© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
4
prostate cancer, and to askwomen about gynecological
surgery or obstetrical procedures. The physician also
needs to assess patients for symptoms of or surgery for
pelvic prolapse. He or she also needs to ask patients
about any history of urinary tract infections (UTIs),
hematuria, or other lower urinary tract symptoms or
problems.
Medications used to treat dementia may affect
the lower urinary tract and be in direct conflict with
anticholinergics used to treat OAB. Furthermore, if
a patient has any cognitive impairment or dementia,
OABmedications mayworsen his or her mental status.
An excellent mnemonic, DIAPERS, can be used
to assess causes of transient incontinence, and this
mnemonic is especially useful for elderly patients,
see Table 4.
10
OAB needs to be distinguished from a less common
disorder, interstitial cystitis (IC), also called painful
bladder syndrome (PBS). IC/PBS is characterized
by suprapubic pain related to bladder filling, which
is accompanied by other symptoms such as urinary
frequency or nocturia, in the absence of any other
disorder.
8
The main distinguishing feature in IC/PBS
is the significant pain associated with urgency. IC/
PBS is less common than OAB, and it is difficult to
accurately diagnose this condition.
Physical examination
In patients with OAB, an examination of the lower
abdomen should detect a distended bladder. Women
should have a pelvic examination that is performed
when they are in a supine position, and which looks
for genitourinary atrophy, prolapse, and movement
of the bladder and urethra (that occurs with straining
and coughing, and causes leakage). Stress incontinence
is best assessed when a patient has a comfortably full
bladder, is in the standing position, and then coughs
and strains. Lastly, a rectal exam should be performed
in men to assess prostate size, consistency, and other
rectal pathology and constipation.
Clinical investigations
Blood and urine tests
If renal dysfunction is suspected, patients should
have blood drawn to determine serum creatinine and
blood urea nitrogen levels. Drug dosage may need
to be adjusted if the patient has severe renal failure.
11
A fasting serum glucose level should be obtained if
a patient may have diabetes. Urinalysis and urine
culture should be done at baseline to rule out UTI,
hematuria, and proteinuria. Men may need to have a
serum prostate-specific antigen (PSA) test.
Voiding diary and voiding questionnaires
A voiding diary, in which patients list the type, time,
and volume of fluid they ingest, as well as the time
of voiding and leakage events, can be very helpful.
Either a simple or detailed voiding diary can be used,
depending on the patient.
Patients can also fill in a validated questionnaire,
such as the International Consultation on Incontinence
Questionnaire (ICIQ) or the Overactive Bladder
Questionnaire (OABq).
12
These can be used to assess
the degree of symptom bother and the impact on
Radomski AND Barkin
TABLE 3.
Medical problems and medications that may lead to urinary frequency, urgency, retention or other
signs of voiding dysfunction
•
Poor blood sugar control in diabetes
•
Congestive heart failure
•
Diuretic use
•
Constipation
•
Medications such as antihistamines, antidepressants, anticholinergics
•
Neurological conditions (stroke, multiple sclerosis, Parkinson’s disease)
•
Benign prostatic hyperplasia, prostate cancer, pelvic prolapse
•
Urinary tract infections, hematuria, lower urinary tract symptoms
•
Interstitial cystitis
TABLE4.
Causesoftransientincontinence:“DIAPERS”
10
•
D
elirium
•
I
nfection (urinary)
•
A
trophy (vagina/urethra)
•
P
harmaceuticals
•
E
xcess urine output
•
R
estricted mobility
•
S
tool impaction
