Urology > General Urology
Prince Philip: Bladder Infection 'Common' in Elderly Men
by Todd Neale Todd Neale, Senior Staff Writer, MedPage Today June 05, 2012
In the middle of the Diamond Jubilee celebration marking the 60 year reign of England's Queen Elizabeth II, Prince Philip -- the Queen's husband -- was hospitalized for a bladder infection.
The nearly 91-year-old prince, who holds the title of the Duke of Edinburgh, was taken by ambulance to King Edward VII Hospital in London on Monday as a precaution, according to a brief statement on the British monarchy's official website.
In an interview, Elizabeth Kavaler, MD, a urologist at Lenox Hill Hospital in New York City, said a bladder infection is relatively common in elderly men, who often have difficulty emptying the bladder related to prostate enlargement, which gives the bacteria more chance to reproduce.
If diagnosed in an outpatient setting, bladder infections are typically treated with quinolones, which have "very high penetration of antibiotic into the kidneys and the bladder so that we can hit the infection really quickly," Kavaler said.
But if the infection isn't detected soon enough, the patient is typically admitted to the hospital, for a course of IV antibiotics and hydration and maintain electrolytes and nutrition.
"Our threshold for admitting somebody in their 90s is very low," Kavaler said. "Any question, we admit them because they're fragile and can wind up septic very quickly."
Older individuals are more likely to require a hospital stay than their younger counterparts because the initial symptoms -- including pain and frequent urinating -- can be less obvious, she said, allowing the infection more time to establish itself. The pain may not be as severe because of neurological impairments, and older people may already be urinating often.
Thus, Kavaler said, the initial presentation of a bladder infection in older individuals may be marked by serious symptoms, which can include fevers, changes in mental status, disorientation, and dizziness, all indications that there could be a systemic issue already.
Prince Philip is expected to spend a few days at the hospital for observation, and Kavaler said his doctors will be looking for signs of sepsis, making sure the infection hasn't spread to the kidneys and remains in the lower urinary tract, and ensuring that the bladder is emptying completely.
After 24 hours of resolution clinically, he'll be able to go home. The minimum hospital stay is 3 days, Kavaler said.
After discharge, patients are typically given oral antibiotics for a week to 10 days, although some clinicians will shorten the course to 5 days because of concerns about colitis and other reactions to antibiotics, especially among older people.
Kavaler said the prince's prognosis is very good, although full recovery may take weeks. Even when the infection is cleared, an older individual might still feel tired and have a poor appetite. It takes time for activity levels and brain function to return to normal, she said.
If a man half Prince Philip's age had a similar bladder infection, he would be back to work in a week, she said, but it could take the prince a month to fully recover.
"It's great to get to 90," she said. "But it's tough because everything hits hard, even a cold. Really, it's debilitating for somebody at his stage in life."
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