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© The Canadian Journal of Urology™; 18(Supplement 1); April 2011
Discussion
Impact of untreated OAB
Untreated OAB can have a profound negative impact
on patients’ psychological well-being, quality of life,
5,6
and physical health (due to increased risk of falling
and, with wet OAB, increased risk of vaginal and
groin infections).
2,7
Brown and colleagues reported
that women with OAB had an increased risk of
falling, fracturing a hip, and losing independence.
8
Hu and colleagues estimated that in 2000, the annual
economic impact in using drugs, diapers and treating
the sequelae of OAB n the United States was $12.0
billion dollars.
9
In 2009, Irwin and colleagues
10
reported on the estimated total costs associated with
OAB treatment in six western countries, including
Canada. They estimated that direct costs for OAB
treatment per patient per year ranged from
€
11,329 in
Canada to
€
34,717 in Italy (about $15,473, and $47,418,
respectively, in March 2011 Canadian dollars). In
Canada, annual OAB-related nursing home costs and
absenteeism were estimated to be
€
338 million and
€
65 million, respectively (about $462 million and $88.8
million, respectively, inMarch 2011 Canadian dollars).
Despite the negative impact of OAB symptoms
on quality of life, patients often do not mention these
symptoms to their physicians. They may feel the
symptoms are a normal part of aging, or they may be
too embarrassed to speak about them.
Diagnosing OAB
In general, the initial patient work up for OAB can
be done by primary care physicians. Rarely should
patients be initially referred to the specialists for
additional invasive testing such urodynamics or
cystoscopy.
When obtaining the patient’s history, the physician
should look for the presence of LUTS (including
difficulties in voiding) or medical conditions related
to OAB (such as diabetes mellitus, congestive heart
failure, neurological disease, or constipation), and
find out about medication use (including diuretics and
antidepressants) and dietary habits (such as excessive
fluid or caffeine intake). Asimple questionnaire can be
used to help to make the diagnosis, Figure 1.
The physical examination should look for distended
bladder, vaginal prolapse or atrophy, enlarged prostate
(determined by a digital rectal examination [DRE],
signs of neurological diseases, phimosis, or meatal
stenosis.
In patients with incontinence, it is important to
try to differentiate between the three main types:
urgency incontinence, stress incontinence, or mixed
incontinence. A proper diagnosis is essential, because
stress incontinence is primarily treated with surgery
whereas urgency incontinence is managed medically.
A urinalysis (including RBCs, WBCs, nitrites, and
glucose) is done to rule out hematuria or signs of a
urinary tract infection (UTI). Appropriate blood tests
include blood glucose and creatinine. An ultrasound
postvoid residual (PVR)measurement is appropriate for
patients with coexistent conditions – diabetes mellitus,
neurologic conditions, a large prostate, or frailness in
the elderly – that could lead to poor bladder emptying.
Patients with OAB who may require further work
up or referral for cystoscopy include those with
hematuria, pain, recurrent UTIs, or risk factors for
bladder cancer (older age, male, smoker, family history
of bladder cancer), or those who are not responding
to therapy.
9
U
rinate:
Do you urinate > 8 times in a 24-hour period?
Yes/No
R
ush:
Have you ever rushed to the bathroom for fear of not making it on time?
Yes/No
G
arments:
Have you ever used pads or diapers to protect your garments from leakage?
Yes/No
E
mbarrassment: Do you ever feel embarrassed by your symptoms?
Yes/No
N
ight:
Do you often wake up more than twice a night to urinate?
Yes/No
C
ontrol:
Do you ever feel the sensation that you will loose control of your bladder?
Yes/No
Y
our fluid
consumption:
Do you limit your fluid consumption?
Yes/No
* Interpretation of the answers: A “yes” reply to one or more of the above questions may indicate the presence of
overactive bladder.
Figure 1.
“URGENCY” questionnaire to screen for overactive bladder.*
Overactive bladder