Transcript DIAGNOSIS OF OAB

MODULE 2
IDENTIFICATION, SCREENING
AND DIAGNOSIS
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Prescribing information is available at this meeting
DET 808
CHALLENGES TO IDENTIFICATION OF OAB
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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.
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Prescribing information is available at this meeting
ASKING THE RIGHT QUESTIONS
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Do you go to the toilet more than 8 times a day?
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Do you often wake up during the night needing to go to the toilet?
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Do you have to hurry to make the toilet in time?
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Do you often not reach the toilet in time?
Prescribing information is available at this meeting
OPPORTUNITIES FOR SCREENING
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Prescribing information is available at this meeting
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
SCREENING IS AN IMPORTANT TOOL
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Reasons for screening
– High prevalence
– Impact on patients’ lives
– Cost to society
– Government initiatives/guidelines such as:
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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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Prescribing information is available at this meeting
A NEW SCREENING TOOL – THE OVERACTIVE
BLADDER – VALIDATED 8-QUESTION
QUESTIONNAIRE
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Prescribing information is available at this meeting
Validated in 1260 patients24
8 simple, self-administered questions
Simple scoring by addition
Available and linguistically validated in 12 languages25
24. Coyne K, Matza L ICS 2004.
25. Conway K, Uzun V, Vigner S et al. ICS 2004.
SCREENING WITH THE OVERACTIVE
BLADDER QUESTIONNAIRE
How bothered have you been by…
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Prescribing information is available at this meeting
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?
14. Coyne K, et al. Qual Life Res. 2002;11:563-574.
HOW TO USE THE OVERACTIVE
BLADDER QUESTIONNAIRE
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Patients complete the screening questions
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Doctor reviews the patient-completed screener
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Doctor makes diagnosis and treats appropriately
Prescribing information is available at this meeting
COMMUNICATION IS THE KEY
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Active listening
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Use of language
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Use of body language
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Questioning techniques
Prescribing information is available at this meeting
DIAGNOSIS OF OAB
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Prescribing information is available at this meeting
WHO IS AT RISK OF OAB?
URGE INCONTINENCE
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Advanced age
Diabetes
Urinary tract infection
Smoking
STRESS INCONTINENCE
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White race
High body mass index
High waist-to-hip ratio
Parity
ANY INCONTINENCE
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Advanced age
White race
Education
Functional or sensory
impairment
High body mass index
Previous hysterectomy
Stroke
Diabetes
Chronic obstructive
pulmonary disease
10. Milsom I, et al. Am J Manag Care. 2000;6(suppl):S565-S573.
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Prescribing information is available at this meeting
OTHER CONDITIONS/MEDICATIONS WHICH
HAVE AN IMPACT ON SYMPTOMS OF OAB
COEXISTING CONDITIONS
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Chronic constipation26
Urinary tract infection26
Delirium26
Depression22
Skin infection22
Sleep deprivation22
DRUGS ASSOCIATED WITH INCONTINENCE
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Diuretics26
Antidepressants26
Antihypertensives26
Sedatives, hypnotics and nacotics26
Muscle relaxants26
22. Thuroff J. EUR Urol. 2003;2 (Suppl):10-15.
26. ASCP website.
http://www.ascp.com/pubs/tcp/1999/special/diagnosing.shtml
Prescribing information is available at this meeting
DIAGNOSIS OF OAB BASED ON SYMPTOMS
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To confirm diagnosis of OAB
– Patient history12
– Overactive Bladder Questionnaire24
– Physical examination12
– Urinalysis12
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Prescribing information is available at this meeting
12. Wein AJ, Royner ES. Int J Fertil. 1999;44:56-66.
24. Coyne K, Matza L. ICS 2004.
DIAGNOSIS OF OAB
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Patient history
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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
Physical examination
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Abdominal
Neurological
Pelvic (women)
Genital/prostate (men)
12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66.
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Prescribing information is available at this meeting
DIAGNOSIS OF OAB (CONTINUED)
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Urinalysis
– Infection
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Tumour
Haematuria
Glucosuria
Proteinuria
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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Prescribing information is available at this meeting
12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66.
DIFFERENTIAL DIAGNOSIS:
OAB AND STRESS INCONTINENCE
SYMPTOM ASSESSMENT
OVERACTIVE BLADDER
SYMPTOMS
Urgency (strong, sudden desire to void)
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No
Frequency with urgency (>8 times/24 h)
Yes
No
Leaking during physical activity;
eg, coughing, sneezing, lifting
No
Yes
Large (if present)
Small
No/ Just barely
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Usually
Seldom
Amount of urinary leakage with each
episode of incontinence
Ability to reach the toilet in time
following an urge to void
Waking to pass urine at night
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STRESS-INCONTINENCE
Prescribing information is available at this meeting
12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66.
TREATMENT VERSUS REFERRAL
OAB
TREAT IF:
REFER TO SPECIALIST IF:
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Frequency/urgency and normal
urinalysis
Frequency with urgency
Urge incontinence
Normal urinalysis
Prescribing information is available at this meeting
No response to treatment
Haematuria without infection
Poor bladder emptying
Neurological or metabolic disease
Genital/prostate abnormalities
12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66.