Urgency: the key to defining the overactive bladder.

8 Classification of nocturia in the adult and elderly patient: a review of clinical criteria and selected literature Yukio Homma Online publication date: 8-Aug-2005 15 Nocturia in relation to sleep, health, and medical treatment in the elderly Ragnar Asplund Online publication date: 8-Aug-2005 22 A developing view of the origins of urgency: the importance of animal models come from a USA prevalence study of patients with OAB with and without UUI [5], and a second similar study in Europe to determine the prevalence of OAB (using a definition from before 2002), defined as the presence of frequency, urgency and UUI, either alone or combined, which is presumed to be caused by DO [6]. Using different definitions, results of both surveys indicated that 16% of the population have OAB. However, when patients say they have urgency, it is difficult to be sure that continent (OAB-dry) patients are describing the same symptom as patients with OAB who have UUI (OAB-UUI). Older clinicians with an interest in OAB and DO recognize the difference between true urgency (for fear of leakage) and a strong or very strong desire to void. If a person is unable to void because of circumstances, e.g. because they are caught in an elevator or in a highway traffic jam, then the normal strong desire to void turns into pain, which can ultimately be as painful as acute retention. This sensation is felt suprapubically. On the other hand, 'latch key' urgency, or urgency during hand-washing, which those same older clinicians have experienced, feels different. It is widely held that with true urgency, leakage is considered a possibility if strong pelvic floor contractions are not used, and that the sensation is more urethral. One colleague has catheterized himself and has correlated what he considers true urgency with involuntary detrusor contractions typical of DO. There is a possibility that the diagnosis of OAB-dry is less secure, as discussed earlier. In turn, this may have implications for the success of OAB treatment, which might be reduced in apparent OAB-dry if the origin of the symptoms is not DO. On the other hand, it also seems likely that in some patients OAB-dry is a mild, or perhaps earlier, form of OAB that will progress with time to OAB-UUI. Additionally, there are undoubted difficulties in ensuring that urgency as described by the patient is understood objectively rather than subjectively by the clinician, doctor or nurse, …