CUA GL 2017 OAB

Question 1

What is the ICS definition of OAB?

Answer 1

Urinary urgency with or without urgency incontinence frequently accompanied by frequency and nocturia in the absence of UTI or other obvious pathology.

Question 2

What is the ICS definition of Urinary frequency?

Answer 2

Patient complaint of urinating too often during the daytime

Question 3

What is the ICS definition of nocturia?

Answer 3

one or more voids per night, preceded and followed by sleep

Question 4

What is the ICS definition of urinary urgency?

Answer 4

urgency is the sudden compelling desire to pass urine that is difficult to defer.

Question 5

what is the ICS definition of Urge incontinence?

Answer 5

involuntary leakage of urine accompanied or immediately preceded by urgency.

Question 6

What is the prevalence of OAB?

Answer 6

14-18% in Canadian population, same between men and women

Question 7

prevalence of OAB without UUI is more common that with UUI in men

Answer 7

Correct, it is the opposite in women

Question 8

OAB and bladder outlet obstruction are comorbid conditions in men due to BPH.

Answer 8

Correct

Question 9

What are the QoL domains negatively affected by OAB? wet or dry

Answer 9

daily life, recreational life, psychological concerns(depression), isolation, sexuality(particularly in women), work productivity(reduction as much as RA and asthma),

Question 10

what is the most common cause for incontinence in older adults?

Answer 10

OAB and UUI

Question 11

What is the first step of assessment of patient presenting for OAB?

Answer 11

Take a history, voiding diary if possible

Question 12

What should be included in physical exam for OAB?

Answer 12

abdominal exam, pelvic exam to assess tissue quality and sensation, urethra and POP, stress incontinence(cough test), DRE, or vaginal exam, neurologic exam( perineal sensation, S1-S4, bulbocavernosal reflex, rectal sphincter tone)

Question 13

Patient self reported questionaries’ are the most suitable method for assessing the patient’s perspective of bothersome symptoms and impact on patients’ quality of life.

Answer 13

Correct

Question 14

A 24 hour voiding diary is adequate

Answer 14

Incorrect. bc of daily variability 3-7 days is.

Question 15

Bladder diaries are not useful in behavioral therapies and bladder training programs.

Answer 15

Wrong. they are.

Question 16

UA and Ucx is recommended for all patients presenting with OAB.

Answer 16

YES

Question 17

Is urine cytology recommended in routine work up of patients with OAB>

Answer 17

NO, but remember that irritative voiding symptoms are associated with UC in women.

Question 18

Is measurement of PVR recommended for patients with OAB?

Answer 18

Not typically unless there are obstructive voiding symptoms or ( neurologic history, prostate or incontinence surgery hx,

Question 19

Are there imaging work up recommended in initial work up of OAB>

Answer 19

Nope( no cysto, US, MRI or CT)

Question 20

Is monitoring of bladder wall thickness useful for monitoring the effects of OAB treatment? or diagnosis

Answer 20

No

Question 21

Is UDS recommended in routine initial work up of OAB?

Answer 21

No

Question 22

Do the findings on UDS predict response to surgical or non surgical treatment for OAB?

Answer 22

NO

Question 23

which patients with OAB should have UDS?

Answer 23

neurogenic voiding dysfunction, history of radical pelvic surgery, pelvic radiation, and those at risk of upper tract deterioration, after failed previous treatment, if diagnosis is not clear after H and P.

Question 24

What are two main components of behavioral therapy for OAB?

Answer 24

PFMT and bladder training,

Question 25

What are components of bladder training?

Answer 25

use of bladder diaries, bladder control strategies, timed voiding, scheduled or prompted voiding, delayed voiding

Question 26

what are components of PFMT for Tx of OAB?

Answer 26

urgency suppression, control strategies, biofeedback

Question 27

when behavioral therapies for compared to medications they were either equal or inferior to medical therapy in reducing Incontinence, frequency, nocturia reduction? T/F

Answer 27

F, they were equal or superior

Question 28

What lifestyle changes can be suggested for OAB that may be helpful?

Answer 28

fluid and caffeine intake, diet management and weight loss. management of bowel irregularity, optimization of other comorbidities

Question 29

changes in daily life should be implemented for how long minimum? how long ideally?

Answer 29

6 weeks minimum, 8-12 weeks ideally.

Question 30

A patient with BMI greater than 30 is at increased risk of developing OAB symptoms

Answer 30

Correct

Question 31

What are three classes of drugs available for use for OAB in Canada?

Answer 31

antimuscaranics, Beta-3 agonists, Combination therapy

Question 32

Name 5 antimuscaranics available in canada?

Answer 32

Oxybutinin(IR, ER, Transdermal), Tolteridine, darifenacin, trospium, propiverine, fesoteridine.

Question 33

Between tolteridine and oxybutinin which one is prefered?

Answer 33

Tolteridine ER bc of lower side effects and similar efficacy

Question 34

Is there a role for combining different AMs?

Answer 34

No, just increases side effects

Question 35

What are common side effects of AM?

Answer 35

dry mouth, pruritus, constipation, dry eyes, cognitive side effects

Question 36

What are contraindications to AM therapy?

Answer 36

uncontrolled narrow angle glaucoma( due to antagonism of M3 and M5 receptors in the eye), GI and GU obstruction, Urinary retention, Pregnancy, breastfeeding, hypersensitivity

Question 37

name 3 side effects of mirabegron

Answer 37

HTN, cardiac arrhythmia, urinary retention, nasopharyngitis, back pain,

Question 38

What combination therapy has been studied?

Answer 38

Mirabegron(25/50)+ solifenacin in symphone and BESIDE studies and combo therapy was found to be more efficacious.

Question 39

Which AM and at what dose is superior to mirabegron i50mg in reducing episodes of UUI?

Answer 39

Solifenacin 10mg

Question 40

Is pregnancy a contraindication to Mirabegron? what about AMs?

Answer 40

YES, YES

Question 41

How are absorption of drugs affected by ageing?

Answer 41

decreased gastric motility, decreased skin thickness

Question 42

How does ageing affect body distribution of drugs?

Answer 42

decreased in lean body mass, decreased protein binding leading to higher concentrations of free drug

Question 43

How is renal clearance of drugs affected by ageing?

Answer 43

decreased

Question 44

How is hepatic metabolism of drugs affected by ageing?

Answer 44

decreased in phase ( (oxidation) reactions, decreased hepatic blood flow and mass( decreased clearance and first pass metabolism),

Question 45

Has trospium and solifenacin at low standard doses been shown to be effective in combination in elderly?

Answer 45

YES, higher efficacy than regular dose

Question 46

what does fesoteridine become after metabolism by cyp3a4?

Answer 46

tolteridine

Question 47

what medications could potentially increase concentration of oxybuytinin, solifenacin, darifenacin, tolteridine?

Answer 47

Azole antifungals, vinblastine, cyclosporin, macrolide antibiotics

Question 48

What dosage of OnabotulinumtoxinA is used for OAB?

Answer 48

100 units, 20 injections( 0.5 ml) per site, trigone is spared

Question 49

what are side effects of intradetrouser botox?

Answer 49

uncomplicated UTI, dysuria, bacteriuria, urinary retention,

Question 50

Based on phase 3 RCTs what is the median duration of effect of botox?

Answer 50

7.6 months

Question 51

what percentage of patients with SNM will require a revision?

Answer 51

30-39%

Question 52

What are side effects of SNM?

Answer 52

pain at the simulator site, pain at the lead site, lead migration, electric shock, infection/irritation

Question 53

does obesity affect chance of success with SNM?

Answer 53

NO