Overactive bladder: the importance of tailoring treatment to the individual patient

Harold P DrutzDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Ontario, CanadaOn behalf of the Specialist Advisory Group on OAB (Lake Como, Italy, June 2009)Introduction: Overactive bladder (OAB) is a prevalent and persistent condition that is often under-diagnosed and under-treated, and which frequently requires tailored treatment for successful management.Methods: This consensus opinion-based review summarizes the discussions of a group of experts in the field of OAB that were assembled to evaluate the importance of correct diagnosis and appropriate pharmacotherapy in patients with OAB.Results: A thorough diagnostic process is crucial for allowing exclusion of underlying medical issues and differentiation from genitourinary conditions other than OAB. In addition, selecting the most appropriate pharmacotherapy needs to be carefully considered in the context of each patient with OAB. In general, patients with OAB tend to be older with various comorbidities and often receiving multiple concomitant medications. Treatment decisions should take into consideration the differing potential for antimuscarinic medications to alter cognitive and cardiovascular functions, both of which may be compromised in this patient population.Conclusion: Tailoring treatment to individual patients by comprehensive patient assessment may lead to more effective management of patients with OAB, especially those receiving polypharmacy for comorbidities.Keywords: overactive bladder, diagnosis, antimuscarinics, cognitive function, cardiovascular&nbsp

FEMALE URINARY INCONTINENCE IN CANADA

In Canada, Urinary Incontinence (UI) is a significant medical and social problem which can be devastating to a women’s physical, social and emotional well being. As in other developed countries our population is aging. In 1993, 11.8 per cent of all Canadians were over age 65; by the year 2011, the proportion of this age group will be 14.0 per cent; by 2031, it will be 21.7 per cent (1). It is estimated that between 1.5 to 2.0 million Canadians (out of a population of just over 30 million) suffer from UI, yet only 1:12 will seek medical attention for this problem. UI is now the commonest cause of admission to long-term institutionalized centers in the United States and Canada. In Canada, we now spend over 1.5 billion dollars annually on this health care problem. At the Baycrest Geriatric Center (BGC) in Toronto, where we have a urogynecology branch of the unit at Mount Sinai Hospital (MSH), recent budget figures indicate that the hospital spends $320,000 (Cadanian) annually on adult diapers (2)