CUA GL 2017 OAB Flashcards
What is the ICS definition of OAB?
Urinary urgency with or without urgency incontinence frequently accompanied by frequency and nocturia in the absence of UTI or other obvious pathology.
What is the ICS definition of Urinary frequency?
Patient complaint of urinating too often during the daytime
What is the ICS definition of nocturia?
one or more voids per night, preceded and followed by sleep
What is the ICS definition of urinary urgency?
urgency is the sudden compelling desire to pass urine that is difficult to defer.
what is the ICS definition of Urge incontinence?
involuntary leakage of urine accompanied or immediately preceded by urgency.
What is the prevalence of OAB?
14-18% in Canadian population, same between men and women
prevalence of OAB without UUI is more common that with UUI in men
Correct, it is the opposite in women
OAB and bladder outlet obstruction are comorbid conditions in men due to BPH.
Correct
What are the QoL domains negatively affected by OAB? wet or dry
daily life, recreational life, psychological concerns(depression), isolation, sexuality(particularly in women), work productivity(reduction as much as RA and asthma),
what is the most common cause for incontinence in older adults?
OAB and UUI
What is the first step of assessment of patient presenting for OAB?
Take a history, voiding diary if possible
What should be included in physical exam for OAB?
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)
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.
Correct
A 24 hour voiding diary is adequate
Incorrect. bc of daily variability 3-7 days is.
Bladder diaries are not useful in behavioral therapies and bladder training programs.
Wrong. they are.
UA and Ucx is recommended for all patients presenting with OAB.
YES
Is urine cytology recommended in routine work up of patients with OAB>
NO, but remember that irritative voiding symptoms are associated with UC in women.
Is measurement of PVR recommended for patients with OAB?
Not typically unless there are obstructive voiding symptoms or ( neurologic history, prostate or incontinence surgery hx,
Are there imaging work up recommended in initial work up of OAB>
Nope( no cysto, US, MRI or CT)
Is monitoring of bladder wall thickness useful for monitoring the effects of OAB treatment? or diagnosis
No
Is UDS recommended in routine initial work up of OAB?
No
Do the findings on UDS predict response to surgical or non surgical treatment for OAB?
NO
which patients with OAB should have UDS?
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.
What are two main components of behavioral therapy for OAB?
PFMT and bladder training,
What are components of bladder training?
use of bladder diaries, bladder control strategies, timed voiding, scheduled or prompted voiding, delayed voiding
what are components of PFMT for Tx of OAB?
urgency suppression, control strategies, biofeedback
when behavioral therapies for compared to medications they were either equal or inferior to medical therapy in reducing Incontinence, frequency, nocturia reduction? T/F
F, they were equal or superior
What lifestyle changes can be suggested for OAB that may be helpful?
fluid and caffeine intake, diet management and weight loss. management of bowel irregularity, optimization of other comorbidities
changes in daily life should be implemented for how long minimum? how long ideally?
6 weeks minimum, 8-12 weeks ideally.
A patient with BMI greater than 30 is at increased risk of developing OAB symptoms
Correct
What are three classes of drugs available for use for OAB in Canada?
antimuscaranics, Beta-3 agonists, Combination therapy
Name 5 antimuscaranics available in canada?
Oxybutinin(IR, ER, Transdermal), Tolteridine, darifenacin, trospium, propiverine, fesoteridine.
Between tolteridine and oxybutinin which one is prefered?
Tolteridine ER bc of lower side effects and similar efficacy
Is there a role for combining different AMs?
No, just increases side effects
What are common side effects of AM?
dry mouth, pruritus, constipation, dry eyes, cognitive side effects
What are contraindications to AM therapy?
uncontrolled narrow angle glaucoma( due to antagonism of M3 and M5 receptors in the eye), GI and GU obstruction, Urinary retention, Pregnancy, breastfeeding, hypersensitivity
name 3 side effects of mirabegron
HTN, cardiac arrhythmia, urinary retention, nasopharyngitis, back pain,
What combination therapy has been studied?
Mirabegron(25/50)+ solifenacin in symphone and BESIDE studies and combo therapy was found to be more efficacious.
Which AM and at what dose is superior to mirabegron i50mg in reducing episodes of UUI?
Solifenacin 10mg
Is pregnancy a contraindication to Mirabegron? what about AMs?
YES, YES
How are absorption of drugs affected by ageing?
decreased gastric motility, decreased skin thickness
How does ageing affect body distribution of drugs?
decreased in lean body mass, decreased protein binding leading to higher concentrations of free drug
How is renal clearance of drugs affected by ageing?
decreased
How is hepatic metabolism of drugs affected by ageing?
decreased in phase ( (oxidation) reactions, decreased hepatic blood flow and mass( decreased clearance and first pass metabolism),
Has trospium and solifenacin at low standard doses been shown to be effective in combination in elderly?
YES, higher efficacy than regular dose
what does fesoteridine become after metabolism by cyp3a4?
tolteridine
what medications could potentially increase concentration of oxybuytinin, solifenacin, darifenacin, tolteridine?
Azole antifungals, vinblastine, cyclosporin, macrolide antibiotics
What dosage of OnabotulinumtoxinA is used for OAB?
100 units, 20 injections( 0.5 ml) per site, trigone is spared
what are side effects of intradetrouser botox?
uncomplicated UTI, dysuria, bacteriuria, urinary retention,
Based on phase 3 RCTs what is the median duration of effect of botox?
7.6 months
what percentage of patients with SNM will require a revision?
30-39%
What are side effects of SNM?
pain at the simulator site, pain at the lead site, lead migration, electric shock, infection/irritation
does obesity affect chance of success with SNM?
NO
