CRC - The Overactive Bladder: Evaluation and Management
|Publication Date:||10 July 2007|
The overactive bladder is not a new disease or a term invented for those wishing to sell pills to patients. The term was coined by Alan Wein and myself when we were asked to organize a meeting on "The Unstable Bladder" on an unrestricted educational grant by Pharmacia in 1996.1 We pointed out that unstable bladder was a urodynamic diagnosis and we usually treated patients with the symptoms of frequency, urgency, urgency incontinence and nocturia without a urodynamics diagnosis, in the first instance. We also pointed out that we wished to include discussion of patients with neurological disease, who would be excluded by the term "unstable bladder", as this only applied to those without an obvious cause for their detrusor overactivity. Pharmacia were most unhappy about our insistence on using the term "overactive bladder" as the title for the meeting. This was because Pharmacia only had "unstable bladder" as an indication for the use of their antimuscarinic drug. Nevertheless, Alan and I insisted and Pharmacia acquiesced. Subsequently, the term has become accepted worldwide and is, of course, used to market all products for the condition. The origin of the term overactive bladder is described in an article in Urology2.
Once the term was coined it had to be defined, and after several iterations the ICS (2002) Standardisation Report defined the overactive bladder as urgency, with or without urgency incontinence, usually with frequency and nocturia. 3 It was also necessary to exclude other conditions such as urinary infection and inadequately controlled diabetes as causes of the same symptoms. However, despite these definitions which are essentially medical, there is still a need for clarity of thought when looking at these definitions in patient terms. It is confusing to patients to talk about urge and urgency and furthermore, it is unnecessary. The ICS (2002) suggested that urge means need and therefore is easily confused with urgency, and should not be used. There is very little point in asking patients whether they have urgency or urgency incontinence. Of much more use are questions such as "do you have to drop everything and rush to the toilet, otherwise you might leak urine?"
Karl Kreder and Roger Dmochowski are to be complimented on assembling this comprehensive book on Overactive Bladder (OAB) written by a distinguished group of clinicians and scientists. Unusually for a text book, it includes not only accepted treatments but also discusses new treatments, still in the development stage, such as implanted pudendal nerve stimulation and the new antimuscarinic fesoterodine. The inclusion of chapters on particularly problematic patient groups, such as children and the elderly, is most welcome, as the importance and implications of OAB in these two important sections of our society are greater than for independently living young to middle aged adults.
The book is an excellent update on Overactive Bladder, the theories behind its genesis, its assessment and its management from behavioural therapy to augmentation cystoplasty.