Treatment of Overactive Bladder in the Frail Patient
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OVERACTIVE BLADDER (U LEE AND S ADELSTEIN, SECTION EDITORS)
Treatment of Overactive Bladder in the Frail Patient Sage Vincent 1 & Anthony Tokarski 1 & Alana Murphy 1 Accepted: 27 October 2020 / Published online: 25 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To understand how frailty interacts with overactive bladder. To explore how frailty should be considered when devising an individualized treatment plan for OAB patients. Recent Findings Frailty can be assessed in the outpatient office without undue burden. The urology community is increasingly aware of the importance of evaluating a patient for frailty and including this assessment in treatment algorithms. Frailty should be considered when treating OAB patients, since frail OAB patients are more susceptible to the potential deleterious consequences of medical therapy, onabotulinumtoxinA therapy, and sacral neuromodulation. Summary A patient’s frailty status should be considered during counseling regarding OAB therapy. Additional studies are needed to examine the treatment effects and risks in the frail OAB population. Keywords Overactive bladder . Frailty . Risk assessment . Cognitive impairment
Introduction International Urogynecological Association (IUGA) and International Continence Society (ICS) define overactive bladder (OAB) as “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence (UUI), in the absence of UTI or other obvious pathology.” [1, 2] Recent population studies estimate that OAB affects 8.1–10.3% of women around the world [3, 4]. These prevalence rates are slightly lower, but comparable to those found by larger epidemiologic studies including the EPIC and National Overactive Bladder Evaluation (NOBLE) studies, which suggested around 10.8–16.0% of men and 12.8–16.9% of women suffer from OAB [5, 6]. It has been reported that patients with OAB have impaired physical, psychological, and economic functioning compared This article is part of the Topical Collection on Overactive Bladder * Alana Murphy [email protected] Sage Vincent [email protected] Anthony Tokarski [email protected] 1
Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
to patients without OAB. This includes metrics such as decreased participation in physical activity, increased weight gain, greater likelihood of a diagnosis of depression or anxiety, and higher rates of occupational absenteeism and unemployment [7–9]. Of similar concern is the high rate of healthcare utilization of patients with OAB. One study found that female patients with OAB had twice as many annual healthcare interactions than their non-OAB counterparts [10]. The financial implications of OAB to society are great, with a predicted cost of $82.6 billion in 2020 in the USA alone [11]. With greater than 1 in 10 people worldwide affected by OAB, the global burden of this pathology is significant. In rece
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