I. Definition of OAB
OAB is defined by the ICS (International Continence Control Society) as a syndrome characterized by symptoms of urinary urgency, often accompanied by symptoms of urinary frequency and nocturia, with or without urge incontinence;
Urodynamically, it may be characterized by overactivity of the detrusor muscles or other forms of urethral-vesical dysfunction; objective examination is free of acute urinary tract infection and other forms of localized lesions of the vesicourethra.
OAB-related concepts
Urinary urgency.
It is a characteristic symptom of overactive bladder disorder.
Urinary urgency describes a sudden onset and intense desire to urinate.
Urinary frequency/nocturia.
Frequent urination refers to the subjective feeling that the patient is urinating too often.
Usually: adults with ≥ 8 times daytime and ≥ 2 times nighttime, with an average volume of < 200 ml per urination, are considered to have frequent urination.
Nocturia refers to patients waking up ≥2 times/night to urinate due to the urge to urinate.
Urgent urinary incontinence
It is the incontinence that accompanies or immediately follows urinary urgency.
Etiology and pathogenesis of OAB
The etiology of OAB is not very clear, but there are four types
(1), instability of the detrusor muscle, caused by non-neurogenic factors, abnormal contraction of the detrusor muscle during the storage period causes the corresponding clinical symptoms.
(2), Bladder sensory hypersensitivity: the desire to urinate occurs at smaller bladder volumes.
(3), abnormal function of urethra and pelvic floor muscles.
(4), Other causes: such as abnormal mental behavior, abnormal hormone metabolism, etc.
Third, the diagnosis of OAB
(i) Screening tests (tests that should be completed in general patients)
1. Medical history.
Typical symptoms, including urinary diary assessment.
Associated symptoms: dyspareunia, urinary incontinence, sexual function, defecation.
Relevant medical history: history of urinary and male genital system diseases and treatment, history of menstrual, fertility, gynecological diseases and treatment, history of neurological diseases and treatment.
2.Physical examination: general physical examination, special physical examination: urinary system, reproductive system, neurological system.
3.Laboratory examination: urinary routine.
4.Special urological examination: urinary flow rate, urological ultrasound examination (including residual urine examination).
(ii), selective examination (suspicion that the patient has some kind of lesion present)
1, pathogenic examination: urine, prostatic fluid, urethra, vaginal secretion examination when inflammation is suspected.
2.Cytological examination: when uroepithelial tumor is suspected.
3.Intravenous pyelogram, endoscopy, CT or MRI: when other diseases of the urinary tract are suspected.
4.Invasive urodynamic examinations.
Bladder pressure measurement, pressure-flow rate measurement.
Purpose of invasive urodynamic examination: to determine the presence or absence of lower urinary tract obstruction and to assess the function of the forced urinary muscle.
Indications: decreased urinary flow rate, increased residual urine, failure of preferred treatment or presence of urinary retention.
5. Other tests: urine culture, blood biochemistry, serum PSA (for men over 40 years old), etc.