Quick five tests, easy to get the differential diagnosis of overactive bladder

Overactive bladder (OAB) is a syndrome characterized by frequent and sudden urges to urinate.

Excluding other causes that cause frequent urination, urgency, and urinary incontinence is important for the diagnosis of overactive bladder.

Usually, some simple routine examinations and laboratory tests, combined with medical history and physical examination, to rule out infections and other diseases, are sufficient to diagnose overactive bladder.

In complex situations, confirmation of potential detrusor overactivity (gradual increase in detrusor pressure) and other tests may be valuable in the diagnosis of overactive bladder.

Figure 1 Overactive bladder (coronal section of female bladder, fat and peritoneum are removed to show pelvic floor and pelvic visceral nerves) Q1.
Which one is the typical symptom of overactive bladder? A.
Nocturia B.
Painful urination C.
Frequent and sudden urge to urinate D.
Abdominal discomfort Answer analysis: C The diagnosis of overactive bladder depends on the existence of urinary urgency, which is different from the general urge to urinate.

The typical urge to urinate is a normal physiological sensation that will gradually increase after a delay.

In contrast, the urgency of urination is an abnormal state characterized by a sudden desire to urinate that is difficult to delay.

Although nocturia is often regarded as a symptom of overactive bladder, not all patients with nocturia have overactive bladder, and the relationship between nocturia and overactive bladder is not very clear.

The 2011 consensus statement on the evaluation and treatment of nocturia concluded that most patients with nocturia do not have overactive bladder, but most patients with overactive bladder have nocturia.

In addition, according to the 2019 guidelines of the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), the symptoms of overactive bladder have four components: urgency, frequent urination, nocturia, and urgency.
incontinence.

Painful urination and abdominal discomfort are not typical symptoms of overactive bladder.

Q2.
How do clinicians rule out polydipsia when diagnosing overactive bladder? A.
Urine analysis B.
Urine cytology examination C.
Urination residual detection D.
Frequency-volume chart Answer analysis: D Patients with overactive bladder have frequent urination but very little urine output each time; while patients with polydipsia, urinate Frequent, normal or large urine output.

The two can only be distinguished by a frequency-capacity chart.

Urinalysis is used to rule out trace hematuria, pyuria, urinary tract infections, and diabetes.

For patients with microhematuria, further evaluation is recommended, including urine cytology.

For individuals at risk of bladder cancer, cytology can be performed even if there is no trace of hematuria.

Not all patients need to be tested for residual urination.

It is helpful for men with symptoms of obstructive and overactive bladder, women who have had pelvic surgery (such as previous urinary incontinence surgery), and women with obvious pelvic organ prolapse.

Q3.
Which symptom is usually benign prostatic hyperplasia rather than overactive bladder? A.
Urgent urinary incontinence B.
Urinary force C.
Nocturia D.
Frequent urination Answer analysis: B.
Benign prostatic hyperplasia patients’ prostate enlargement may look soft Like the clamp on the tube, it restricts the flow of urine.

The nerves in the prostate and bladder may also play a role in causing a variety of symptoms, including the need for Valsalva action to initiate and maintain urination in order to empty the bladder more fully.

According to the 2019 AUA/SUFU guidelines, urge incontinence, nocturia, and frequent urination are common symptoms of overactive bladder.

Q4.
Which of the following should be used for the initial diagnosis of uncomplicated overactive bladder? A.
Urodynamics B.
Cystoscopy C.
Diagnostic renal and bladder ultrasound D.
Urinalysis answer analysis: D Urinalysis and culture (if urinary tract infection is suspected) is a necessary condition for the evaluation of patients with overactive bladder.

Urinalysis is used to rule out trace hematuria, pyuria, urinary tract infections, and diabetes.

For patients with microhematuria, further evaluation is recommended, including urine cytology.

According to the AUA/SUFU guidelines, urodynamics, cystoscopy, diagnostic renal and bladder ultrasound should not be used for the initial examination of uncomplicated overactive bladder.

These examinations and other items should be used in refractory or other complicated cases.

Q5.
A female patient has urgency, difficulty urinating, blood in the urine and a feeling of full bladder.

Which of the following do you think is the cause of these symptoms? A.
Overactive bladder B.
Urinary tract infection (UTI) C.
Vaginitis D.
Pregnancy Answer analysis: B These are most likely symptoms of urinary tract infection.

The typical symptoms of adult urinary tract infection are mainly difficulty urinating, accompanied by urgency and frequency, often with a feeling of bladder filling or lower abdominal discomfort.

Among otherwise healthy women, as many as 10% of urinary tract infection cases report hematuria, a condition called hemorrhagic cystitis.

Because blood in the urine is not a common symptom of overactive bladder, it can be ruled out.

Since the patient is a female, benign prostatic hyperplasia can also be ruled out.

Vaginitis is a very common gynecological disease, usually with symptoms of abnormal discharge and vulvar discomfort.

Pregnancy is usually accompanied by disturbing urinary symptoms, including nocturia, urgency, frequent urination, and bladder pain.

However, blood in the urine should be considered a symptom of a urinary tract infection, not pregnancy.

References: 1.
Lightner DJ, Gomelsky A, Souter L, et al.
Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019[J].
J Urol.
2019 Sep; 202(3 ): 558-563.
2.
Weiss JP, Blaivas JG, Bliwise DL, et al.
The evaluation and treatment of nocturia: a consensus statement[J].
BJU Int.
2011 Jul; 108(1): 6-21.