Sogc Guideline: Oab Treatments

Front 1

What is the prevalence of OAB?

Back 1

12-17%

- increases with age

Front 2

What non-gynaecological comorbidities are associated with OAB?

Back 2

- depression
- falls and fractures
- increased admissions to hospitals and nursing homes

Front 3

List conservative management options for OAB

Back 3

- behavioural management protocols
- bladder training programs
- functional electrical stimulation

Front 4

List approved anticholinergic medications for OAB

Back 4

- oxybutinin (Ditropan)
- tolterodine (Detrol)
- tropsium (Trosec)
- solifenacin (Vesicare)
- darifenacin (Enablex)
- fesoterodine (Toviaz)

Front 5

What receptors and neural pathways are involved in voiding?

Back 5

- voiding occurs via parasympathetic activation of M2 or M3 receptors
- M2 receptors also inhibit sympathetically mediated bladder relaxation

- receptors are in detrusor muscles and urothelium

Front 6

What are some CNS side effects of anticholinergics?

Back 6

- immediate
- confusion
- delirium
- headache
- blurred vision
- dizziness
- hallucinations
- delayed: memory loss

- smaller molecules, neutral in charge, lipophilic are more likely to cross BBB and cause CNS S/Es

Front 7

What are some cardiac side effects of anticholinergics?

Back 7

- increase in heart rate
- small increases in QT interval (tolterodine and solifenacin)
- do not cause clinically significant outcomes

Front 8

Which anticholinergic is renally metabolized instead of hepatically?

Back 8

tropsium

Front 9

Which anticholinergic has the highest discontinuation rates due to side effects?

Back 9

oxybutinin

- adverse events in up to 80%
- discontinuation rates of up to 33%

Front 10

Which anticholinergic can be used in conjunction with cholinesterase inhibitor (Tx for Alzheimer's)?

Back 10

tropsium

Front 11

Which anticholinergic can be used in conjunction with medications that inhibit CYP450 (eg. antifungals, antiretrovirals, macrolide antibiotics, OCPs)?

Back 11

tropsium

Front 12

Absolute contraindications to anticholinergics

Back 12

- urinary retention
- gastric retention
- uncontrolled narrow-angle glaucoma
- known hypersensitivity

Front 13

Relative contraindications to anticholinergics

Back 13

- partial bladder outlet obstruction (borderline or high PVRs)
- controlled narrow-angle glaucoma
- impaired cognitive function
- reduced renal or hepatic function
- concomitant excessive EtOH use
- decreased GI motility
- constipation
- myasthenia gravis

Front 14

What pregnancy classification are anticholinergics?

Back 14

Category C

Front 15

List factors that increase the odds of early discontinuation of anticholinergics

Back 15

- previous depression
- previous UTI diagnosis
- polypharmacy

Front 16

Should estrogen supplementation be recommended as treatment for OAB?

Back 16

- oral or transdermal estrogen should not be recommended (comparable to placebo)
- vaginal estrogen can be used for subjective improvements in OAB symptoms

Front 17

What is the role of TCAs in treating OAB?

Back 17

- biological plausibility
- mild anticholinergic (relaxes detrusors)
- alpha agonist (contracts urethral sphincter)
- minimal evidence for TCAs

Front 18

What are treatment options for refractory OAB?

Back 18

- intravesical botulinum toxin injection (80% improvement, 43% w/ urinary retention requiring self-cath)
- sacral nerve stimulation (64-88% effective, 33% reoperation rate to treat lead migration, pain, and infection)
- tibial nerve stimulation