How should we address the diagnosis of overactive bladder in women?

Clinical and urodynamic impact of detrusor overactivity in women with overactive bladder

OBJECTIVE

To evaluate the clinical and urodynamic differences (associated with the presence or absence of detrusor overactivity [DO]) in women with overactive bladder (OAB) referred to Functional Urology and Urodynamic Units in Spain.

MATERIAL AND METHODS

Observational, cross-sectional, multicenter and prospective study conducted in Spain in women with clinical diagnosis of OAB, who had been referred to urodynamic study (UDS) of which centralized reading was performed. Patients completed the 3-day voiding diary (DM3d) with the PPIUS scale (Patient Perception of Intensity of Urgency Scale), the B-SAQ (Bladder Self-Assessment Questionnaire) and the OABq-SF (Overactive Bladder Questionnaire Short Form). The questionnaires and UDS variables of women with OAV, with or without DO, were compared using the Mann-Whitney test (continuous variables) and the chi-square test (χ²) (categorical variables).

RESULTS

A total of 247 women with OAB were evaluated, and 103 of them had DO. According to the presence or absence of DO, significant differences were observed in the number of episodes of urge urinary incontinence (UUI), urinary frequency, nocturia, mean micturition volume and number of pads (P<.05 for all comparisons). A higher percentage of patients with OAB and DO presented reduced bladder capacity, urgency, urge urinary incontinence (UUI) and lower volume for first voiding desire, strong desire to void and maximum cystomanometric capacity in UDS compared with patients without DO (P<.05 for all comparisons). The only significant differences between both groups were regarding the B-SAQ symptoms scale (P=.011).

CONCLUSIONS

The presence of DO in women with OAB is related to a more severe alteration of the bladder filling phase.

[Prevalence and characterization of overactive bladder detected in a population in Madrid with self-administered OAB-V3 questionnaire in Primary Care]

Objetivo

Determinar la prevalencia de síntomas sugestivos de vejiga hiperactiva (VH) en una población española y evaluar su impacto en el bienestar y la productividad laboral de esta población.

Diseño

Estudio transversal.

Emplazamiento

Atención primaria, Madrid, España.

Participantes

Varones y mujeres > 30 años.

Intervenciones

Clasificación con el instrumento abreviado Overactive Bladder Awareness Tool (OAB-V3). Sujetos con puntuación ≥ 3 y una población control similar con puntuación < 3 fueron investigados clínicamente.

Mediciones principales

Anamnesis, exploración física, análisis de orina, ecografía, escala de bienestar general y cuestionarios PPBC, OAB-q y WPAI-SHP.

Resultados

Se cribaron 923 sujetos, 209 (22,6%) de los cuales —35% hombres y 65% mujeres— presentaron probable VH. La distribución por edad aumentó del 11,1% en la cuarta década al 44,4% en la novena década. El coeficiente kappa entre probable VH y diagnóstico definitivo fue de 0,83. El área bajo la curva ROC para el diagnóstico según el cuestionario OAB-V3 y la constatación de molestias percibidas y estrategias de afrontamiento fue del 92%. Los sujetos clasificados por OAB-V3 ≥ 3 tuvieron peor bienestar, mayor puntuación PPBC y peores parámetros en las puntuaciones OAB-q total y transformadas para cada subescala OAB-q (p < 0,0001). Su productividad laboral no se vio afectada (p = 0,14), pero sí la capacidad de realizar actividades cotidianas (p < 0,0001).

Conclusiones

OAB-V3 es un cuestionario simple para el cribado de VH con buena exactitud de predicción en atención primaria y que conlleva implicaciones importantes en la calidad de vida relacionada con la salud.

Comparative study of the B-SAQ, OAB-V8 and OAB-V3 questionnaires as screening tools for overactive bladders in clinical practice

OBJECTIVE

To compare the capacity shown by 3 self-assessment questionnaires validated in Spanish (B-SAQ, OAB-V8 and OAB-V3) for the screening of patients with overactive bladder (OAB) in clinical practice.

MATERIAL AND METHOD

A noninterventional observational study was conducted of men and women older than 30 years evaluated in primary care consultations. The clinical diagnosis of OAB was conducted through a case history review, physical examination, urine analysis, ultrasonography and voiding diary. The presence of coping strategies and discomfort was investigated. The differential diagnosis was established in patients with symptoms not due to OAB. We assessed the correlation between the clinical tests and diagnosis (kappa <.4 poor; .4-.6 moderate; >.6 good; >.8 excellent) and ROC curves to define the capacity to screen the assessed questionnaires.

RESULTS

A total of 411 patients were investigated. OAB was detected in 207 (50.4%) patients, other causes for the lower urinary tract symptoms were detected in 63 (15.3%), and 141 (34.3%) patients had no diagnosis. The voiding diary suggested OAB in 197 (47.9%) patients. The correlation between the clinical diagnosis and the diagnosis based on the voiding diary was .702. The correlation between the clinical diagnosis and B-SAQ, OAB-V8 and OAB-V3 was .59, .673 and .732, respectively. The area under the curve (AUC) was .799 for B-SAQ; .837 for OAB-V8 and .867 for OAB-V3 (OAB-V3 vs. OAB-V8, P=.02; OAB-V3 vs. B-SAQ, P<.0001). The AUC for the voiding diary was .852 (OAB-V3 vs. diary, P=.47).

CONCLUSIONS

OAB-V3 is a simple questionnaire with excellent performance for screening OAB in a specific population and that is superior to the OAB-V8 and B-SAQ. The accuracy of the voiding diary for the same indication is equivalent to that of the OAB-V3 in our setting.