Overview: Recognition and Management of Overactive Bladder
AMA Therapeutic Insights newsletter overview – December 2008
AMA Therapeutic Insights is a free, online CME program featuring the latest treatment guidelines and prescribing data for specific disease states. This is an overview of the December 2008 newsletter, "Recognizing and Managing Overactive Bladder ." To view the full newsletter and prescribing information or to take the CME self-assessment, visit Therapeutic Insights (free for both AMA members and non-members).
What pharmacologic agents are used to treat OAB?
Anticholinergic/antimuscarinic agents are the pharmacologic treatment of choice for OAB symptoms. There are currently six antimuscarinic agents available with well established efficacy for the treatment of OAB and urge UI. Other anticholinergic medications, such as flavoxate and tricyclic antidepressants, are either ineffective or limited by marked anticholinergic and cardiac effects. Figure 1 shows the relative use of these agents which also includes two agents, hyoscyamine and dicyclomine, that are not FDA-labeled for OAB and are considered less effective.
Are there differences in the degree of treatment of OAB in women and men?
Antimuscarinics are not used in men with OAB to the same degree as in women (Figure 2), probably because of the perception that there is potential risk for causing urinary retention in men with OAB symptoms and BPH. Several recent studies have demonstrated that antimuscarinics in this group of men are safe, with urinary retention exceedingly rare with usual clinical doses.
Sample case study from "Recognizing and Managing Overactive Bladder"
A 65-year-old man presents with bothersome complaints of urgency and frequency, with as many as 10 episodes/day. He also complains of worsening nocturia of 2-3 episodes/night. The patient reports progressively worse symptoms over the past several months. He drinks two cups of coffee in the morning only, and a small glass of water with dinner. His past medical history includes well-controlled COPD, and he uses only an albuterol inhaler and occasional acetaminophen. Physical examination reveals a well-developed, well-nourished man in no apparent distress, with normal vital signs. He has no peripheral edema. His rectal sphincter tone is intact, and his prostate is smooth. His urinalysis is negative. What is your approach?
To view the full newsletter and receive CME credit, visit AMA Therapeutic Insights (available to all physicians, not just AMA members).