Overactive bladder – 18 years – Part II

Abstract

Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

High Frequency Stimulation of the Pelvic Nerve Inhibits Urinary Voiding in Anesthetized Rats

“…In patients refractory to pharmacological treatment intravesical injection of botulinum toxin may be offered, although this requires frequent re-injection for continued benefit. There is also a risk of urinary tract infection and high residual volume, which may require patients to perform self-catheterization (Gupta et al, 2015 ; Tubaro et al, 2015 ; Olivera et al, 2016 ; Truzzi et al, 2016 ).…”

“…Percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS) have both been adopted as clinical procedures for urge incontinence (Yamanishi et al, 2015 ). However, PTNS requires a frequent schedule of re-application whereas high levels of re-intervention are required with SNS and pain is a frequent side effect (Gupta et al, 2015 ; Tubaro et al, 2015 ; Olivera et al, 2016 ; Truzzi et al, 2016 ).…”

Sacral Neuromodulation: A Worldwide Survey Conducted Among Surgeons

“…Salvage treatment can be done with or without SNM, including oral medication (anticholenergic, beta 3 agonist), intravesical Botox injection, percutaneous tibial nerve stimulation, unilateral or contralateral revision of electrode, and pudendal nerve stimulation or bladder augmentation [19].…”

The Relationship between Overweight and Overactive Bladder Symptoms

“…The International Continence Society and the International Urogynecological Association define OAB as urinary urgency, usually accompanied by frequency and nocturia, with or without UUI, and with the absence of urinary tract infection or other obvious pathology [7][8][9]. According to epidemiological studies, the prevalence of OAB was from 5 to 10% [10].…”