Dr. Kennelly, Dr. Kevin Benson, and Dr. Karyn Eilber delve into the significant impact of OAB on patients' quality of life, including its effects on daily activities and mental well-being, and how this burden shapes clinical decisions in the early stages of treatment and selection of appropriate therapeutic options.
Dr. Kennelly: Dr. Benson, when people come in to see you, what is their complaint or what are they trying to solve?
Dr Benson: Sure. So usually they're frustrated by quality of life indications. So these are folks that are really focused on their bladder throughout the day. And again, quality of life and what matters to individuals is highly varied, but these people are frustrated. They're thinking about the bathroom a lot, they're changing behaviors, they're worried. protection. They're really limited.
Dr. Kennelly: I would say most of the people we see it's those irritative factors that just are influencing their behaviors that bring them in. I even recall just in my practice, which also includes men, is what I tend to see the male side seem to be getting up at nighttime. Dr. Eilber, do you see that as getting up at nighttime? And what if does that have on the patients?
For sure. I think people who are still working, it's going to affect the way, you know, they're functioning during the day. And I think Dr. Benson makes a great point. Some people can urinate 10, 12, 15 times a day doesn't bother them. Other people, it's, you know, really impactful, especially if you have a occupation where you don't have easy access to a bathroom. But oftentimes when patients complain of getting up at night, they're actually urinating as frequently during the day. It's just much more bothersome because your sleep is interrupted. –
Dr. Kennelly: And you talk about bother, do you ask people about bother? Like, did you use scales or some other methodology to kind of quantitate bother?
Dr Benson: We do have intake questionnaires, but I think that sometimes, even though we think those questions are very straightforward, I think people struggle a little bit answering them, but I routinely ask people, are you bothered enough that you want to have treatment? And many people say, no, I just want to make sure there's nothing wrong.I think it is a good move in medicine in general that we're moving towards really what patient report outcomes are, and not so much what we think is a problem for someone.
Dr. Kennelly: I kind of like how you phrased that, asking someone, are you bothering up to want whatever therapy that could be behavioral therapy or are you bothering up to want medication therapy or a treatment beyond that? In my practice, I think I see a value to doing that. Dr. Benson, do you use some type of bother to decide on which method you might treat with?
Dr. Benson: Sure. Sure. That, that's an absolute mainstay of kind of a question that I ask. And I just use a simple scale of one to five. One is you're barely aware in five is it's making you miserable to the point that you really are bothered significantly. And they can really pretty easily quantify on a one to five scale. I used to use one to 10, but one to five is even simpler. And usually those patients who seek treatment three, four and five is kind of the number where they're at. As Dr. Albers said,that one and two, they just want reassurance. They just want to know, frankly, oftentimes what's normal, you know, because they're living as they are and they're like, well, hey, what is normal? Should I be up at night? Should I, how many times should I go during the day?And sometimes it's just that aligning with what normative data is that's helpful.
Dr. Kennelly: That's interesting to bother one to five. I like it as it's simple. And do you have an idea if someone says they're two or one? Does that dictate therapy?
Dr. Benson: Sure. Well, the first thing I say is why are you here if you're a one or a two? Because just as Dr. Eilber said, a one and a two, I need to make sure that we're doing goal directed therapy. A one and a two to me is education. A one and a two is behavioral change and maybe just some reassurance. And then I'm already thinking in my mind that three four, and five might need more than that. But it helps also to align that if they are truly telling me how bothered they are, and they say it's a one or a two, then I'm missing something in the story. So that's the other part that's helpful for me. It just helps me to align, you know, their severity with what they're saying.
Dr. Kennelly: Got it. Actually, we talked, we started to talk about treatments, but really back up a little bit. Dr. Eilber, what do you do to evaluate these patients? Is it a difficult workup? Or what should urologist and other providers do?
Dr Eilber: I think there definitely should be some basics. Starting with the history, first and foremost, how much are you drinking and what are you drinking? Like my favorite story is I had a spouse of a neurosurgeon who was drinking like five vente lattes a day. And I said, your neurosurgeon husband couldn't figure out what to tell you to cut back on that. I think the history, how long this has been going on, you know, if they leak or not, then I think at a minimum, they should get a urinalysis. It is actually surprising how many patients have reported say to their primary doctor their urinary symptoms and haven't even had a basic urinalysis. And then also checking a post void residual. Sometimes you're surprised, even though women don't generally retain every once in a while they have the urgency because you know they're very low-stage bladders the cysticeal is actually causing obstruction.
Dr. Kennelly: So in that regards from examination part, GU exam for the male. Dr. Benson pelvic exam would that be needed for this condition?
Dr Benson: Yeah for sure. You know I think that's just part and parcel to what we do. I think that if you're seeing someone, you owe it to them to know what's happening anatomically. And in our practice, we do essentially just a simple CMG and a Euroflow and check a PBR because again, a patient with a 75CC bladder capacity is different than a person who has a 500CC capacity. So there might be other things going on too that bring them in beyond just specifically OAB, but looking for that prolapse looking for pelvic floor muscle tone, seeing if they're hypertonic or have other issues. Just a lot of things. Do they have genital urinary syndrome and menopause? Do they have atrophy? Do they have other things that might be irritating and causing a problem? Do they have urethral pathology? Do they have a diverticulum? Do they have some sort of urethral prolapse or other issues as well?
Dr. Kennelly: Right, so I think you all bring up a great point. And it's really that evaluation. is sort of excluding other conditions that may mimic overactive bladder.
*Video transcript is AI-generated and reviewed by Urology Times® editorial staff.