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© The Canadian Journal of Urology™; 18(Supplement 1); April 2011
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References
1. Abrams P, Cardozo L, Fall M et al. The standardization of
terminology of lower urinary tract function: report from the
Standardization Sub-committee of the International Continence
Society.
Neurourol Urodyn
2002;21(2):167-178..
2. WeinAJ, Rackley RR. Overactive bladder: a better understanding
of pathophysiology, diagnosis and management.
J Urol
2006:175(3 Pt 2):S5-S10.
3. Stewart WF, Van Rooyan JB, Cundiff GW et al. Prevalence and
burden of overactive bladder in the United States.
World J Urol
2003;20(6):327-336.
4. Hershorn S, Gajewski J, Schulz J, Corcos J. A population-based
study of urinary symptoms and incontinence: the Canadian
Urinary Bladder Survey.
BJU Int
2008;101(1):52-58.
5. Brunton S, Kuritzky. Recent developments in the management
of overactive bladder: focus on the efficacy and tolerability
of once daily solifenacin succinate 5 mg.
Curr Med Res Opin
2005;21(1):71-80.
6. Chappel CR, Artibani W, Cardozo LD et al. The role of urinary
urgency and itsmeasurement in the overactive bladder symptom
syndrome: current concepts and future prospects.
BJU Int
2005:95(3):335-340.
7. Milson I. Overactive bladder: Current understanding and future
issues.
BJOG
2006;113(Suppl 2):2-8.
8. Brown JS, Vittinghoff E, Wyman JF et al. Urinary incontinence:
does it increase risk for falls and fractures? Study of Osteoporotic
Fractures Research Group.
J Am Geriatr Soc
2000;48(7):721-725.
9. Hu T, Wagner TH, Bentkover JD et al. Estimated economic
costs of overactive bladder in the United States.
Urology
2003;61(6):1123-1128.
10. Irwin DE, Mungapen L, Milsom I, Kopp Z, Reeves P, Kelleher
C. The economic impact of overactive bladder syndrome in six
Western countries.
BJU Int
2009;103(2):202-209.
of OAB and prevent urgency incontinence. However,
some patients who take a tricyclic antidepressant feel
very tired.
Themost common cause of symptoms of frequency,
nocturia, and urgency in men over age 50 is bladder
outlet obstruction (BOO) secondary to BPH. Even
with combination therapy for BOO (an alpha blocker
and a 5-alpha reductase inhibitor), some men still have
frequency and urgency. These persistent symptoms are
believed to be the result of up-regulation of nerve fibers
in the detrusor muscle, which results in OAB. Some
studies have reported that men with BOO secondary
to BPH after full treatment for BPH, who still have
non-relenting frequency and urgency symptoms can
be treated with drugs for OAB and expect greatly
improved outcomes.
20,21
Other studies are looking
at the use of low-dose, daily PDE-5 inhibitors to
treat frequency and nocturia in men with BOO that
is secondary to BPH and who are not responding to
standard medications for the prostate. Preliminary
results suggest that these drugs diminish frequency
and urgency but do not increase urine flow rates.
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Invasive therapies for refractory OAB
Patients with severe OAB who do not respond to
behavioral therapy or cannot tolerate or do not
respond to conventional polypharmacologic agents
used to treat OAB may be offered other highly
specialized, expensive therapies. These therapies
include botulinum toxinA(BOTOX) injections (which
are not approved for treatment refractory OAB),
neuromodulator (nerve stimulator) implants, and
augmentation cystoplasty. These are third-line, last
resort approaches that are only recommended and
accepted in the most refractory, devastating cases.
Conclusion
In most cases, patients with OAB can be initially
managed at the primary care level. However, certain
patients may later be referred to a urologist or other
specialist for followup. These include patients who fail
to respond to behavioral and pharmacological therapy,
or have certain coexisting conditions (hematuria,
pyuria, recurring UTIs, or BPH), or have PVR urine
volumes greater than 100 mL, or have associated
confounding neurological conditions.
The prevalence of OAB increases significantly
with increasing age. It can have a dramatic effect on
a patient’s quality of life, and at the same time it has a
significant impact on healthcare costs. If a physician
performs a careful patient history and a complete
physical examination, with minimal laboratory tests,
inmost cases, the diagnosis of OAB can be made easily.
With behavioral modification and compliance with
effective medical therapy most patients will enjoy a
very satisfactory improvement in their OAB symptoms.
Researchers are still searching for the most effective
drugwith the fewest or least bothersome or insignificant
side effects. This ideal drug would encourage patients
to complywith taking this drug for the rest of their lives
in order to provide the maximumbenefit and response
in treating this chronic condition.
Disclosure
Dr. Jack Barkin is an active urologist and Chief of Staff
at the Humber River Regional Hospital in Toronto.
He sits on the medical advisory board for Abbott,
AstraZeneca, Bayer, Boehringer-Ingelheim, Eli Lilly,
GlaxoSmithKline, Merck Frosst, Paladin, Pfizer, sanofi-
aventis and Solvay. He has done the clinical research
onAndrogel, Avodart, Casodex, Cialis, Detrol, Flomax,
Hytrin, Levitra, Xatral, Proscar and Viagra. He has
spoken all over the world for all of the companies
outlined.
BARKIN