UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

DIAGNOSIS OF OVERACTIVE BLADDER

Halime Şen Selim

İzmir Atatürk Training and Research Hospital, Department of Gynecology and Obstetrics, İzmir, Türkiye

Şen Selim H. Diagnosis of Overactive Bladder. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.103-113.

ABSTRACT

Overactive bladder (OAB) refers to a collection of symptoms including urinary urgency, frequent urination, and nocturia. These symptoms may occur with or without urinary incontinence, and without the presence of a urinary tract infection or other identifiable pathologies. Frequency is the most frequently reported symptom (85%), and 54% complained of urge urinary incontinence (UUI). This condition is widespread, and it can be costly, but addressing it can lead to significant improvements in the quality of life for both men and women. While the overall prevalence rates are similar among men (16.0%) and women (16.9%), urinary incontinence (UI) resulting from OAB is more common in women than in men, with rates of 9.3% compared to 2.6%. Although there is no definitive consensus on the etiopathogenesis, many factors have been blamed, such as dysfunction of the autonomic nervous system (ANS), estrogen deficiency or insufficient progesterone, the myogenic hypothesis, the urothelial hypothesis, and disturbances between various mediators such as ATP, prostanoids, and tachykinins, such as nitric oxide. The initial evaluation for diagnosing idiopathic overactive bladder should be initiated with a thorough history and physical examination, followed by a urinalysis as the primary diagnostic test. Urinary tract infection and microhematuria should be ruled out; if suggestive findings are present, a urine culture is recommended. A detailed gynecological examination should be performed. Initially, the presence of a cystocele should be assessed during the inspection, and a detailed POP examination should be performed. Another essential point to note during inspection and speculum examination is the presence of vaginal atrophy. Existing vaginal atrophy may indicate estrogen deficiency, which may contribute to urge symptoms. In these patients, an abdominal examination should be performed in addition to a gynecological examination to rule out a mass that may be causing intraabdominal pressure. Cystometry, uroflowmetry, pressure-flow studies, electromyography, and video-urodynamic testing provide concrete information that allows for the assessment of normal or abnormal urinary tract and pelvic floor function, and provides data on the pathophysiological processes that cause OAB symptoms. However urodynamics, cystoscopy, and imaging studies are not relevant in the initial evaluation of OAB, and they should only be used in cases of diagnostic uncertainty.

Keywords: Overactive bladder; Detrusor overactivity; Urge urinary incontinence; Urodynamics; Uroflowmetry

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