OAB Syndroem

Urge Urinary Incontinence

Definition: Involuntary loss of urine associated with urgency (intense need to pass urine).

Causes:

  • Bladder Pathology.
  • Urinary tract infection
  • Over Active Bladder (OAB) Syndrome

Definition of OAB Syndrome

  • Urinary urgency
  • With/without urinary urge incontinence (urine leak before you reach the toilet).
  • Usually with increase day and night frequency.
  • In the absence of urinary infection or other pathology.

Risk Factors

  • Increasing age
  • Obesity
  • Constipation
  • Pelvic organ prolapse
  • Neurological conditions: e.g. Parkinson’s, MS, Stroke.
  • Fecal incontinence

Investigations for OAB

  • Bladder diary.
  • Mid Stream Urine for Culture & Sensitivity
  • Ultrasound scan (kidney, ureter and bladder) and residual volume assessment
  • Urodynamic study (before the second line treatment).

First Line Treatment

  • Lifestyle adjustment & Fluid management.
  • Pelvic Floor exercise and bladder re-training.
  • Anticholinergic drugs (Vesicare, Toviaz, Regurin XL, Oxybutynin patches)
  • Betmiga (Mirabegron) tablet.

Lifestyle Adjustment

  • Fluid modification: High or low intake
  • Tea & coffee reduction.
  • Resection of fizzy drinks
  • Weight loss
  • Treat constipation
  • Stop smoking

Indication for Second Line Treatment (Refractory OAB)

  • Failed life style adjustment & anticholinergic medications:
  • 3 anticholinergic medications over a course of one year
  • Sever side-effects from anticholinergic tablets
  • Contra-indications to anticholinergic medications

Second Line Treatment

Both treatments are avialable with Mr. Hammadeh

1- Percutaneous Tibial Nerve   Stimulation

2-Intravesical BOTOX injection

percutaneous-tibial-nerve-stimulation-ptns

Percutaneous Tibial Nerve Stimulation (PTNS)

  • Your posterior tibial nerve runs down your leg to your ankle and contains nerve fibres that start from the same place as nerves that run to your bladder.
  • Stimulating the tibial nerve will affect these other nerves and help control bladder symptoms, such as the urge to pass urine.
  • A very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and causing your foot to move.
  • PTNS is only recommended in a few cases where urge incontinence has not improved with medication and you don’t want to have botulinum toxin A injections or sacral nerve stimulation.
  • You may need 12 sessions of stimulation, each lasting around half an hour, one week apart.

Intravesical BOTOX injection

  • Indications:
    • Failed 3 antichilnergic drugs over a year or failed Betmega.
    • Severe side effects of antichilnergic treatment.
    • Contraindications for anticholenergic drugs
    • The effects usually take between three days to three weeks to appear.
  • Most patients find the effects of the injections last between six and nine months, although they can last longer
  • Repeated injections will be required each time the effects wear off.
  • Potential Side Effects:
    • Blood in the urine.
    • Urine infection.
    • Difficulty in passing urine in 1 out of 6 patients and sometimes needs for urethral self catheterisation.

These are some comments from my patients following intravesical BOTOX treatment:

“Thank you so much for giving me my life back”

“Absolutely brilliant – able to go on holiday and wear swimsuit with no worries”

“I am amazed! The op was painless and now I have regained my confidence”

“Botox has been life changing for me”

“Life has reverted back to normality”