THE BLADDER MATTERS!

Lindsey A Kerr MD

Associate Professor of Urology

Co-Director, Center for Pelvic Floor

Disorders University of Utah

THE BLADDER MATTERS!

Pelvic Floor Disorders are Common

Bladder Dysfunction including Pain Disorders and Incontinence disproportionately impact Women

These are Expensive, Debilitating but Treatable Entities

Bladder Matters and Urinary Incontinence

Incontinence: The unexpected and unwanted leakage of urine

Uromythology: Uncommon Natural part of aging Nuisance but not a health issue Not cost effective to treat

Senate Special Committee on Aging

Alzheimer’s Loss of Vision Osteoporosis

Urinary Incontinence

Determined four health problemsaffecting quality of life for seniors:

Urinary Incontinence

Affects as many as 30+ million Americans Three quarters are women Half of nursing home residents are

incontinent Associated with other disease processes

and the treatment of those diseases

Conservative Estimates...

1996 AHCPR Urinary Incontinence Guidelines estimates 15% to 30% of community-dwelling adults

5% to 10% of all Americans are affected by periodic or chronic urinary incontinence

More Common than Asthma and Heart Disease

Costs of UI to Older PeopleCosts of UI to Older People(65+ in the United States)

$667 Million $390 Million

$1.6 Billion

$380 Million

$58.4 Million

$4.2 Billion

$6.2 Billion

$4.2 Billion$10.2 Billion

Falls

Additional Admissions

Longer Hospital Stays

Home Care

Diagnostic Tests

Treatment

Routine Care

Skin Care

Urinary Tract Infections(T.W. Hu, 1997)

The Bladder Matters!

Patients with incontinence also complain of Decreased sexual function Sleep disturbances Decrease in normal activities Fear of stigmatization

Roe B et al. J Adv Nurs. 1999;30:573-579. Abrams P et al. Am J Manag Care. 2000;6(suppl):S580-590.Lenderking WR et al. Phamacoeconomics. 1996; 9:11-23.

The Bladder Matters!

Patients with incontinence are at increased risk for falls and fractures

More urinary tract infections and skin infections

More likely to need treatment for depression

Wagner TH et al. Am J Manag Care. 2002;8:S598-607., Brown JS et al. Am J Manag Care. 2000;6:S574-579.Fonda D et al. Aust Clin Rev. 1988;8:102-107., Stewart WF et al. Eur Urol. 2003;20:327-336.

Bladder Matters: Urinary Incontinence

A valid predictor of heavy nursing home use

Nursing home costs are between $39,000 and $43,000 per year

Two-thirds paid by Medicare and Medicaid

Urinary Incontinence: Terminology

Stress incontinence – Leakage that occurs with “stress maneuvers” coughing, running

Urge incontinence – Leakage associated with the “urge” to void, cannot make it to the bathroom on time.

Functional incontinence – inability to get to the bathroom

Overflow incontinence – bladder is overly full, does not empty on its own

2001 ICS Terminology

Urge incontinence now included in the definition of Overactive Bladder

Overactive bladder is an empiric diagnosis

Patients can be wet or dry

Used as the basis for initial management

Abrams P et al. Urology. 2003;61:37-49.

17%Take a Prescription Medication

Multiple Types of Coping Behaviors Used in Attempt to Regain Control

45%

53%

28%

28%

29%

29%

32%

42%

44%

Empty Bladder Frequently, Even Without Urge

Learn in Advance Where Bathrooms Are

Limit Intake of Fluids

Use Panty Liners

Use Incontinence Pads

Use Pads/Sanitary Napkins

Do Pelvic Floor Exercises

Avoid Going Where I Don’t KnowLocation of Bathroom

Limit Activities That Are Not Close to a Bathroom

Voiding/Mapping Fluid IntakePads/

Undergarments

Exercises Lifestyle Rx Therapy

Source: Consumer Segmentation Study (2002).

Options for Incontinence

Improved Understanding

Better Pharmaceuticals

New Devices

Novel approaches

Options for Incontinence

Improved Understanding – Research Requires commitment and funding UITN Network NIH funded www.UTIN.net

PFDN Network

HR 4979 support these , but no funding for these initiatives

Options for Incontinence

Improved Understanding – Research TRU Act -Training and Research in Urology

Act of 2003 Establishes a Division of Urology at NIDDK Stimulates intra- and interagency research in

incontinence Establish O’Brien Research Centers with

emphasis on women’s urologic issues –incontinence and IC

Better Pharmacologic Options for Incontinence

20041965Oxybutynin

2000

Tolterodine IR, Oxybutynin ER

1998

Tolterodine ER

Oxybutynin TDS2003

DuloxetineSolifenacin

Darifenacin, Trospium

Abrams P, Wein AJ. The Overactive Bladder: A Widespread but Treatable Condition. Stockholm, Sweden: Erik Sparre Medical AB;1998.

Muscarinic Receptor Distribution

CNS

• Dizziness

• Somnolence

• Cognitive deficits

Iris/ciliary body Blurred visionDry eyesLacrimal gland

Stomach and esophagus

Colon

Bladder (detrusor muscle)

Constipation

Dyspepsia

Heart Tachycardia

Salivary glands

Dry mouth

Incontinence: Better devices

Novel approaches

Implantable stimulators

Botox for the bladder

Radiofrequency modification of tissues

Graphics complements of Pfizer

Incontinence: Biofeedback and Electrical Stimulation

Incontinence: Urethral Devices

Uromed

RochesterMedical

Incontinence: Better devices

Improved Surgical Devices

Better conservative management

Cutting edge minimally invasive procedures

Graphics complements of Pfizer

The Bladder Matters Incontinence is prevalent It is very treatable Better therapies are needed

More investment in research and better diagnostic tools Support is needed at every level

Ask your urologist

Key Global MessagesKey Global Messages

A significant health issue

The importance of adding life to years

Reimbursement scrutiny

Women’s health issue-

Education of professionals and patients

Public health directives

Help is available New options

The Bladder Matters!

www.womenshealthresearch.org www.urologyhealth.org www.UITN.net National Association for Continence

1-800-BLADDER