Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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The diagnosis of Overactive Bladder at Liv Hospital is a methodical process of exclusion and characterization. Because OAB is defined by its symptoms, there is no single test that can confirm it in isolation. Instead, the diagnostic pathway is designed to rule out other pathologies that mimic OAB—such as infections, tumors, or stones—and to assess the functional status of the lower urinary tract objectively. This ensures the treatment targets the correct physiological mechanism. The process begins with non-invasive assessments and progresses to more specialized testing if the clinical picture is complex.
The foundation of the diagnosis is a comprehensive medical history. The urologist explores the specific nature of the symptoms: the intensity of urgency, the frequency of voiding, the presence of leakage, and the impact on quality of life. Differentiating between “urge incontinence” (leakage preceded by a strong desire to void) and “stress incontinence” (leakage with exertion) is critical, although many patients present with “mixed incontinence.” The history also covers fluid intake habits, medication use, and relevant obstetric, gynecological, or neurological history.
A focused physical examination follows. In women, a pelvic exam assesses for urogenital atrophy (tissue thinning due to estrogen loss) and pelvic organ prolapse, which can mechanically irritate the bladder. In men, a digital rectal examination (DRE) evaluates the prostate size and consistency to rule out obstruction or cancer. A neurological assessment of the perineal area and lower extremities evaluates reflexes and sensation, helping identify potential neurogenic causes, such as spinal cord issues.
One of the most valuable diagnostic tools is the Bladder Diary. Patients are asked to maintain a detailed log for a period, typically three days. In this diary, they record:
A urinalysis is mandatory for every patient presenting with OAB symptoms. This simple test screens for:
This non-invasive test measures the amount of urine left in the bladder immediately after urination. It is typically performed using a portable ultrasound scanner. A significant amount of residual urine suggests that the bladder is not emptying effectively. This could be due to obstruction (like an enlarged prostate) or a weak bladder muscle (detrusor underactivity). Identifying a high PVR is crucial because prescribing common OAB medications, which relax the bladder, could cause complete urinary retention in these patients.
When the diagnosis remains unclear or when conservative treatments have failed, Urodynamics is the gold standard for functional assessment. This suite of tests evaluates the hydrodynamics of the lower urinary tract.
In specific cases, imaging such as a renal and bladder ultrasound may be performed to detect structural abnormalities, including stones, diverticula, or wall thickening. Cystoscopy, the visual inspection of the bladder interior using a flexible camera, is not routinely used for uncomplicated OAB but is essential if there is blood in the urine, pain, or risk factors for bladder cancer. It rules out intravesical pathology that could be irritating the bladder lining.
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Many urinary tract conditions, including mild infections and early-stage bladder cancer, can mimic the symptoms of Overactive Bladder without causing typical pain. A urinalysis is a crucial screening tool to rule out these “mimics.” Treating an infection or identifying blood in the urine early changes the entire treatment plan and ensures severe conditions are not missed.
Urodynamic testing involves the insertion of small catheters, which can be slightly uncomfortable or embarrassing, but it is generally not painful. A local anesthetic gel is used to numb the urethra. The test is vital for understanding the physics of your bladder—how it holds pressure and muscle tone—information that cannot be gained from a simple exam.
The Post-Void Residual (PVR) test checks whether your bladder empties completely. If you retain a large amount of urine after going to the bathroom, it might indicate a blockage or a weak muscle. Knowing this is critical because some OAB medicines relax the bladder; if you are already retaining urine, these medicines could make it impossible for you to urinate.
Cystoscopy does not diagnose OAB itself, as OAB is a problem with how the bladder functions, not necessarily what it looks like. However, cystoscopy is used to rule out other causes of urgency, such as bladder stones, tumors, or interstitial cystitis. It ensures that the lining of the bladder is healthy and that no physical irritants are causing your symptoms.
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