Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
MODULE 2 IDENTIFICATION, SCREENING AND DIAGNOSIS 1 Prescribing information is available at this meeting DET 808 CHALLENGES TO IDENTIFICATION OF OAB • • • Patients do not initiate discussions since they may not see OAB as a legitimate condition or may not understand the terminology Patients are often too embarrassed to talk about their symptoms Patients learn to accept and cope with their symptoms – Avoiding social interaction – Mapping toilet locations – Carrying spare clothing 17. Abrams P, et al. Am J Manag Care. 2000;6(suppl):S580-S590. 2 Prescribing information is available at this meeting ASKING THE RIGHT QUESTIONS 3 • Do you go to the toilet more than 8 times a day? • Do you often wake up during the night needing to go to the toilet? • Do you have to hurry to make the toilet in time? • Do you often not reach the toilet in time? Prescribing information is available at this meeting OPPORTUNITIES FOR SCREENING • • • • • • • • 4 Prescribing information is available at this meeting New patient medical questionnaires New patient medical examinations Routine cervical smears Routine checkups for patients over 40 years old Family planning/menopause clinics Patient leaflets/posters Health visitors/district nurses/practice nurses Nursing homes SCREENING IS AN IMPORTANT TOOL • Reasons for screening – High prevalence – Impact on patients’ lives – Cost to society – Government initiatives/guidelines such as: • Good Practice in Continence Services in the UK23 23. Donaldson L, Mullally S. London, England: Department of Health; April 19, 2000. 5 Prescribing information is available at this meeting A NEW SCREENING TOOL – THE OVERACTIVE BLADDER – VALIDATED 8-QUESTION QUESTIONNAIRE • • • • 6 Prescribing information is available at this meeting Validated in 1260 patients24 8 simple, self-administered questions Simple scoring by addition Available and linguistically validated in 12 languages25 24. Coyne K, Matza L ICS 2004. 25. Conway K, Uzun V, Vigner S et al. ICS 2004. SCREENING WITH THE OVERACTIVE BLADDER QUESTIONNAIRE How bothered have you been by… • • • • • • • • 7 Prescribing information is available at this meeting Frequent urination during the day? Uncomfortable urge to urinate? Sudden urge to urinate with little or no warning? Accidental leakage of small amounts of urine? Night-time urination? Waking up at night because of the need to urinate? Uncontrollable urge to urinate? Urine leakage associated with a strong desire to urinate? 14. Coyne K, et al. Qual Life Res. 2002;11:563-574. HOW TO USE THE OVERACTIVE BLADDER QUESTIONNAIRE 8 • Patients complete the screening questions • Doctor reviews the patient-completed screener • Doctor makes diagnosis and treats appropriately Prescribing information is available at this meeting COMMUNICATION IS THE KEY 9 • Active listening • Use of language • Use of body language • Questioning techniques Prescribing information is available at this meeting DIAGNOSIS OF OAB 10 Prescribing information is available at this meeting WHO IS AT RISK OF OAB? URGE INCONTINENCE • • • • Advanced age Diabetes Urinary tract infection Smoking STRESS INCONTINENCE • • • • White race High body mass index High waist-to-hip ratio Parity ANY INCONTINENCE • • • • • • • • • Advanced age White race Education Functional or sensory impairment High body mass index Previous hysterectomy Stroke Diabetes Chronic obstructive pulmonary disease 10. Milsom I, et al. Am J Manag Care. 2000;6(suppl):S565-S573. 11 Prescribing information is available at this meeting OTHER CONDITIONS/MEDICATIONS WHICH HAVE AN IMPACT ON SYMPTOMS OF OAB COEXISTING CONDITIONS • • • • • • 12 Chronic constipation26 Urinary tract infection26 Delirium26 Depression22 Skin infection22 Sleep deprivation22 DRUGS ASSOCIATED WITH INCONTINENCE • • • • • Diuretics26 Antidepressants26 Antihypertensives26 Sedatives, hypnotics and nacotics26 Muscle relaxants26 22. Thuroff J. EUR Urol. 2003;2 (Suppl):10-15. 26. ASCP website. http://www.ascp.com/pubs/tcp/1999/special/diagnosing.shtml Prescribing information is available at this meeting DIAGNOSIS OF OAB BASED ON SYMPTOMS • To confirm diagnosis of OAB – Patient history12 – Overactive Bladder Questionnaire24 – Physical examination12 – Urinalysis12 13 Prescribing information is available at this meeting 12. Wein AJ, Royner ES. Int J Fertil. 1999;44:56-66. 24. Coyne K, Matza L. ICS 2004. DIAGNOSIS OF OAB • Patient history – – – – • Form a working diagnosis Assess the impact of symptoms on QoL Review body systems (neurologic, metabolic) Identify coexisting conditions and treatments that can cause incontinence Physical examination – – – – Abdominal Neurological Pelvic (women) Genital/prostate (men) 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. 14 Prescribing information is available at this meeting DIAGNOSIS OF OAB (CONTINUED) • Urinalysis – Infection – – – – • Tumour Haematuria Glucosuria Proteinuria Postvoid residual volume (PVR) – Elderly with voiding symptoms and/or recurrent UTI – Neurological disease and voiding dysfunction – Symptoms of poor bladder emptying 15 Prescribing information is available at this meeting 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. DIFFERENTIAL DIAGNOSIS: OAB AND STRESS INCONTINENCE SYMPTOM ASSESSMENT OVERACTIVE BLADDER SYMPTOMS Urgency (strong, sudden desire to void) Yes No Frequency with urgency (>8 times/24 h) Yes No Leaking during physical activity; eg, coughing, sneezing, lifting No Yes Large (if present) Small No/ Just barely Yes Usually Seldom Amount of urinary leakage with each episode of incontinence Ability to reach the toilet in time following an urge to void Waking to pass urine at night 16 STRESS-INCONTINENCE Prescribing information is available at this meeting 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. TREATMENT VERSUS REFERRAL OAB TREAT IF: REFER TO SPECIALIST IF: • • • • • • • • • 17 Frequency/urgency and normal urinalysis Frequency with urgency Urge incontinence Normal urinalysis Prescribing information is available at this meeting No response to treatment Haematuria without infection Poor bladder emptying Neurological or metabolic disease Genital/prostate abnormalities 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66.