Overactive Bladder syndrome Flashcards
1
Q
Management
A
- Conservative
o Lifestyle - Reduce caffeine, soft drink, nocturnal fluid consumption
- Avoid constipation
o Bladder training
0 Under supervision of specialist nurse/physiotherapist - Training in deferred voiding and timed voiding
- Need to trial for at least 4/12
o Pelvic floor exercises - Medical
o Topical oestrogen
o Anticholinergic/antimuscarinic medications - 15% improvement compared to placebo
- Normal detrusor contraction mediated by parasympathetic nerves releasing ACh onto muscarinic receptors (M2 and M3)
- Side effects: Dry mouth, constipation, blurry vision, sedation
- Oxybutynin
- Ditropan (tablet) – 2.5mg bd -> 5mg tds
- Oxytrol (patch) – twice weekly
- Side effects often worse than symptoms so poor compliance
o These may be less with the patch - Tolterodine (Detrusitol) – 2mg bd
- Selective for bladder receptors so better side effects
- Selective M3 blockers
- Solifenacin (Vesicare) – 5-10mg d
- Darifenacin (Enablex) – 7.5-15mg d
- Equal efficacy to Oxybutynin but fewer side effects
o Mirabegron (Betmiga)
- Beta-3 adrenoreceptor agonist
- Better side effect profile than anticholinergics
- Surgical
o All procedures have risk of urinary retention and need for ISC
o Sacral nerve root stimulation - 63% improvement/cure rate
o Intravesical Botox injection - Using cystoscopy
-Effective for 3-6/12 - Benefit less in idiopathic OAB
o Augmentation cystoplasty - Use of bowel graft to improve bladder capacity
o Urinary diversion - Last resort for intractable OAB
- Ileal conduit and stoma
