Overactive Bladder (OAB) is a common urinary dysfunction that affects the quality of life of a wide range of people worldwide. Although OAB is not life-threatening, the quality of life of patients is severely affected, such as frequent visits to the toilet, frequent toilet searches, forced to drink less water, afraid to participate in social activities, unable to work long hours, reduced efficiency, fear of urine leakage and avoidance of sexual life, etc. The quality of life of 54.9% of patients with OAB with urge incontinence is severely affected, with the most significant impact on leisure activities and psychological and emotional well-being, both of which exceed 30%. OAB also predisposes to other problems and diseases such as falls and fractures (25.3%) and depression (10.5%). Therefore, it is very necessary to pay attention to OAB.
I. Definition
It is a syndrome characterized by the symptoms of urinary urgency
Often associated with frequent urination and nocturia, with or without urge incontinence
Urodynamically it can be characterized by overactivity of the detrusor muscle, but this can also be other forms of urethral-vesical dysfunction
Objective examination without clear infection and other obvious pathological changes
Etiology: it is not clear.
III. Pathogenesis: Currently, the following four are thought to be involved.
(1) forceps instability: caused by non-neurogenic factors, abnormal forceps during the storage phase, contraction causes the corresponding clinical symptoms;
(2) Bladder sensory hypersensitivity: the desire to urinate occurs at smaller bladder volumes;
(3) Abnormal function of the urethra and pelvic floor muscles;
(4) Other causes: such as abnormal mental behavior, hormone metabolism disorder, etc.
IV. Symptoms
1.Urgency: a sudden, strong desire to urinate, and it is difficult to be subjectively suppressed and delayed urination;
2, Urge incontinence: refers to the incontinence phenomenon that accompanies urinary urgency or occurs immediately after urinary urgency;
3, frequent urination: frequent urination is a complaint, referring to the patient’s subjective feeling that the number of urination is too frequent. Usually, it is considered as frequent urination when adults urinate ≥8 times during the day and ≥2 times during the night, with an average urine volume of <200ml each time.
4. Nocturia: It refers to the complaint that the patient wakes up to urinate due to the urge to urinate ≥ 2 times/night.
V. Diagnosis
1.Screening examination: refers to the examination items that should be completed in general patients.
Medical history.
(1) Typical symptoms:including assessment of urinary diary.
(2)Related symptoms:Difficulty in urination, urinary incontinence, sexual function, defecation status, etc.
(3)Relevant medical history: history of urinary and male reproductive system diseases and treatment; history of menstrual, fertility, gynecological diseases and treatment; history of neurological diseases and treatment.
Physical examination:
(1)General physical examination.
(2) Special physical examination: urinary and male reproductive system, neurological system, female reproductive system.
Laboratory examination: urinary routine.
Special urological examination: urinary flow rate, urological ultrasonography (including residual urine determination).
2.Elective examination:
Refers to special patients, such as patients suspected of the presence of a certain pathology, should be selective to complete the examination program.
1.Pathogenic examination: pathogenic examination of urine, prostatic fluid, urethral and vaginal secretions should be performed for suspected inflammatory diseases of the urinary or reproductive system.
2, cytological examination: urine cytological examination should be performed for suspected uroepithelial tumor.
3.Urethral plain film, intravenous urography, urological endoscopy, CT or MRI examination: if other diseases of the urinary tract are suspected.
4.Invasive urodynamic examination.
(1) Purpose: To determine the presence or absence of lower urinary tract obstruction and to assess the function of the forced urinary muscle.
(2) Indications: Invasive urodynamic testing is not a routine test, but should be performed in the following cases: decreased urinary flow rate or increased residual urine; failure of preferred treatment or presence of urinary retention; prior to any invasive treatment; further evaluation is needed for lower urinary tract dysfunction identified during screening tests.
(3) Select items: bladder pressure measurement; pressure-flow rate measurement, etc.
(5) Other tests: urine culture, blood biochemistry, serum PSA (for men over 40 years old), etc.
VI. Treatment
(I) Preferred treatment
1.Behavioral training
(1) Bladder training
Method 1: Delay urination and gradually make each urination volume greater than 300ml.
(1) Treatment principle: relearning and mastering the skill of controlling urination; interrupting the vicious circle of mental factors; reducing the sensitivity of the bladder.
(ii) Contraindications: low compliant bladder with end-of-filling period forced urinary muscle pressure greater than 40cmH2O.
③Requirements: practical implementation of treatment as planned
④Cooperative measures: adequate ideological work; voiding diary; others.
Method 2: Regular urination
①Objective: to reduce the number of incontinence and improve the quality of life.
②Indications: those with severe incontinence and difficult to control.
③ Contraindication: with severe urinary frequency.
(2)Biofeedback therapy
(3)Pelvic floor muscle training
(4)Other behavioral therapy: hypnotherapy.
2.Drug therapy
(1) First-line drugs: Tolterodine, Trospium, Solifenacin
(2) Other optional drugs.
1, other M receptor antagonists: Oxybutynin (Oxybutynin), Propiverine (Propiverine), Probenecid, etc.
2, sedative, anxiolytic drugs: promethazine, doxorubicin, Valium, etc.
3, calcium channel blockers: isoparaben, cardiac pain.
4, prostaglandin synthesis inhibitors: anti-inflammatory pain.
(3) other drugs: the efficacy of flavonol permethrin is not exact, herbal preparations are still lack of credible trial reports.
3, change the indications of preferred treatment.
1, ineffective ;
2.Patients can not adhere to treatment or request to change the treatment method;
3.The appearance or possibility of intolerable side effects;
4.Significant decrease in urinary flow rate or significant increase in residual urine volume during treatment.
(II) Optional treatment
1.Multi-point injection of botulinum toxin type A into the bladder forced urinary muscle: it is effective for severe forced urinary muscle instability.
2, bladder perfusion RTX, hyaluronidase, capsaicin: the above substances can be involved in bladder sensory afferents, reduce bladder sensory afferents after perfusion, can be tried for severe bladder sensory allergy.
3.Neuromodulation: Sacral nerve electro-modulation therapy is effective for some patients with intractable urinary frequency and urgency and urinary incontinence.
4.Surgery.
1, surgical indications: should be strictly controlled, only for those with severe low compliance bladder, bladder volume too small and endangering the function of the upper urinary tract, and ineffective by other treatments.
2, surgical methods: forced urinary muscle transection, autologous bladder enlargement, intestinal bladder enlargement, urinary diversion.
5, acupuncture treatment: some data show that acupuncture at the foot Sanli, Sanyinjiao, Qihai, and Guan Yuan points help relieve symptoms.
Guiding principles of combined medication: Since the etiology of OAB is unknown and some patients have poor treatment results, it is recommended in the selection of treatment methods that.
①Bladder training can be performed alone, but it is more acceptable to patients when combined with pharmacotherapy;
②In pharmacological treatment, on the basis of first-line drugs, other drugs should be used according to the patient’s condition: sedative and anxiolytic drugs should be added for patients with significant neurasthenia, poor sleep and nocturnal frequency; female hormones should be added for postmenopausal patients on a trial basis; α-blockers should be used in combination with mild bladder outlet obstruction; 1 or 2 different therapeutic mechanisms should be used for patients with severe symptoms, especially in combination with significant instability of the detrusor muscle. -The dose can start from a small dose and be gradually increased until the efficacy or side effects appear; the duration of administration should not be too short, and the efficacy should be evaluated after 2 weeks of continuous administration (except for those with side effects) until the symptoms are completely controlled and then gradually reduced;
(iii) Botulinum toxin type A, RTX and other optional treatments should be considered only when the symptoms are heavy and other treatments are not effective.
(iii) Other
If OAB is secondary, the primary disease and related symptoms should also be treated actively.
Conclusion: Studies have reported that the incidence of OAB is much higher than that of diabetes, asthma, and angina, and the incidence increases significantly with age. We believe that urinary diseases such as OAB are both a physical and a psychological disease, and most people, especially women, are ashamed to talk about it and do not know what to do, in addition many people consider the symptoms of OAB as a natural phenomenon and do not give enough attention and importance to it. We need to raise awareness of this disease so that more patients can get rid of the pain and return to a healthy life as soon as possible.