Most prior clinical studies of overactive bladder (OAB) have looked at either its epidemiology or have been clinical trials of medicines or devices. The uniqueness of the present study is its description of “real world” patterns of OAB diagnosis, evaluation and treatment.
To accomplish this, an electronic health records system (EHR), which contained information on almost 20 million U.S. patients who enrolled during the study period, was utilized to gain insight into practice patterns. Ultimately we found that few patients undergo cystoscopy or urodynamics during the evaluation of OAB (as this reflects patients seen across all specialties this is to be expected) and that a minority is treated with medical therapy.
The study could not account for behavioral therapy (as there is no coding for that) nor for physical therapy (PT) (as there is no way to differentiate PT for OAB from PT for a myriad of other problems). Despite this limitation, the fact that only 30% received medical therapy does seem low and may indicate undertreatment of this important problem. Further education of treatment options to both physicians and patients may be needed.
Written by: Howard B. Goldman MD FACS Professor and Vice Chair (Quality and Patient Safety) Glickman Urologic and Kidney Institute Cleveland Clinic Lerner College of Medicine Cleveland, OH.