Overactive Bladder: Evaluation and Diagnosis

Charles Butrick; Linda Cardozo; Peter Sand

Overactive Bladder: Evaluation and Diagnosis

Moderator:

There is no moderator for this particular article.

Discussants:

Peter Sand, MD

Date: August 4, 2012

Roundtable ID: GM6346

Citation: Med Roundtable Gen Med Ed. ; 1(3): 212 - 221.

Summary:
Dr. Charles Butrick from the Urogynecology Center, Overland Park, KS moderated the topic "Overactive Bladder: Evaluation and Diagnosis" with Drs. Linda Cardozo from King's College Hospital and Peter Sand from the Evanston Continence Center, Chicago, IL.

The discussion focused primarily on:
1. The definition, prevalence, and symptoms of overactive bladder (OAB) syndrome;
2. the risk factors for and comorbidities associated with OAB;
3. the importance of the differential diagnosis of OAB;
4. combined use of behavioral modification and medication or a combination of medications as first-line therapy;
5. pharmacological treatment of OAB, focusing on antimuscarinic medications, and its outcomes;
6. treatment of patients with mixed symptoms and/or nocturia;
7. the importance of ensuring patient compliance; and
8. second-line and emerging therapies for patients who fail to respond.
Med Roundtable Gen Med Ed. 2014;1(3):212–221.

Compounds:
amitriptyline, anticholinergics, antimuscarinics, beta-3 agonists, darifenacin, imipramine, mirabegron, onabotulinumtoxinA, oxybutynin, selective M3 drugs, solifenacin, tricyclics, trospium chloride

Trials:
No trials discussed.

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"Knowing that efficacy is not 100% and that comorbidities can add to a poor response, we realize that some patients need to move on to second-line therapies."

Charles Butrick

"Because OAB [overactive bladder] is a symptomatic diagnosis rather than a diagnosis based on investigations, it’s quite possible to get it wrong…Therefore, when treatment doesn’t work, it’s very important to make sure that the diagnosis was correct."

Linda Cardozo

"Only about 1 in 4 patients actually receive either some form of treatment or a referral when they discuss OAB with their primary care physicians. We certainly need to do a much better job as physicians in identifying and helping our patients when they are brave enough to talk about OAB and guide them to receive help in some way."

Peter Sand