Page 1 - Appendix: Executive summary of CUA guideline on adult overactive bladder

P. 1

CUA GUIDELINE – SUMMARY

Appendix: Executive summary of CUA guideline on adult overactive

bladder

Jacques Corcos, MD, FRCSC ; Mikolaj Przydacz, MD ; Lysanne Campeau, MD, PhD, FRCSC ; Jonathan Witten, MD ;
1
1
2
1
Duane Hickling, MD, MSCI, FRCSC ; Christiane Honeine, RN, BN ; Sidney B. Radomski, MD, FRCSC ;
1
3
4
Lynn Stothers, MD, MHSc, FRCSC ; Adrian Wagg, MD, FRCP (Lond), FRCP (Edin), FHEA 6
5
2
1 Department of Urology, Jewish General Hospital, McGill University, Montreal, QC; Northern Alberta Urology Centre, Edmonton, AB; Division of Urology, Department of Surgery, The Ottawa Hospital,
3
Ottawa, ON; Division of Urology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON; Department of Urological Sciences, University of British Columbia, Vancouver,
4
5
BC; Department of Medicine, University of Alberta, Edmonton, AB; Canada
6
Cite as: Can Urol Assoc J 2017;11(5):E248-9. been validated for English or French. Measurement of the
Pubished online May 9, 2017 micturition frequency and fluid intake habits should be per-
formed with voiding diaries (Evidence strength Grade B). It
veractive bladder (OAB) is a symptom syndrome is recommended to perform a voiding diary observation of
consisting of urinary urgency with or without urge 3‒7 days’ duration.
Oincontinence, often accompanied by frequency As OAB symptoms may occur during symptomatic UTI,
and nocturia, in the absence of urinary tract infection (UTI) urinalysis should be included in the initial evaluation of all
or other obvious pathology. OAB is common in both sexes, patients suspected of OAB (Evidence strength Grade C).
with increasing prevalence with age. The overall prevalence Post-voiding residual (PVR) volume measurement, bladder/
of OAB in a Canadian population is estimated at 14‒18%. renal ultrasound, cystoscopy, computed tomography (CT),
Most patients have a combination of OAB symptoms. In magnetic resonance imaging (MRI), and urodynamic study
men with benign prostatic hyperplasic (BPH), OAB and (UDS) are not recommended in the initial diagnosis pro-
bladder outlet obstruction (BOO) often coexist (Evidence cess of the uncomplicated OAB patients (Evidence strength
strength Grade B). Grade A/B/C). Additional tests are indicated when the diag-
Since OAB is not life-threatening, its impact on quality of nosis remains uncertain after history and physical examina-
life (QOL) plays a major role in the decision to treat patients. tion, when the symptoms do not correlate with physical
The significant negative impact that OAB has on daily activ- findings, or after failed previous treatment (Expert opinion).
ities, mental health, sexual function, and marital satisfaction Behavioural therapies and lifestyle changes should be the
has been highlighted by a number of studies. Furthermore, first-line therapy in all patients because of the non-invasive
OAB symptoms are linked to depressive illness. Usually, a nature of the treatment. Bladder training and pelvic floor
distinction is made between QOL and well-being in those muscle therapy may be effective methods of treatment in
patients with incontinence (OAB-wet) and those without certain cases (Evidence strength Grade B). Lifestyle changes
(OAB-dry). Individuals who develop urinary incontinence involving modifications of fluids/caffeine intake, weight con-
(UI) have worse QOL. There is limited evidence concerning trol, dietary modifications, management of bowel regular-
the psychosocial impact of OAB in either frail or multimor- ity, and optimization of other comorbidities (i.e., diabetes,
bid older persons; however, currently available data suggest congestive heart failure, obstructive sleep apnea) can be
that it is a serious concern. effective (Evidence strength Grade B/C).
Patients with OAB require comprehensive assessment. Patient education empowers patients and engages them in
There is a universal agreement that taking a history should their treatment plan. First-line treatments for OAB strongly rely
be the first step in the assessment of OAB patients (Evidence on patient compliance and adherence. Patients with OAB and
strength Grade B). Clinical examination should be part of UI have an improved QOL when they have a comprehensive
assessment of people with OAB (Expert opinion). knowledge of their medical problem and seek to develop
Patient self-completed questionnaires are the most suit- an avoidance-oriented, stress-coping lifestyle that promotes
able method for assessing the patient’s perspective of both- social contact. Knowing about the condition that causes their
ering symptoms and further implications on patients’ QOL symptoms can aid in the adoption of measures that lower the
(Evidence strength Grade B). Questionnaires should have severity and impact of the condition (Expert opinion).

1 2