URINE CONTROLPatient perspective on OAB management

OAB, overactive bladder

Appendix

OAB is a significant economic burden

1. Irwin DE, et al. BJU Int. 2009;103(2):202-209. 2. Durden E, et al. Neurourol Urodyn. 2018;37(5):1641-1649.

$550 per patient per year1

This includes prescription medication, incontinence pads and clinical depression

$175 million1

This number increases to:

$325 million if urgency urinary incontinence is included1

The estimated cost of OAB is:

The direct cost of OAB in Canada is:

The healthcare costs of OAB patients were more than 2.5X those of similar patients without OAB2

• Pelvic floor muscle therapy (PFMT)• Strengthens and improves function of pelvic floor• Shown improvement in urethral stability, decreasing OAB

symptoms• PFMT is only effective if the pelvic floor muscles are

tightened correctly• Should be incorporated into daily life

Improving pelvic floor function with physiotherapy

A physiotherapist specializing in pelvic floor physiotherapy can help patients improve pelvic floor muscle strength

• Contract PFM 10 seconds, relax 10 seconds• Repeat 15x• This set of exercises should be repeated 3 times a day• Try alternating sitting, standing and lying down during exercises

PFM

T RO

UTI

NE

PFM, pelvic floor muscles1. Corcos J, et al. Can Urol Assoc J. 2017;11(5):E142-E173.

Considerations for patients with cardiac disease

1. Corcos J, et al. Can Urol Assoc J. 2017;11(5):E142-E173.

• Antagonism of M2/M3 receptors may:• ↑ blood pressure and/or heart rate• Prolong the QT interval• Cause tachycardia

OXYBUTYNIN AND CONTEMPORARY ANTICHOLINERGICS

BETA-3 RECEPTOR AGONISTS• At supradoses, agonism of the B3 receptor may:

• ↑ blood pressure and/or heart rate• Prolong the QT interval

• Unknown effects in patients with severe uncontrolled hypertension

CAUTION in patients with pre-existing cardiac disease.

M2

M3

β3

Considerations for patients with depression

AE, adverse events; QOL, quality of life; UI, urinary incontinence1. Corcos J, et al. Can Urol Assoc J. 2017;11(5):E142-E173.

• Patients may lack self-motivation, desire, and persistence

• Important to recognize how psychosocial comorbidities can affect treatment outcomes

• Patients with depression report more severe UI symptoms, greater bother, and more of an impact on QOL

PATIENT ADHERENCE ANTICHOLINERGIC BURDEN• The cumulative effect of multiple anticholinergics

• Associated with AEs and negative health outcomes

• Consider the total anticholinergic load from all sources including:

• Antidepressants, antihistamines, bladder anticholinergics

Voiding diaries and questionnaires

• CUA Voiding Diary• Urology Care Foundation Bladder Diary• OAB-q questionnaire• OABSS questionnaire• UDI questionnaire

Patient motivation and counselling

Partner with patients

Emphasize patient ownership

Identify small steps Frequent follow-ups

Show care

• Communicate that the patient is in control

• Create goals, strategize and problem solve together to develop a partnership

• Take small, feasible steps

• Set realistic treatment expectations

• Celebrate successes, discuss concerns and manage treatment expectations

• Make sure patients know you care and are concerned about their wellbeing

1. Greene J et al. Annals of Family Medicine. 2016:14(2):148-154. 2. Corcos J, et al. Can Urol Assoc J. 2017;11(5):E142-E173.