© The Canadian Journal of Urology™; 21(Supplement 2); June 2014
10
Rosenberg ET AL.
refer the patient for consultation and possibly advanced
testing or other interventions.
Other treatment options include sacral nerve
stimulation (SNS), percutaneous nerve stimulation
(PTNS) or intradetrusor injections of onabotulinum
toxin A (Botox).
1
Conclusion
The evaluation and treatment of uncomplicated OAB
should, most definitely, be in the domain of the PCP.
However, facilitating this takes the teamwork of the
patient, the PCP and the specialist. The patient must
be willing to discuss his or her symptoms, make
recommended lifestyle changes andadhere toprescribed
medications. The PCP, must first ask the questions and
then needs to educate the patient on normal versus
abnormal urinary function, be able to diagnose OAB,
set realistic goals, provide initial treatment and refer
when necessary. In addition to offering treatment for the
refractoryor complicatedpatient, the specialistmust offer
education for the PCP in regards to initial management
and,more importantly, what “redflags” towatch for and
when to refer. OAB does not take your life, but it can
steal it. Awareness can help those that suffer in silence.
Disclosures
Dr Matt T. Rosenberg has been a speaker and consultant
for Astellas, Easai, Ferring, Forest, Horizon, Ortho-
McNeil, Lilly, Pfizer and Bayer. Erik S. Witt has no
potential conflict of interest. Dr. Jack Barkin has been
a clinical investigator, speaker and medical advisory
board member and consultant for Abbott, Lilly, Bayer,
Paladin,Actavis,AstraZeneca,Astellas, Pfizer andTriton.
Dr. Martin Miner has been a consultant for Abbvie and
Endo. He has also done research for Forest.
References
1. Gormley EA, Lightner DJ, Burgio KL et al. Diagnosis and
treatment of overactive bladder (non-neurogenic) in adults:
AUA/SUFU guideline.
J Urol
2012;188(6 Suppl):2455-2463.
2. WeinAJ, Rovner ES. Definition and epidemiology of overactive
bladder.
Urology
2002;60(5-Suppl 1):7-12.
3. Rosenberg MT, Newman DK, Tallman CT et al. Overactive
bladder: recognition requires vigilance for symptoms.
Cleve Clin
J Med
2007;74(Suppl 3):S21-S29.
4. Coyne KS, Sexton CC, Vats V et al. National community
prevalence of overactive bladder in the United States stratified
by sex and age.
Urology
2011;77(5):1081-1087.
5. Stewart WF, Van Rooyen JB, Cundiff GW et al. Prevalence and
burden of overactive bladder in the United States.
World J Urol
2003;20(6):327-336.
6. Milsom I, Abrams P, Cardozo L et al. How widespread are the
symptoms of an overactive bladder and how are theymanaged?
Apopulation-based prevalence study.
BJU Int
2001;87(9):760-766.
7. Ricci JA, Baggish JS, Hunt TL et al. Coping strategies and
health care-seeking behavior in a US national sample of adults
with symptoms suggestive of overactive bladder.
Clin Ther
2001;23(8):1245-1259.
8. Dmochowski RR, Newman DK. Impact of overactive bladder
on women in the United States: results of a national survey.
Curr Med Res Opin
2007;23(1):65-76.
9. McVary KT, Roehrborn CG, Avins AL et al. Update on AUA
guideline on the management of benign prostatic hyperplasia.
J Urol
2011;185(5):1793-1803.
10. Rosenberg MT, Staskin DR, Riley J et al. The evaluation and
treatment of prostate-related LUTS in the primary care setting:
the next STEP.
Curr Urol Rep
2013;14(6):595-605.
11. Hannestad YS, Rortveit G, Daltveit AK et al. Are smoking
and other lifestyle factors associated with female urinary
incontinence? The Norwegian EPINCONT Study.
BJOG
2003;
110(3):247-254.
12. Rosenberg MT, Staskin DR, Kaplan SA et al. A practical guide
to the evaluation and treatment of male lower urinary tract
symptoms in the primary care setting.
Int J Clin Pract
2007;61(9):
1535-1546.
13. Rehsia S, Shayegan B. PSA implications and medical
management of prostate cancer for the primary care physician.
Can J Urol
2012;19(Suppl 1):28-35.
14. Roehrborn CG. The utility of serum prostatic-specific antigen
in the management of men with benign prostatic hyperplasia.
Int J Impot Res
2008;20(Suppl 3):S19-S26.
15. Crawford ED, Wilson SS, McConnell JD et al. Baseline factors as
predictors of clinical progression of benign prostatic hyperplasia
in men treated with placebo.
J Urol
2006;175(4):1422-1427.
16. Kaplan SA, Wein AJ, Staskin DR et al. Urinary retention and
post void residual urine inmen: separating truth from tradition.
J Urol
2008;180(1):47-54.
17. May M, Brookman-Amissah S, Hoschke B et al. Post-void
residual urine as a predictor of urinary tract infection--is there a
cutoff value in asymptomatic men?
J Urol
2009;181(6):2540-2544.
18. Emberton M, Cornel EB, Bassi PF et al. Benign prostatic
hyperplasia as a progressive disease: a guide to the risk factors
and options for medical management.
Int J Clin Pract
2008;62(7):
1076-1086.
19. Burgio KL, Locher JL, Goode PS. Combined behavioral and drug
therapy for urge incontinence in older women.
J Am Geriatr Soc
2000;48(4):370-374.
20. Physicians’ Desk Reference. 66
th
ed. Montvale, NJ: Thomson
PDR; 2014.
21. DuBeau CE, Kraus SR, Griebling TL et al. Effect of fesoterodine
in vulnerable elderly subjects with urgency incontinence: a
double-blind, placebo controlled trial.
J Urol
2014;191(2):395-404.
22. Moehrer B, Hextall A, Jackson S. Oestrogens for urinary
incontinence in women.
Cochrane Database Syst Rev
2003;(2):
CD001405.
23. Blake-James BT, Rashidian A, Ikeda Y et al. The role of
anticholinergics in men with lower urinary tract symptoms
suggestive of benign prostatic hyperplasia: a systematic review
and meta-analysis.
BJU Int
2007;99(1):85-96.
24. Martín-Merino E, García-Rodríguez LA, Massó-González EL
et al. Do oral antimuscarinic drugs carry an increased risk of
acute urinary retention?
J Urol
2009;182(4):1442-1448.
25. Liao CH, Lin VC, Chung SD et al. Therapeutic effect of
α
-blockers and antimuscarinics in male lower urinary tract
symptoms based on the International Prostate Symptom Score
subscore ratio.
Int J Clin Pract
2012;66(2):139-145.
26. Kaplan SA, Roehrborn CG, Abrams P et al. Antimuscarinics for
treatment of storage lower urinary tract symptoms in men: a
systematic review.
Int J Clin Prac
t 2011;65(4):487-507.