Prevalence of the Overactive Bladder Syndrome by Applying the International Continence Society Definition

doi:10.1016/j.eururo.2005.04.026

European Urology

Volume 48, Issue 4, October 2005, Pages 622-627

https://doi.org/10.1016/j.eururo.2005.04.026 Get rights and content

Abstract

Purpose:

To determine the prevalence of the overactive bladder (OAB) syndrome in an urban population by using the International Continence Society (ICS) definition and to determine its impact on quality of life and sexual function.

Methods:

Women and men participating in a health screening project in the area of Vienna completed the Bristol Lower Urinary Tract Symptoms (LUTS) questionnaire. To assess the prevalence of OAB the 2002 ICS definition was applied. In addition, all participants underwent a detailed health examination, including physical assessment, evaluation of life style factors, laboratory study and urinalysis.

Results:

A total of 1199 men and 1219 women aged 20–91 years were analysed. The prevalence of OAB in men (48.5 ± 13.1 years) was 10.2% (OAB_dry: 8.4%; OAB_wet: 1.8%) and 16.8% in women (49.5 ± 13.5 years; OAB_dry:10.3%; OAB_wet: 6.5%). In women, the prevalence of OAB_dry remained fairly stable over 6 life decades, while OAB_wet increased substantially after the age of 40 years. In men OAB_wet and OAB_dry increased after the third life decade. In men with OAB, 48% did not report a negative impact on quality of life, 36% had minimal, 9.8% moderate and 2.5% severe impairment; the respective percentages for women were 53%, 33%, 7.3% and 6.3%. OAB_wet had a more profound impact on quality of life. A negative impact of OAB on sexuality was reported by 24% of men and 31% of women.

Conclusion:

The high prevalence of OAB in this population, its negative impact of quality of life and sexuality underline the importance of this syndrome.

Introduction

According to the International Continence Society (ICS) “urgency, with or without urge incontinence, usually with frequency and nocturia, can be described as the overactive bladder (OAB) syndrome, urge syndrome or urgency-frequency syndrome. These terms can be used if there is no proven infection or obvious pathology” [1]. There is a continuing debate regarding the appropriateness of this definition, it has been questioned whether OAB is really a syndrome, particularly because the symptoms frequency, urgency and urge incontinence do not indicate a single disease [8]. Instead they are a set of symptoms for various diseases, such as detrusor overactivity, detrusor hypersensitivity, infravesical obstruction, bladder neck insufficiency and polyuria, just to mention some [8]. Nevertheless the term OAB (syndrome) became popular in the urological field within the past 3–4 years [2], [3], [4], [5], [6], [7], [8].

It is generally accepted that OAB is a highly prevalent disorder that increases with age in both sexes and that has a profound impact on quality of life. Solid data on the prevalence of OAB in both sexes are scant. Three large-scale studies on the prevalence of OAB have recently been published [9], [10], [11]. Unfortunately, these three studies used individual definitions of OAB, none of which was entirely conform to the current ICS proposal [9], [10], [11]. As a result of this inconsistency, substantial differences on OAB prevalence rates have been reported [9], [10], [11].

To circumvent these shortcomings, we aimed to assess the prevalence of OAB in both sexes using the most recent 2002 ICS definition. Almost 2500 consecutive men and women with an age range of 20–91 years, participating in a health screening project in the area of Vienna, entered this analysis.

Section snippets

Study design

Voluntary health examinations free of charge are regularly organized in Vienna (approximately 1.6 million inhabitants; 47% men). Overall, there are seven sites at which the city's inhabitants can participate in a health survey; in addition, employees of large companies are also invited to participate. During this health examination the following parameters are routinely assessed: (1) a detailed medical history; (2) assessment of all concurrent medical therapies; (3) physical examination with

Study population

A total of 2418 individuals (1219 women/1199 men), aged 20–91 years, were enrolled in this study. The mean age of the female population was 49.5 ± 13.5 years (mean ± SD), that of the male population 48.5 ± 13.1 years (mean ± SD). The age distribution of the female population was as follows: 20–29 years: 5.4% (n = 66), 30–39 years: 14.1% (n = 172), 40–49 years: 31% (n = 378), 50–59 years: 25.8% (n = 315), 60–69 years: 12.7% (n = 155) and 70+ years: 10.9% (n = 133). In the male population, the respective percentages

Discussion

By using the 2002 ICS definition we obtained an overall prevalence of OAB in our population (20–91 years) of 10.2% in men and 16.8% in women. We have studied individuals participating in a health screening survey. One advantage of this approach is the fact that all participants underwent a health investigation. In contrast to mailed surveys or phone interviews, co-morbidities were assessed by a general practitioner. We were therefore able to exclude individuals with urinary tract infection as

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Overactive bladder syndrome (OAB) is highly prevalent among women and has a negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities.
To provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome.
The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. The risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions, and quality of evidence was assessed using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A meta-analysis was performed where appropriate.
Antimuscarinics and beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists being more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events. Onabotulinumtoxin-A (Onabot-A) was more effective than placebo across most outcomes, but with significantly higher rates of acute urinary retention/clean intermittent self-catheterisation (six to eight times) and urinary tract infections (UTIs; two to three times). Onabot-A was also significantly better than antimuscarinics in the cure of urgency urinary incontinence (UUI) but not in the reduction of mean UUI episodes. Success rates of sacral nerve stimulation (SNS) were significantly higher than those of antimuscarinics (61% vs 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% vs 10%). SNS was associated with 9% removal rate and 3% revision rate.
Overactive bladder is a manageable condition, with first-line treatment options including antimuscarinics, beta-3 agonists, and posterior tibial nerve stimulation. Second-line options include Onabot-A bladder injections or SNS. The choice of therapies should be guided by individual patient factors.
Overactive bladder is a manageable condition. All patients should be informed and advised on conservative treatment measures in the first instance. The first-line treatment options for its management include antimuscarinics or beta-3 agonists medication, and posterior tibial nerve stimulation procedures. The second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation procedure. The therapy should be chosen based on individual patient factors.
Women With Overactive Bladder Exhibit More Unhealthy Toileting Behaviors: A Cross-sectional Study
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To determine whether women overactive bladder symptoms would report more frequent unhealthy toileting behaviors.
A community-based sample of adult women was electronically recruited to complete the Toileting Behavior Scale and the International Consultation on Incontinence Questionnaire – Overactive Bladder module, as well as clinical and demographic questionnaires. The associations between overactive bladder and toileting behavior subscales were assessed as continuous variables using Spearman's rank correlation and as dichotomous variables with multivariable logistic regression.
Of the 6562 adult women included in the analytic sample, 1059 (16.1%) were classified as having overactive bladder. Of the toileting behavior subscales, convenience voiding had the highest, positive association with overactive bladder score (r = 0.301, P < .0001). On multivariable logistic regression, women with overactive bladder (OAB) were more likely to report behaviors of convenience voiding (odds ratio [OR] 1.13, confidence intervals [CI] 1.11-1.15), delayed voiding (OR 1.05, CI 1.02-1.08), straining to void (OR 1.05, CI 1.03-1.07), and position preference (OR 1.13, CI 1.08-1.18).
OAB symptoms were associated with specific toileting behaviors of convenience voiding, delayed voiding, straining to void, and position preference. Further investigation is needed to determine if toileting behaviors are a risk factor for OAB or a compensatory adaptation to mitigate symptoms.
Are patients with bladder oversensitivity different from those with urodynamically proven detrusor overactivity in female overactive bladder syndrome?
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To determine if there are clinical and urodynamic (UD) differences between female overactive bladder (OAB) patients with bladder oversensitivity (BO) and detrusor overactivity (DO) via a much lower filling rate.
In total, 205 patients with OAB symptoms were recruited for this study. During filling cystometry, the bladder was filled at a more “physiological” rate of 20 ml/min. All patients underwent a complete urogynecological evaluation including detailed history, physical examination, urinalysis, pad test for quantification of urine leakage, 3-day frequency-volume chart (FVC) documentation, and completion of a UD study.
The overall incidence of BO was 34.2% and that of DO was 65.8%. The first desire to void (FDV) in patients with BO and DO were at filling of 117.47 ± 21.68 ml and 135.23 ± 22.88 ml, respectively (p < 0.05). Maximal cystometric capacities (MCC) in patients with BO and DO were recorded at 259.44 ± 33.87 ml and 265.32 ± 44.05 ml (p > 0.05). A receiver operating characteristic (ROC) curve was used to find the cut-off values of FDV for sensitivity and specificity in patients diagnosed with DO. Area under the curve (AUC) was 0.702 (p < 0.005, 95% confidence interval: 0.626–0.779) if FDV was determined as more than 127 ml. Patients with BO experienced significantly increased daytime urinary frequency and nocturia symptoms (<0.05). Patients with DO had a significantly higher prevalence of urgent urinary incontinence (p < 0.05). In this study, a higher FDV and higher body mass index (BMI) were correlating factors for OAB patients with DO after multiple logistic regression analysis.
Patients with BO seemed to be on a different spectrum compared to those with DO and also had different symptom-specific and associative factors. It was also found that FDV could be good predictive indicator for detecting DO at a low filling rate.
Clinical tools for evaluating the severity of overactive bladder: A systematic review of psychometric properties
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Systematic review and meta-analysis of urinary incontinence prevalence and population estimates
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Female Urology – IncontinencePrevalence of the Overactive Bladder Syndrome by Applying the International Continence Society Definition

Abstract

Purpose:

Methods:

Results:

Conclusion:

Introduction

Section snippets

Study design

Study population

Discussion

Urology

Urology

Eur Urol

Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society

Neurourol Urodyn

Clinical aspects of the overactive bladder and detrusor overactivity

Scand J Urol Nephrol Suppl

Overactive bladder revisited

Neurourol Urodyn

Overactive bladder: symptom or syndrome?

BJU Int

Management of overactive bladder

New Engl J Med

Female Urology – Incontinence
Prevalence of the Overactive Bladder Syndrome by Applying the International Continence Society Definition