Overactive bladder

Question 1

What is overactive bladder?

Answer 1

A symptom syndrome that includes urgency, with or without urge incontinence, usually with frequency and nocturia

Question 2

What causes overactive bladder?

Answer 2

Usually caused by bladder (detrusor) overactivity
Detrusor muscle contraction before the bladder is full

Question 3

Describe the aetiology of overactive bladder

Answer 3

Affects 40% of the population >40 years in Europe

Question 4

What are some conservative management options for overactive bladder?

Answer 4

Behavioural modification
Pelvic floor exercises
Biofeedback
Medications

Question 5

What are some medications used in overactive bladder?

Answer 5

Anticholinergic medication e.g. tolterodine (inhibit contraction)
β-adrenoceptor agonists (induce detrusor relaxation)

Question 6

Example of a ß agonist used in overactive bladder?

Answer 6

Mirabegron (Betmiga)

Question 7

How do anticholinergic medications help in overactive bladder?

Answer 7

ACh acts on muscarinic receptors on the bladder smooth muscle to cause involuntary contractions and provoke the symptoms of bladder overactivity

Question 8

Contraindications for anticholinergic medications

Answer 8

Uncontrolled narrow-angle glaucoma, myasthenia gravis, BOO, bowel disorders

Question 9

Common side effects of anticholinergic medications

Answer 9

Dry mouth, constipation, blurred vision, urinary retention, cognitive impairment

Question 10

Contraindication of ß agonists

Answer 10

Uncontrolled hypertension

Question 11

What are some options for failed conservative management of overactive bladder?

Answer 11

Intravesical botulinum toxin A
Neuromodulation
Augmentation “clam” ileocystoplasty
Iléal conduit urinary diversion

Question 12

What is meant by neuromodulation for overactive bladder?

Answer 12

• Sacral nerve stimulation to suppress reflexes responsible for involuntary detrusor contraction
• The interstim device stimulates S3 afferent nerve

Question 13

What is involved in augmentation “clam” ileocystoplasty?

Answer 13

• Relieves intractable frequency, urge and UII in 90% patients
• Bladder dome is divalves and a detabularised segment of the ilium is anastamosed, greating a larger bladder volume

Question 14

What is involved in ideal conduit urinary diversion?

Answer 14

For intractable cases only - Both ureters anastamosed and connected to a short length of ilium which is brought out cutaneously as a stoma