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Learning Objectives. Accurately recognize overactive bladder (OAB), with urgency as the core symptom, in the context of other urinary symptoms that are commonly encountered in men and women

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learning objectives
Learning Objectives
  • Accurately recognize overactive bladder (OAB), with urgency as the core symptom, in the context of other urinary symptoms that are commonly encountered in men and women
  • Confidently assess important measures like symptom severity and health-related quality of life (HRQOL) and use this information for patient management
  • Apply behavioral and lifestyle modifications to treatment strategies using an individualized and patient-centered approach to OAB
  • Understand the current first-line treatments for OAB in both men and women
  • Employ a patient-centered treatment strategy that explores the benefits of dosing antimuscarinics to obtain a balance between efficacy and tolerability
premeeting survey

?

Premeeting Survey
  • True or False: The core symptom of OAB is urgency.
    • True
    • False
premeeting survey3

?

Premeeting Survey
  • Which of the following are NOT considered comorbidities in patients with OAB?
    • Falls and fractures
    • Urinary tract infections (UTIs)
    • Skin infections
    • Kidney stones
premeeting survey4

?

Premeeting Survey
  • True or False: Using a flexible-dosing regimen of antimuscarinics results in improved efficacy and patient satisfaction.
    • True
    • False
overactive bladder impact

Overactive Bladder: Impact

Matt T. Rosenberg, MD

MidMichigan Health Centers

Jackson, MI

ics definition of overactive bladder
ICS Definition of Overactive Bladder
  • A symptom syndrome suggestive of lower urinary tract dysfunction1,2
  • Urgency, with or without urge incontinence, usually with frequency and nocturia1,2
  • In absence of metabolic or pathologic conditions1,2

1Abrams P, et al. Neurourol Urodyn. 2002;21:167-178.

2 Wein AJ, et al. Urology. 2002;60(5 suppl 1):7-12.

ICS: International Continence Society

overactive bladder definitions
Overactive Bladder Definitions

1Abrams P, et al. Neurourol Urodyn. 2002;21:167-178.

2Wein AJ, et al. J Urol. 2006;175(3 pt 2):S5-S10.

3Zinner N, et al. Int J Clin Pract. 2006;60:119-126.

healthy bladder versus overactive bladder
Holds 300-500 cc

Empties < 8 times per day

Holds at night

After gradual filling, urge is felt

Empties > 8 times per day

Empties > 2 times per night

Has urgency (sudden compelling desire to void that is difficult to defer)

Healthy Bladder Versus Overactive Bladder

Pfisterer MH-D, et al. Neurourol Urodyn. 2007;26:356-361.

Wein AJ. Am J Manag Care. 2000;6(11 suppl):S559-S564.

Wein AJ, et al. J Urol. 2006;175(3 pt 2):S5-S10.

oab symptoms are as prevalent in men as in women and increase with age

Men (SIFO 1997)

16.6

Women (SIFO 1997)

Men (EPIC 2005)

11.8

OAB Symptoms Are as Prevalent in Men as in Women and Increase With Age

Population-based prevalence studies:

Comparison of data from the SIFO study (1997)*1and the EPIC study (2005)†2

40

35

30

25

Women (EPIC 2005)

Prevalence (%)

20

15

10

5

0

18-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

> 70

Age (years)

SIFO: Sifo/Gallup telephone survey

* N = 16,776 interviews (6 European countries)

† N = 19,165 interviews (4 European countries and Canada)

1Milsom I, et al. BJU Int. 2001;87:760-766.

2Irwin DE, et al. Eur Urol. 2006;50:1306-1314.

urgency leading to urgency incontinence more prevalent in women
Urgency Leading to Urgency Incontinence: More Prevalent in Women

Women with OAB

(n = 463)

Men with OAB

(n = 401)

With UUI

16%

With UUI

55%

Without UUI

84%

Without UUI

45%

National Overactive Bladder Evaluation Study

Stewart WF, et al. World J Urol. 2003;20:327-336.

patients suffer needlessly from oab
OAB negatively impacts QOL:

Emotional well-being

Social relationships

Productivity

Physical functioning

Anxiety

Hostility

Depression

Avoid activities like travel

Fear of embarrassment

Fear resulting from misconceptions

Differences in perception:

Symptom severity

Degree of bother

Willingness to seek treatment

Patients Suffer Needlessly From OAB

Patients Would Rather Cope With OAB Than Seek Help Due to:

Khullar V, et al. Urology. 2006;68(2 suppl):38-48.

Dmochowski RR, et al. Curr Med Res Opin. 2007;23:65-76.

oab symptoms negatively affect patients
OAB Symptoms Negatively Affect Patients

Percent of patients

HRQOL assessed with King’s Health Questionnaire

N = 2878

Sand P, et al. BJU Int. 2007;99:836-844.

women prefer clinicians to initiate discussion about urinary symptoms
Women Prefer Clinicians to Initiate Discussion About Urinary Symptoms

Percentage of women

(agree strongly or completely)

  • Participant question: “I would be more comfortable discussing urinary symptoms if my health care provider brought up the topic.”

(n = 389)

(n = 1046)

(n = 386)

(n = 271)

SUI: stress urinary incontinence

MUI: mixed urinary incontinence

MacDiarmid S, et al. Curr Med Res Opin. 2005;21;1413-1421.

look for comorbidities of oab
Look for Comorbidities of OAB

P < 0.0001

  • These conditions were 2.8 times more likely to occur in patients with OAB compared to controls (95% CI, 2.6-2.9):
    • Adjusted for neurologic conditions, diuretic use, potentially inappropriate drug use, and UTI risk factors

11,556 adult patients with OAB and 11,556 controls matched on propensity score

Adapted from Darkow T, et al. Pharmacotherapy. 2005;25:511-519.

how do you approach a conversation about urinary problems like oab

?

How Do You Approach a Conversation About Urinary Problems Like OAB?
  • I ask 1 or more questions like, “Do you have urinary problems?”
  • I let the patient bring it up
  • I use a questionnaire
  • I do not routinely ask about urinary problems
how to optimally obtain a patient history first line of questioning
How to Optimally Obtain a Patient History: First Line of Questioning
  • Do you have urinary problems?1,2
  • How much do the symptoms bother you?
  • Do you want medication for your problems?

1Lavelle JP, et al. Am J Med. 2006;119(3 suppl 1):37-40.

2Rosenberg MT, et al. Cleve Clin J Med. 2005;72:149-156.

how to optimally obtain a patient history second line of questioning
How to Optimally Obtain a Patient History: Second Line of Questioning

Rosenberg MT, et al. Cleve Clin J Med. 2005;72:149-156.

Irwin DE, et al. Eur Urol. 2006;50:1306-1314.

Marschall-Kehrel D, et al. Urology. 2006;68(2 suppl):29-37.

how to optimally obtain a patient history elements of the examination
How to Optimally Obtain a Patient History: Elements of the Examination
  • Now that the urinary problem is identified, inquire about:
    • Lower urinary tract symptoms (LUTS)
    • Medical and surgical history
    • Medications
    • Focused physical examination
    • Laboratory examinations and/or tests:
      • Voiding diary, pad test

Lavelle JP, et al. Am J Med. 2006;119(3 suppl 1):37-40.

Rosenberg MT, et al. Cleve Clin J Med. 2005;72:149-156.

clinical practice recommendation
Clinical Practice Recommendation
  • Practice recommendation:
    • Patient history in combination with pad tests and urinary diaries is effective in diagnosing OAB
  • Evidence-based source:
    • Health Technology Assessment
  • Web site of supporting evidence:
    • http://www.ncchta.org/fullmono/mon1006.pdf
  • Strength of evidence:
    • Of 6009 papers, 121 were relevant for inclusion in the review:
      • Comparison of 2 or more assessment/diagnostic techniques
    • Simple investigations (eg, pad test and diary) may offer useful information on severity
    • Combined with history, process may provide sufficient information to commence primary care interventions (which are low cost and low risk)
case study 1 carol presentation
Case Study 1: CarolPresentation
  • Carol, aged 55 years, has been a long-term patient of yours and presents to your office to check on her hypertension and get a new prescription
  • She seems hesitant to leave after the examination and you question her on other troubling symptoms
  • She admits to experiencing OAB symptoms with great bother:
    • Frequency has increased in the past 6 months
    • Nocturia
  • Medical history:
    • Previously treated for depression and UTIs
    • Hypertension treated with diuretic and calcium channel blocker
    • Atrophic vaginitis testing was unremarkable
what is your initial approach to treating carol

?

What Is Your Initial Approach to Treating Carol?
  • Behavioral modifications
  • Pharmacotherapy
  • Combination of behavioral modifications and pharmacotherapy
  • I ask the patient for her treatment goals and preference first
  • I do not treat OAB
behavioral modifications are a good starting point
Behavioral Modifications Are a Good Starting Point
  • Bladder training: scheduled voiding/voiding deferment1,2
  • Pelvic floor exercises1-4:
    • Can be easily performed at home with no equipment needed
    • Not associated with significant adverse events
    • Significant impact in women with UUI and MUI
    • Evidence for men lacking
  • Significantly higher cure rates and satisfaction associated with combined bladder training and pelvic floor exercises than either therapy alone4

1Christofi N, et al. Menopause Int. 2007;13:154-158.

2Newman DK. Am J Nurs. 2002;102:36-45.

3Burgio KL. J Am Acad Nurse Pract. 2004;16(10 suppl):4-7.

4Milne JL. J Wound Ostomy Continence Nurs. 2008;35:93-101.

clinical practice recommendation24
Clinical Practice Recommendation
  • Practice recommendation:
    • Behavioral therapy improves symptoms of UUI and MUI
  • Evidence-based source:
    • National Guideline Clearinghouse
  • Web site of supporting evidence:
    • http://www.guideline.gov/summary/summary.aspx?doc_id=10931&nbr=005711&string=incontinence
  • Strength of evidence:
    • Level A
    • Can be recommended as a noninvasive treatment in many women
lifestyle modifications in oab current evidence is sparse and inconsistent
Lifestyle Modifications in OAB:Current Evidence Is Sparse and Inconsistent
  • Caffeine reduction dose dependent1:
    • Affects patients consuming ≥ 400 mg caffeine or 2.5 cups of coffee
  • Weight loss1:
    • Significant reduction in UUI reported:
      • No data in men or in OAB dry or moderately overweight patients
  • Adjusting fluid intake1,2:
    • Greater impact than caffeine restriction
    • For significant improvement in urgency, frequency, and nocturia episodes, modify fluid input by 25% (goal: 1500-2400 mL/day)
  • Few data for smoking cessation and regulation of bowel function2

1Milne JL. J Wound Ostomy Continence Nurs. 2008;35:93-101.

2Newman DK, et al. Am J Nurs. 2002;102:36-45.

case study 1 carol treatment
Case Study 1: CarolTreatment
  • Low-dose antimuscarinic with daily dosing
  • Take diuretic before bedtime to improve nocturia
  • Behavioral modifications
differential diagnosis of symptoms in women with oab
Differential Diagnosis of Symptoms in Women With OAB

Rosenberg MT, et al. Cleve Clin J Med. 2007;74(suppl 3):S21-S29.

ici management of incontinence in women

Incontinence on physical activity

Incontinence with mixed symptoms

Incontinence

with urgency/frequency

Evaluation

SUI

MUI

UUI

Pelvic floor muscle training

Bladder retraining

Treat most bothersome symptoms for MUI

Antimuscarinics

ICI Management of Incontinencein Women

ICI: International Consultation on Incontinence

Adapted from Kirby M, et al. Int J Clin Pract. 2006;60:1263-1271.

treatment strategies and pharmacotherapy for oab

Treatment Strategies and Pharmacotherapy for OAB

David R. Staskin, MD

New York Presbyterian Hospital

New York, NY

treatment goals for oab
Treatment Goals for OAB

Hegde SS. Br J Pharmacol. 2006;147(suppl 2):S80-S87.

Staskin DR, et al. Am J Med. 2006;119(3 suppl 1):9-15.

Cardozo L, et al. J Urol. 2005;173:1214-1218.

patient and physician expectations
Patient and Physician Expectations
  • Not tailoring treatment may lead to2:
  • Disillusionment
  • Avoidable adverse events
  • Unneeded use of time and resources
  • Harmful and unnecessary surgery
  • Morbidity/mortality
  • Worsening symptoms

Tailor to2:

  • Environment
  • Expectations
  • Lifestyle
  • Age
  • Health

1Robinson D, et al. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:273-279.

2Cardozo L. BJU Int. 2007;99(suppl 3):1-7.

clinical practice recommendation33
Clinical Practice Recommendation
  • Practice recommendation:
    • Antimuscarinics significantly reduce OAB symptoms
  • Evidence-based source:
    • Cochrane Database of Systematic Reviews
  • Web site of supporting evidence:
    • http://www.cochrane.org/reviews/en/ab003781.html
  • Strength of evidence:
    • 61 trials included in the review
    • The use of anticholinergic drugs for OAB results in statistically significant improvements in symptoms
symptom based oab management
Symptom-Based OAB Management

Patient perception of improvement in overall bladder condition at week 12*1

Questionnaires used:

OAB symptom questionnaire (OAB-q)

American Urological Association Symptom Index

Patient Perception of Bladder Condition (PPBC)

863 patients from 82 primary care and 16 obstetric/gynecology offices1,2

  • OAB symptoms ≥ 3 months; at least moderately bothered by most bothersome symptom
  • 69% of patients had ≥ 1 comorbid condition; none of the patients had retention requiring catheterization

* IMPACT: tolterodine extended release (ER) 12-week, open-label study

1Roberts R, et al. Int J Clin Pract. 2006;60:752-758.

2Elinoff V, et al. Int J Clin Pract. 2006;60:745-751.

pros and cons antimuscarinics
Pros and Cons: Antimuscarinics

Adapted fromChapple C, et al. Eur Urol. 2008;54:226-230.

potential adverse events contraindications and drug interactions of antimuscarinics
Potential Adverse Events, Contraindications, and Drug Interactions of Antimuscarinics

* eg, paroxetine (SSRI) shares CYP2D6

liver metabolism with darifenacin

† eg, ketoconazole, fluoxetine (SSRI)

SSRI: selective serotonin reuptake inhibitor

1Steers WD. Urol Clin North Am. 2006;33:475-482.

2Erdem N, et al. Am J Med. 2006;119(3 suppl 1):29-36.

3Staskin DR. Drugs Aging. 2005;22:1013-1028.

4Physicians’ Desk Reference. 62nd ed. Montvale, NJ: Thomson PDR; 2008.

5Swart PJ, et al. Basic Clin Pharmacol Toxicol. 2006;99:33-36.

adverse events decline over time
Adverse Events Decline Over Time*

Consistent finding across long-term studies for OAB:

adverse events are most common within 3 months of therapy and decline thereafter

Percent of patients

Treatment duration (months)

N = 716

* 24-month, noncomparative, darifenacin, open-label extension study

Haab F, et al.

BJU Int. 2006;98:1025-1032.

enhanced therapeutic effects with combined pharmacologic and behavioral therapy

Behavioral

therapy

Combined

therapy*

Pharmacologic

therapy

Combined

therapy*

0

–10

–20

–30

–40

Mean reduction in UUI (%)

–50

–60

–57.5

–70

–72.7

–80

–90

–84.3

–88.5

–100

P = 0.001

P = 0.034

Enhanced Therapeutic Effects With Combined Pharmacologic and Behavioral Therapy

N = 197

* Behavioral therapy and pharmacotherapy

Burgio KL, et al. J Am Geriatr Soc. 2000;48:370-374.

outcome measures
Outcome Measures
  • Objective versus subjective measures
  • Metrics for urgency:
    • Urgency severity
    • Warning time
correlation of subjective and objective measures
Correlation of Subjective and Objective Measures

Coyne KS, et al. Int J Clin Pract. 2008;62:925-931.

metrics for urgency reduction in urgency severity

Weeks

1

4

12

0

–0.1

–0.2

P = 0.0002

P = 0.0008

–0.3

P = 0.0004

–0.4

Trospium 60 mg daily

Placebo

(n = 292)

(n = 300)

–0.5

Metrics for Urgency: Reduction in Urgency Severity

Reduction in urgency severity score/void (IUSS) from baseline

Trospium significantly reduced urgency severity episodes in patients with OAB

IUSS: Indevus Urgency Severity Scale

Staskin D, et al. J Urol. 2007;178(3 pt 1):978-983.

antimuscarinics and warning time in oab impact of urgency
Antimuscarinics and Warning Time in OAB: Impact of Urgency

First study to demonstrate significant increase in warning time in a large clinical setting (VENUS)

(n = 739; solifenacin vs placebo)1

  • Warning time:
    • Time from first sensation of urgency to voiding1-3
  • Increase in warning time significant to patients1-3:
    • More time to reach a toilet
    • Avoid urge incontinence episodes
  • Other warning time placebo-controlled studies:
    • Darifenacin 15 mg daily (P = not significant; N = 432)2
    • Darifenacin 30 mg daily (P = 0.003; N = 67)3
    • Oxybutynin 2.5 mg TID (P < 0.001; N = 44)4

*

Median change in warning time from baseline (seconds)

(n = 372)

(n = 367)

(5-10 mg daily)

* P = 0.032

Primary end point: mean reduction in urgency episodes per 24 hours: 3.91 for solifenacin vs 2.73 for placebo (P < 0.001)

1Toglia M, et al. Neurourol Urodyn. 2006;25:655. Abstract 123.

2Zinner N, et al. Int J Clin Pract. 2006;60:119-126.

3Cardozo L, et al. J Urol. 2005;173:1214-1218.

4Wang AC, et al. Urology. 2006;68:999-1004.

oab patients frequently request dose adjustments

48%

Solifenacin 10 mg

Solifenacin 5 mg (n = 578)

Higher dose (10 mg) available

51%

Tolterodine ER 4 mg + placebo

Tolterodine ER 4 mg (n = 599)

Higher dose not available

Start

4 weeks

12 weeks

OAB Patients Frequently Request Dose Adjustments

Percent of patients requesting a dose increase at 4 weeks*1

  • Similar results (59% vs 68%) were obtained after 2 weeks by a 12-week efficacy, safety, and tolerability study of darifenacin vs placebo2

* Prospective 12-week, parallel-group, double-dummy,

2-arm, double-blind, efficacy and safety study

1Chapple CR, et al. Eur Urol. 2005;48:464-470.

2Steers W, et al. BJU Int. 2005;95:580-586.

slide45

Antimuscarinic Flexible Dosing (1)STAR Study: Incontinent Patients Reporting No Incontinence Episodes at End Point on a 3-Day Diary*

Incontinent patients reporting no

incontinence episodes (%)

Baseline

(per 24 hours):

2.77 episodes 2.55 episodes

* Patients who reported experiencing incontinence episodes per 24 hours at baseline and who did not report any episodes of incontinence for 3 consecutive days prior to the study visit

† P = 0.006 vs tolterodine ER

Chapple CR, et al. Eur Urol. 2005;48:464-470.

antimuscarinic flexible dosing 2 flexible dosing study

Placebo

Dose Escalation

0 mg

0 mg

7.5 mg

15 mg

Antimuscarinic Flexible Dosing (2)Flexible-Dosing Study

Reduction in incontinence episodes per week with darifenacin

No Dose Escalation

7.5 mg

7.5 mg

(n = 104)

(n = 157)

(n = 127)

Median change from baseline (%)

■ 2 weeks

■ 12 weeks

Steers W, et al. BJU Int. 2005;95:580-586.

antimuscarinic flexible dosing 3 cumulative response rate with increasing dose
Antimuscarinic Flexible Dosing (3)Cumulative Response Rate With Increasing Dose

Percent of patients

N = 368

MacDiarmid SA, et al. J Urol. 2005;174(4 pt 1):1301-1305.

dosing options comparison
Dosing Options Comparison

* 1 hour before meal or on an empty stomach

IR: immediate release

TDS: transdermal delivery system

Physicians’ Desk Reference. 62nd ed. Montvale, NJ: Thomson PDR; 2008.

low patient persistence medicaid and prescription drug databases

Tolterodine ER

Oxybutynin ER

Patients remaining persistent (%)1

Days

Low Patient PersistenceMedicaid and Prescription Drug Databases

Only 44% out of 1637 Medicaid patients remained persistent after 30 days

  • Low adherence and persistence reported by various clinical studies2-4:
    • Adherence rates reported for OAB similar to other chronic diseases5
    • Low level of education and cultural and social support factors may contribute to poor compliance6
  • Antimuscarinic therapy for OAB3,5-6:
    • Short- and long-term efficacy for significant proportion of users
    • Therapeutic/patient perceived benefits require at least 4-8 weeks of continuous therapy

Persistence: time to discontinuation

1Adapted from Shaya FT, et al. Am J Manag Care. 2005;11(4 suppl):S121-S129.

2Chui MA, et al. Value Health. 2004;7:366. Abstract PUK11. 3Yu YF, et al. Value Health. 2005;8:495-505.

4Balkrishnan R, et al. J Urol. 2006;175(3 pt 1):1067-1071. 5Basra RK, et al. BJU Int. 2008. Epub ahead of print.

6Thomas L, et al. J Manag Care Pharm. 2008;14:381-386.

factors affecting adherence
Factors Affecting Adherence
  • Presentation and efficacy of medication
  • Cost (financial or personal)
  • Dosing frequency
  • Expectations of treatment
  • Route of administration of medication
  • Adequate follow-up after initiation of therapy

Follow-up is important to ensure patient adherence to treatment

Basra RK, et al. BJU Int. 2008. Epub ahead of print.

D’Souza AO, et al. J Manag Care Pharm. 2008;14:291-301.

case study 2 tom presentation
Case Study 2: TomPresentation
  • Tom, aged 60 years, presents to your office for his annual physical examination
  • At the end of the examination, he asks about the definition of normal voiding:
    • Works at night
    • Frequent bathroom visits interrupt his work
    • Slow urine stream and feeling that bladder has not emptied completely
  • Unremarkable medical history and physical examination:
    • Checked blood sugar levels
  • Normal laboratory values
differential diagnosis of symptoms in men with oab
Differential Diagnosis of Symptoms in Men With OAB

Rosenberg MT, et al. Cleve Clin J Med. 2007;74(suppl 3):S21-S29.

men with oab luts storage and voiding symptoms
Men With OAB: LUTSStorage and Voiding Symptoms

1Abrams P, et al. Neurourol Urodyn. 2002;21:167-178.

2Chapple CR, et al. Eur Urol. 2006;49:651-658.

clinical algorithm for the management of luts in men
Clinical Algorithm for the Management of LUTS in Men

Focused history and physical examination

Urinalysis/PSA

Blood sugar

Unlikely BPH or OAB

LUTS

Referral

and/or treat

Watchful

waiting

Desires treatment

No

Provisional OAB

Provisional BPH

Ineffective

Effective

Continue

medication

Check PVR

Trial α-blocker

< 50 cc

50-200 cc

> 200 cc

Referral

PSA: prostate-specific antigen

PVR: postvoid residual

Rosenberg MT, et al. Int J Clin Pract. 2007;61:1535-1546.

clinical algorithm for the management of luts in men cont
Clinical Algorithm for the Management of LUTS in Men (Cont.)

Check PVR

> 200 cc

Referral

< 50 cc

50-200 cc

Possible

OAB

Diagnosis

unclear

  • Optional
  • Titrate α-blocker
  • Switch medication
  • Try ARI, combination therapy
  • Refer

Effective

Uroflow

Continue

therapy

High

Low

Mixed OAB/BPH

Ineffective

Uroflow

Antimuscarinics

Low

Referral

High

Effective

Ineffective

Continue

medication

Referral

ARI: α-reductase inhibitor

Rosenberg MT, et al. Int J Clin Pract. 2007;61:1535-1546.

low risk of retention in men on antimuscarinics for oab luts evidence from trials
Low Risk of Retention in Men on Antimuscarinics for OAB/LUTSEvidence From Trials

* Not available in the United States

DO: detrusor overactivity

oab symptom improvement in men patient reported outcomes
Antimuscarinic treatment effective and well tolerated in men with OAB:

Regardless of history of “prostate condition”

Percent of

male respondents

Baseline

Month

Percent of

male respondents

Baseline

Month

OAB Symptom Improvement in Men: Patient-Reported Outcomes

■ PPBC = 1, 2, or 3 ■ PPBC = 4, 5, or 6

Global assessment of OAB severity

■ Always ■ Most of the time

■ Sometimes, infrequently, or never

“Within the past month, do you feel that you had enough time to get to the bathroom?”

MATRIX: open-label study with oxybutynin TDS

N = 369 men with PPBC ≥ 4

(condition caused moderate,

severe, or many severe problems)

Staskin DR, et al. Int J Clin Pract. 2008;62:27-38.

case study 2 tom treatment and follow up
Case Study 2: TomTreatment and Follow-Up
  • You use a questionnaire to assess Tom’s symptoms
  • Behavioral modifications
  • You start him on an α-blocker:
    • At follow-up, obstruction has improved
  • He still complains of nocturia and you add antimuscarinic treatment:
    • After 4 weeks of antimuscarinic treatment, his nocturia episodes have been reduced to 2 times a night
summary
Summary
  • OAB is a prevalent disease that increases with age
  • OAB impacts comorbidities and QOL
  • OAB symptoms can be treated:
    • Move toward symptom/syndrome-based treatment
    • Individualized to match patient’s preference and expectations (tolerability and efficacy)
    • Recognize comorbidities and treatment fluid imbalances
    • Institute behavioral changes and pelvic floor exercises
    • Flexible-dosing regimens
postmeeting survey

?

Postmeeting Survey
  • True or false: The core symptom of OAB is urgency.
    • True
    • False
postmeeting survey62

?

Postmeeting Survey
  • Which of the following are NOT considered comorbidities in patients with OAB?
    • Falls and fractures
    • UTIs
    • Skin infections
    • Kidney stones
postmeeting survey63

?

Postmeeting Survey
  • True or False: Using a flexible-dosing regimen of antimuscarinics results in improved efficacy and patient satisfaction.
    • True
    • False