© The Canadian Journal of Urology™; 21(Supplement 2); June 2014
Basic work up: history, physical, labs and
role of other tests
Once symptoms are identified the evaluation should
turn to the history, physical and a limited laboratory
evaluation. During the examination it is useful to pay
attention to items that may be transient or reversible.
It is also helpful to try to identify any temporal
relationship between the patient’s symptoms and any
changes or new occurrences in their medical history.
Recognizing the temporal relationship between the
symptoms and recent medical conditions is helpful.
The symptoms the patient has may well have been
present for some time, however, a recent change (i.e.,
diet, surgery medication) may have exacerbated the
problem.
The past medical history may identify poorly
controlled diabetes, apnea, congestive heart failure or
renal abnormalities. Afull neurological history should
be taken looking for the onset of dementia, Parkinson’s,
spinal cord injury or stenosis, multiple sclerosis or
stroke. Functional and cognitive assessment should
be performed on older adult patients. Dietary
habits, especially fluids, have long been thought to
be associated with urinary symptoms and should be
addressed in the history.
3
Prior surgeries need to be
addressed, especially any genitourinary intervention
(examples include prostate surgery, hysterectomy or
bladder suspensions). Orthopedic procedures can be
the cause of transient OAB as a result of temporary
mobility issues. Obstetrical history should be
addressed in females as several or difficult vaginal
deliveries can predispose the patient to OAB or stress
incontinence. Medications should be reviewed to see if
any associationwith the symptoms could bemade. For
example, the timing of a diuretic could have profound
effects on urinary habits. Medications that can affect
urinary function are listed in Table 2.
3
5
A practical primary care approach to overactive bladder
TABLE 2.
Medications that affect bladder function
3
Medication
Effect
Angiotensin converting enzyme inhibitors Increased cough leading to stress urinary incontinence (UI)
(captopril, lisinopril, enalapril)
Alpha-adrenergic agonists
Increase urethral resistance causing post void dribbling, straining,
hesitancy in urine flow
Alpha-receptor agonists
Urethral constriction, urinary retention (male)
(pseudoephreine, ephedrine)
Alpha-receptor antagonists
Urethral relaxation and decreases urethral resistance causing
(prazosin, terazosin, doxazocin)
stress UI (females) with UI with cough, sneeze, or other activity
Anticholinergics
Urinary retention with symptoms of post void dribbling, straining,
(H1 antihistamines, antiparkinsonian agents) hesitancy in urine flow, overflow incontinence, fecal impaction
Antidepressants, tricyclic
Anticholinergic effect, alpha-receptor antagonist effect causing
post void dribbling, straining, hesitancy in urine flow
Antipsychotics, sedatives
Act as sedativecausingconfusion,mayrelaxdestrusormuscle leading
to urinary retention
Beta-receptor antagonists
Urinary retention
(propranolol, metoprolol, atenolol)
Calcium channel blockers
Urinary retention, fecal impaction
(verapamil, diltiazem, nifedipine)
Diuretics
Increases urine production (polyuria) and volume leading to
urgency and frequency
Methylxanthines (caffeine, theophylline)
Polyuria, bladder irritation
Neuroleptics (thioridazine, chlorpromazine) Anticholinergic effect, sedation
Other (caffeine and alcohol)
Act as diuretic leading to urgency and frequency, induces sedation
Opiods
Urinary retention, fecal impaction, sedation, delirium
Sedative-hypnotics
Sedation effect may relax detrusor muscle
