Defining and Managing Overactive Bladder: Disagreement Among the Experts - 31/01/13

Doi : 10.1016/j.urology.2012.09.028

Una J. Lee ^a, Victoria C.S. Scott ^b, Rezoana Rashid ^b, Ajay Behniwal ^b, Alan J. Wein ^c, Sally L. Maliski ^b, Jennifer T. Anger ^b,^d,^⁎
^a Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
^b David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
^c Division of Urology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
^d Division of Urologic Reconstruction, Female Urology, and Urodynamics, Cedars-Sinai Medical Center, Beverly Hills, CA

Reprint requests: Jennifer T. Anger, M.D., M.P.H., Division of Urologic Reconstruction, Female Urology, and Urodynamics, Cedars-Sinai Medical Center, 99 La Cienega, Suite 307, Beverly Hills, CA 90211.

Abstract

Objective

To better understand experts’ perceptions of the definition of overactive bladder (OAB) and the evaluation and treatment of OAB in women.

Materials and Methods

OAB has been defined by the International Continence Society as “urinary urgency, with or without urge urinary incontinence, usually with frequency and nocturia.” Under the current definition, people with very different clinical conditions are included under the OAB umbrella. In the present study, 12 interviews with leading urologic, gynecologic, and geriatric practitioners in urinary incontinence and OAB were performed. Questions were asked about their perception and agreement with the current definition of OAB. The interviews were audiotaped and transcribed verbatim. The grounded theory method was used to analyze the data.

Results

Overall, a great amount of variability was found in the definition and management of OAB. Four categories of definitions were derived from the qualitative analysis: the current OAB definition is adequate, OAB is a constellation of symptoms, OAB should include the fear of leakage, and OAB is a marketing term. Although some consensus has been reached on the evaluation, several areas have demonstrated disagreement over elements of the evaluation. Experts also believed that OAB is a chronic condition, with symptom variability, and has no cure. Managing patient expectations is essential, because OAB is challenging to treat. A focus was placed on behavioral therapy.

Conclusion

The experts disagreed over the definition and workup of OAB. However, the experts agreed that OAB is a chronic condition with a low likelihood of cure.

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Plan

	*Financial Disclosure:* The authors declare that they have no relevant financial interests.
	*Funding Support:* This study was supported by the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases (grant 1 K23 DK080227-01 to J. T. Anger).