european urology 49 (2006) 1087–1092
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Neuro-Urology
Overactive Bladder: Prevalence and Implications in Brazil Claudio Teloken a, Fernanda Caraver a, Fernanda A. Weber a, Patrick E. Teloken a,*, Joa˜o F. Moraes b, Paulo R. Sogari a, Tu´lio M. Graziottin a a b
Fundac¸a˜o Faculdade Federal de Cieˆncias Me´dicas de Porto Alegre e Complexo Hospitalar Santa Casa, Porto Alegre, Brazil Pontifı´cia Universidade Cato´lica do Rio Grande do Sul, Brazil
Article info
Abstract
Article history: Accepted January 5, 2006 Published online ahead of print on February 9, 2006
Objectives: To assess overactive bladder (OAB) prevalence, associated factors and implications in a young population. Methods: An independent population-based study was carried out. A self-applicative questionnaire covering urinary symptoms, coping strategies, quality of life and treatment seeking behavior was developed. Results: A total of 848 subjects between 15 and 55 years completed the questionnaire. The overall prevalence of OAB was 18.9%. Women were significantly more affected than men ( p = 0.001). All age groups were equally affected ( p = 0.152). Subjects with OAB reported significant impairment on household chores ( p = 0.009), physical activities ( p = 0.016), sleep ( p < 0.001), work ( p < 0.001), social life ( p < 0.001) and sexual life ( p < 0.001). In addition, OAB individuals present higher prevalence of depression ( p = 0.036), anxiety ( p < 0.001), shame ( p < 0.001) and tiredness ( p < 0.001) OAB was independently associated to sexual life impairment (OR = 3.36, 95% CI = 1.20–9.39). Only 27.5% of OAB subjects sought for medical counseling. Conclusions: OAB is a highly prevalent condition, even in such a young population. It affects both genders, yet it is more frequently observed in women. OAB is an important health condition, with serious impact on quality of life and sexual function. A large percentual of individuals remain unrecognized, under treated and consequently suffer for long periods of time. # 2006 Elsevier B.V. All rights reserved.
Keywords: Overactive bladder Sexual function Quality of life
* Corresponding author. 245, Sarmento Leite, Porto Alegre, RS, 90050-170, Brazil. Tel. +55 51 99577916; Fax: +55 51 33281975. E-mail address:
[email protected] (P.E. Teloken).
1.
Introduction
In 2002, the International Continence Society (ICS) standardized the terminology of lower urinary tract
function. The committee defined the equivalent terms OAB, urge syndrome, or urgency-frequency syndrome as the condition characterized by the
0302-2838/$ – see back matter # 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2006.01.026
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european urology 49 (2006) 1087–1092
presence of urgency, with or without urge incontinence, usually with frequency and nocturia in a patient without infection or other obvious pathology [1]. Recent studies of OAB report an estimated prevalence of 2.4% to 18.6% in the general population [2–4]. However, one caveat is that none of these considered ICS new terminology. The importance of OAB symptoms was not well recognized in the past. Patients with OAB frequently have to change their daily habits and anticipate the localization of restrooms, causing anxiety and stress. The majority of men and women with an overactive bladder report that their symptoms have an effect on daily living [2]. Usually these patients suffer with the condition for long periods before the diagnosis is established [2]. Recently, quality of life (QoL) assessment became an important tool in the evaluation of OAB symptoms impact. Sexual function in men and women is a relevant component of quality of life. Lower urinary tract symptoms (LUTS) are an independent risk factor for sexual dysfunction, as long as sexual symptoms increase with LUTS severity. Urinary symptoms are associated with erection problems, ejaculatory dysfunction, dissatisfaction with sex life, decrease in libido, decrease in sexual activity, intercourse dissatisfaction, and overall impairment in sexual function in women [5–8]. Overactive bladder has the potential to affect sexual function. The impact of OAB symptoms on sexual function in women has been evaluated in a few studies [9–11]. To our knowledge no study has evaluated its impact on men. This is the first independent population-based study assessing the prevalence of OAB symptoms in young men and women utilizing the new ICS terminology. General characteristics, treatment seeking behavior, impact on QoL, and sexual problems were also investigated. 2.
Subjects and methods
During the period of November 2003 to August 2004, an independent community-based survey was conducted in Porto Alegre, Brazil. Areas of the city with agglomeration of citizens were chosen to carry out the study. Individuals of both genders were invited to answer our self-applicative questionnaire. Inclusion criteria were age between 15 and 55 years, in the absence of the following medical conditions: current pregnancy, urinary tract infection, diabetes mellitus, stress urinary incontinence, use of diuretics, history of urinary system or gynecological cancer, urinary lithiasis, and previous surgery of gynecological or urologic tract. A total of 913 subjects answered the questionnaire.
Our questionnaire was developed by the combination of questions from the King’s Health Questionnaire validated for OAB syndrome [12,13], the AUA Symptoms Score [14] and original questions. Both questionnaires have been also validated in Portuguese [15,16]. A total of 34 questions were categorized into five domains: general characteristics (gender, age, body mass index (BMI), race, education, past medical history, and parity), urinary symptoms (urgency, frequency, nocturia and incontinence), coping strategies (avoid drinking liquids, regular schedule for urination, immediate localization of bathrooms in new locations, use of absorvent products), quality of life and treatment seeking behavior. The study was approved by the Institutional Review Board. We are the first study assessing the diagnosis of OAB based on the latest ICS definition: urgency, with or without urge incontinence, usually with frequency and nocturia. Urgency was characterized as the complaint of a sudden compelling desire to pass urine, which is difficult to defer; urge urinary incontinence as the complaint of involuntary leakage accompanied by or immediately preceded by urgency; nocturia as the complaint that the individual has to wake at night one or more times to void; increased daytime frequency as the complaint by the patient who considers that he/she voids too often by day [1]; and frequency as objectively assessed as voiding at least eight times per day [2,9,11,17,18]. The differences between proportions (prevalences) were compared by Z test. Categorical variables were analyzed by Chi-square. The threshold p value for variable inclusion in multivariate analyzes was 0.25. The strength of association between variables was determined by odds ratio (OD) and confidence intervals (CI), calculated by Woolf’s method. All p values of
