Overactive bladder and urgency urinary incontinence

It is the urogynae clinic on a wet Tuesday. A 64-year-old retired teacher is sitting on the edge of her chair, telling you she has not slept through the night in six months. She gets up four, five, six times; she knows where every public toilet is between home and the shops; she has stopped meeting her friends for coffee. Her mother had a stroke and ended up in a nursing home with incontinence, and she is terrified that is her future. She has tried two courses of oxybutynin "from the chemist" and stopped both because of dry mouth and foggy thinking. Your job over the next twenty minutes is to name her problem, show her the ladder, and pick the rung that fits her brain and her bladder.^[1][9]

Overview and definition

The ICS 2002 standardisation report separated the symptom-based syndrome from the urodynamic observation, and that single sentence is the whole topic:^[1][2]

• Overactive bladder (OAB) — symptomatic. Urgency, with or without urge incontinence, usually with frequency and nocturia. The syndrome, in the absence of infection or other obvious cause.^[1]
• Detrusor overactivity (DO) — urodynamic. Involuntary detrusor contractions during the filling phase. Divided into idiopathic (no proven cause) and neurogenic (a known neurological lesion such as multiple sclerosis, spinal cord injury, Parkinson's disease).^[1][2]

Roughly half of patients with OAB symptoms have demonstrable DO on urodynamics; the rest have urgency generated by afferent sensitisation without a measurable contraction. The clinical syndrome is what you treat empirically; the urodynamic finding is what you reserve for refractory or diagnostic-uncertainty cases.^[1][11]

References18ShowHide

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