Page 13 - Urology Update for Primary Care Physicians for 2013

© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
Address correspondence to Dr. Sidney B Radomski, Toronto
WesternHospital (University HealthNetwork), 399 Bathurst
Street, MP8-304, Toronto, Ontario M5T 2S8 Canada
Medical management of overactive bladder
Sidney B. Radomski, MD,
1
Jack Barkin, MD
2
1
University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
2
University of Toronto, Humber River Regional Hospital, Toronto, Ontario, Canada
RADOMSKI SB, BARKIN J. Medical management
of overactive bladder. Can J Urol 2012;19(Suppl 1):
2-9.
Overactive bladder (OAB) with or without urinary
incontinence is a common condition in both men and
women. OAB has a significant impact on quality of life
for most patients. In most cases, sophisticated testing
is not required for a primary care physician to diagnose
OAB and start treating a patient. Management of
OAB requires behavioral modification and, if necessary,
pharmacotherapy may be added. If a patient does not
respond to treatment initiated by a primary care physician,
then he or she should be referred to a specialist in OAB to
undergo further investigations and treatments.
Key Words:
pharmacotherapy, overactive bladder,
behavioral modification
incontinence).
2
The prevalence of OAB in the general
population is approximately 16%, according to two
large studies.
2,3
These studies also reported that men
had a higher prevalence of OAB dry and women had
a higher prevalence of OAB wet.
2,3
OAB wet is often
related to bladder instability or involuntary detrusor
contractions of neurogenic or myogenic origin. In
urodynamic testing, this can be seen as an unwanted
or uncontrollable bladder contraction. The prevalence
of OAB increases with age in both men and women,
but this age-related increase is more pronounced in
women.
2,3
Both types of OAB have a significant impact
on quality of life.
4
The impact on quality of life from
OAB appears to be the same as or even greater than
that from diabetes.
4-6
Clinical assessment and diagnosis
Many other diseases have symptoms that mimic those
of OAB, so other causes of LUTS, such as urinary tract
infections (UTIs), need to be excluded before making
Introduction
Overactive bladder (OAB) may be defined as
urgency—that is, a sudden, compelling, difficult-to-
defer desire to pass urine —usually accompanied by
frequency and nocturia and possibly accompanied by
incontinence.
1
Frequency can be defined as a patient’s
perception that he or she is voiding too often during
the day; nocturia can be defined as waking up one or
more times a night to void; and urge incontinence is
involuntary urine leakage immediately after or along
with urgency.
1
OAB can have a neurological cause, such as
multiple sclerosis, or a non-neurogenic cause, such as
lower urinary tract symptoms (LUTS) due to benign
prostatic hyperplasia (BPH). It can be subdivided into
OAB dry” (with no incontinence) or “OABwet” (with
2