Challenges in Managing Urge Incontinence

1. Challenges in Managing Urge Incontinence/OAB in the Elderly Patient: Introduction and Overview of OAB

2. Demographics and Classification

4. Prevalence of OAB Age and Gender Slide 4: Prevalence of OAB by Age and Gender in the US The overall prevalence of OAB was 16.5% in adults =18 years of age as determined in the National Overactive Bladder Evaluation (NOBLE) program, which was designed to gain a better understanding of the prevalence and burden of OAB in the US. As part of NOBLE, a national telephone survey using a clinically validated, computer-assisted telephone interview questionnaire was administered to a sample of 5,204 adults who were representative of the US population. The overall prevalence of OAB was 16.0% in men and 16.9% in women. The age-specific prevalence of OAB was similar for men and women, as shown in this slide. However, the age patterns differed by sex and by type of OAB, as shown in the next 2 slides. Reference Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327-336. Slide 4: Prevalence of OAB by Age and Gender in the US The overall prevalence of OAB was 16.5% in adults =18 years of age as determined in the National Overactive Bladder Evaluation (NOBLE) program, which was designed to gain a better understanding of the prevalence and burden of OAB in the US. As part of NOBLE, a national telephone survey using a clinically validated, computer-assisted telephone interview questionnaire was administered to a sample of 5,204 adults who were representative of the US population. The overall prevalence of OAB was 16.0% in men and 16.9% in women. The age-specific prevalence of OAB was similar for men and women, as shown in this slide. However, the age patterns differed by sex and by type of OAB, as shown in the next 2 slides. Reference Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327-336.

8. DEFINITIONSEPIDEMIOLOGYCLASSIFICATIONPHYSIOLOGY

9. OAB Symptom Definitions Urgency: a sudden compelling desire to pass urine that is difficult to defer Urgency Urinary Inc. (UUI): involuntary leakage accompanied by or immediately preceded by urgency Frequency: 8 voids / day = �normal� Nocturia: patient wakes one or more times at night to void (sleep �before� and �after�) Slide 9: Symptoms of OAB as Defined by ICS The symptoms of OAB as defined by the International Continence Society are as follows: Urgency: a sudden compelling desire to pass urine that is difficult to defer Urge urinary incontinence (UUI): involuntary leakage of urine accompanied by or immediately preceded by urgency Frequency (increased daytime): patient considers that he/she voids too often during the day Nocturia: patient wakes one or more times at night to void Reference Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Urology. 2003;61:37-49. Slide 9: Symptoms of OAB as Defined by ICS The symptoms of OAB as defined by the International Continence Society are as follows: Urgency: a sudden compelling desire to pass urine that is difficult to defer Urge urinary incontinence (UUI): involuntary leakage of urine accompanied by or immediately preceded by urgency Frequency (increased daytime): patient considers that he/she voids too often during the day Nocturia: patient wakes one or more times at night to void Reference Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Urology. 2003;61:37-49.

10. OAB Symptom Definitions Urinary Stress Incontinence (USI): urinary loss with �effort� Overflow Incontinence: urinary leakage with retention OAB � WET: urgency, frequency, incontinence OAB � DRY: no urinary incontinence Slide 10: Symptoms of OAB as Defined by ICS The symptoms of OAB as defined by the International Continence Society are as follows: Urgency: a sudden compelling desire to pass urine that is difficult to defer Urge urinary incontinence (UUI): involuntary leakage of urine accompanied by or immediately preceded by urgency Frequency (increased daytime): patient considers that he/she voids too often during the day Nocturia: patient wakes one or more times at night to void Reference Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Urology. 2003;61:37-49. Slide 10: Symptoms of OAB as Defined by ICS The symptoms of OAB as defined by the International Continence Society are as follows: Urgency: a sudden compelling desire to pass urine that is difficult to defer Urge urinary incontinence (UUI): involuntary leakage of urine accompanied by or immediately preceded by urgency Frequency (increased daytime): patient considers that he/she voids too often during the day Nocturia: patient wakes one or more times at night to void Reference Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Urology. 2003;61:37-49.

11. Types of Incontinence/Etiology

12. What Is Overactive Bladder? Slide ID: 7576 Key Messages: The International Continence Society (ICS) redefined overactive bladder, or OAB, in 2002. This definition identifies OAB as symptom syndromes of �urgency, with or without urge incontinence, usually associated with frequency and nocturia� and distinguishes it from earlier terminology such as reflex incontinence. These symptoms are suggestive of detrusor overactivity (urodynamically demonstrable involuntary bladder contractions) but can be due to other forms of voiding or urinary dysfunction. These terms can be used if there is no proven infection or other obvious pathology.1 Urgency is defined by ICS as the complaint of a sudden, compelling desire to pass urine, which is difficult to defer. Reference Notes: None Reference 1. Abrams P et al. Neurourol Urodyn. 2002;21:167-178.Slide ID: 7576 Key Messages: The International Continence Society (ICS) redefined overactive bladder, or OAB, in 2002. This definition identifies OAB as symptom syndromes of �urgency, with or without urge incontinence, usually associated with frequency and nocturia� and distinguishes it from earlier terminology such as reflex incontinence. These symptoms are suggestive of detrusor overactivity (urodynamically demonstrable involuntary bladder contractions) but can be due to other forms of voiding or urinary dysfunction. These terms can be used if there is no proven infection or other obvious pathology.1 Urgency is defined by ICS as the complaint of a sudden, compelling desire to pass urine, which is difficult to defer. Reference Notes: None Reference 1. Abrams P et al. Neurourol Urodyn. 2002;21:167-178.

13. Symptom Spectrum of OAB Slide ID: 8474 Key Messages: A key feature of OAB is urgency, which is defined by the ICS as a �sudden, compelling desire to pass urine, which is difficult to defer.� Urgency is associated with the key symptoms of OAB (ie, increased frequency, with or without nocturia), and it may lead to incontinence episodes. Individuals are incontinent because they don�t have enough time to get to the bathroom. There also may be a reduced volume of urine voided with each micturition, as urgency may be sensed at a lower bladder capacity.1 References Notes: None Reference 1. Abrams P et al. Neurourol Urodyn. 2002;21:167-178. Slide ID: 8474 Key Messages: A key feature of OAB is urgency, which is defined by the ICS as a �sudden, compelling desire to pass urine, which is difficult to defer.� Urgency is associated with the key symptoms of OAB (ie, increased frequency, with or without nocturia), and it may lead to incontinence episodes. Individuals are incontinent because they don�t have enough time to get to the bathroom. There also may be a reduced volume of urine voided with each micturition, as urgency may be sensed at a lower bladder capacity.1 References Notes: None Reference 1. Abrams P et al. Neurourol Urodyn. 2002;21:167-178.

25. Storage and Voiding Symptoms According to the International Continence Society (ICS), lower urinary tract symptoms (LUTS) can be divided into 3 major categories: Storage symptoms include increased daytime frequency, nocturia, urgency, and various types of urinary incontinence. Frequency is a subjective complaint that the patient believes that he/she voids too often during the day. Nocturia is a complaint that the individual has to arise 1 or more times at night to void. Urinary incontinence (UI) is any involuntary leakage of urine.1 Voiding symptoms include slow stream, splitting or spraying, intermittent stream of urine, hesitancy (difficulty in starting), straining to initiate, maintain, or improve the urine stream.1 Postmicturition symptoms are experienced immediately after micturition in men, usually after leaving the toilet, and include a feeling of incomplete emptying and terminal dribble�a prolonged final part of micturition.1 It is important for the clinician to carefully evaluate male patients presenting with LUTS to determine the root of the problem because symptoms, especially those related to storage, reported by men can be attributed to overactive bladder (OAB), bladder outlet obstruction (BOO), or both.2 References 1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178. 2. Abdel-Aziz KF, Lemack GE. Overactive bladder in the male patient: bladder, outlet, or both? Curr Urol Rep. 2002;3:445-451. According to the International Continence Society (ICS), lower urinary tract symptoms (LUTS) can be divided into 3 major categories: Storage symptoms include increased daytime frequency, nocturia, urgency, and various types of urinary incontinence. Frequency is a subjective complaint that the patient believes that he/she voids too often during the day. Nocturia is a complaint that the individual has to arise 1 or more times at night to void. Urinary incontinence (UI) is any involuntary leakage of urine.1 Voiding symptoms include slow stream, splitting or spraying, intermittent stream of urine, hesitancy (difficulty in starting), straining to initiate, maintain, or improve the urine stream.1 Postmicturition symptoms are experienced immediately after micturition in men, usually after leaving the toilet, and include a feeling of incomplete emptying and terminal dribble�a prolonged final part of micturition.1 It is important for the clinician to carefully evaluate male patients presenting with LUTS to determine the root of the problem because symptoms, especially those related to storage, reported by men can be attributed to overactive bladder (OAB), bladder outlet obstruction (BOO), or both.2 References 1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178. 2. Abdel-Aziz KF, Lemack GE. Overactive bladder in the male patient: bladder, outlet, or both? Curr Urol Rep. 2002;3:445-451.

26. Storage and Voiding Symptoms According to the International Continence Society (ICS), lower urinary tract symptoms (LUTS) can be divided into 3 major categories: Storage symptoms include increased daytime frequency, nocturia, urgency, and various types of urinary incontinence. Frequency is a subjective complaint that the patient believes that he/she voids too often during the day. Nocturia is a complaint that the individual has to arise 1 or more times at night to void. Urinary incontinence (UI) is any involuntary leakage of urine.1 Voiding symptoms include slow stream, splitting or spraying, intermittent stream of urine, hesitancy (difficulty in starting), straining to initiate, maintain, or improve the urine stream.1 Postmicturition symptoms are experienced immediately after micturition in men, usually after leaving the toilet, and include a feeling of incomplete emptying and terminal dribble�a prolonged final part of micturition.1 It is important for the clinician to carefully evaluate male patients presenting with LUTS to determine the root of the problem because symptoms, especially those related to storage, reported by men can be attributed to overactive bladder (OAB), bladder outlet obstruction (BOO), or both.2 References 1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178. 2. Abdel-Aziz KF, Lemack GE. Overactive bladder in the male patient: bladder, outlet, or both? Curr Urol Rep. 2002;3:445-451. According to the International Continence Society (ICS), lower urinary tract symptoms (LUTS) can be divided into 3 major categories: Storage symptoms include increased daytime frequency, nocturia, urgency, and various types of urinary incontinence. Frequency is a subjective complaint that the patient believes that he/she voids too often during the day. Nocturia is a complaint that the individual has to arise 1 or more times at night to void. Urinary incontinence (UI) is any involuntary leakage of urine.1 Voiding symptoms include slow stream, splitting or spraying, intermittent stream of urine, hesitancy (difficulty in starting), straining to initiate, maintain, or improve the urine stream.1 Postmicturition symptoms are experienced immediately after micturition in men, usually after leaving the toilet, and include a feeling of incomplete emptying and terminal dribble�a prolonged final part of micturition.1 It is important for the clinician to carefully evaluate male patients presenting with LUTS to determine the root of the problem because symptoms, especially those related to storage, reported by men can be attributed to overactive bladder (OAB), bladder outlet obstruction (BOO), or both.2 References 1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178. 2. Abdel-Aziz KF, Lemack GE. Overactive bladder in the male patient: bladder, outlet, or both? Curr Urol Rep. 2002;3:445-451.

27. Why Do We Treat Men Differently Than Women When It Comes to Bladder Symptoms?