Evaluation and Treatment of Overactive Bladder in Women

Abstract

Overactive bladder (OAB) is a symptom complex that includes urinary urgency, frequency, urgency incontinence, and nocturia. It is highly prevalent, affecting up to 12% of the adult population, and can significantly impact quality of life. The diagnosis of OAB is made by history, physical examination, and a urinalysis to rule out underlying infection or other concerning potential etiologies. The need for additional testing is based on the initial evaluation findings, and is recommended in cases of underlying urinary tract infection, microscopic hematuria, obstructive voiding symptoms, and symptoms refractory to previous treatments. Initial management includes behavioral modification with attention to total daily fluid intake, avoidance of bladder irritants, treatment of constipation, weight loss, timed voiding, urge-suppression techniques, and pelvic floor physical therapy. Options for oral medications include antimuscarinic agents and b adrenergic agents, and can be used following or in conjunction with behavioral treatment. For patients refractory to behavioral therapy and oral medications, consideration should be given to referral to a specialist (eg, a urologist or urogynecologist) for discussion of more advanced therapies such as sacral neuromodulation, percutaneous tibial nerve

Monotherapy with mirabegron had a better tolerance than the anticholinergic agents on overactive bladder

“…[ 2 , 3 ] It is reported that 3.4% of men and 8.7% of women aged from 40 to 44 years old would have symptoms of OAB, and more than 80% of individuals aged 80 to 90 years may have at least one void per night. [ 4 – 6 ] As the globe is expected to step into old-age society, the OAB is likely to place an increasing strain on healthcare resources. Anticholinergic agents, [ 7 ] such as solifenacin and tolterodine, are used as the cornerstone of pharmacotherapy for OAB symptoms.…”

Drug Delivery Approaches for Managing Overactive Bladder (OAB): A Systematic Review

“…Hence, the vaginal route has several advantages such as high permeability to many drugs, avoidance of first-pass hepatic metabolism, and the suitability to accommodate relatively large doses [ 30 ]. A delivery system could be used to treat overactive bladder and vaginal dryness simultaneously, which are common issues faced by human females after menopause [ 31 ]. However, it is obviously limited to females as well as being associated with local irritation and variability in the extent and rate of drug absorption [ 32 ].…”

Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review

“…There are several alternatives for OAB and UI treatment: behavioral treatments, considered first-line treatments; pharmacological or second-line treatments such as anticholinergic or antimuscarinic and b-adrenergic drugs, and, by way of a third line of treatment, injections of OnabotulinumtoxinA and therapies with electrical stimulation, including, among others, percutaneous and transcutaneous electrical stimulation (PTNS and TTNS, respectively), which are the object of this study [ 8 ].…”

“…With regard to treatment by electrical stimulation of the posterior tibial nerve (PTN), this involves retrograde stimulation of the nerve fibers of the sacral plexus, which innervates the bladder and detrusor muscle [ 2 , 3 , 4 , 5 , 8 ]. Electrical stimulation can be applied through insertion of a needle in the PTN—that is, PTNS is carried out in the said nerve—or through surface electrodes, with TTNS [ 9 ], with beneficial and safe effects in the short term in women with OAB, and no relevant adverse effects [ 10 ], according to the review by Sousa-Fraguas et al, 2020.…”