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Speaker: Dr. Amitabh Sinha, India
Important Takeaways
1. Prevalence and impact on elderly women: OAB prevalence increases significantly with age, particularly in women due to hormonal changes, childbirth, and pelvic floor trauma.
2. Importance of differential diagnosis: Accurate diagnosis of OAB necessitates excluding conditions such as UTIs, bladder stones, cancer, or neurological disorders.
3. Tailored goals in treatment: Realistic treatment goals should focus on symptom reduction rather than a cure, improving quality of life with lifestyle adjustments, behavioural therapy, and medication.
4. Individualised pharmacotherapy: Beta-3 agonists like mirabegron offer effective treatment with fewer side effects, especially for those intolerant to antimuscarinics.
5. Comprehensive management strategy: A multimodal approach, combining lifestyle changes, bladder training, and targeted pharmacologic treatments, is recommended to enhance treatment outcomes.
Key Highlights
Definition and Prevalence of OAB:
The International Continence Society (ICS) defines OAB as a syndrome marked by urinary urgency, typically accompanied by frequency, nocturia, and urgency incontinence, absent of infections or other pathological conditions. Approximately 37% of OAB cases are "wet OAB" (with incontinence), and 63% are "dry OAB" (without incontinence). Studies, such as the EPIC study, indicate a 12% overall prevalence of OAB, increasing to 30–35% in people over 60. Notably, over 40% of women over age 60 are affected.
Pathophysiology of OAB: OAB's aetiology is complex and includes four main theories -
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Neurogenic Theory: Increased excitatory afferent signals trigger involuntary bladder contractions.
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Myogenic Theory: Detrusor muscles become hypersensitive, increasing spontaneous contractions.
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Autonomous Bladder Theory: Altered muscarinic stimulation heightens detrusor phasic activity.
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Afferent Signalling Theory: Spontaneous contractions during bladder filling lead to heightened awareness of bladder fullness.
OAB in Specific Populations: Elderly and Post-Menopausal Women: Increased OAB prevalence among elderly and post-menopausal women is attributed to -
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Higher infection risk due to hormonal shifts and reduced immune responses.
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Pelvic floor trauma from childbirth or hysterectomy, causing weakened pelvic support.
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Weight gain and diet contributing to bladder sensitivity.
Goals in OAB Treatment:
The goal of OAB treatment should centre on symptom relief and improvement rather than complete cure. For many, realistic improvement focuses on decreased urgency, reduced incontinence episodes, and longer intervals between voiding.
Non-Pharmacological Management: Non-drug treatments form the foundation of OAB management, including -
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Lifestyle adjustments: Reducing caffeine, spicy foods, and fluid intake to 2–2.5 litres per day.
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Bladder training: Delayed voiding and maintaining a voiding diary help patients manage symptoms.
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Pelvic floor exercises: Kegel exercises are especially beneficial for patients with weak pelvic support.
Pharmacologic Treatments: Pharmacological options include -
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Antimuscarinics: These agents reduce detrusor overactivity but often cause side effects like dry mouth and constipation, which can be problematic, especially in older adults.
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Beta-3 Agonists: Mirabegron, the primary licensed beta-3 agonist, is well-tolerated with minimal side effects, offering an effective option for patients who experience adverse effects from antimuscarinics.
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A multimodal, patient-centred approach that combines lifestyle, behavioural, and pharmacologic interventions is vital in managing OAB, especially for elderly and female patients with unique physiological and lifestyle challenges.
Société Internationale d'Urologie Congress, 23-26 October 2024, New Delhi, India.
