patient outcomes and quality of life [109, 110]. Nurse-led management of incontinence through scheduled toileting, prompted voiding, bladder training, pelvic floor muscle exercises, and lifestyle changes such as fluid management and weight loss has proven to work in reducing incontinence episodes but the ability to scale up these treatments in varied settings in home care, residential care, and long-term care settings needs to undergo rigorous appraisal for consistency in their beneficial impact [100, 109, 111]. Prevention of Urinary Tract Infections screening strategies through hydration protocols, good catheter care, cranberry products, probiotics, and topical oestrogen in postmenopausal women along with interventions such as the “Skip the Dip” program for reducing unnecessary urinedipstick tests have the potential to reduce the use of unnecessary antibiotics but longitudinal studies need to determine their sustainability, cost-effectiveness, and adaptability in diverse care settings [112–114]. Comprehensive Geriatric Assessment (CGA), which focuses on the evaluation of the patient’s physical condition, functional status, mental condition, social support system, and the environment, plays a critical role in the identification of multifactorial causes of urological disorders and the creation of personalized care strategies but its maximum integration into routine practice in urban as well as rural and scarce resource settings remains an important area for ongoing research [108, 112]. Enhancing interdisciplinary cooperation among nurses, geriatricians, urologists, physical therapists, occupational therapists, dieticians, and social workers ensures the delivery of comprehensive and whole-person care, but future work must establish evidence-based protocols to address teamwork communications, role clarification, and conflict management to maximize care delivery [115]. Research should also investigate the use of theoretical frameworks for developing these interventions, that is the Intervention Mapping Approach and Transformative Learning Theory to base these interventions on experiential education along with critical reflection to create these interventions to suit the real-world practice settings [116].

Policy and education are vital to provide high-quality nursing care for and manage the multifaceted needs of older adults with urological conditions. Combined care models, e.g., the Program of All-inclusive Care for the Elderly (PACE), which integrates medical, social, and community-based services seamlessly, provide a promising model for comprehensive care but need to be tested through empirical studies for their efficacy, replicability, and adaptability for urological care in varied populations [117, 118]. Experimental gerontological nursing education programs, e.g., the IGNITE initiative and the Hartford Institute’s Try This series, offer evidence-based structured education in geriatric care but longitudinal studies are required to determine their effects on nurse competence, patient outcomes, and quality of care in varied settings [116]. Ongoing professional education is also required to provide nurses with knowledge of technological advances e.g., telehealth platforms, wearable real-time monitoring sensors, and AI-based decision-making support and revised clinician guidelines for evidence-based care, requiring inquiry into efficient training strategies, including simulation-based education and virtual reality-based education [108]. Cultural competence education is important to promote care for diverse population segments and accommodate diverse cultural belief patterns, practice patterns, and patterns of illness and care-seeking but future studies are required to create and test evidence-based culturally responsive interventions that provide respect for diverse cultural beliefs and practice patterns and illness and care-seeking patterns in multicultural or under-served communities [119]. Policy support for aging-in-place and community-based models for care, e.g., home adaptation programs, community-based care services, and payment for home healthcare services, can increase patient autonomy and satisfaction but their replicability, cost-effectiveness, and impact on urological care outcomes need to undergo rigorous evaluation [112, 116]. The Medical and Old-Age Care Integration Model and the Geri-FORCE case management system that focus on interdisciplinary teamwork and precision healthcare must undergo evaluation to develop scalable systems for urological care [114, 120]. With a focus on these clinical education and policy directions for inquiry, nursing can revolutionize the management of urological conditions in the elderly population as a whole, enhancing their medical outcomes, lowering healthcare costs, and advancing patient well-being.

Conclusion

This narrative review underlines the importance of evidence-based nursing approaches to the management of urological conditions UI, BPH, LUTS, and UTIs among aged people, with up to 50% of elderly women experiencing UI and 60–80% of men aged above 65 years experiencing BPH. All of these conditions degrade the quality of life, drive high health care costs (over 5 billion dollars each year), and heighten risks for falls, depression, and infections. Some of the chief intervention strategies include behavioral education (e.g., bladder training, pelvic floor muscle training), medication management with judicious anticholinergic use, management of incontinence through prompted voiding and sensor-enabled technologies such as TENA SmartCare, UTI prevention through hygiene and restricted catheter use, and psychosocial support to ensure dignity. These approaches, underpinned in geriatric syndromes, deficit theory of self-care, and person-centered care, underscore nurses’ central role in interdisciplinary care, preventing complications and improving patient outcomes in long-term care environments where prevalence of UI is above 50%. Despite advances, there are still gaps, such as shortage of long-term data about behavioral treatment, under researched urinary microbiome treatment, and lack of standardized protocols for post-operative care. Heterogeneity of study and short sample sizes, alongside staff shortages and cognitive limitations, reduce generalizability and implementation. Future studies should focus on longitudinal studies, microbiome-innovations, culturally appropriate treatment, and scalable technologies like AI tools and telemedicine to fill the gaps. In promoting a move from passive to active care, the review challenges stigma and training gaps, aligning with global trends in aging (22% aged + 65 by 2050). It advances nursing by encouraging innovative, accessible care models, informing practice, education, and policy to enhance quality of life in older adults with urological disorders.

Abbreviations

BPH

Benign Prostatic Hyperplasia

BOO

Bladder Outlet Obstruction

CAUTI

Catheter-Associated Urinary Tract Infection

ED

Erectile Dysfunction

eGFR

Estimated Glomerular Filtration Rate

GnRH

Gonadotropin-Releasing Hormone

ICIQ-SF

International Consultation on Incontinence Questionnaire-Short Form

ICT

Information and Communication Technology

IL-1β

Interleukin-1 Beta

LTC

Long-Term Care

LUTS

Lower Urinary Tract Symptoms

mCRPC

Metastatic Castration-Resistant Prostate Cancer

NLRP3

NOD-Like Receptor Protein 3

NO

Nitric Oxide

OAB

Overactive Bladder

PFME

Pelvic Floor Muscle Exercises

PSA

Prostate-Specific Antigen

QoL

Quality of Life

ROS

Reactive Oxygen Species

SASP

Senescence-Associated Secretory Phenotype

SPEC

Systems for Person-centered Elder Care

TURP

Transurethral Resection of the Prostate

UI

Urinary Incontinence

UTIs

Urinary Tract Infections

Authors’ contributions

HL and JV wrote the paper, revised and validated it.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.