Prescribing information is available at this meeting 1 © 2004 Pfizer Inc. All rights reserved August 2005 DET 808

Prescribing information is available at this meeting MODULE 1: Overactive bladder (OAB) disease overview MODULE 2: Identification, screening and diagnosis MODULE 3: Treatment options and expectations MODULE 4: Detrusitol ® XL: In the treatment of OAB PROGRAM OVERVIEW 2

Prescribing information is available at this meeting MODULE 1 OVERACTIVE BLADDER (OAB) DISEASE OVERVIEW 3

Prescribing information is available at this meeting “I always assumed that the problem was largely due to my age” ICS Annual Meeting, Montreal 2005

Prescribing information is available at this meeting “I have this fear of being incontinent when I’m out” ICS Annual Meeting, Montreal 2005

Prescribing information is available at this meeting “If I felt there was any hint of smell on me, I would not want to go anywhere near my husband” ICS Annual Meeting, Montreal 2005

Prescribing information is available at this meeting “I can’t remember when I last slept through the night” ICS Annual Meeting, Montreal 2005

Prescribing information is available at this meeting OAB: TERMINOLOGY AND PREVALENCE 8

Prescribing information is available at this meeting OAB defined based on symptoms 2 –Urgency, with or without urge incontinence, usually with frequency and nocturia –In the absence of pathological or metabolic conditions that might explain these symptoms ICS = International Continence Society ( 2. Abrams P, et al. Neurourol Urodyn. 2002;21: ICS TERMINOLOGY: OAB 9

Prescribing information is available at this meeting URGENCY Sudden, strong desire to urinate which is difficult to defer 2 OAB SYMPTOMS 2. Abrams P, et al. Neurourol Urodyn. 2002;21: Milsom I, et al. BJU Int. 2001;87: FREQUENCY 8 or more visits to the toilet per 24 hours 3 Usually with nocturia 2 URGE INCONTINENCE Involuntary leakage accompanied by urgency 2 OAB 10

Prescribing information is available at this meeting MaleFemale PREVALENCE OF OAB IN ADULTS  40 OAB AFFECTS BETWEEN 12% TO 22% OF ADULTS OVER 40 ACROSS EUROPE 3. Milsom I, et al. BJU Int. 2001;87: PREVALENCE (%) Country FRANCEGERMANYITALYSPAINSWEDENUK 11

Prescribing information is available at this meeting OAB AFFECTS YOUNGER & OLDER ADULTS PREVALENCE (%) OAB PREVALENCE INCREASES WITH AGE 3. Milsom I, et al. BJU Int. 2001;87: MaleFemale 12

Prescribing information is available at this meeting COMPARATIVE PREVALENCE OF OAB WITH OTHER DISEASES EUROPEAN DISEASE PREVALENCE 3. Milsom I, et al. BJU Int. 2001;87: AIRE. 5. IDF O’Brien JT, Ballard CG. BMJ. 2001;323: Capocaccia R, et al. Ann Oncol. 2002;13: PREVALENCE (%) OAB 3 ASTHMA 4 DIABETES 5 ALZHEIMER’S DISEASE 6 CANCER 7 13

Prescribing information is available at this meeting OAB AND INCONTINENCE 14

Prescribing information is available at this meeting The majority of people with OAB experience urgency without urinary leakage SUI: stress urinary incontinence UUI: urge urinary incontinence OAB Wet: 37% DETRUSITOL XL SPECTRUM OF OAB & INCONTINENCE ADAPTED FROM: 2. Abrams P, et al. Neurourol Urodyn. 2002;21: Stewart WF, et al. World J Urol. 2003;20: Hampel C, et al. Urology. 1997;50(suppl 6A):4-14. OAB Dry: 63% FREQUENCY URGENCY STRESS INCONTINENCE 29% MIXED INCONTINENCE 24% URGE INCONTINENCE 47% 15

Prescribing information is available at this meeting MIXED SYMPTOMS 11 Combination of stress and urge incontinence URGE 10 Urine loss accompanied by urgency resulting from abnormal bladder contractions STRESS 10 Urine loss resulting from sudden increased Intra-abdominal pressure (eg, laugh, cough, sneeze) TYPES OF URINARY INCONTINENCE 10. Milsom I, et al. Am J Manag Care Chaliha C, Khullar V. Urology Sudden increase in intra-abdominal pressure Uninhibited detrusor contractions Urethral pressure 16

Prescribing information is available at this meeting NORMAL MICTURITION CYCLE Bladder filling First sensation to void Normal desire to void Bladder filling STORAGE PHASEEMPTYING PHASE BLADDER PRESSURE Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66.

Prescribing information is available at this meeting HOW DOES OAB OCCUR? 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44: Bladder fills Increase in detrusor pressure First sensation to void Loss of urine Involuntary relaxation of urethral sphincter & pelvic floor Sudden detrusor contraction with increased intravesical pressure 2. Bladder half full 18

Prescribing information is available at this meeting 13. Coyne KS, et al. BJU Int. 2003;92: URGE INCONTINENCE IS MORE BOTHERSOME THAN STRESS INCONTINENCE URGE INCONTINENCE (n=69) MIXED INCONTINENCE (n=40) *A higher score indicates greater bother. OAB-q SUBSCALES SCORE* P<0.01 P< STRESS INCONTINENCE (n=62)

Prescribing information is available at this meeting MOST DIAGNOSED PATIENTS ARE NOT ON MEDICATION 3. Milsom I, et al. BJU Int. 2001;87: OAB (n=1916) SPOKEN TO DOCTOR 60% NOT SPOKEN TO DOCTOR 40% ON MEDICATION 27% NOT ON MEDICATION 73% TRIED/FAILED 27% LIKELY TO DISCUSS AGAIN 54% NOT LIKELY TO DISCUSS AGAIN 46% LIKELY TO DISCUSS AGAIN 65% NOT LIKELY TO DISCUSS AGAIN 35% NEVER TRIED 73% 20

Prescribing information is available at this meeting IMPACT OF OAB ON PATIENTS’ LIVES 21

Prescribing information is available at this meeting 14. Coyne K, et al. Qual Life Res. 2002;11: BOTH OAB DRY AND OAB WET ADVERSELY AFFECT QUALITY OF LIFE Physical Functioning SF-36 SUBSCALE SCORE 22 Normal (n=130)Continent OAB (n=225)Incontinent OAB (n=543) Role Limitations - Physical Bodily Pain General Health Perceptions Vitality Social Functioning Role Limitations - Emotional Mental Health

Prescribing information is available at this meeting 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44: OAB NEGATIVELY IMPACTS ON PATIENTS’ LIVES OAB causes: –Psychological distress –Reduced social and personal activities –Overall decreased quality of life 23

Prescribing information is available at this meeting UTIs = urinary tract infections. 15. Wagner TH, et al. Am J Manag Care. 2002;8(suppl):S598-S607. OAB IMPACTS ON PATIENTS’ HEALTH People with OAB: Average 20% more visits to a physician (p<0.05) Experience 13.8% more UTIs per year (p<0.001) Have double the odds of being injured in a fall Compared with people without OAB 24

Prescribing information is available at this meeting UI = urge incontinence. 16. Brown JS, et al. J Am Geriatr Soc. 2000;48: ASSOCIATION OF INCONTINENCE WITH FALLS AND FRACTURES 26% greater risk of falls 34% greater risk of fractures RISK OF FALLS AND FRACTURES IN PATIENTS WITH ≥1 EPISODE/WEEK OF UI FALLS INCREASED RISK (%) FRACTURES 25

Prescribing information is available at this meeting AVOIDANCE OF SOCIAL ACTIVITIES 17. Abrams P, et al. Am J Manag Care. 2000;6(suppl):S580-S590. OAB RESULTS IN SOCIAL ISOLATION % OF PATIENTS =1 SOCIAL ACTIVITY >1 SOCIAL ACTIVITY SPORTS 26

Prescribing information is available at this meeting FREQUENCY Altered their lives Limited activities IMPACT OF OAB ON FAMILY MEMBERS 18. Coyne K, et al. 17th World Conference of Family Doctors, Most bothersome symptoms for family members: NOCTURIA Impacted on their sleep Caused fatigue Impacted family members emotionally, causing: STRESS FRUSTRATION ANNOYANCE SYMPATHY EMBARRASSMENT ANXIETY ANGER WORRY IRRITATION 27

Prescribing information is available at this meeting *1= £ Adapted from Lloyd et al TOTAL IDENTIFIED COSTS OF MANAGING URINARY INCONTINENCE IN THE UK SUBSTANTIAL ECONOMIC BURDEN TO SOCIETY United Kingdom Per patient annual cost of UI = £138.04* *UI patients only 28

Prescribing information is available at this meeting RESPONDERS (%) 21. Milsom I, et al. EAU, WORRIED ABOUT INTERRUPTED MEETINGS EFFECT OF OAB ON EMPLOYMENT MenWomen 29 DECISIONS ABOUT WORK LOCATION AND HOURS AFFECTED POSSIBLE INFLUENCE ON VOLUNTARY OR EARLY RETIREMENT

Prescribing information is available at this meeting OAB AFFECTS SEXUAL FUNCTIONING 17.Abrams P, et al. Am J Manag Care. 2000;6(suppl): S580-S DIFFERENCE BETWEEN PATIENTS WITH URINARY INCONTINENCE OR PELVIC ORGAN PROLAPSE AND THOSE WITH NONE (%) Difference between desired and actual frequency of sex Loss of urine during sex Dyspareunia Restricted sexual activity Vaginal dryness

Prescribing information is available at this meeting 16. Brown JS, et al. J Am Geriatr Soc. 2000;48: Abrams P, et al. Am J Manag Care. 2000;6(suppl):S580-S Thuroff J. Eur Urol 2003; (suppl):10-15 Comorbidities –Depression 22 –Sleep deprivation 22 –UTI 22 –Skin infection 22 –Falls and fractures 16 –Sexual dysfunction 17 OAB IS MULTIDIMENSIONAL 31