The overactive bladder

Abstract

Urinary urgency and the associated symptoms which comprise overactive bladder are prevalent amongst the general population and adversely affect quality of life. Disease management consists of a sequential series of options starting with behavioural and lifestyle techniques, pharmacological management (antimuscarinics) and, in severe cases, surgical treatment (urinary diversion, neuromodulation, augmentation cystoplasty and detrusor myectomy). There is increasing recognition of pathophysiological mechanisms in the urothelium, interstitial cells and afferent neurons allowing the importance of peripheral integrative interaction to be identified. The hierarchy of the central nervous system control adds additional complexity to understanding the oflower urinary tract function. Some newer methods of treatment include Botulinum toxin A intramural injections, oral beta-3 adrenergic agonists and rho-kinase inhibitors. The lack of a disease generating hypothesis, the lack of animal models for disease and the subjective nature of the central symptom (urgency) still pose considerable theoretical and scientific hurdles that need to be overcome in the treatment of this condition.

Usefulness of sacral nerve modulation in a series of multiple sclerosis patients with bladder dysfunction

“…In patients with severe bladder overactivity unresponsive to anticholinergics there is evidence for the use of bladder injections of botulinum toxin A [6,7] and also emerging evidence on the use of cannabinoids [8] and tibial nerve stimulation [9]. Surgical procedures, which have been advocated with varying success [10], are a last resort being irreversible, with a risk of major operative morbidity and long-term consequences; they include augmentation cystoplasty [11], in which the bladder is transected and repaired with a patch of ileum isolated from the small intestine, and urinary diversion [12].…”

A survey on the management of overactive bladder by Indonesian urologists

“…June 2015 OAB cases managed by urologists per year (n=129) Total (%) Overactive bladder (OAB) is defined as urinary urgency with or without incontinence, usually coincide with frequency and nocturia, without urinary tract infection or other abnormality. [1][2][3][4] OAB occurs in millions of people around the world. Its prevalence increases with age.…”

“…12 When these symptoms occur without any other abnormality of the urinary tract and bothersome to the patient, then diagnoses of OAB can be made. 2,3 Treatment of OAB requires a proper and good diagnostic evaluation. A careful history taking of the genitourinary disorders and other diseases should be obtained from each patient.…”

“…2 Abdomen, genitourinary, and rectal examination as well as assessment of the lower extremities are pivotal for diagnosis. 2,3,12 Urinalysis is useful to exclude hematuria, leukosituria and glucose in the urine. 2,3,12 Some additional investigations are needed to establish diagnosis, design a proper treatment and exclude other diseases.…”

Avaliação dos biomarcadores urinários de inflamação e de remodelação tecidual na disfunção vesical em pacientes com hiperplasia prostática benigna

“…Existem guidelines que recomendam o teste urodinâmico para a avaliação inicial de pacientes com sintomas do trato urinário baixo (de Sèze et al, 2007). No entanto, nem todos os pacientes com urgência tem HD Foon et al, 2010). Por outro lado, alguns pacientes com HD submetidos à estudos urodinâmicos ambulatoriais não apresentaram urgência miccional (Bristol et al, 1996) (Mukerji, 2006).…”