Urology E88 Flashcards
What is overactive bladder?
Overactive bladder (OAB) is a symptom syndrome that includes urgency,
with or without urge incontinence, usually with frequency and nocturia. It is primarily a neuromuscular problem where the detrusor muscle contracts inappropriately during bladder filling. The contractions occur regardless of the amount of urine in the bladder
Causes of overactive bladder?
spinal cord injury,MS, parkinsons
Medications, abdominal\pelvic trauma, too much caffeine
Clinical features of OAB?
Frequency >8x daily
Urgency (hallmark sx)
Nocturia >3x per night
Urge incontinence may or may not be present
Dx of OAB?
Cytometry: tests bladder’s storage function. Gives info on bladder capacity, compliance, ability to sense bladder filling, temperature, helps assess detrusor overactivity.
Urodynamic study consists of cystometrography and uroflowmetry used to assess: capacity, compliance, detrusor activity, detrusor pressure during voiding, relaxation of pelvic floor muscles during voiding
Pharmacological tx of OAB?
M3 and m2 muscarinic receptors stimulate smooth muscle of bladder so treatment is with anticholinergics\ antimuscarinics
1st line: behavioural therapy and education and antimuscarinic agents
2nd line: extended release antimuscarinics like tolterodine should be used instead of immediate release. Transdermal oxybutynin can also be used
Botulinum toxin A? inhibits ACh release
Surgical tx of OAB?
Augmentation enterocystoplasty: The bladder dome is cut open (bivalved) and a detubularized segment of ileum is anastomosed,
creating a larger bladder volume.
Auto augmentation (detrusor myectomy): detrusor muscle is excised. Then large epithelial bulge is created to augment bladder capacity
