117 Overactive Bladder Flashcards
Definition of overactive bladder according to the International Continence Society
Urinary urgency usually accompanied by frequency and nocturia, with or wihtout urgency urinary incontinece (UUI), in the absence of urinary tract infection (UTI) or other obvious pathology.
Amongst all the components of OAB, which has the strongest negative association for diminished QOL?
Urgency and UUI
Main difference between OAB and detrusor overactivity?
OAB - symptom based
DO - urodynamic observation
How is detrusor overactivity characterized urodynamically?
Involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked.
What is complaint of involuntary loss of urine associated with urgency and also with effort or physical exertion on sneezing or coughing?
Mixed urinary incontinence
SUI and UUI are present in the same person
What is mixed incontinence?
The coexistence of urinary and anal incontinence
Complaint of urinary incontinence where the patient has been unaware of how it occured
Insensible urinary incontinence
Complaint of suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and night-time frequency int he absence of proven urinary infection or other obvious pathology.
Bladder pain syndrome (BPS)
How is OAB differentiated from bladder pain syndrome?
BPS has
- painful nature of symptoms
- steady increase in pain with filling
- more consistent voided volume
- the ability to defer voiding
Where is the discomfort in OAB usually felt?
Perineum
Base of penis
Vagina
Urethra
Complaint of involuntary loss of urine associated with urgency
Urgency urinary incontinence (UUI)
Complaint of a sudden, compelling desire to void that is difficult to defer.
Urgency
Complaint of interruption of sleep one or more times because of the need to micturate. Each void is preceded and followed by sleep.
Nocturia
Complaint by the patient who considers that he/she voids too often by day (seven voids upper limit of normal)
Increased daytime urinary frequency
Urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.
Overactive bladder syndrome
In what sex is OAB more common?
Females
Does the prevalence of symptoms of OAB increase with aging?
Yes
Women in their 40s and men in their 50s to 60s
The 3 key aspects of OAB
Sensory nerve (afferent signaling)
Contractile motor function
Sensory information ascending in afferents is integrated at several levels in the CNS
Where is the main regulatory region of sensory information from the bladder to the brain?
At the level of the midbrain and brainstem – where the periqueductal gray and pontine micturition center integrate the key elements of vegtative function, including the voiding reflex.
Where are the afferent nerve endings particularly dense in the bladder?
Tissue beneath the urothelium
Main type of afferent nerves found in the bladder for sensing bladder volume and contractile state of the detrusor
Small caliber, myelinated A-DELTA fibers
Location of the cell bodies of A-DELTA fibers subserving the bladder
S2-S4
T11-L2
True or false: lare caliber, unyelinated C fibers participate in normal physiologic bladder function
False
Only responds to high intensity activation (extreme distention, cold, heat, chemical irritation)
What are the two predominant hypotheses of increased afferent activity which may give rise to the characteristic symptoms of OAB and to the phenomenon of uninhibited detrusor contractions and DO
- Urothelium based hypothesis
2. Myogenic hypothesis
Urothelium based hypothesis of increased afferent activity in OAB:
- the urothelium actively responds to local mechanical, osmotic, inflammatory, and chemical stimuli with alterations in expression and /or sensitivity of cell membrane receptors and channels and with release of chemical mediators that act on adjacent afferent neurons, effectively transducing stimulating signals.
Myogenic hypothesis of increased afferent activity in OAB
Overactive detrusor contractions result from a combination of an increased likelihood of spontaneous excitation within the smooth muscle of the bladder and enhanced propagation of this activity to affect an excessive proportion of the bladder wall.
Even in a nonpathological state, continuous bladder afferent activity during the micturition cycle delivers a myriad of signals conveying pain, mechanosensation, chemical sensitivity, and motor and/or sensory function to the CNS for processing
Afferent noise
True or false.
Most of the time, the bladder is neurologically trying to empty rather than store.
False
True or false.
Aging is NOT associated with increased LUTS, including OAB
False
True or false.
DO usually resolves with prostate surgery.
False
Main theories on the association between psychology and OAB.
- Serotogenic mechanisms on the CNS
2. Dysregulation of the pituitary-hypothalamic adrenal axis.
Is “bother” an essential component of the history of patients with OAB?
Yes.
Presence of and bother from each of the storage LUTS that make up the OAB syndrome (i.e., urgency, urgency incontinence, daytime frequency, and nocturia), other storage disorders (e.g., SUI), and voiding LUTS (e.g., straining, hesitancy, sesation of incomplete emptying) whose presence may indicate BOO. POst-micturition LUTS, dysuria, hematuria should be assessed.
True or false, fluid intake is not essential to recognize in patients with OAB.
False.
Nature and volume of fluid intake, recognizing that stiumulants like caffeine, and polydipsia affect LUTS and that patients may adapt their intake to reduce the impact of symptoms
True or false. A history of erectile dysfunction is not likely related to OAB.
False.
Occult neurologic disease could be present.
OAB with symptoms of ED or tremor or history of spine surgery or disk disease with or without sensory and/or musculoskeletal symptoms.
