John Thomas Stoffel, MD, presented “Overactive Bladder vs. Interstitial Cystitis: Overlapping Conditions?” during the 41st Annual Ralph E. Hopkins Urology Seminar on February 3, 2022, in Jackson Hole, Wyoming.
How to cite: Stoffel, John Thomas. “Overactive Bladder vs. Interstitial Cystitis: Overlapping Conditions?” February 3, 2022. Accessed Dec 2024. https://grandroundsinurology.com/overactive-bladder-vs-interstitial-cystitis-overlapping-conditions/
Overactive Bladder vs. Interstitial Cystitis: Overlapping Conditions?
John Thomas Stoffel, MD, Associate Professor of Urology and Chief of the Division of Neurourology and Pelvic Reconstruction within the University of Michigan Department of Urology in Ann Arbor, Michigan, discusses how to differentiate overactive bladder (OAB) from interstitial cystitis (IC), as well as how to appropriately treat both conditions. He begins with some background, explaining that OAB is common and affects 30 to 50 million women worldwide. IC is also common, and may affect between 2 and 17% of US adults. Dr. Stoffel argues that despite this prevalence, clinicians do not understand the depth of these conditions nor how to differentiate them. He then defines OAB as “[urinary] urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia,” whereas IC is an unpleasant sensation (pain, pressure, discomfort) perceived to be related in the urinary bladder, associated with LUTS, of greater than 6 weeks duration in the absence of infection. Dr. Stoffel posits that IC is more associated with sensory symptoms while OAB more associated with motor symptoms. He then discusses the work-up for OAB and IC, explaining that the work-up for the former should include a physical exam, urine analysis, and a voiding diary, while the work-up for the latter should feature a physical exam, a history of symptoms, urinalysis, urine culture, and urine cytology. Dr. Stoffel moves on to treatment strategies, describing the treatment of OAB as like a ladder, moving sequentially from behavioral therapy to medications to neuromodulation/onabotulinum toxin. He recommends tracking outcomes for OAB with patient reported outcome measures (PROMS), and highlights the effectiveness of behavioral therapies such as timed voiding/fluid management, weight loss, and biofeedback. Dr. Stoffel also notes that there are no clear winners among OAB medications, and he emphasizes the need to define patients’ expectations. He describes the treatment strategy for IC as less like a ladder than a grab bag, explaining that “initial treatment type and level should depend on symptom severity, clinician judgment, and patient preferences.” Dr. Stoffel briefly considers the evidence for neuromodulation and onabotulinum toxin, concluding that they are effective for OAB, but there is little extended data in IC.
About The 41st Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. Dr. Stoffel presented this lecture during the 41st iteration of the meeting on February 3rd, 2022 in Jackson Hole, Wyoming.
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ABOUT THE AUTHOR
John Thomas Stoffel, MD, is Associate Professor of Urology and Chief of the Division of Neurourology and Pelvic Reconstruction within the University of Michigan Department of Urology in Ann Arbor, Michigan. He completed his residency at Massachusetts General Hospital and the Lahey Clinic, followed by a Fellowship in Female/Neuro/Reconstructive Urology at the University of Michigan. He is an active clinician and surgeon whose clinical and research interests include urinary incontinence, neurogenic bladder, and complex abdominal reconstructive surgery. He has received several grants, both federal and industry-sponsored, to study these topics and has written over 110 papers, invited articles, and book chapters on these topics. He recently edited a textbook on neurogenic bladder titled Urologic Care for the Patient with a Progressive Neurologic Condition.
Dr. Stoffel is certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and is a member of the Society of Female Pelvic Medicine and Urogenital Reconstruction (SUFU) and the Society of Genitourinary Reconstructive Surgeons (GURS). He is currently President of the Neurogenic Bladder Research Group (NBRG.org) which is a collaboration of researchers from across the United States and Canada who study and publish quality of life outcomes in neurogenic bladder patients. He has chaired national white paper work groups on Chronic Urinary Retention and Pre-Operative Surgical Care and been a committee member for Practice Guidelines and Quality Improvement/Patient Safety for the American Urological Association.
