Journal Medico – FGM doctor ‘to administer first therapeutic approach’ for overactive bladder and urinary tract infection

A study prepared by the Gynecological Urology Unit of the Department of Obstetrics, Gynecology and Reproductive Medicine at the Centro Hospitalar Universitário Lisboa Norte, the conclusions of which were known in 2020, showed that the prevalence of urinary leakage in Portuguese women was 35.1%, while the European rate was. Between 18% and 42%. Of the 2,226 women surveyed in this study, 14.6% reported that a urinary tract infection (UI) interfered with five or more activities of their daily life. In that sense, read the interview with Teresa Abreu, GP and Family Medicine and Medical Director at Astellas Farma, in the field of Urology.

Medical Journal (JM) | What are the main signs of an overactive bladder?

Theresa Abreu (TA) | Overactive bladder (OAB) is a syndrome characterized by urinary urgency, usually accompanied by increased frequency of urination and nocturia, with or without urge incontinence (UI) and in the absence of a urinary tract infection or other underlying disease.

Although it is not associated with increased mortality, it has a profound impact on the well-being and quality of life of patients, who are often diagnosed with depression or anxiety, accompanied by difficulties in the context of work and social isolation.

JM | Could the number of births be an indication of this problem?

ta | There is general agreement that the first step in the management of these patients includes the collection of a detailed clinical history, which includes, among other things, an obstetric and gynecological history, in the particular case of women.

In this chapter, the increasing number of deliveries is a risk factor for UI as well as pelvic organ prolapse. However, UI is described in women who have not given birth (prevalence can be as high as 32% between 55 and 64 years of age.

When compared to women who had a caesarean section (who had an adjusted prevalence of UI similar to women who had not given birth), women who had a vaginal delivery had a higher risk of UI fatigue. Maternal age at first birth and newborn weight were also considered as obstetric risk factors for UI, although they were not modifiable.

Pregnancy also configures itself for the user interface, with it becoming more prevalent at all different stages of pregnancy. However, primary prevention through pelvic floor training exercises during pregnancy has been shown to reduce the likelihood of UI at the end of pregnancy by 62% and by 29% of trying it 3 to 6 months after delivery.

JM | What is the effect of aging on the urinary system?

ta | We know that the prevalence of BH increases with age, and its expression is expected to increase in the coming years, following an aging population.

Indeed, physiological changes associated with aging, such as changes in muscle tone or decreased bladder capacity, favor the development of OAB, especially in the presence of etiological factors. However, BH should not be viewed as an inevitable part of aging and therefore deserves appropriate evaluation and treatment.

JM | When is involuntary leakage of urine normal and when to consider “incontinence”?

ta | Urinary incontinence is defined by the term International Hosr Association (ICS), refers to the involuntary loss of urine. The UI can be isolated or associated with other lower urinary tract symptoms. According to the terminology developed by ICS and International Association of Gynecological Urology (IUGA), user interfaces are categorized into subtypes, according to the conditions in which they occur, namely: stress, urgency, or mixed; Postural, continuous, functional, enuresis, among others.

JM | The fact that any supermarket offers dressings in order to simplify day by day Who suffers from urine leakage reduces this problem?

ta | Taboo and shame remain major barriers to seeking help for these patients. For this reason, easy access to pads/nappies or containment aids is important for those with incontinence episodes that do not fully respond to available treatment (or for those not indicated). By the way, it is this sense also that the latest recommendations European Society of Urology (UAE) as of 2021.

JM | What non-surgical treatment can be used and what is the success rate? Existing What kind of gymnastics or exercises can help strengthen muscles?

ta | There is a wide range of treatment options, and choosing one in particular depends on the severity of the symptoms and their impact on the patient’s daily life.

The first approach is usually non-invasive and includes lifestyle modifications (aimed at reducing irritants to the bladder), bladder training, stimulus suppression techniques and pelvic floor exercises.

Pelvic floor muscle therapy (PPMT), originally prescribed by Kegel in 1948 for stress incontinence, has also been shown to reduce episodes of urge incontinence. Its success depends on adhering to a regular exercise program and performing the technique correctly, which includes exercises designed to improve the function of the pelvic floor muscles and the urethral sphincter. Although most studies were conducted in patients with stress and mixed incontinence, a Cochrane meta-analysis concluded that PPMT is a valid first-line treatment in the presence of enuresis.

Behavioral interventions must be part of any treatment strategy.

Of the three main groups of available treatment options (behavioral, pharmacological and surgical), the combination of the first two groups allows to obtain results in about 80% of patients.

JM | When should a family and general practitioner refer a patient to A Urologist?

ta | The patient’s doctor, usually a specialist in general and family medicine, performs the initial evaluation, which includes the collection of a clinical history (which may include, for example, a dump diary and the application of scales or questionnaires to assess symptoms and impact on quality of life), as well as a physical examination detailed. To reach a diagnosis, you may have to turn to complementary tests that allow you to rule out other possible diagnoses. In addition, he will manage the first therapeutic approach, starting with behavioral interventions and the introduction of medications, if required.

The need to resort to complementary means for subsequent diagnosis or treatment, as well as the presence of warning signs, may require the intervention of a urologist or urogenital pathologist, and the patient should be referred for this.

JM | In what situations are you heading towards surgical treatment and how successful is it?

ta | Surgical treatment of stress UI has evolved over the past few decades towards minimally invasive methods. This alternative is chosen when a conservative approach and pharmacotherapy do not have sufficiently satisfactory results, which is why it is assigned to a small percentage of patients.

The choice of surgery to be performed (as well as its success) depends on the type of user interface, patient characteristics, and experience of the surgeon.