Exploring Overactive Bladder: Diagnosis, Impact, and Treatment Approaches


In this Urology Times® episode, Dr. Kennelly, Dr. Kevin Benson, and Dr. Karyn Eilber discuss overactive bladder (OAB), focusing on its diagnosis, symptomatology, and patient populations most at risk, including gender and age-related factors.

Michael J. Kennelly, MD, FPMRS, FACS: Hello, welcome to this Urology Times Viewpoints on a patient-centric approach in the management of overactive bladder. I'm Dr. Michael Kennelly from Charlotte, North Carolina, Clinical Professor at Wake Forest University School of Medicine in Charlotte, at Carolinas Medical Center. Tonight, I have the pleasure of being with two outstanding experts from urology and urogynecology. We have Dr. Kevin Benson from the urogynecology specialty and Dr. Karyn Eilber from urology. I'd like both of them to introduce themselves tonight.

Karyn S. Eilber, MD: Thank you for having us this evening. My name is Karyn Eilber. I am a urologist specializing in urogynecology and reconstructive pelvic surgery, practicing at Cedars-Sinai in Los Angeles.

Kevin D. Benson, MD, MS: I'm Kevin Benson, a Clinical Professor of Gynecology at the University of South Dakota in Sioux Falls, South Dakota. I practice clinical urogynecology.

Michael J. Kennelly, MD, FPMRS, FACS: Thank you both for joining us. We're going to focus on different aspects within urogynecology and overactive bladder, examining the standard of care, treatment modalities, both pharmacologic and newer therapies like procedural or neuromodulation device therapies. We'll conclude with practical approaches and considerations. Dr. Benson, could you start by explaining the term overactive bladder (OAB)?

Kevin D. Benson, MD, MS: Certainly. Overactive bladder is a generalized term referring to patients who may experience urinary urgency, frequency, urgency incontinence, nocturia, or a combination of irritative lower urinary tract symptoms. These patients often exhibit the 'got to go, got to go' urgency and may frequently think about their bladder more than necessary, often bathroom mapping.

Michael J. Kennelly, MD, FPMRS, FACS: Dr. Eilber, do patients typically exhibit one symptom more than others? It seems there's a lot of symptoms there.

Karyn S. Eilber, MD: They definitely can. I think an important thing to point out is especially when people are very fixated and convinced that you have to drink, you know, a minimum amount of water. And oftentimes you ask people, you know, "How much do you drink?" And they will say I don't drink enough which really there's not a lot of scientific basis behind you having to drink that much fluid so I think isolated frequency oftentimes people have has to be correlated with fluid intake but I think more often than not people are experiencing a combination of the frequency and the urgency and then sometimes the urgency incontinence.

Michael J. Kennelly, MD, FPMRS, FACS: So really is a variety of things. Are there certain people that are at risk? Meaning, is it equal to males, females, is it younger vs older? Are there certain populations where this condition really affects?

Karyn S. Eilber, MD: I think after a certain age, if I recall, about the age of 62, the same number of men and women can be affected by OAB. But the difference is, mainly because of childbirth, more women are affected by the incontinence portion. because it is unusual for men to have leakage if they still have their prostate. And certainly one of the things women of a certain age can experience are menopausal hormonal changes that can affect the bladder function as well.

Michael J. Kennelly, MD, FPMRS, FACS: Males and females both seem to have this overactive bladder condition. Dr. Benson, from the urogynecologic perspective of treating women, are you noticing young, as well as older, any differences in that situation?

Kevin D. Benson, MD, MS: Traditionally, older patients exhibit more overactive bladder symptoms, while younger patients, being more physically active, often have stress-predominant symptoms that may transition to OAB. It's a heterogeneous condition affecting both young and elderly patients. I think that traditionally patients as they age see more of the overactive bladder, we often see more stress predominant symptoms younger, probably because patients are more physically active, they're demanding more of their body, and oftentimes they may transition from more of a stress type picture into an overactive bladder picture. But I think it affects everyone. There are patients who are very young and patients who are elderly don't have it. And so it's a very heterogeneous group. I'm always amazed at how you can't really pigeonhole a demographic into this. Certainly, we do think with aging—statistically we do see more of it.

Michael J. Kennelly, MD, FPMRS, FACS: Dr. Eilber you mentioned about menopausal changes. that must have some effect also, like estrogen on things?

Karyn S. Eilber, MD: Yeah, so there are estrogen receptors in the bladder. Replacing vaginal estrogen or even systemic estrogen can oftentimes help these symptoms and just to touch on Dr. Benson's comments about seeing the symptoms both in younger women and older women. I think that when you're seeing these OAB symptoms and especially incontinence in young women who have not had children, you should be thinking about other things like there are large conditions that can cause their symptoms. Sometimes it's severe anxiety that just cause a lot of frequency. But I think when a young woman who has never had childbirth or any major pelvic surgeries or other risk factors presents incontinence, we do need to keep that top of mind.

Video transcript is AI-generated and reviewed by Urology Times® editorial staff.

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