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FRCSC 2020 Guidelines > CUA GL 2017 OAB > Flashcards

CUA GL 2017 OAB Flashcards

1
Q

What is the ICS definition of OAB?

A

Urinary urgency with or without urgency incontinence frequently accompanied by frequency and nocturia in the absence of UTI or other obvious pathology.

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2
Q

What is the ICS definition of Urinary frequency?

A

Patient complaint of urinating too often during the daytime

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3
Q

What is the ICS definition of nocturia?

A

one or more voids per night, preceded and followed by sleep

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4
Q

What is the ICS definition of urinary urgency?

A

urgency is the sudden compelling desire to pass urine that is difficult to defer.

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5
Q

what is the ICS definition of Urge incontinence?

A

involuntary leakage of urine accompanied or immediately preceded by urgency.

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6
Q

What is the prevalence of OAB?

A

14-18% in Canadian population, same between men and women

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7
Q

prevalence of OAB without UUI is more common that with UUI in men

A

Correct, it is the opposite in women

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8
Q

OAB and bladder outlet obstruction are comorbid conditions in men due to BPH.

A

Correct

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9
Q

What are the QoL domains negatively affected by OAB? wet or dry

A

daily life, recreational life, psychological concerns(depression), isolation, sexuality(particularly in women), work productivity(reduction as much as RA and asthma),

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10
Q

what is the most common cause for incontinence in older adults?

A

OAB and UUI

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11
Q

What is the first step of assessment of patient presenting for OAB?

A

Take a history, voiding diary if possible

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12
Q

What should be included in physical exam for OAB?

A

abdominal exam, pelvic exam to assess tissue quality and sensation, urethra and POP, stress incontinence(cough test), DRE, or vaginal exam, neurologic exam( perineal sensation, S1-S4, bulbocavernosal reflex, rectal sphincter tone)

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13
Q

Patient self reported questionaries’ are the most suitable method for assessing the patient’s perspective of bothersome symptoms and impact on patients’ quality of life.

A

Correct

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14
Q

A 24 hour voiding diary is adequate

A

Incorrect. bc of daily variability 3-7 days is.

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15
Q

Bladder diaries are not useful in behavioral therapies and bladder training programs.

A

Wrong. they are.

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16
Q

UA and Ucx is recommended for all patients presenting with OAB.

A

YES

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17
Q

Is urine cytology recommended in routine work up of patients with OAB>

A

NO, but remember that irritative voiding symptoms are associated with UC in women.

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18
Q

Is measurement of PVR recommended for patients with OAB?

A

Not typically unless there are obstructive voiding symptoms or ( neurologic history, prostate or incontinence surgery hx,

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19
Q

Are there imaging work up recommended in initial work up of OAB>

A

Nope( no cysto, US, MRI or CT)

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20
Q

Is monitoring of bladder wall thickness useful for monitoring the effects of OAB treatment? or diagnosis

A

No

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21
Q

Is UDS recommended in routine initial work up of OAB?

A

No

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22
Q

Do the findings on UDS predict response to surgical or non surgical treatment for OAB?

A

NO

23
Q

which patients with OAB should have UDS?

A

neurogenic voiding dysfunction, history of radical pelvic surgery, pelvic radiation, and those at risk of upper tract deterioration, after failed previous treatment, if diagnosis is not clear after H and P.

24
Q

What are two main components of behavioral therapy for OAB?

A

PFMT and bladder training,

25
Q

What are components of bladder training?

A

use of bladder diaries, bladder control strategies, timed voiding, scheduled or prompted voiding, delayed voiding

26
Q

what are components of PFMT for Tx of OAB?

A

urgency suppression, control strategies, biofeedback

27
Q

when behavioral therapies for compared to medications they were either equal or inferior to medical therapy in reducing Incontinence, frequency, nocturia reduction? T/F

A

F, they were equal or superior

28
Q

What lifestyle changes can be suggested for OAB that may be helpful?

A

fluid and caffeine intake, diet management and weight loss. management of bowel irregularity, optimization of other comorbidities

29
Q

changes in daily life should be implemented for how long minimum? how long ideally?

A

6 weeks minimum, 8-12 weeks ideally.

30
Q

A patient with BMI greater than 30 is at increased risk of developing OAB symptoms

A

Correct

31
Q

What are three classes of drugs available for use for OAB in Canada?

A

antimuscaranics, Beta-3 agonists, Combination therapy

32
Q

Name 5 antimuscaranics available in canada?

A

Oxybutinin(IR, ER, Transdermal), Tolteridine, darifenacin, trospium, propiverine, fesoteridine.

33
Q

Between tolteridine and oxybutinin which one is prefered?

A

Tolteridine ER bc of lower side effects and similar efficacy

34
Q

Is there a role for combining different AMs?

A

No, just increases side effects

35
Q

What are common side effects of AM?

A

dry mouth, pruritus, constipation, dry eyes, cognitive side effects

36
Q

What are contraindications to AM therapy?

A

uncontrolled narrow angle glaucoma( due to antagonism of M3 and M5 receptors in the eye), GI and GU obstruction, Urinary retention, Pregnancy, breastfeeding, hypersensitivity

37
Q

name 3 side effects of mirabegron

A

HTN, cardiac arrhythmia, urinary retention, nasopharyngitis, back pain,

38
Q

What combination therapy has been studied?

A

Mirabegron(25/50)+ solifenacin in symphone and BESIDE studies and combo therapy was found to be more efficacious.

39
Q

Which AM and at what dose is superior to mirabegron i50mg in reducing episodes of UUI?

A

Solifenacin 10mg

40
Q

Is pregnancy a contraindication to Mirabegron? what about AMs?

A

YES, YES

41
Q

How are absorption of drugs affected by ageing?

A

decreased gastric motility, decreased skin thickness

42
Q

How does ageing affect body distribution of drugs?

A

decreased in lean body mass, decreased protein binding leading to higher concentrations of free drug

43
Q

How is renal clearance of drugs affected by ageing?

A

decreased

44
Q

How is hepatic metabolism of drugs affected by ageing?

A

decreased in phase ( (oxidation) reactions, decreased hepatic blood flow and mass( decreased clearance and first pass metabolism),

45
Q

Has trospium and solifenacin at low standard doses been shown to be effective in combination in elderly?

A

YES, higher efficacy than regular dose

46
Q

what does fesoteridine become after metabolism by cyp3a4?

A

tolteridine

47
Q

what medications could potentially increase concentration of oxybuytinin, solifenacin, darifenacin, tolteridine?

A

Azole antifungals, vinblastine, cyclosporin, macrolide antibiotics

48
Q

What dosage of OnabotulinumtoxinA is used for OAB?

A

100 units, 20 injections( 0.5 ml) per site, trigone is spared

49
Q

what are side effects of intradetrouser botox?

A

uncomplicated UTI, dysuria, bacteriuria, urinary retention,

50
Q

Based on phase 3 RCTs what is the median duration of effect of botox?

A

7.6 months

51
Q

what percentage of patients with SNM will require a revision?

A

30-39%

52
Q

What are side effects of SNM?

A

pain at the simulator site, pain at the lead site, lead migration, electric shock, infection/irritation

53
Q

does obesity affect chance of success with SNM?

A

NO

FRCSC 2020 Guidelines (49 decks)

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