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Diagnosis and management of patients with overactive bladder syndrome and abnormal detrusor activity

Nature Clinical Practice Urology volume 1, pages 78–84 (2004)Cite this article

Abstract

Overactive bladder syndrome (OABS) is a widely recognized syndrome with symptoms that can include urinary urgency, frequency, nocturia, and incontinence. Although there may be several causative factors for OABS, detrusor overactivity is the most common. In addition, urinary incontinence can also be due to a distinct but equally bothersome condition underactive bladder syndrome, or detrusor underactivity. The incomplete bladder emptying that characterizes detrusor underactivity often arises from impaired contractile function of the detrusor muscle. The variations in etiologies of the two syndromes necessitate patient evaluations tailored to individual symptom presentation. Increased awareness of the differences between the manifestations of OABS and underactive bladder syndrome call for specific approaches to the management of bladder dysfunction.

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Figure 1: Cystometrograms (CMG) in normal urination, OABS, and detrusor underactivity.
Figure 2: Effect of bethanechol in the diabetic woman (as described in Figure 1C).

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References

  1. Abrams P et al. (2003) The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 61: 37–49

    Article  Google Scholar 

  2. Resnick NM and Yalla SV (1987) Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. JAMA 257: 3076–3081

    Article  CAS  Google Scholar 

  3. Ouslander JG (2004) Management of overactive bladder. N Engl J Med 350: 786–799

    Article  CAS  Google Scholar 

  4. Kumar V et al. (2003) Recent developments in the management of detrusor overactivity. Curr Opin Urol 13: 285–291

    Article  Google Scholar 

  5. Goldberg RP and Sand PK (2002) Pathophysiology of the overactive bladder. Clin Obstet Gynecol 45: 182–192

    Article  Google Scholar 

  6. Wein AJ (2001) Pharmacological agents for the treatment of urinary incontinence due to overactive bladder. Expert Opin Investig Drugs 10: 65–83

    Article  CAS  Google Scholar 

  7. Turner WH and Brading AF (1997) Smooth muscle of the bladder in the normal and the diseased state: pathophysiology, diagnosis and treatment. Pharmacol Ther 75: 77–110

    Article  CAS  Google Scholar 

  8. Mostwin JL (2002) Pathophysiology: the varieties of bladder overactivity. Urology 60: 22–27

    Article  Google Scholar 

  9. Wein AJ (2003) Diagnosis and treatment of the overactive bladder. Urology 62: 20–27

    Article  Google Scholar 

  10. Todorova A et al. (2001) Effects of tolterodine, trospium chloride, and oxybutynin on the central nervous system. J Clin Pharmacol 41: 636–644

    Article  CAS  Google Scholar 

  11. Pietzko A et al. (1994) Influences of trospium chloride and oxybutynin on quantitative EEG in healthy volunteers. Eur J Clin Pharmacol 47: 337–343

    Article  CAS  Google Scholar 

  12. Indevus Pharmaceuticals Inc. (online Jul 04) Sanctura trospium chloride 20 mg tablets: Prescribing Information [www.sanctura.com] (accessed 15 Aug 04)

  13. Kim YT et al. (2004) New mechanisms of action of intravesical antimuscarinic agents [abstract 167]. Neurourol Urodyn 23: 387–616

    Article  Google Scholar 

  14. Fantl JA et al. (1991) Efficacy of bladder training in older women with urinary incontinence. JAMA 265: 609–613

    Article  CAS  Google Scholar 

  15. Wein AJ and Rovner ES (2001) Voiding function and dysfunction. In Clinical Manual of Urology, 3rd edn (Eds Hanno PM et al.) New York: McGraw-Hill

    Google Scholar 

  16. Wein AJ (2002) Neuromuscular dysfunction of the lower urinary tract and its management. In Campbell's Urology, Volume 2, 8th edn (Eds Walsh PC et al.) Philadelphia: WB Saunders

    Google Scholar 

  17. Burgio KL et al. (2000) Combined behavioral and drug therapy for urge incontinence in older women. J Am Geriatr Soc 48: 370–374

    Article  CAS  Google Scholar 

  18. Andersson KE (2004) New pharmacologic targets for the treatment of the overactive bladder: an update. Urology 63: 32–41

    Article  Google Scholar 

  19. Schurch B et al. (2000) Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 164: 692–697

    Article  CAS  Google Scholar 

  20. Lopez-Alonso E et al. (1995) Botulinum toxin type A inhibits Ca(2+)-dependent transport of acetylcholine in reconstituted giant liposomes made from presynaptic membranes from cholinergic nerve terminals. Neurosci Lett 196: 37–40

    Article  CAS  Google Scholar 

  21. Chancellor MB and Yoshimura N (2002) Physiology and pharmacology of the bladder and urethra. In Campbell's Urology, Volume 2, 8th edn (Eds Walsh PC et al.) Philadelphia: WB Saunders

    Google Scholar 

  22. Yoshimura N and Chancellor MB (2004) Differential diagnosis and treatment of impaired bladder emptying. Rev Urol 6: S24–S31

    PubMed  PubMed Central  Google Scholar 

  23. Kamo I et al. (2003) Urethral closure mechanisms under sneeze-induced stress condition in rats: a new animal model for evaluation of stress urinary incontinence. Am J Physiol Regul Integr Comp Physiol 285: R356–R365

    Article  CAS  Google Scholar 

  24. Blaivas JG et al. (1979) Urodynamic evaluation as neurologic test of sacral cord function. Urology 13: 682–687

    Article  CAS  Google Scholar 

  25. Chancellor MB et al. (1992) Lyme cystitis and neurogenic bladder dysfunction. Lancet 339: 1237–1238

    Article  CAS  Google Scholar 

  26. Jones DL and Moore T (1973) The types of neuropathic bladder dysfunction associated with prolapsed lumbar intervertebral discs. Br J Urol 45: 39–43

    Article  CAS  Google Scholar 

  27. Yoshimura N and Chancellor MB (2002) Current and future pharmacological treatment for overactive bladder. J Urol 168: 1897–1913

    Article  CAS  Google Scholar 

  28. Riedl CR et al. (2000) Electromotive administration of intravesical bethanechol and the clinical impact on acontractile detrusor management: introduction of a new test. J Urol 164: 2108–2111

    Article  CAS  Google Scholar 

  29. Carlson KV et al. (2001) Dysfunctional voiding in women. J Urol 165: 143–147

    Article  CAS  Google Scholar 

  30. Vinik AI et al. (2003) Diabetic autonomic neuropathy. Diabetes Care 26: 1553–1579

    Article  Google Scholar 

  31. Tanagho EA and Schmidt RA (1988) Electrical stimulation in the clinical management of the neurogenic bladder. J Urol 140: 1331–1339

    Article  CAS  Google Scholar 

  32. Huard J et al. (2002) Muscle-derived cell-mediated ex vivo gene therapy for urological dysfunction. Gene Ther 9: 1617–1626

    Article  CAS  Google Scholar 

  33. Awad SA (1985) Clinical use of bethanechol. J Urol 134: 523–524

    Article  CAS  Google Scholar 

  34. Phelan MW et al. (2001) Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol 165: 1107–1110

    Article  CAS  Google Scholar 

  35. Cain MP et al. (2003) Alpha blocker therapy for children with dysfunctional voiding and urinary retention. J Urol 170: 1514–1515

    Article  CAS  Google Scholar 

  36. Presti JC Jr (2004) Neoplasms of the prostate gland. In Smith's General Urology, 16th edn (Eds Tanagho EA and McAninch JW) New York: Lange Medical Books/McGraw-Hill

    Google Scholar 

  37. Smith CP et al. (2002) Botulinum toxin: poisoning the spastic bladder and urethra. Rev Urol 4: 61–68

    PubMed  PubMed Central  Google Scholar 

  38. Duel BP (2003) Biofeedback therapy and dysfunctional voiding in children. Curr Urol Rep 4: 142–145

    Article  Google Scholar 

  39. Kuo HC (2003) Effect of botulinum a toxin in the treatment of voiding dysfunction due to detrusor underactivity. Urology 61: 550–554

    Article  Google Scholar 

  40. Chancellor MB et al. (2001) Gene therapy strategies for urological dysfunction. Trends Mol Med 7: 301–306

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Pittsburgh Medical Center, Pennsylvania

    Michelle Jo Semins & Michael B Chancellor

  2. McGowan Institute of Regenerative Medicine, University of Pittsburgh School of Medicine,

    Michelle Jo Semins & Michael B Chancellor

Authors
  1. Michelle Jo Semins
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  2. Michael B Chancellor
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Corresponding author

Correspondence to Michael B Chancellor.

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Competing interests

Michael B Chancellor is a consultant for the following companies: Astra-Zeneca, Cook Group Inc., GlaxoSmithKline, Indevus Pharmaceuticals Inc., Lilly (Eli Lilly and Company), Novartis, Ortho-McNeil Pharmaceutical Inc., Pfizer Inc., Watson Pharmaceuticals Inc., and Yamanouchi Pharamceutical Co., Ltd.

Glossary

DETRUSOR UNDERACTIVITY

Impaired contractile function of the detrusor muscle leading to incomplete and/or prolonged bladder emptying

BEHAVIORAL THERAPY

A method of educating the bladder by documenting and timing micturitions, managing liquid intake, and controlling bladder contractions

URODYNAMICS

Catheter-based test measuring bladder sensation and involuntary detrusor contractions

PARURESIS

A form of social phobia expressed through the physical symptom of being unable to urinate whenever the person desires (i.e. in a public restroom)

IDIOPATHIC DETRUSOR SPHINCTER DYSSYNERGIA

Nonobstructive retention or voiding dysfunction due to functional bladder outlet obstruction at the external sphincter striated muscle

DIABETIC CYSTOPATHY

Polyneuropathy characterized by impaired sensation of bladder fullness, increased capacity and residual urine volume, and reduced detrusor contractility

RESIDUAL URINE SCREENING

Noninvasive ultrasonographic assessment of residual urine volume rather than catheterization for residual volume

UROFLOWMETRY

A noninvasive private test to screen for diminished flow rate; can predict impaired contractility, bladder outlet obstruction, or both

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Semins, M., Chancellor, M. Diagnosis and management of patients with overactive bladder syndrome and abnormal detrusor activity. Nat Rev Urol 1, 78–84 (2004). https://doi.org/10.1038/ncpuro0054

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