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

Abstract

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: antimuscarinics; cardiovascular; cognitive function; diagnosis; overactive bladder.

Figure 1

The prevalence of overactive bladder (OAB), taking prescription medicines and comorbidities all increase with age.–

Figure 2

Increased heart rate is associated with increased cardiovascular mortality. Notes: ^aP < 0.05; ^bP < 0.01 for increased risk of cardiovascular mortality versus risk ratio of 1.0. Relative hazards were calculated by Cox proportional hazard model and adjusted for variables. Adapted with permission from Macmillan Publishers Ltd: American Journal of Hypertension, Hozawa A, Ohkubo T, Kikuya M, et al. Prognostic value of home heart rate for cardiovascular mortality in the general population: the Ohasama study. Am J Hypertens. 2004;17(11 Pt 1):1005–1010., Copyright 2004. Abbreviation: bpm, beats per minute.