Urgency: the key to defining the overactive bladder.
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Humans↗
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Results for “Urinary Bladder, Overactive”
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[Overactive bladder syndrome].
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Fibromyalgia↗
[There are no "overactive bladders"].
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Drug Costs↗
Capsaicin receptor VR1 and ATP-gated ion channel P2X3 in human urinary bladder.
OBJECTIVES: To determine the presence, distribution and molecular forms of the vanilloid receptor VR1, and confirm the presence and distribution of the ATP-gated ion channel P2X3 in the human urinary bladder. Materials and methods Normal urinary bladder tissues were obtained at postmortem from four subjects. Eight urinary bladder biopsies were also taken from patients with detrusor hyper-reflexia treated with intravesical resiniferatoxin. The specimens were studied using affinity-purified specific antibodies to VR1 and P2X3 by Western blotting and immunocytochemistry, and compared with immunostaining using antibodies to the pan-neuronal marker PGP 9.5 and Schwann cell marker S-100. RESULTS: VR1- and P2X3-immunoreactive fine nerve fibres were scattered throughout the suburothelium of the normal bladder and cystoscopic biopsies, and traversed the muscle layer. They had a similar distribution to PGP 9.5-immunoreactive fibres, but there were fewer, suggesting localization in subsets of axons. Western blot studies showed an expected 100-kDa VR1 protein and a P2X3-immunoreactive 66-kDa protein. Conclusion VR1 and P2X3 are present in the human urinary bladder and may contribute to distinct pathophysiological states of bladder overactivity, in accord with their differential expression in sensory neurones. Intravesical vanilloids act via VR1 and are effective in the treatment of detrusor hyper-reflexia. P2X3 may represent a selective therapeutic target for other causes of overactive bladder.
Adenosine Triphosphate↗
[Clinical significance of urinary flow pattern--based on combined uroflowmetry and external sphincter electromyography].
We performed combined uroflowmetry and external sphincter electromyography in 108 patients (87 males and 21 females); 16 serving as normal controls, 49 with benign prostatic hyperplasia, 16 with overactive type of neurogenic bladder, 27 with underactive type of neurogenic bladder. Urinary flow pattern was classified into 5 categories. All of urinary flow patterns of normal controls showed pattern A which had the form of a bell. EMG showed complete suppression during micturition followed by a few intermittent increases in amplitude. Urinary flow patterns of BPH patients were distributed widely from pattern A to E. Intermittent increases in EMG amplitude during a late phase of micturition were characteristic in patients with BPH. We must pay attention to sex differences to evaluate urinary flow pattern because it could be influenced by abdominal pressure such as stressing or Créde maneuver in female patients with an underactive type of neurogenic bladder.
Adult↗
Transdermal oxybutynin: a new treatment for overactive bladder.
Overactive bladder has been successfully treated with oral anticholinergic drugs such as oxybutynin chloride. Although oral oxybutynin has been effective in controlling urinary urge incontinence and in decreasing incontinence episodes, adverse events, particularly dry mouth, often cause patients to discontinue oral therapy and to endure incontinence. Transdermal oxybutynin (Oxytrol, Watson Pharmaceuticals) is applied twice-weekly to maintain the efficacy of oral oxybutynin while significantly minimising side effects (e.g., dry mouth) that complicate therapy. By avoiding hepatic and gastrointestinal metabolism of oxybutynin, less N-desethyloxybutynin (N-DEO), the compound thought to be responsible for anticholinergic side effects, such as dry mouth, is produced. The new transdermal oxybutynin formulation offers patients with urinary incontinence an effective, safe and well-tolerated option for managing the symptoms of overactive bladder.
Administration, Cutaneous↗
Integrative control of the lower urinary tract: preclinical perspective.
Storage and periodic expulsion of urine is regulated by a neural control system in the brain and spinal cord that coordinates the reciprocal activity of two functional units in the lower urinary tract (LUT): (a) a reservoir (the urinary bladder) and (b) an outlet (bladder neck, urethra and striated muscles of the urethral sphincter). Control of the bladder and urethral outlet is dependent on three sets of peripheral nerves: parasympathetic, sympathetic and somatic nerves that contain afferent as well as efferent pathways. Afferent neurons innervating the bladder have A-delta or C-fibre axons. Urine storage reflexes are organized in the spinal cord, whereas voiding reflexes are mediated by a spinobulbospinal pathway passing through a coordination centre (the pontine micturition centre) located in the brainstem. Storage and voiding reflexes are activated by mechanosensitive A-delta afferents that respond to bladder distension. Many neurotransmitters including acetylcholine, norepinephrine, dopamine, serotonin, excitatory and inhibitory amino acids, adenosine triphosphate, nitric oxide and neuropeptides are involved in the neural control of the LUT. Injuries or diseases of the nervous system as well as disorders of the peripheral organs can produce LUT dysfunctions including: (1) urinary frequency, urgency and incontinence or (2) inefficient voiding and urinary retention. Neurogenic detrusor overactivity is triggered by C-fibre bladder afferent axons, many of which terminate in the close proximity to the urothelium. The urothelial cells exhibit 'neuron-like' properties that allow them to respond to mechanical and chemical stimuli and to release transmitters that can modulate the activity of afferent nerves.
Afferent Pathways↗
The overactive bladder: pharmacologic basis of drug treatment.
OBJECTIVES: To provide an overview of the basis for drug treatment of the overactive bladder. METHODS: Published information is evaluated. RESULTS: The causes of bladder overactivity are not known, but theoretically, increased afferent activity, decreased inhibitory control in the central nervous system (CNS) or peripheral ganglia, and increased sensitivity of the detrusor to efferent stimulation may be involved. Several CNS transmitters can modulate voiding, but few useful drugs with a defined CNS site of action have been developed. Drugs that stimulate gamma-aminobutyric acid receptors are used clinically. Potentially, drugs affecting opioid, 5-hydroxytryptamine, norepinephrine, dopamine, and glutamatergic receptors and mechanisms can be developed, but a selective action on the lower urinary tract may be difficult to obtain. Traditionally, drugs used for treatment of bladder overactivity have had a peripheral site of action, mainly efferent neurotransmission or the detrusor itself. Antimuscarinic drugs, beta-adrenoceptor agonists, alpha-adrenoceptor antagonists, drugs affecting membrane channels, prostaglandin synthetase inhibitors, and several other agents have been used with limited success. New information on the alpha-adrenoceptor and muscarinic receptor subtypes in the human detrusor has emerged and may be the basis for the development of new compounds with effects on bladder overactivity. Decreasing afferent activity seems an attractive therapeutic approach, and drugs affecting afferent nerves by causing release of tachykinins, such as capsaicin and analogs, as well as agents blocking tachykinin receptors, may be of therapeutic interest. CONCLUSIONS: New drugs, specifically designed for the treatment of bladder overactivity, are desirable.
Central Nervous System↗
Pathophysiology: the varieties of bladder overactivity.
Overactive bladder (OAB) is the most common term currently used in clinical medicine to describe a complex of lower urinary tract symptoms (LUTS) with or without incontinence. The symptoms usually include urgency, frequency, nocturia, troublesome or incomplete emptying, and, occasionally, pain. Causes of bladder overactivity include neurologic illness or injury, bladder outlet obstruction, urethral weakness, detrusor hyperactivity and impaired contractility in elderly patients, emergence of new voiding reflexes, and so-called idiopathic bladder overactivity. Most clinicians agree that effective treatment for OAB symptoms should be guided by a basic assessment of patients for these contributing factors. However, it is not at all certain that outcomes are significantly improved by diagnostic precision. This is in part because of the ubiquity of LUTS in the setting of the various common lower urinary tract disorders: stress incontinence, outlet obstruction, and neurologic illness or injury. The ubiquity of LUTS would imply that they are caused by common mechanisms and, theoretically at least, would be amenable to a single form of effective therapy. Conversely, the limited kinds and number of LUTS and the limited representation of lower urinary tract structures in the central nervous system may mean that several different causes produce similar symptoms, but these are not amenable to a single form of effective therapy. Future research directions should keep each possible explanation in mind as new knowledge about lower urinary tract function and possible intervention continues to emerge.
Animals↗
Treatment of urge incontinence in Veterans Affairs medical centers.
Urinary incontinence has far-reaching medical, psychological, social, and economic effects. The objectives of this descriptive study were to examine utilization patterns and discontinuation rates of various pharmacologic agents used to treat symptoms of overactive bladder, primarily urge incontinence (UI), and to estimate the prevalence of urinary incontinence in the study population. Patient-level data regarding specific drugs used to treat UI and the use of diapers or pads over a 9-month period from October 1995 to May 1996 were retrospectively extracted from the medication databases of 9 Department of Veterans Affairs medical centers. A total of 2233 male patients were included in the analyses. Most patients were receiving oxybutynin chloride (39.8%), dicyclomine hydrochloride (16.0%), or imipramine hydrochloride (13.9%), and the remaining 30.3% were using flavoxate hydrochloride, propantheline bromide, hyoscyamine sulfate, and adult diapers or pads. Overall, 72.1% of patients had been prescribed daily dosages within the recommended dosing ranges for these medications. The majority (91.3%) of patients had not switched to another UI medication during the study period. Based on a chronic disease index, 47.6% of patients had 2 or fewer chronic diseases. Using pooled prevalence estimates, the estimated percentage of patients who had ever experienced UI in this population ranged from 7.4% to 20.8%; however, a considerably smaller percentage were taking medications for the treatment of UI. The results of this study suggest that oxybutynin, dicyclomine, and imipramine are the agents most commonly used to treat urinary incontinence within Veterans Affairs medical centers. The majority of patients who received a prescription for one of these drugs did not routinely refill the medication over the course of the study. There are many reasons for patients not to refill a prescription (eg, ineffectiveness, side effects, complications, obtaining the drug from another source), but the present study did not address the causes.
Adult↗
Management of overactive bladder--looking to the future.
OBJECTIVES: To offer a perspective on potential future advances in the understanding and management of the overactive bladder. METHODS: Consideration is given to potential developments in the areas of pathophysiology, prevention, early intervention, and new pharmacologic targets for the treatment of overactive bladder. RESULTS: The future will likely reveal that motor urgency is usually a premature micturition reflex with a limited and variable degree of penetrance. Overactivity of all types in the lower urinary tract (LUT) will be regarded as the result of a partially uncontrolled on-off mechanism in the nervous system. Neurogenic factors will be found to initiate a premature activation of urethral and bladder activity, whereas myogenic factors will be recognized as serving as facilitators. As is the case today, we will probably be unable to cure or normalize the overactive bladder in the future. However, our growing understanding of the pathophysiology of the LUT will open up new possibilities for prophylactic, diagnostic, and therapeutic measures. Advances in cellular and molecular biology may allow early intervention or even prevention of the overactive bladder. Pharmacologic treatment will not only aim at functional intervention, but will attempt to influence the structure of the organs by means of trophically active drugs. Prevention of muscle cell hypertrophy and induction of nerve growth might become therapeutic realities. CONCLUSIONS: The future holds the promise of important advances that will improve our understanding of the overactive bladder and will hopefully lead to more effective treatments.
Adrenergic Antagonists↗
Defining words: overactive bladder.
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Animals↗
Trospium chloride (Sanctura): another anticholinergic for overactive bladder.
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Benzilates↗
[Treatment of overactive bladder].
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Electric Stimulation Therapy↗
[Urinary disturbance due to HTLV-1 associated myelopathy].
Patients with human T-cell lymphotropic virus type 1 associated myelopathy (HAM) have complaints of urinary disturbance frequently. Symptoms and urodynamic examinations were evaluated in untreated twenty-one patients with HAM. Although two cases (11%) had no urinary symptom, nineteen cases (89%) suffered from dysuria, pollakisuria, incontinence or urgency. The combination of irritative and obstructive urinary disturbance was a characteristic symptom in the HAM patients. In three cases the urinary symptoms preceded the gait disturbance which is a main symptom of HAM. In urodynamic study overactive bladder was found in fourteen cases (66%), although three cases (15%) showed underactive or acontractile bladder with disturbance of urinary sensation. There was no abnormal finding by urethral pressure profile (UPP), but detrusor sphincter dyssynergia (DSD) was revealed frequently by EMG. This typical dysfunction of the HAM patients was thought to be caused by destruction of the lateral column of the spinal cord.
Adult↗
Anticholinergic drugs in patients with bladder outlet obstruction and lower urinary tract symptoms: A systematic review.
OBJECTIVES: To review the available evidence concerning the use of anticholinergic drugs, alone or in combination with alpha-blockers, in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and concomitant overactive bladder syndrome, to assess whether the currently available evidence suggests a role for antimuscarinic drugs in patients with BPH. METHODS: A systematic review of the literature was performed using Embase, MEDLINE, and Web of Science through a complex search strategy including "free text" and "MeSH" protocols. Moreover, the Cochrane database of systematic review was browsed for records regarding BPH and the abstract books of the American Urological Association, European Association of Urology, and International Continence Society annual meetings from 2000 to 2005 were hand-searched for studies concerning the topic of the review. RESULTS: From the literature search, we identified four randomised controlled trials (RCTs), two prospective case series, and a few congress abstracts. For methodologic issues, the best RCT was based on urodynamic data, but did not provide any clinical insight on the patients' symptoms. The other papers were affected by significant methodologic or clinical drawbacks. CONCLUSION: The available data may be considered promising in terms of safety and efficacy. The evidence of the limited number of RCTs available, considering their methodologic or clinical shortcomings, is not sufficient to support the clinical use of combination therapy with alpha-blockers and anticholinergic drugs in patients with associated storage and voiding symptoms. Well-designed, large, double-blind, placebo-controlled, long-term RCTs are needed to assess the long-term safety and efficacy of antimuscarinic drugs, alone or in combination with alpha-blockers, in this category of patients.
Cholinergic Antagonists↗
Does anticholinergic medication have a role for men with lower urinary tract symptoms/benign prostatic hyperplasia either alone or in combination with other agents?
PURPOSE OF REVIEW: A substantial proportion of men with lower urinary tract symptoms have a combination of both 'storage' and 'voiding' symptoms, suggesting possible coexisting bladder outlet obstruction and bladder overactivity. Bladder overactivity is traditionally treated with anticholinergic drugs. However, guidelines from the European Association of Urologists make no mention of the possible therapeutic role of anticholinergic drugs for treating storage symptoms in such patients. It is a common perception that using an anticholinergic drug in men with bladder outlet obstruction runs the risk of inducing acute urinary retention, because of the inhibitory effect of anticholinergics on bladder contraction in the presence of outlet obstruction. This review focuses on recent data determining the efficacy of anticholinergic medication in men with lower urinary tract symptoms/benign prostatic hyperplasia and the associated risk of acute urinary retention. RECENT FINDINGS: One recent study in men with urodynamically confirmed obstruction supports the assertion that anticholinergic drugs are safe in men with bladder outlet obstruction. Safety data from larger studies using anticholinergics in patients with overactive bladders supports these findings. SUMMARY: Efficacy and safety studies of anticholinergic medication in men with lower urinary tract symptoms/benign prostatic hyperplasia are few and far between, but preliminary data suggests they are not associated with a substantial risk of urinary retention nor with a substantial increase in residual urine volume.
Aged↗