Urgency Incontinence Articles

Articles

  • AUGS 2012 - Anticholinergic versus botulinum toxin-A comparison trial for the treatment of urinary incontinence: The ABC randomized trial - Session Highlights

    CHICAGO, IL USA (UroToday) - In this double-blinded study of 249 participants, 242 were available for analysis.

    Published October 4, 2012
  • Choosing oral drug therapy for overactive bladder in older people.

    Overactive bladder (OAB) and urgency incontinence are common in older people. Nevertheless, there remains a paucity of prospectively collected data on the efficacy of commonly used drug treatments for the condition.

    Published August 12, 2018
  • Impact of intravesical onabotulinumtoxinA on sexual function in women with OAB.

    Urgency urinary incontinence (UUI), and the symptoms of overactive bladder (OAB) have a negative impact on female sexual function. The aim of this study was to investigate the effect of intravesical onabotulinumtoxinA (Botox) injection on sexual function in women with OAB, using the multi domain Female Sexual Function Index (FSFI) questionnaire.

    Published October 11, 2016
  • National Trends in the Surgical Management of Urinary Incontinence Among Insured Adult Women, 2004-2013: The Urologic Diseases in America Project.

    The objective of this study was to examine national trends in the surgical management of urinary incontinence (UI) among women in the United States from 2004-2013.

    We analyzed the Optum© de-identified Clinformatics® Data Mart (CDM) Database for women 18-64 years of age and the Medicare 5% Sample (CMS) for women 65+ years of age.

    Published October 6, 2019
  • Overactive Bladder (OAB) Etiology & Clinical Assessment

    The overactive bladder (OAB) is a prevalent problem, with considerable effects on the quality of life of affected individuals and substantial health economic costs.

    The condition is symptom based and defined by the International Continence Society (ICS) standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, if there is no proven infection or other obvious pathology.

    • Urgency with at least one other symptom is essential to diagnose OAB.
    • Urgency is the central symptom, defined by the ICS as the complaint of a sudden compelling desire to void that is difficult to defer.
    • The normal urge to void is terms the desire to void, by the ICS and is used to describe normal filling sensation.
    • Urgency incontinence is defined as involuntary leakage of urine, accompanied or immediately preceded by urgency.
    • The symptom of “increased daytime frequency” is the complaint by the patient who considers that they void too often throughout the day.
    • Although the ICS has not defined normal daytime voiding frequency, many references and clinical trials have reported baselines of 8 - 10 daytime voids as normal. Variables include the intake of liquids and medications that may increase voiding frequency.
    • The symptom of nocturia is the complaint that the individual is awakened from sleep at night one or more times to void.

    Etiology - OAB:

    • Neurologic disease is associated with a high prevalence of lower urinary tract dysfunction (LUTD).
    • OAB increases with increasing age.

    Prevalence of OAB:

    • The NOBLE study established the prevalence of OAB in more than 5000 community-dwelling individuals in the United States using a validated computer-assisted telephone interview.
    • Men and women had the same prevalence of OAB overall (16.0% and 16.9%, respectively) as defined by the ICS.
    • Men were shown to have a higher prevalence of “OAB dry” (13.4% as opposed to 7.6% in women)
    • Women had a higher prevalence of “OAB wet” (9.3% as opposed to 2.6% in men).
    • In women the prevalence of “OAB wet” rose from 2.0% in the youngest group (ages 18 to 24) to 19.1% in those 65 to 74 years of age.
    • Men, on the other hand, did not experience an increase in “OAB wet” until older: 8.22% for those 65 to 74 and 10.2% for those 75 years and older.
    • Using the standardized ICS definition of OAB, the EPIC study reported the prevalence of OAB in four European countries and in Canada, reporting an overall OAB prevalence of 11.8%.
    • Both types of OAB have a significant impact on the patients’ quality of life.
    • OAB is a chronic condition, and ongoing quality of life impairment can be anticipated in many patients.

    Clinical Evaluation:

    • Patients with OAB may present to health care professional in primary care, OBGYN, or urology.
    • It is critical for the healthcare professional to hear the patient defining either signs or symptoms of OAB.
    • OAB is a condition that requires management, and “cure” is not a realistic possibility. Appropriate expectations and explanation are important to the success of patient treatments.
    • An initial assessment gives a diagnosis and the basis for empirical treatment.
    • Establish the patient's desire for treatment and which therapies are open to consideration..

    History to include:

    • Presence or absence, incidence, severity, and bother for each of the OAB symptoms including urgency incontinence.
    • Other lower urinary tract symptoms (LUTS) should also be assessed.
    • Presence or absence of dysuria and hematuria.
    • Nature and volume of fluid intake.
    • Whether occult neurologic disease could be present.
    • Obstetric and gynecologic history, previous surgery/radiotherapy, bowel symptoms, and drug history.
    • Other medical issues
    • Dipstick urinalysis is necessary to exclude hematuria or urinary tract infection.
    • A significant postvoid residual volume must be considered when evaluating OAB.

    Symptom assessment questionnaires provide valuable information for baseline assessment and follow-up of treatment response.

    • Thebladder diary is essential for assessing OAB and excluding additional problems such as polydipsia or nocturnal polyuria.
    • The OAB-q is highly responsive to change between continent and incontinent patients with OAB, and is a valid tool for measuring treatment outcomes among continent OAB patients. 

    Mixed Urinary Incontinence

    • Mixed OAB is where OAB and stress urinary incontinence (SUI) are both present.
    • Mixed urinary incontinence (MUI) is the complaint of involuntary leakage associated with urgency and with exertion, effort, sneezing, or coughing.
    • The history can be helpful; the primary problem in mixed UI is often that component (the stress or the urge) that occurred first chronologically.
    • The voiding diary can provide important information on chronological order.
    • When OAB is the predominant problem the void volumes should be small both day and night.
    • If there are small daytime voids with little or no nocturia and a large first morning void the urgency symptoms tend to be a manifestation of SUI, perhaps stimulated as a few drops of urine leak into the proximal urethra with activity and trigger a sense of urgency.
    • Pelvic organ prolapse can have a similar effect. When SUI is suspected to be the primary component, a short-term trial of one of the vaginal support devices may clarify the picture.
    • If the symptoms are relieved by the device the patient may decide to continue using it or feel more confident that surgical intervention will be successful.
    • A pessary trial is doubly important before correcting pelvic organ prolapse (with or without UI).
    • Elevation of a cystocele will unmask occult sphincteric incompetence in approximately 50% of patients who are continent with the prolapse.
    • If an ambulatory trial of a pessary is not performed, then a pessary or vaginal packing may be used during preoperative urodynamic testing.
    • The urethral stent/plug devices are relatively contraindicated in this patient population because clinical experience suggests that they typically aggravate the underlying urge and become totally ineffective.

    Mixed Incontinence

    Mixed incontinence is the combination of urinary symptoms and fecal incontinence.


    OAB-q and OAB-q short form symptom bother



    References:

    • Abrams P, Artibani W, Cardozo L, et al: Reviewing the ICS 2002 terminology report: the ongoing debate. Neurourol Urodyn 2009; 28(4):287.
    • References:
    • Abrams P, Cardozo L, Fall M, et al: The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21(2):167-178.
    • Abrams P, Klevmark B: Frequency volume charts: an indispensable part of lower urinary tract assessment. Scand J Urol Nephrol Suppl 1996; 179:47-53.
    • Al-Hayek S, Belal M, Abrams P: Does the patient's position influence the detection of detrusor overactivity?. Neurourol Urodyn 2008; 27(4):279-286.
    • Brading AF: A myogenic basis for the overactive bladder. Urology 1997; 50(6A Suppl.):57-67.
    • Coyne KS, Elinoff V, Gordon DA, et al: Relationships between improvements in symptoms and patient assessments of bladder condition, symptom bother and health-related quality of life in patients with overactive bladder treated with tolterodine. Int J Clin Pract 2008; 62:925-931.
    • Coyne KS, Sexton CC, Irwin DE, et al: The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int 2008; 101(11):1388-1395.
    • de Groat WC: A neurologic basis for the overactive bladder. Urology 1997; 50(6A Suppl.):36-52.
    • Fitzgerald MP, Kenton KS, Brubaker L: Localization of the urge to void in patients with painful bladder syndrome. Neurourol Urodyn 2005; 24:633-637.
    • Irwin DE, Milsom I, Hunskaar S, et al: Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50(6):1306-1314.
    • rwin DE, Milsom I, Kopp Z, et al: Prevalence, severity, and symptom bother of lower urinary tract symptoms among men in the EPIC study: impact of overactive bladder. Eur Urol 2009; 56:14-20.
    • Milsom I, Abrams P, Cardozo L, et al: How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 2001; 87(9):760-766.
    • Stewart WF, Van Rooyen JB, Cundiff GW, et al: Prevalence and burden of overactive bladder in the United States. World J Urol 2003; 20(6):327-336.

    Published April 25, 2012
  • Patterns of medical management of overactive bladder (OAB) and benign prostatic hyperplasia (BPH) in the United States.

    Overactive bladder (OAB) and benign prostatic hyperplasia (BPH) are highly prevalent conditions that place a large burden on the United States (US) health care system. We sought to analyze patterns of prescription medication usage for incident OAB in men and women, and for incident BPH in men using US health insurance claims data.

    Published April 30, 2017
  • Symptom-Based Clustering of Women in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort Study.

    Women with lower urinary tract symptoms (LUTS) are often diagnosed based on a pre-defined symptom complex, or on a predominant symptom. There are many limitations to this paradigm, as often patients present with multiple urinary symptoms that do not perfectly fit the pre-established diagnoses.

    Published July 25, 2018
  • The bladder is not sterile: History and current discoveries on the urinary microbiome.

    In the human body, there are 10 bacterial cells for every one human cell. This fact highlights the importance of the National institutes of Health's initiative to map the human microbiome. The Human Microbiome Project was the first large-scale mapping of the human microbiome of 5 body sites: GI tract, mouth, vagina, skin and nasal cavity using culture-independent methods.

    Published May 23, 2016
  • The Current Evidence on the Association Between the Urinary Microbiome and Urinary Incontinence in Women.

    Urinary incontinence (UI) is a burdensome condition with high prevalence in middle-aged to older women and an unclear etiology. Advances in our understanding of host-microbe interactions in the urogenital tract have stimulated interest in the urinary microbiome.

    Published June 9, 2019
  • The Impact of Dry Mouth on Fluid Intake and Overactive Bladder Symptoms in Women taking Fesoterodine.

    To investigate the long-term relationships between dry mouth, fluid intake and overactive bladder symptoms in women undergoing treatment with fesoterodine. We hypothesize that women who experience dry mouth will increase their fluid intake and worsen their urinary symptoms.

    Published December 29, 2015
  • The LURN Research Network Neuroimaging and Sensory Testing (NIST) Study: Design, protocols, and operations.

    The Neuroimaging and Sensory Testing (NIST) Study of the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is a cross-sectional, case-control study designed to investigate whether disrupted brain connectivity and sensory processing are associated with abnormal lower urinary tract symptoms (LUTS) in patients with overactive bladder syndrome (OAB).

    Published November 5, 2018
  • Urinary retention in female OAB after intravesical Botox injection: who is really at risk?

    Intravesical onabotulinumtoxinA (Botox) injections are effective for the treatment of idiopathic overactive bladder (OAB) symptoms. The aim of our study was to assess the predisposing factors for urinary retention in women with OAB after intravesical Botox injection.

    Published November 30, 2016