oab diagnosis & evaluation
DESCRIPTION
Oab diagnosis & evaluation膀胱的診斷及評估TRANSCRIPT
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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.
BORNEO REGIONAL UROLOGY WORKSHOP, Kota Kinabalu, 9-10 July 2011
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Prostate: sex organ, semen, erection, ejaculation, affects urinationWhat about the bladder?
Urology: URINARY SYMPTOMS
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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
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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
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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
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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”
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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
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How Does Urge incontinence Occur?
Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. Stress incontinence: weak sphincter vs cough
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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%
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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
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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
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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
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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.
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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
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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
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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.
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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
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OAB in females (Asian)
• Prevalence – 51.4%
• Seek treatment - 21.1%
Lapitan et al Int Urogynaecol J 2001;12:226-231
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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%
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OAB in males
Sought treatment - 6%
• GP - 30%
• Specialist - 30%
• Others - 30%
Moorthy et al BJUI 2004;93:528-531
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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
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Beware
• High prevalence of OAB
• Small proportion seek treatment
• Lack of awareness
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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.
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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
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• Avoidance of sexual contact
• 20%
Pix Courtesy Dr Peter Ng,
J Sex Med 2007, 4, 656 - 666
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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
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Thank you