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© The Canadian Journal of Urology™; 23(Supplement 1); February 2016
Eapen AND Radomski
4
EpiLUTS study
5
The Epidemiology of Lower Urinary Tract Symptoms
(EpiLUTS) survey is a population based, cross sectional
survey conducted in the United States, United
Kingdom and Sweden to evaluate the prevalence and
bother of OAB as well as to update the results of the
NOBLE survey done in 2003.
Gender specific differences could be seen in the
EpiLUTS study. In men, the prevalence of OAB
symptoms “sometimes” and “often” were 27.2% and
15.8% respectively, whereas in women, the prevalence
of OAB symptoms “sometimes” and “often”was 43.1%
and 32.6%. Women had an overall higher prevalence
of symptoms such as urgency, UI or both. All these
symptoms increased in prevalence with increasing
age in both sexes.
MILSOM study
9
Milsom et al conducted a population based prevalence
study to determine the prevalence and symptoms
of OAB. The surveys were carried out in France,
Germany, Italy, Spain, Sweden and United Kingdom.
Telephone and direct interviews were conducted in
16776 randomly selected men and women aged over
40 years. Milsom’s study found an overall prevalence
of OAB symptoms of 16.6%. This study also looked at
the rate at which OAB patients sought medical advice
and treatment.
Womenwere slightlymore likely thanmen to report
OAB symptoms with the gender specific prevalence
being 15.6% in men and 17.4% in women. This is
interesting to note as other studies have suggested
that male OAB was much more likely to have DO as
an underlying cause than female OAB.
10
In Milsom’s
study, the overall prevalence of frequency and urgency
were comparable irrespective of gender. However,
UI was found to be more prevalent among women
than men. The prevalence of OAB symptoms in men
increases slowly until the age of 70 but then a sharp
increase can be observed after 75 years of age, with a
slight fall in prevalence between the ages of 70 to 75
years. In women, there is also a gradual increase seen
until the age of 60, with a leveling off seen between
60-70 years of age and a gradual increase in prevalence
thereafter.
Quality of life
It is interesting to take note of the thought processes
and behaviors of participants with OAB symptoms as
demonstrated by Milsom’s study.
9
OAB symptoms
adversely affected quality of life in 65%of participants.
However, less than one third of patients who sought
medical help were receiving medications. Frequency
and urgency symptoms were almost as much of a
precipitant to seek help as was UI. Two thirds of
participants with OAB had tried various conservative
measures such as decreasing fluid intake to manage
their symptoms. Women were twice as likely as men
to use various coping strategies such as physiotherapy
and absorbent products as non-medical management
of OAB.
9
Older patients are more likely to consult a
doctor than younger patients with OAB. One of the
main reasons for not seeking help or advice was the
lack of awareness that effective treatment was available
for such conditions.
Irwin et al’s review of the EPIC study showed, as
would be expected, that the degree of bother amongst
OAB sufferers increased as the number of LUTS
increased.
7
The effect of nocturia on quality of life is interesting.
The significance of one episode of nocturia per night is
debated as in the minds of many, this falls within the
normal clinical spectrum.
7
Studies have shown that
even in healthy individuals, any episodes of nocturia
can have a significantly negative impact on quality of
life, sleep, work performance and general well being.
7
Studies assessing quality of life highlight the
significant negative impact that OAB has on daily
activities, mental health and sexual function.
11,12
Under-reporting, under-recognition and under-
treatment can lead to long term suffering that affects
multiple facets of patients’ lives.
Evaluation and investigations
When patients present with symptoms suggestive of
OAB, a basic evaluationmust be undertaken. Ahistory
is particularly important in eliciting the symptoms as
well as the level of bother for the patient.
13,14
Whilst
important in both genders, a thorough history that
covers all the relevant questions is particularly important
inmenwhomay not be forthcoming about their issues.
In men, often OAB and bladder outlet obstruction can
coexist and men are often more bothered by the OAB
symptoms.
15
The degree of bother is important in
guiding treatment and management of expectations.
Physical examination differs in the genders. In females,
a pelvic examination is important and inmales, a digital
rectal examination (DRE) to examine the prostate is
routinely performed as is examination of the penis.
Any signs of neurological disease should be sought
for in both genders. The algorithm in Figure 1, offers
a practical approach in evaluating the patient with
symptoms consistent with OAB.
16
The diagnosis of OAB is usually clinical but
sometimes an initial work up is required.
17
Basic