Overactive bladder (OAB) is a common condition that affects millions of people. Overactive bladder isn't a disease. It's the name of a group of urinary symptoms. The most common symptom of OAB is a sudden urge to urinate that you can't control. Some people will leak urine when they feel the urge.
2. ❑Overactive bladder (OAB) is not a disease; it is a
symptom; Patients with OAB do not complain of pain or
dysuria
❑Bladder storage symptoms have a severe impact on many areas
as regards the quality of life including health-related, social,
psychological and working functions
❑Overactive bladder (OAB) is highly prevalent and is
associated with considerable morbidity, especially in
aging population
OAB
3. OAB-Symptoms
Urgency
Frequent strong, sudden and
unpredictable desire to urinate
UrgeIncontinence
Involuntary urine loss associatedwith
sudden, strong desire to void
Eur.Ass.Gyn.Obs,1999
6. Overactive bladder: treatment options
First-line treatments:
❑Behavioral therapies (e.g. bladder training, bladder control
strategies, pelvic floor muscle training, fluid management) as
first-line therapy to all patients with overactive bladder.
❑Pharmacologic management.
7. 7
Mattiasson A. Urology. 2000;55(suppl 5a):12-13, Mattiasson A. Neuro Urodyn. 2001;20:403-404, Burgio et al. JAGS. 2000;48:370-374.
Drug therapy: becoming increasingly important & currently
mainstay in treatment for OAB
OAB: Pharmacotherapy
Antimuscarinic agents: Gold standard
Second-line treatments:
8. 8
Ideal muscarinic receptor antagonist
Efficacious:
Inhibits involuntary bladder contractions
Does not adversely affect voluntary detrusor activity
Organ selective:
Preferentially affects bladder over other organs
Minimal side effects
Tolerable:
Improves compliance
9. Choice of agent
may not experience the full benefit of these drugs until after
4 weeks of treatment
If the first choice is not effective or is poorly tolerated, it is
reasonable to offer another drug, preferably the least
expensive.
should be counseled about the need for concurrent
behavioral therapy, because these drugs are more effective
in combination with behavioral therapy than with either
treatment modality alone.
10. Side effects
Common adverse effects include constipation,
impaired cognition, sedation, and blurred vision.
These agents should not be used in patients with
narrow angle glaucoma because they can increase
intraocular pressure.
Extra caution in frail patients-cognitive function
SR preparation preferred
start with Lowest possible dose
11. Drugs
Oxybutynin- side effects
Tolterodine 4 mg OD
Trospium 60 mg OD- safe in elderly as it doesn’t cross
blood brain barrier
Darifenacin-frequency 7.5mg OD /15 mg
Solifenacin-urgency 5mg OD / 10mg
Mirabegron-50 mg OD
Combination
12. Mirabegron-Beta 3 agonist
USFDA approved in 2012
A placebo controlled RCT found that patients taking once daily mirabegron
had 1.1 (−1.35 to −0.91) fewer daily episodes of urinary incontinence with
placebo, compared with 1.5 (−1.69 to −1.25) for 50 mg mirabegron, and 1.6
(−1.86 to −1.40) with 100 mg mirabegron, from a baseline of 2.4 episodes daily.
Adverse effects were uncommon, with dry mouth and constipation reported in
less than 2% of all patients.
In addition, a pooled phase III clinical trial showed no significant increase in
hypertension (<1 mm Hg) with mirabegron versus placebo.
Dose- 50 mg ODX 8 weeks- 12 month
Can be given in association with solifenacin 5 mg OD-urgency/nocturia
Caution- renal impairment and HT
13. Third-line treatments:
❑ Intradetrusor onabotulinum toxin A (100 U) as third-line treatment in the carefully-selected
and thoroughly counseled; patient who has been refractory to first- and second-line
overactive bladder treatments. The patient must be able and willing to return for frequent
post-void residual evaluation and able and willing to perform self-catheterization if
necessary.
Standard Option
❑ Peripheral tibial nerve stimulation (PTNS) as third-line treatment in a carefully selected
patient population.
❑ Sacral neuromodulation (SNS) as third-line treatment in a carefully selected patient
population characterized
❑ By severe refractory overactive bladder symptoms or patients who are not candidates for
second-line therapy and are willing to undergo a surgical procedure.
Additional treatments:
❑ Indwelling catheters (including transurethral, suprapubic, etc.) are not recommended as a
management strategy for overactive bladder because of the adverse risk/benefit balance
except as a last resort in selected patients.
❑ In rare cases, augmentation cystoplasty or urinary diversion for severe, refractory,
complicated overactive bladder patients may be considered.
Overactive bladder: treatment options
14. 1. Underreporting • Increase patient awareness
about OABasadisease
2. High discontinuation
rates with antimuscarinic
therapy
• Increase awareness
regarding OABmanagement
• Need anantimuscarinic
agent:
➢ Better efficacy
➢ Better persistencerates
➢ Goodsafety profile
➢ Integration with behavioural
therapy