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Differential Diagnosis of Overactive Bladder in Women
Brian K Marks1, Jerry G Blaivas2, Fernando Cabrera1, Johnson F Tsui1, Jeffrey P Weiss1
1SUNY Downstate, Brooklyn, NY;2Urology, Weill Cornell Medical College, New York, New York, NY

The aim of this study is to evaluate the differential diagnosis in women with symptoms of overactive bladder (OAB).
This is a retrospective study demonstrating the differential diagnosis of women with symptoms of OAB using a previously validated OAB symptom questionnaire (OABSS). All patients underwent history and physical, OABSS questionnaire, 24-hour voiding diary, urinalysis, uroflow and post-void residual. Cystoscopy and urodynamics were completed when required for diagnosis. Selection criteria were developed to assign patients to the various diagnostic categories.
125 women (mean age 67) met inclusion criteria for OAB. Cystoscopy and urodynamics were completed in 106 (85%) women and detrusor overactivity was demonstrable in 54 (43.2%). The differential diagnosis for all patients and patients with OABSS≥9 is listed in Table 1. 103 (82.4%) patients had an OABSS≥9 with a mean OABSS of 15.4 (range 5-27, SD 5.5). The differential diagnosis of this subset of patients is listed in table along with mean OABSS for each category.
Women who present with OAB symptoms exhibit a differential diagnosis of concomitant urologic pathologies, we believe that OAB should be considered a symptom complex, not a syndrome. This series confirms that up to 79% of women with OAB symptoms have other diagnosable conditions, many of which may be remediable to treatment.

Table 1.
Differential Diagnosis
All Patients (N=125)OABSS 9 (N=103)
CategoryNumber (%)Mean OABSS# DONumber (%)Mean OABSS# DO
UTI16 (13)13.31015 (15)13.89
Sphincteric incontinence46 (37)14.72542 (41)15.423
POP29 (23)14.61829 (28)14.618
Neurogenic bladder15 (12)15.31314 (14)16.012
Bladder outlet obstruction6 (5)15.766 (6)15.76
Miscellaneous22 (18)13.01419 (18)13.913
Idiopathic26 (21)13.51321 (20)15.011

*Each subject could be represented in more than one diagnostic category.

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