An overview of treatment alternatives for different types of neurogenic bladder dysfunction in adults
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Intravesical treatment Bladder overactivity involves an intact sacral reflex arc. Intravesically administered substances can act on the efferent or afferent branches of this reflex arc. Anticholinergics block the efferent part of the reflex and can be used via intravesical administration in addition to the more traditional oral route. Brendler et al.42 used 5 mg oxybutynin chloride in 20–30 mL of water in 10 incontinent patients. All of them became continent. Madersbacher and Jilg43 studied oxybutynin in 13 overactive bladder patients: out of ten of these who presented incontinence between CICs, nine became continent. Even if the oxybutynin serum level was higher after intravesical than after oral administration, the side effects of anticholinergics were totally absent in the intravesical group. In patients with enterocystoplasty, the side effects were identical to the oral group. This observation led Massad et al.44 to conclude that a hepatic metabolite of oxybutynin is probably responsible for the side effects. In a study of 12 patients with overactive bladder, Di Stasi et al.45 found that oral oxybutynin had no effect. When administered intravesically, passive diffusion of oxybutynin significantly reduced urinary leakage, but with electromotive diffusion it caused significantly greater postvoid residual urine volume and fewer episodes of urinary leakage, together with measurable changes in urodynamic parameters: decreased duration and amplitude of uninhibited contractions as well as increased bladder wall compliance.
Continence
Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson in Health Care Needs Assessment, 2018
The role of PFMT for women with urge incontinence alone remains unclear.121 There is level 1 evidence that PFMT is better than placebo treatments for women with urge incontinence.106 In their review of the literature of pelvic floor exercises for the treatment of overactive bladder, Bø and Berghmans found that because of the lack of evidence, no firm conclusion can be drawn on the effect of pelvic floor muscle exercise on the overactive bladder.162 In a review of 15 randomised controlled trials to assess the efficacy of physical therapies for first line use in the treatment of urge urinary incontinence in women, Berghmans et al. concluded that although almost all studies included reported positive results in favour of physical therapies, there were too few studies to evaluate the effect of pelvic floor muscle exercise with or without biofeedback in this group of women.163
Pathologies of the Basal Ganglia, such as Parkinson's and Huntington's Diseases
Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg in Essentials of the Adult Neurogenic Bladder, 2020
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
Short-term benefits of balneotherapy for patients with chronic pelvic pain: a pilot study in Korea
Published in Journal of Obstetrics and Gynaecology, 2020
Kyung-Jin Min, Hoon Choi, Bum Sik Tae, Min-Goo Lee, Sung-Jae Lee, Kwang Dae Hong
The combination of these three mechanisms (thermal stimuli, chemical stimuli and change of environment) seems to have improved the symptoms of CPP. Looking at the responses to the questionnaires, we found that pelvic pain (via VAS), urinary symptoms (via OABSS) and quality of life (via SF-36) can be improved after balneotherapy. These improvements were sustained one month after completion of the balneotherapy programme. Along with improvement of pain, change to a pleasant environment can improve the quality of life for patients with CPP. An interesting finding was that bladder irritation symptoms, which were measured by OABSS, were also improved after balneotherapy. Overactive bladder is characterised by symptoms of urgency, with or without urgency incontinence, usually with urinary frequency and nocturia in the absence of confirmed infection or other pathologies (Abrams et al. 2002). Overactive bladder is very common in the general population. More research needs to be done to test the application of balneotherapy in patients with overactive bladder symptoms who do not respond to usual medical therapy.
Investigation of pelvic floor disorders
Published in Climacteric, 2019
T. Grigoriadis, S. Athanasiou
Overactive bladder (OAB) is defined as a symptom complex of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology1. UDS performed on women with OAB may show multiple diagnoses such as DO, USI, or voiding dysfunction and only 54% of women are shown to have DO18. Various studies showed that there is no strong association between OAB symptoms and DO during urodynamic investigation, failing to predict the response of OAB treatment on the basis of the characterization or quantification of DO during UDS. In 2015, a Cochrane systematic review13 found that while UDS did change clinical decision-making, there was some high-quality evidence that this did not result in lower UI rates after treatment. However, a recent multicenter study in the UK showed that women with OAB treated based on UDS diagnoses appear to have greater reductions in symptoms than those who do not19.
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).
Related Knowledge Centers
- Bladder Training
- Constipation
- Diabetes
- Kegel Exercise
- Nocturia
- Pelvic Pain
- Urinary Incontinence
- Urinary Tract Infection
- Urination
- Neurogenic Bladder Dysfunction