1. Prescribing information is available at this meeting 1 MODULE 2 IDENTIFICATION, SCREENING AND DIAGNOSIS DET 808

2. Prescribing information is available at this meeting Patients do not initiate discussions since they may not see OAB as a legitimate condition or may not understand the terminology Patients are often too embarrassed to talk about their symptoms Patients learn to accept and cope with their symptoms –Avoiding social interaction –Mapping toilet locations –Carrying spare clothing 17. Abrams P, et al. Am J Manag Care. 2000;6(suppl):S580-S590. CHALLENGES TO IDENTIFICATION OF OAB 2

3. Prescribing information is available at this meeting Do you go to the toilet more than 8 times a day? Do you often wake up during the night needing to go to the toilet? Do you have to hurry to make the toilet in time? Do you often not reach the toilet in time? ASKING THE RIGHT QUESTIONS 3

4. Prescribing information is available at this meeting New patient medical questionnaires New patient medical examinations Routine cervical smears Routine checkups for patients over 40 years old Family planning/menopause clinics Patient leaflets/posters Health visitors/district nurses/practice nurses Nursing homes OPPORTUNITIES FOR SCREENING 4

5. Prescribing information is available at this meeting SCREENING IS AN IMPORTANT TOOL Reasons for screening –High prevalence –Impact on patients’ lives –Cost to society –Government initiatives/guidelines such as: Good Practice in Continence Services in the UK 23 23. Donaldson L, Mullally S. London, England: Department of Health; April 19, 2000. 5

6. Prescribing information is available at this meeting Validated in 1260 patients 24 8 simple, self-administered questions Simple scoring by addition Available and linguistically validated in 12 languages 25 A NEW SCREENING TOOL – THE OVERACTIVE BLADDER – VALIDATED 8-QUESTION QUESTIONNAIRE 6 24. Coyne K, Matza L ICS 2004. 25.Conway K, Uzun V, Vigner S et al. ICS 2004.

7. Prescribing information is available at this meeting How bothered have you been by… Frequent urination during the day? Uncomfortable urge to urinate? Sudden urge to urinate with little or no warning? Accidental leakage of small amounts of urine? Night-time urination? Waking up at night because of the need to urinate? Uncontrollable urge to urinate? Urine leakage associated with a strong desire to urinate? SCREENING WITH THE OVERACTIVE BLADDER QUESTIONNAIRE 7 14.Coyne K, et al. Qual Life Res. 2002;11:563-574.

8. Prescribing information is available at this meeting Patients complete the screening questions Doctor reviews the patient-completed screener Doctor makes diagnosis and treats appropriately HOW TO USE THE OVERACTIVE BLADDER QUESTIONNAIRE 8

9. Prescribing information is available at this meeting COMMUNICATION IS THE KEY Active listening Use of language Use of body language Questioning techniques 9

10. Prescribing information is available at this meeting DIAGNOSIS OF OAB 10

11. Prescribing information is available at this meeting WHO IS AT RISK OF OAB? 10.Milsom I, et al. Am J Manag Care. 2000;6(suppl):S565-S573. 11 URGE INCONTINENCE STRESS INCONTINENCE ANY INCONTINENCE Advanced age Diabetes Urinary tract infection Smoking White race High body mass index High waist-to-hip ratio Parity Advanced age White race Education Functional or sensory impairment High body mass index Previous hysterectomy Stroke Diabetes Chronic obstructive pulmonary disease

12. Prescribing information is available at this meeting OTHER CONDITIONS/MEDICATIONS WHICH HAVE AN IMPACT ON SYMPTOMS OF OAB 12 22. Thuroff J. EUR Urol. 2003;2 (Suppl):10-15. 26. ASCP website. http://www.ascp.com/pubs/tcp/1999/special/diagnosing.shtml COEXISTING CONDITIONS DRUGS ASSOCIATED WITH INCONTINENCE Chronic constipation 26 Urinary tract infection 26 Delirium 26 Depression 22 Skin infection 22 Sleep deprivation 22 Diuretics 26 Antidepressants 26 Antihypertensives 26 Sedatives, hypnotics and nacotics 26 Muscle relaxants 26

13. Prescribing information is available at this meeting To confirm diagnosis of OAB –Patient history 12 –Overactive Bladder Questionnaire 24 –Physical examination 12 –Urinalysis 12 DIAGNOSIS OF OAB BASED ON SYMPTOMS 13 12. Wein AJ, Royner ES. Int J Fertil. 1999;44:56-66. 24. Coyne K, Matza L. ICS 2004.

14. Prescribing information is available at this meeting Patient history –Form a working diagnosis –Assess the impact of symptoms on QoL –Review body systems (neurologic, metabolic) –Identify coexisting conditions and treatments that can cause incontinence 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. DIAGNOSIS OF OAB Physical examination –Abdominal –Neurological –Pelvic (women) –Genital/prostate (men) 14

15. Prescribing information is available at this meeting Urinalysis –Infection –Tumour –Haematuria –Glucosuria –Proteinuria 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. DIAGNOSIS OF OAB (CONTINUED) Postvoid residual volume (PVR) –Elderly with voiding symptoms and/or recurrent UTI –Neurological disease and voiding dysfunction –Symptoms of poor bladder emptying 15

16. Prescribing information is available at this meeting 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. DIFFERENTIAL DIAGNOSIS: OAB AND STRESS INCONTINENCE Urgency (strong, sudden desire to void) Yes No Frequency with urgency (>8 times/24 h) Yes No Leaking during physical activity; eg, coughing, sneezing, lifting No Yes Amount of urinary leakage with each episode of incontinence Large (if present) Small Ability to reach the toilet in time following an urge to void No/ Just barely Yes Waking to pass urine at nightUsually Seldom SYMPTOMS STRESS-INCONTINENCEOVERACTIVE BLADDER SYMPTOM ASSESSMENT 16

17. Prescribing information is available at this meeting TREAT IF: Frequency/urgency and normal urinalysis Frequency with urgency Urge incontinence Normal urinalysis REFER TO SPECIALIST IF: No response to treatment Haematuria without infection Poor bladder emptying Neurological or metabolic disease Genital/prostate abnormalities OAB 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. TREATMENT VERSUS REFERRAL 17