Prescribing information is available at this meeting 1 MODULE 2 IDENTIFICATION, SCREENING AND...

Prescribing information is available at this meeting1

MODULE 2

IDENTIFICATION, SCREENINGAND DIAGNOSIS

DET 808

Prescribing information is available at this meeting

• Patients do not initiate discussions since they may not see OAB as a legitimate condition or may not understand the terminology

• Patients are often too embarrassed to talk about their symptoms

• Patients learn to accept and cope with their symptoms

– Avoiding social interaction– Mapping toilet locations– Carrying spare clothing

17. Abrams P, et al. Am J Manag Care. 2000;6(suppl):S580-S590.

CHALLENGES TO IDENTIFICATION OF OAB

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• Do you go to the toilet more than 8 times a day?

• Do you often wake up during the night needing to go to the toilet?

• Do you have to hurry to make the toilet in time?

• Do you often not reach the toilet in time?

ASKING THE RIGHT QUESTIONS

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• New patient medical questionnaires

• New patient medical examinations

• Routine cervical smears

• Routine checkups for patients over 40 years old

• Family planning/menopause clinics

• Patient leaflets/posters

• Health visitors/district nurses/practice nurses

• Nursing homes

OPPORTUNITIES FOR SCREENING

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SCREENING IS AN IMPORTANT TOOL

• Reasons for screening

– High prevalence

– Impact on patients’ lives

– Cost to society

– Government initiatives/guidelines such as:

• Good Practice in Continence Services in the UK23

23. Donaldson L, Mullally S. London, England: Department of Health;April 19, 2000.

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• Validated in 1260 patients24

• 8 simple, self-administered questions

• Simple scoring by addition

• Available and linguistically validated in 12 languages25

A NEW SCREENING TOOL – THE OVERACTIVE BLADDER – VALIDATED 8-QUESTION QUESTIONNAIRE

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24. Coyne K, Matza L ICS 2004.25. Conway K, Uzun V, Vigner S et al. ICS 2004.


How bothered have you been by…

• Frequent urination during the day?

• Uncomfortable urge to urinate?

• Sudden urge to urinate with little or no warning?

• Accidental leakage of small amounts of urine?

• Night-time urination?

• Waking up at night because of the need to urinate?

• Uncontrollable urge to urinate?

• Urine leakage associated with a strong desire to urinate?

SCREENING WITH THE OVERACTIVE BLADDER QUESTIONNAIRE

7 14. Coyne K, et al. Qual Life Res. 2002;11:563-574.


• Patients complete the screening questions

• Doctor reviews the patient-completed screener

• Doctor makes diagnosis and treats appropriately

HOW TO USE THE OVERACTIVE BLADDER QUESTIONNAIRE

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COMMUNICATION IS THE KEY

• Active listening

• Use of language

• Use of body language

• Questioning techniques

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DIAGNOSIS OF OAB

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WHO IS AT RISK OF OAB?

10. Milsom I, et al. Am J Manag Care. 2000;6(suppl):S565-S573.11

URGE INCONTINENCE STRESS INCONTINENCE ANY INCONTINENCE

• Advanced age

• Diabetes

• Urinary tract infection

• Smoking

• White race

• High body mass index

• High waist-to-hip ratio

• Parity

• Advanced age

• White race

• Education

• Functional or sensory impairment

• High body mass index

• Previous hysterectomy

• Stroke

• Diabetes

• Chronic obstructive pulmonary disease


OTHER CONDITIONS/MEDICATIONS WHICHHAVE AN IMPACT ON SYMPTOMS OF OAB

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22. Thuroff J. EUR Urol. 2003;2 (Suppl):10-15.26. ASCP website.

http://www.ascp.com/pubs/tcp/1999/special/diagnosing.shtml

COEXISTING CONDITIONS DRUGS ASSOCIATED WITH INCONTINENCE

• Chronic constipation26

• Urinary tract infection26

• Delirium26

• Depression22

• Skin infection22

• Sleep deprivation22

• Diuretics26

• Antidepressants26

• Antihypertensives26

• Sedatives, hypnotics and nacotics26

• Muscle relaxants26


• To confirm diagnosis of OAB

– Patient history12

– Overactive Bladder Questionnaire24

– Physical examination12

– Urinalysis12

DIAGNOSIS OF OAB BASED ON SYMPTOMS

1312. Wein AJ, Royner ES. Int J Fertil. 1999;44:56-66.24. Coyne K, Matza L. ICS 2004.


• Patient history

– Form a working diagnosis– Assess the impact of symptoms on QoL– Review body systems (neurologic, metabolic)– Identify coexisting conditions and treatments that can cause

incontinence

12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66.

DIAGNOSIS OF OAB

• Physical examination

– Abdominal– Neurological– Pelvic (women)– Genital/prostate (men)

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• Urinalysis

– Infection

– Tumour

– Haematuria

– Glucosuria

– Proteinuria


DIAGNOSIS OF OAB (CONTINUED)

• Postvoid residual volume (PVR)

– Elderly with voiding symptoms and/or recurrent UTI

– Neurological disease and voiding dysfunction

– Symptoms of poor bladder emptying

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DIFFERENTIAL DIAGNOSIS:OAB AND STRESS INCONTINENCE

Urgency (strong, sudden desire to void) Yes No

Frequency with urgency (>8 times/24 h) Yes No

Leaking during physical activity; eg, coughing, sneezing, lifting No Yes

Amount of urinary leakage with each episode of incontinence Large (if present) Small

Ability to reach the toilet in time following an urge to void No/ Just barely Yes

Waking to pass urine at night Usually Seldom

SYMPTOMS STRESS-INCONTINENCEOVERACTIVE BLADDER

SYMPTOM ASSESSMENT

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TREAT IF:

• Frequency/urgency and normal urinalysis

• Frequency with urgency• Urge incontinence• Normal urinalysis

REFER TO SPECIALIST IF:

• No response to treatment• Haematuria without infection• Poor bladder emptying• Neurological or metabolic disease• Genital/prostate abnormalities

OAB


TREATMENT VERSUS REFERRAL

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Prescribing information is available at this meeting 1 MODULE 2 IDENTIFICATION, SCREENING AND...

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