Overactive bladder syndrome (Complete) Flashcards
Define overactive bladder syndrome
Bladder dysfunction caused by hyperactivity of detrusor muscles leading to urinary urgency
What are the main risk factors for overactive bladder syndrome?
Age
Neurological factors:
Multiple sclerosis
Parkinsons
Stroke
Metabolic/endocrine factors:
Diabetes mellitus
Female sex (hormonal changes)
- Menopause
- Pregnancy
- Childbirth
What are the main clinical features of overactive bladder syndrome?
Urinary urgency
Urge incontinence
- Feeling of needing to urinatre followed by uncontrollable leakage
Increased urinary frequency
Nocturia
What differentials should be considered alongside overactive bladder syndrome?
Stress incontinence
- Icontinence in moments of increased abdominal pressure
Pelvic organ prolapse
- Sense of heaviness/fullness + vaginal wall bulging
Functional incontinence
- Unable to reach toilet due to reduced mobility
Overflow incontinence
- Involuntary release of urine due to bladder being overfilled
UTI
- Frequency alongisde haematuria, dysuria, suprapubic pain,
Diabetic neuropathy
What investigations should be considered for patients with suspected overactive bladder syndrome?
Bedside:
Bimanual + speculum examination: Rule out prolapse
Urinalysis + culture: Rule out UTI
Bladder diary: For a minimum of 3 days
Imaging:
Urodynamics: Evaluate bladder muscle function
What is the management plan for patients with overactive bladder syndrome?
Conservative:
Behavioural modification
- Reduce oral intake
- Avoid caffeine and alcohol
Bladder retraining therapy
Medical:
Anticholinergics
- Oxybutinin
- Solifenacin
Beta-3 agonists (e.g. Mirabegron)
Vaginal oestrogen (Can help if urogenital atrophy a likely factor)
Surgical:
Botulism toxin (for refractory cases)
Percutaneous tibial nerve stimulation (PTNS)
Sacral nerve stimulation (SNS)
What is first-line management for OABS?
Behavioural changes such as:
- Reduced fluid intake
- Avoid caffeine and alcohol
What is 2nd-line management for OABS if behavioural changes have no improvement in symptoms?
Bladder retraining therapy
What medication can be considered in OABS if conservative measures ineffective?
Anticholinergics
Beta-3 agonists
Vaginal oestrogen
Name 2 examples of anticholinergic drugs used in management of OABS
Oxybutinin
Solifenacin
Caution should be taken when prescribing anticholinergics in which patients?
Elderly patients due to anticholinergic burdern side-effects
What medication should be considered over anticholinergics in elderly population?
Beta-3 agonsists (e.g. mirabegron)
What medication should be considered if urogenital atrophy is a likely causative factor for OABS?
Vaginal oestrogen
What surgical options are available for patients with OABS if conservative management ineffecitive?
Botulinum toxin (for refractory cases)
Percutaneous tibial nerve stimulation (PTNS)
Sacral nerve stimulation (SNS)
Percutaneous tibial nerve stimulation
Sacral nerve stimulation
What surgical option is considered in reractory cases of OABS?
Botulinum toxin (Botox)
Botunilum toxin type A
