Factors associated with clinical assessment of overactive bladder and selection of treatment

Background: Overactive bladder (OAB) affects >17 million individuals in the United States, but the symptoms of OAB are frequently underreported by pat ients and therefore untreated by physicians. Objective: The purpose of this observational study was to investigate the d emographic and clinical factors associated with the decision to treat OAB p harmacologically and identify factors associated with physicians' assessmen t of symptom severity. Methods: We studied 31 physicians treating 217 patients with OAB and collec ted data on patient demographic characteristics, OAB symptoms, previous man agement strategies, physicians' assessments of OAB severity, and treatment prescribed. Stepwise logistic regression was used to identify factors assoc iated with selecting pharmacologic treatment and with physician assessment of severity of OAB symptoms. Results: The mean age of the patients was 61.3 years; similar to 82% were f emale, and similar to 73% were white. Participants with urinary incontinenc e were significantly (P<0.001) more likely to be treated with medication th an were those with only symptoms of nocturia or urinary frequency. Other si gnificant factors associated with pharmacologic treatment were being white (odds ratio [OR], 9.5; 95% CI, 2.9-30.8); being, black (OR, 5.9; 95% CI, 1. 2-29.7); physician's clinical assessment of OAB as moderate (OR, 3.5; 95% C I, 1.5-8.2) or severe (OR, 3.8; 95% CI, 1.1-13.7); previous use of medicati on (OR, 2.9; 95% CI, 1.1-8.1); and number of incontinence episodes in the l ast 24 hours (OR, 1.2; 95% CI, 1.0-1.5). Factors associated with physician assessment of OAB severity included distress due to OAB symptoms (OR, 2.1; 95% CI, 1.3-3.2), number of incontinence episodes in the last 24 hours (OR, 1.2; 95% CI, 1.1-1.4), and use of previous treatment(s) (OR, 0.4; 95% CI, 0.2-0.8). Conclusions: Both demographic and clinical symptoms of OAB were associated with the decision to treat OAB with medication, whereas physicians' assessm ent of OAB severity was associated only with clinical symptoms. Urinary inc ontinence was the key symptom associated with the decision to treat patient s with medication and with the assessment of OAB symptom severity.