OAB, Over Active Bladder

DIAGNOSIS & EVALUATION

Dr Clarence Lei Chang Moh, FRCS Urol,

Consultant Urologist

• Adjunct Professor, Universiti Malaysia Sarawak

• Honorary Consultant to SGH & HKL

• c/o Kidney & Urology Centre, Normah Hospital, KUCHING.

• clarencelei@gmail.com

BORNEO REGIONAL UROLOGY WORKSHOP, Kota Kinabalu, 9-10 July 2011

Prostate: sex organ, semen, erection, ejaculation, affects urinationWhat about the bladder?

Urology: URINARY SYMPTOMS

What is OAB, overactive bladder?

Is it a specific disease eg PTB? NO

Is there a specific cause?Bacteria? Viral? Neuropathic eg Parkinsonism? NO

Is it a specific syndrome?

eg interstitial cystitis NO

Are there any objective tests?

eg urine, blood, urodynamics NO

OAB is defined as “urgency, with or without urge incontinence, usually with frequency and nocturia”

( group of symptoms)

Urgency: “the only symptom a patient must have to be described as having OAB”

• In the absence of pathologic or metabolic conditions that might explain these symptoms

1. Abrams P et al, ICS, 2. Neurourol Urodyn, 21:167, 2002

What is urinary urgency?URGENCY = the sudden compelling

sensation to pass urine, which is difficult to defer

• Quite distinct from normal desire to void

Patients with OAB can have both normal bladder sensations and urgency

Abrams P BJU Int 2005;96 (Suppl 1):1-3

Urgency drives all other symptoms of OAB

Adapted from Chapple CR BJU Int 2004; 95: 335-340Abrams P BJU Int 2005; 96 (Suppl 1);1-3Coyne KS et al. Value Health 2004; 7: 455 – 463

Urgency

Increased frequency

Urgency

incontinence

Reducedvolume voided

Nocturia

Usually results from urgency or the “fear

of urgency”

Why is urgency so important?

• It is reported to be one of the most bothersome symptom for patients

– Urgency drives behavioral adaptation and impacts heavily on QoL

– Urgency drives a fear and anxiety of “leakage”

– Frequency usually results from urgency or the “fear of urgency”

Abrams P BJU Int 2005; 96 (Suppl 1);1-3Coyne KS et al. Value Health 2004; 7: 455 – 463

How Does Urge incontinence Occur?

Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. Stress incontinence: weak sphincter vs cough

Spectrum of OAB and Incontinence

• The majority of people with OAB experience urgency without urinary leakage: DRY OAB

Abrams P, et al. Neurourol Urodyn. 2002;21:167-178.Stewart WF, et al. World J Urol. 2003;20:327-326.Hampel C, et al. Urology. 1997;50(suppl 6A):4-14.Abrams P. Urology. 2003;62(suppl 5B):28-37.

SUI: stress urinary incontinence

UUI: urge urinary incontinence

OAB Wet37%

OAB Dry

63%

Incontinence

• Sudden & involuntaryloss of urine

OAB

OAB Symptoms – FUNI

Urgency

• Sudden, strong desireto urinate

Frequency

• 8 or more visits to the

toilet per 24 hours

Milsom I, et al. BJU Int. 2001;87:760-766.

Abrams P, et al. Neurourol Urodyn. 2002;21:167-178.

Nocturia

• 2 or more visits to toilet

during sleeping hours

OAB in males

Symptoms:

– Frequency – 38%

– Urgency – 35%

– Urge incontinence – 13%

Bothersome:

• Mild – 70%

• Moderate – 14%

• Severe – 14%

Moorthy et al BJUI 2004;93:528-531

OAB in females (Asian)

Symptoms:

– Urgency – 65.4%

– Frequency – 55.4%

– Urge incontinence – 21.4% (more cf men)

Bothersome:

– Not bothered – 75.4%

– Very mild – 10.3%

– Mild – 6.4%

– Moderate – 3.3%

– Severe – 2.1%

– Very severe – 2.4%Lapitan et al Int Urogynaecol J 2001;12:226-231

OAB - More Common Than Other Diseases

Pre

vale

nce

(%) 20

15

10

5

0OAB

16.6

Asthma

8.6

Diabetes

5.5

Alzheimer’sDisease

4.02.0

Cancer

European Disease Prevalence

Milsom I, et al. BJU Int. 2001;87:760-766.AIRE. http://www.asthma.ac.psiweb.com/executive/fr_executive.html.IDF. http://www.idf.org/e-atlas/home/index.cfm?node=84.O’Brien JT, Ballard CG. BMJ. 2001;323:123-124.Capocaccia R, et al. Ann Oncol. 2002;13:831-839.

OAB Affects 11% to 22% of Adults Over 40 in Europe, Asia, and the United States

Milsom I, et al. BJU Int. 2001;87:760-766.Stewart WF, et al. World J Urol. 2003;20:327-336.Homma Y, et al. ICS, 2003.

Male Female

25

20

15

10

5

0

Pre

vale

nce

(%)

France Germany Italy Spain Sweden UK Japan

Country

Prevalence of OAB in Adults 40

USA

OAB in malesPrevalence: 30%

• Malaysia – 27%

• China – 30%

• Hong Kong – 84%

• Singapore – 29%

• India – 14%

• Indonesia – 43%

Moorthy et al BJUI 2004;93:528-531

Prevalence of OAB by Age

0

5

10

15

20

25

30

35

Pre

vale

nce

(per

cent

)

<25 25-34 35-44 45-54 55-64 65+

Age (years)

MenWomen

Adapted from Stewart W et al. WHO/ICI. 2001. Poster.

OAB Affects Older

Milsom I, et al. BJU Int. 2001;87:760-766.

OAB : older men more

50

40

30

20

10

0

Pre

vale

nce

(%)

40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Men Women

OAB in females (Asian)

• Prevalence – 51.4%

• Seek treatment - 21.1%

Lapitan et al Int Urogynaecol J 2001;12:226-231

OAB in females (Asian)

Lapitan et al Int Urogynaecol J 2001;12:226-231

Source of help:

– Traditional medicine – 14.2%

– GP – 33.1%

– Specialist – 25.9%

OAB in males

Sought treatment - 6%

• GP - 30%

• Specialist - 30%

• Others - 30%

Moorthy et al BJUI 2004;93:528-531

Reasons for not seeking treatment• Not a major health problem – 29.1%

• Fear of treatment – 12.7%

• Acceptance of condition – 11.8%

• Unaware of available treatment – 7.7%

• Embarrassment – 5.8%

• Worried about cost – 5.4%

Low BY et al Urology 2006;68:751-758

Beware

• High prevalence of OAB

• Small proportion seek treatment

• Lack of awareness

OAB Negatively Impacts

Toilets/ Pampers/ social Inconvenience Psycho: Loss of control/ self esteemSEXFalls / FracturesSkin care

Milsom I, et al. BJU Int. 2001;87:760-766.

OAB:Develop coping mechanisms

• Reduction in social interaction/ increased social isolation

• Alteration of travel plans (e.g. plan around availability of toilets)

• Cessation of some hobbies

• Avoidance of sexual contact

• 20%

Pix Courtesy Dr Peter Ng,

J Sex Med 2007, 4, 656 - 666

Non-pharmacological treatments• Behaviour modification

– Dietary and fluid management: ON, bus, aisle seat,

Caffeine, alcohol etc– Timed voiding– Adjustment of medication: diuretics

• Physiotherapy– Pelvic floor exercises– Biofeedback– Functional electrical stimulation (FES)– Improvement of pelvic floor neuromuscular function –

improving bladder and urethral function

Thank you