Sage Journals: Discover world-class research

Abstract

Overactive bladder (OAB) is defined as urgency, with or without urge incontinence, usually with frequency and nocturia, in the absence of local pathological or hormonal factors. It is a common complaint of men and women alike, with estimates of 22 million sufferers. Approximately 70% of men with bladder outflow obstruction will have some symptoms of OAB. The exact pathophysiology of OAB in bladder outflow obstruction is yet to be elucidated; evidence to date points to changes in both the efferent and afferent innervation and the detrusor. Management of OAB can be is generally with pharmacological agents such as anticholinergics or operative measures such as the ëClamí cystoplasty. More recent treatment modalities include intravesical oxybutynin, intradetrusor botulinum toxin and neuromodulation. More specific treatment options for OAB in bladder outflow obstruction include relief of the obstruction with surgical (e.g. transurethral resection of prostate) or pharmaceutical (e.g. a blockers) methods.

Keywords

Anticholinergics bladder outflow obstruction detrusor overactivity lower urinary tract symptoms prostatectomy

Get full access to this article

View all access options for this article.

References

Milsom I , Abrams P , Cardozo L , Roberts RG , Thuroff J , Wein AJ . Hu TW , Wagner TH , Bent Kauer JD , Le Blanc K , Piancentini A , Stewart WF , et al. Estimated economic costs of overactive bladder in the United States . Urology 2003;61: 1123-1128

Abrams P , Cardozo L , Fall M , Griffiths D , Rosier P , Ulmsten U , et al. The standardisation of terminology in lower urinary tract function: report from the standardisation subcommittee of the International Continence Society . Urology 2003;61: 37-49

Dmochowski RR , Staskin D . Overactive bladder in men: special considerations for evaluation and management . Urology 2002;60(5 Suppl 1): 56-62; discussion 62-63

Thomas AW , Abrams P . Lower urinary tract symptoms, benign prostatic obstruction and the overactive bladder . BJU Int 2000;85(Suppl 3): 57-68; discussion 70-71

de Groat WC . A neurologic basis for the overactive bladder . Urology 1997;50(6A Suppl): 36-52; discussion 53-56

Yoshimura N , Chancellor MB . Current and future pharmacological treatment for overactive bladder . J Urol 2002;168(5): 1897-1913

Brading AF . A myogenic basis for the overactive bladder . Urology 1997;50(6A Suppl): 57-67; discussion 68-73

Kumar V , Templeman L , Chapple CR , Chess-Williams R . Recent developments in the management of detrusor overactivity . Curr Opin Urol 2003;13: 285-291

Davila GW , Daugherty CA , Sanders SW . A short-term, multicenter, randomized doubleblind dose titration study of the efficacy and anticholinergic side effects of transdermal compared to immediate release oral oxybutynin treatment of patients with urge urinary incontinence . J Urol 2001;166(1): 140-115

10.

Madersbacher H , Stohrer M , Richter R , Burgdorfer H , Hachen HJ , Murtz G . Trospium chloride versus oxybutynin: a randomized, double-blind, multicentre trial in the treatment of detrusor hyper-reflexia . Br J Urol 1995;75(4): 452-446

11.

Chapple CR , Rechberger T , Al-Shukri S , Meffan P , Everaert K , Huang M , et al. Randomized, double-blind placebo and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder . BJU Int 2004;93(3): 303-310

12.

Brady CM , DasGupta R , Dalton C , Wiseman OJ , Berkley KJ , Fowler CJ . An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis . Mult Scler 2004;10(4): 425-433

13.

Reitz A , Stohrer M , Kramer G , Del Popolo G , Chartier-Kastler E , Pannek J , et al. European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity . Eur Urol 2004;45(4): 510-555

14.

Harper M , Popat RB , Dasgupta R , Fowler CJ , Dasgupta P . A minimally invasive technique for outpatient local anaesthetic administration of intradetrusor botulinum toxin in intractable detrusor overactivity . BJU Int 2003;92(3): 325-336

15.

Abrams P , Blaivas JG , Fowler CJ , Fourcroy JL , Macdiarmid SA , Siegel SW , et al. The role of neuromodulation in the management of urinary urge incontinence . BJU Int 2003;91(4): 355-339

16.

Gosling JA , Kung LS , Dixon JS , Horan P , Whitbeck C , Levin RM . Correlation between the structure and function of the rabbit urinary bladder following partial outlet obstruction . J Urol 2000;163(4): 1349-1356

17.

Kato K , Wein AJ , Radzinski C , Longhurst PA , McGuire EJ , Miller LF , et al. Short-term functional effects of bladder outlet obstruction in the cat . J Urol 1990;143(5): 1020-1025

18.

Goldberg RP , Sand PK . Pathophysiology of the overactive bladder . Clin Obstet Gynecol 2002;45(1): 182-192

19.

de Nunzio C , Franco G , Rocchegiani A , Iori F , Leonardo C , Laurenti C . The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction . J Urol 2003;169(2): 535-559

20.

Andersson KE . Treatment of overactive bladder: other drug mechanisms . Urology 2000;55(5A Suppl): 51-57 ; discussion 59