Fast Five Quiz: Overactive Bladder Differential Diagnosis

Bradley Schwartz, DO


February 26, 2021

In OAB, urinary frequency is associated with many small-volume voids. But in polydipsia, urinary frequency occurs with normal or large-volume voids. The two can only be distinguished with the use of frequency-volume charts.

In polydipsia, the intake is volume-matched to the void volume, and therefore the frequency is appropriate because of the intake volume and OAB can be ruled out. Frequency due to polydipsia is physiologically self-induced OAB and should be managed with education, with consideration of fluid management.

Urinalysis is used to exclude microhematuria, pyuria, urinary tract infection, and glucosuria. In persons with microhematuria, further evaluation, including urine cytology, is recommended. In individuals at risk for bladder cancer, a cytology study may be indicated even in the absence of microhematuria.

Postvoid residual testing is not indicated in all patients. It is helpful in men with both obstructive and OAB symptoms and in women who have undergone prior pelvic surgery (eg, prior incontinence surgery) and those with significant pelvic organ prolapse.

Learn more about OAB differential diagnosis.


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