Overactive Bladder Workup

  • Author: Pamela I Ellsworth, MD, FACS; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Jan 10, 2012
 

Approach Considerations

A few simple office and laboratory tests, in conjunction with the history and physical examination, usually suffice for a diagnosis of overactive bladder (OAB). A urinalysis and culture (if UTI is suspected) is indicated in patients being evaluated for OAB. In select individuals, further testing such as an assessment of postvoid residual may be indicated.

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Urine Studies

Urinalysis is used to exclude microhematuria, pyuria, urinary tract infection, and glucosuria. In those individuals with microhematuria, further evaluation including a urine cytology is recommended. In individuals at risk for bladder cancer, a cytology even in the absence of microhematuria may be indicated.

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Postvoid Residual Testing

Postvoid residual testing is not indicated in all patients. It is helpful in men with both obstructive and OAB symptoms, in women who have undergone prior pelvic surgery (eg, prior incontinence surgery), and those with significant pelvic organ prolapse.

Postvoid residual volume is assessed by means of urethral catheterization or ultrasonography. There is no definitive upper level of normal for postvoid residual, but many would argue that postvoid residuals greater than 150-200 mL are indicative of incomplete bladder emptying and may warrant further evaluation.

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Cystometry

Cystometry is a simple method for testing the bladder’s storage function and provides information on bladder capacity, the extent of accommodation or compliance, the ability to sense bladder filling, and temperature; it can also help assess for detrusor overactivity during bladder filling.

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Urodynamic Study

Urodynamic study is not indicated as part of the first-line evaluation of patients with OAB unless a neurologic etiology is suspected. It is most commonly performed in individuals in whom first-line therapies for OAB fail and/or in whom a neurogenic etiology is suspected. There are multiple components to a urodynamic study; cystometrography (CMG) assesses the storage phase of bladder function — looking at bladder capacity, compliance, detrusor overactivity, sensation of filling, the voiding phase — and uroflow/electromyelography assesses detrusor pressure during voiding, relaxation of the pelvic floor muscles during voiding, the nature of the flow pattern (ie, bell-shaped curve, staccato), and whether or not there is Valsalva voiding.

Intravesical pressure is a combination of intra-abdominal pressure and detrusor pressure. To determine the detrusor pressure, the intra-abdominal pressure is measured with a rectal catheter; this pressure is subtracted from the total intravesical pressure (measured with the bladder catheter). In males, a nomogram is available, the pressure/flow study, whereby detrusor pressure is plotted against flow rate, and this is used to assess for bladder outlet obstruction.

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Contributor Information and Disclosures
Author

Pamela I Ellsworth, MD, FACS  Associate Professor of Urology, The Warren Alpert Medical School of Brown University; Consulting Staff, University Urological Associates

Pamela I Ellsworth, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Urological Association, Phi Beta Kappa, Society for Fetal Urology, and Society of University Urologists

Disclosure: Pfizer Consulting fee advisory board, speaking; allergan Honoraria advisory board

Coauthor(s)

Wellman W Cheung, MD, FACS  Clinical Associate Professor of Urology, Clinical Associate Professor of Obstetrics and Gynecology, State University of New York Downstate Medical School

Wellman W Cheung, MD, FACS is a member of the following medical societies: American Board of Urology, American College of Surgeons, American Medical Association, American Urogynecologic Society, American Urological Association, Chinese American Medical Society, Endourological Society, International Urogynaecology Association, and Society of Urodynamics and Female Urology

Disclosure: Astallas Grant/research funds PI

LiAnn N Handel, MD  Resident Physician, Department of Urology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University

LiAnn N Handel, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Aneela Naureen Hussain, MD, FAAFM  Assistant Professor, Department of Family Medicine, State University of New York Downstate Medical Center; Consulting Staff, Department of Family Medicine, University Hospital of Brooklyn

Aneela Naureen Hussain, MD, FAAFM is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Medical Women's Association, Medical Society of the State of New York, and Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Nadia Hasan Khan, MD  Clinical Assistant Instructor, Staff Physician, Department of Family Practice, State University of New York Downstate Medical Center

Nadia Hasan Khan, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Miriam T Vincent, MD, PhD  Professor and Chair, Department of Family Practice, State University of New York Downstate Medical Center

Miriam T Vincent, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association for the Advancement of Science, Medical Society of the State of New York, North American Primary Care Research Group, Sigma Xi, and Society of Teachers of Family Medicine

Disclosure: Joslin Diabetes Group, Harvard Honoraria Speaking and teaching

Specialty Editor Board

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

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Communication between urothelium and suburothelium. ACh—acetylcholine; ATP—adenosine triphosphate; M2—muscarinic receptor subtype 2; M3—muscarinic receptor subtype 3; NO—nitric oxide; P2X1—purinergic receptor P2X, ligand-gated ion channel 1; P2X3—purinergic receptor P2X, ligand-gated ion channel 3; sGC—soluble guanyl cyclase; VR1—vanilloid receptor 1.
Overactive bladder (OAB) and quality of life (QoL). Short Form-36 (SF-36). Reprinted with permission from Blackwell.
Total community and institutional costs of overactive bladder (OAB) (in millions of dollars). UTI—urinary tract infection (UTI). Reprinted with permission from Elsevier.
 
 
 
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