Does the Imprecise Definition of Overactive Bladder Serve Commercial Rather than Patient Interests?

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
European Urology (Impact Factor: 13.94). 04/2012; 61(4):746-8; discussion 749-50. DOI: 10.1016/j.eururo.2011.12.013
Source: PubMed
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Available from: Kari A O Tikkinen, Jan 03, 2014
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    • "Although there have been clear advantages in developing a symptom-based definition and adoption of the term OAB, OAB continues to generate controversy. Some have argued that the definition of OAB is too vague, with the inclusion of terms such 'usually' and 'with or without', to have sufficient specificity [3]. A further criticism is the lack of standardised outcome measures for symptom severity, e.g., how many voids, the degree of frequency (above the threshold of eight episodes per day) and the degree of incontinence, in the definition. "
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    ABSTRACT: Objectives The overactive bladder syndrome (OAB) is a highly prevalent and bothersome symptom complex. We review contemporary reports to provide an update of the key aspects of its pathogenesis and the therapeutic approaches. Methods The PUBMED database was searched for relevant publications in the period from 1 January 1985 to 1 May 2013, using the keywords ‘overactive bladder’, ‘anti-muscarinics’, ‘β-3 agonists’, ‘intravesical botulinum toxin’, ‘tibial nerve stimulation and ‘sacral neuromodulation’. Results In all, 33 articles were selected for this review. OAB is very common, affecting 10–20% of the population. It is often bothersome and frequently affects the quality of life. The current definition of OAB remains a source of controversy. Anti-muscarinic agents remain the mainstay of pharmacotherapy. The new β-3 agonists have some efficacy whilst avoiding anti-cholinergic effects, and so might benefit patients who are unable to tolerate anti-muscarinic agents. Intravesical botulinum toxin is recommended for patients in whom oral pharmacotherapy fails, although the optimal parameters in terms of dosing, number of injections and injection site are yet to be fully established. Sacral neuromodulation is another option that has a good response in about half of patients. Conclusions OAB remains an incompletely understood problem that presents a significant management challenge. A range of therapeutic options is now available for clinicians managing this problem.
    Full-text · Article · Dec 2013 · Arab Journal of Urology
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    Preview · Article · Apr 2012 · European Urology
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    ABSTRACT: The results from two new randomized trials suggest that urodynamic assessment might not be necessary to select patients for stress incontinence surgery. However, whether these findings change clinical practice remains to be seen.
    No preview · Article · Jun 2012 · Nature Reviews Urology
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