117 Overactive Bladder

Question 1

Definition of overactive bladder according to the International Continence Society

Answer 1

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.

Question 2

Amongst all the components of OAB, which has the strongest negative association for diminished QOL?

Answer 2

Urgency and UUI

Question 3

Main difference between OAB and detrusor overactivity?

Answer 3

OAB - symptom based

DO - urodynamic observation

Question 4

How is detrusor overactivity characterized urodynamically?

Answer 4

Involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked.

Question 5

What is complaint of involuntary loss of urine associated with urgency and also with effort or physical exertion on sneezing or coughing?

Answer 5

Mixed urinary incontinence

SUI and UUI are present in the same person

Question 6

What is mixed incontinence?

Answer 6

The coexistence of urinary and anal incontinence

Question 7

Complaint of urinary incontinence where the patient has been unaware of how it occured

Answer 7

Insensible urinary incontinence

Question 8

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.

Answer 8

Bladder pain syndrome (BPS)

Question 9

How is OAB differentiated from bladder pain syndrome?

Answer 9

BPS has

• painful nature of symptoms
• steady increase in pain with filling
• more consistent voided volume
• the ability to defer voiding

Question 10

Where is the discomfort in OAB usually felt?

Answer 10

Perineum
Base of penis
Vagina
Urethra

Question 11

Complaint of involuntary loss of urine associated with urgency

Answer 11

Urgency urinary incontinence (UUI)

Question 12

Complaint of a sudden, compelling desire to void that is difficult to defer.

Answer 12

Urgency

Question 13

Complaint of interruption of sleep one or more times because of the need to micturate. Each void is preceded and followed by sleep.

Answer 13

Nocturia

Question 14

Complaint by the patient who considers that he/she voids too often by day (seven voids upper limit of normal)

Answer 14

Increased daytime urinary frequency

Question 15

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.

Answer 15

Overactive bladder syndrome

Question 16

In what sex is OAB more common?

Answer 16

Females

Question 17

Does the prevalence of symptoms of OAB increase with aging?

Answer 17

Yes

Women in their 40s and men in their 50s to 60s

Question 18

The 3 key aspects of OAB

Answer 18

Sensory nerve (afferent signaling)

Contractile motor function

Sensory information ascending in afferents is integrated at several levels in the CNS

Question 19

Where is the main regulatory region of sensory information from the bladder to the brain?

Answer 19

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.

Question 20

Where are the afferent nerve endings particularly dense in the bladder?

Answer 20

Tissue beneath the urothelium

Question 21

Main type of afferent nerves found in the bladder for sensing bladder volume and contractile state of the detrusor

Answer 21

Small caliber, myelinated A-DELTA fibers

Question 22

Location of the cell bodies of A-DELTA fibers subserving the bladder

Answer 22

S2-S4

T11-L2

Question 23

True or false: lare caliber, unyelinated C fibers participate in normal physiologic bladder function

Answer 23

False

Only responds to high intensity activation (extreme distention, cold, heat, chemical irritation)

Question 24

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

Answer 24

1. Urothelium based hypothesis

2. Myogenic hypothesis

Question 25

Urothelium based hypothesis of increased afferent activity in OAB:

Answer 25

• 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.

Question 26

Myogenic hypothesis of increased afferent activity in OAB

Answer 26

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.

Question 27

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

Answer 27

Afferent noise

Question 28

True or false.

Most of the time, the bladder is neurologically trying to empty rather than store.

Answer 28

False

Question 29

True or false.

Aging is NOT associated with increased LUTS, including OAB

Answer 29

False

Question 30

True or false.

DO usually resolves with prostate surgery.

Answer 30

False

Question 31

Main theories on the association between psychology and OAB.

Answer 31

1. Serotogenic mechanisms on the CNS

2. Dysregulation of the pituitary-hypothalamic adrenal axis.

Question 32

Is “bother” an essential component of the history of patients with OAB?

Answer 32

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.

Question 33

True or false, fluid intake is not essential to recognize in patients with OAB.

Answer 33

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

Question 34

True or false. A history of erectile dysfunction is not likely related to OAB.

Answer 34

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.