AUA guidelines address overactive bladder, microhematuria, vasectomies, urodynamic testing
New guidelines from the American Urological Association (AUA) update the diagnosis and treatment of non-neurogenic overactive bladder in adults, as well as microhematuria, vasectomies and urodynamic testing.
New guidelines from the American Urological Association (AUA) update the diagnosis and treatment of non-neurogenic overactive bladder in adults, as well as microhematuria, vasectomies and urodynamic testing.
The guidelines appeared online Oct. 23 at the AUA's website.
Regarding overactive bladders, proper diagnosis requires at minimum a careful history, physical exam and urinalysis to document symptoms and signs that characterize overactive bladder and exclude other disorders, the guidelines said. Next, a urine culture and/or post-void residual assessment may be performed and information from bladder diaries and/or symptom questionnaires may be obtained.
Urodynamics, cystoscopy and diagnostic renal and bladder ultrasound should not be used in the initial workup of an uncomplicated patient.
First-line treatments include behavioral therapies such as bladder training, bladder control strategies, pelvic floor muscle training and fluid management. They can be combined with anti-muscarinic therapies.
Second-line treatments include oral anti-muscarinics, with extended-release formulations preferred over immediate-release ones because of lower rates of dry mouth. Clinicians should manage constipation and dry mouth through bowel management, fluid management, dose modification or alternative anti-muscarinics before abandoning effective therapy.
Clinicians should avoid using anti-muscarinics in patients using other medications with anti-cholinergic properties, in patients with open-angle glaucoma or in frail patients.
Third-line treatments include FDA-approved methods such as sacral neuromodulation or peripheral tibial nerve stimulation in patients with severe refractory symptoms or those ineligible for second-line treatments and who are willing to undergo a surgical procedure.
A non-FDA-approved method includes intradetrusor onabotulinumtoxinA in patients willing to return for frequent post-void residual evaluation and perform self-catheterization. Augmentation cystoplasty or urinary diversion for severe, refractory, complicated patients may be considered.
Indwelling catheters are not recommended.
AUA released three other guidelines as well.
The guideline for the diagnosis, evaluation, and follow-up of asymptomatic microhematuria is geared toward primary care physicians as well as urologists. It updates an earlier “best practice” document from the AUA, including a reduction in the number of urinalyses required to determine need for evaluation, preferred radiological imaging and follow-up.
The AUA guideline on vasectomy reviewed 284 articles published from 1949 to 2011 and is targeted to vasectomy providers.
The AUA guideline on urodynamic testing for common lower urinary tract symptoms is intended to assist clinicians in the appropriate selection of urodynamic tests.