My m-i-l has been having frequent UTIs . She has Dementia and has been living alone with assistance. The situation has prompted us to retire and buy a house so she can live with us. Unfortunately her primary care practice closed suddenly. Her physician recommended seeing a Urologist who could cover her during the six weeks transition (we live 3 hours away). We are still at least a month away from being able to move her to our home. The urologist is strongly encouraging a cystoscopy. We are going to have difficulty explaining this to her. We are also concerned about the pain not only from the procedure but also the positioning - she already has back pain(Osteoporosis)
She may actually become combative if we insist. What questions should we be asking? Considerations? Do we dare wait until she is established with new doctors?

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I'd be reluctant to have a 98 year old woman undergo that procedure; if she doesn't understand what's happening, it could be very traumatic for her. And I wouldn't recommend a stronger anesthetic so she was unaware as that could be just as traumatic for her recovery.

I think I'd get a second opinion, perhaps from a gynecologist.

Maggie's described the procedure well; you could confirm that's how it would be done by the urologist. I would also insist on knowing what the immediate post-surgical pain and/or confusion level would be, and most importantly ask what level of sedation would used and which specific anesthesia drugs will be used.

I had a bad experience during and after some minor exploratory surgery. I contacted the anesthesiologist prior to surgery and we agreed on the level of anesthesia, but I also refused to sign the operative consent without specifically addressing that issue. We discussed it, the anesthesiologist signed and I initialed, but those conditions were ignored and I was overdosed on a combination of narcotics.

Post-op was confusing and difficult, and I was sick for a week. After getting my medical records and realizing that the consent form changes had been ignored, I took my business elsewhere and never went back to that hospital.

So anesthesia and the administration of narcotics can worsen the procedure.
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Mom would be put on her back in an "assume the position" PAP smear stance. She'd be covered with a sheet so she couldn't see what was going on . . . Urged to slide further down the table until she was right on the edge.

The nurse would swab her down with an antiseptic...then the doctor would swoop in, use an antiseptic cleaner as he/she washes his hands, and liberally apply a numbing gel to her urethra area. After a couple minutes, he would insert a small tube into her urethra, slip the itty-bitty camera and wire into the tube, empty her bladder and then have a look around.

Occurs to me that if I had enough dementia not to understand what was going on, I might think I was visiting with Dr Frankenstein.

ORRRRR, get this. You could tell the doctor, "No, but please do a urinanalysis looking for cancer cells and let us know the results. Then we'll decide what to do about it.

The urologist is right to recommend it, by the way. I had more than occasional blood in my urine...doctored a year for recurring bladder infections. My cystoscope finally revealed a cancerous tumor. I had successful surgery ten years ago.

While the urinanalysis isn't foolproof, I personally would consider it second best. And that's what I'd do if it were MY 98 year old mom.
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The question that mom's getiatrician taught us was "what are the possible outcomes of this procedure? What treatment options will it yield?"

If the treatment option is say aggressive surgery, and you already know you wouldn't do that, then you dont do an invasive and painful test. If the treatment is a medication with few dide effects, then why can't that be prescribed without the test?

I would not put an elderly patient with dementia through this procedure.
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ASK: What is the worse case scenario if we TREAT IT WITH UTI MEDICATIONS, CHANGE DIAPERS LONGER, AND KEEP HER HYDRATED BETTER? THEN SEE IF THE UTE STOP. Give it a week. These things make my MIL CRAZY. Mentally you should see a difference if UTI meds are taking effect. YOU DONT WANT TO OPERATE ON A 98 YEAR OLD, DO YOU? I WOULDN'T
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