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Pathologies of the Basal Ganglia, such as Parkinson's and Huntington's Diseases
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Teruyuki Ogawa, Naoki Yoshimura
Various antimuscarinic drugs are currently available for the treatment of overactive bladder. Clinical and urodynamic data provide significant improvements in patients with PD.5,71 However, it should be noted that these patients might have bowel dysfunction such as constipation secondary to PD.72 If medical treatment fails and patients have large residual volumes, the introduction of clean intermittent catheterization is an option. For the refractory overactive bladder, intradetrusor injection of botulinumtoxinA is available for patients with PD.73,74 Stem cell implantation therapy is also investigated for the treatment of motor dysfunction and lower urinary tract symptoms in patients with PD, although it is not available in clinical settings.75–78
Practice exam I: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Three pharmacological agents used to treat the overactive bladder are oxybutynin, tolterodine and solifenacin (1). [Other possibilities include trospium chloride, darifenacin, propantheline and propiverine hydrochloride.]
Female and Functional Urology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Angela Cottrell, Hashim Hashim
Whilst antimuscarinic agents are the mainstay of pharmacological treatment of overactive bladder syndrome, their use can be limited by side effects. Central nervous system effects are particularly important in the elderly population as the structure of the blood brain barrier may be impaired due to stroke, Alzheimer’s disease or diabetes. Central nervous system side effects include headache, dizziness or tiredness. These may be determined by the ability of the antimuscarinic agent to cross the blood brain barrier, the specificity for muscarinic receptors or actions of metabolites. Antimuscarinics are described as tertiary (e.g., oxybutynin) or quaternary amines (e.g., trospium chloride). Tertiary amines are lipophilic and are more likely to cross the blood brain barrier compared with quaternary amines which are, in theory, associated with fewer central nervous system side effects. All the tertiary amines (darifenacin, tolterodine and solifenacin) may cause cognitive side effects and exacerbating the anticholinergic burden but oxybutynin seems to be the one with the most negative effect on cognitive function. All five muscarinic receptors are found in the brain. M1 and M2 receptors are associated with memory and cognition whereas M3 receptors (which are clinically significant for detrusor contraction) have a low expression in the brain. Antimuscarinics, which have receptor specificity for M3 receptors, in theory, should have a lower risk of cognitive side effects.
Metabolic syndrome-related factors as possible targets for lower urinary tract symptoms in Korean males
Published in The Aging Male, 2023
Ji Eun Heo, Dong Gyun Kim, Jeong Woo Yoo, Kwang Suk Lee
IPSS is based on the answers to seven questions concerning urinary symptoms and one regarding the quality of life. The answers are assigned points from 0 to 5. The total score ranges from 0 to 35 (asymptomatic to very symptomatic). Total IPSS values were categorized as mild (scores 0–7), moderate (scores 8–19), and severe (scores 20–35) LUTS. OABSS consists of four symptoms (daytime frequency, nocturia, urgency, and urge incontinence), and the total score is obtained as the sum of the four symptom scores. Overactive bladder (OAB) diagnosis was defined as an OABSS ≥ 3 with an urgency score of ≥ 2. PV was calculated using the prostate ellipsoid formula (height × width × length × π/6) from TRUS data. BPH was defined by PV ≥ 30 cm3 [16]. Fatty liver disease was diagnosed and stratified in severity based on known standard criteria according to the level of hepatic tissue hyperechogenicity, a discrepancy between the liver and right kidney, and visibility of the vascular structures [17].
Oxybutynin nanosuspension gel for enhanced transdermal treatment for overactive bladder syndrome
Published in Pharmaceutical Development and Technology, 2022
Yuze Sheng, Shuang Zhang, Jiawei Ling, Chenlu Hu, Zhenhai Zhang, Huixia Lv
Overactive bladder (OAB) is defined as a symptom syndrome involving urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence in the absence of urinary tract infection or other obvious pathology (Haylen et al. 2010). Epidemiological studies regarding the prevalence of OAB performed, respectively, in Europe and USA represented a similar incidence rate, approximately 17% of the general adult population (Wein and Rackley 2006). The prevalence increases with age advancing, higher in women. OAB significantly declines the quality of life, leading billions of patients to suffer from impairments in social, psychological, occupational, domestic, physical, and sexual aspects, and inflicts great economic costs to society (Hashim and Abrams 2007; Fontaine et al. 2021).
Evaluating vibegron for the treatment of overactive bladder
Published in Expert Opinion on Pharmacotherapy, 2021
Tomasz Rechberger, Andrzej Wróbel
The symptoms of overactive bladder, although not fatal, affect around 16% of population over 40 years old with steadily increasing prevalence in elderly patients [1]. The causes of OAB symptoms still remain unknown and when unraveling the etiology of a disease it seems prudent to state that there is not only one form of OAB, but rather several OAB phenotypes based on the underlying mechanisms and pathophysiological cofactors. Regardless of underlying conditions, OAB symptoms are caused by changes in lower urinary tract due to deterioration of the sensory connections between bladder, spinal cord and brain, leading to abnormal bladder sensations of the urge to void at small bladder volumes. Additionally, especially in postmenopausal women atrophy of pelvic floor muscles and external urinary sphincter accompanied by decreased of bladder compliance associated with an impairment in detrusor contractility may also lead to OAB symptoms [2].