Overactive Bladder (OAB) is a syndrome characterized by symptoms of urinary urgency, often accompanied by frequent urination and nocturia, with or without urge incontinence. Overactive bladder disorder is a common condition that is not life-threatening, but it can seriously affect a patient’s quality of life. Symptoms such as urinary urgency, frequency, nocturia and urge incontinence can affect all aspects of a patient’s life. In particular, frequent trips to the toilet can cause great distress to patients’ daily life and work, overshadowing their physical and mental health, social interactions, sexual life and career development. Patients with frequent nighttime urination can have their sleep quality seriously affected, even causing insomnia. Frequent nighttime visits to the toilet by the elderly also increase the risk of fractures due to falls. Frequent urine leakage is not only uncomfortable, but also leaves the skin in a moist environment, causing bacterial growth and leading to rashes, skin cracking, skin infections and urinary tract infections.
Clinical manifestations of overactive bladder syndrome
1, Urinary urgency is a sudden and strong desire to urinate that is difficult to delay.
2.Frequent urination refers to excessively frequent urination, more than 8 times a day.
3.Nocturia refers to the need to get up and go to the bathroom 2 or more times at night.
4.Urgent urinary incontinence refers to the occurrence of uncontrollable leakage of urine after the appearance of urgency.
Based on a survey on the epidemiology of the United Kingdom in 2003, it was shown that 1 in 6 adults suffered from OAB; the epidemiological report of the United States showed that the prevalence of OAB among adults was 16.6%; in 2008, a survey in the Fuzhou area of China showed that the prevalence of OAB among women was about 8%, so it can be initially presumed that the number of OAB patients in China is not small. Unfortunately, the public awareness of OAB is very low in China, and it is estimated that only 15% of OAB patients seek treatment, and only half of these patients can be correctly diagnosed and treated. According to the rules established by the 3rd International Advisory Committee on Incontinence in 2004, the basic evaluation of OAB should include a complete and comprehensive history, a direct physical examination and appropriate ancillary tests. Because the pathogenesis of OAB is unclear and involves various factors such as the sensory nerves of the bladder, the voiding center, and the detrusor muscle, and other forms of urinary storage and voiding disorders can also cause non-inhibitory contractions of the detrusor muscle, a proper diagnosis of OAB relies on a proper evaluation by a medical professional.
Treatment of overactive bladder syndrome
There are many treatments for overactive bladder disorder. Behavioral therapy, although noninvasive, has uncertain clinical outcomes and is difficult to adhere to. Medication is preferred, but many patients do not benefit in the long term, and there are also problems with medication side effects. In severe cases of overactive bladder where medication is ineffective, surgical treatment may be considered.
1. Behavioral therapy
It mainly includes lifestyle coaching, bladder training, pelvic floor muscle exercises and voiding assistance. However, its clinical efficacy as a stand-alone treatment for OAB needs further evaluation and research due to the lack of results reported in long-term studies and the difficulty of standardizing treatment methods.
2. Drug therapy
The key issue in the treatment of OAB is when to use pharmacotherapy, but in actual clinical work most patients use pharmacotherapy as the first line of treatment.
(1) Anti-muscarinic drugs: Anti-muscarinic drugs are the first-line drugs for the clinical treatment of OAB. Currently, the more common ones include oxybutynin, tolterodine, trasylolamine, solifenacin and so on. All drugs are fairly well tolerated except for oxybutynin, which has more adverse effects in dry mouth and central nervous system. Highly selective M receptor
body blockers act on bladder M receptors and reduce the effect on M receptors in other parts and organs of the body, thus reducing the adverse effects caused by the drugs.
(2) Flavopiridol: The main effect is a mild calcium antagonist and phosphodiesterase inhibitor, resulting in a relaxing effect on bladder smooth muscle. However, the reported efficacy is inconsistent, with some considered effective and others ineffective.
(3) Antidepressants: Tricyclic antidepressants such as promethazine, amitriptyline, and anafranil are commonly used in clinical practice, and more studies are needed to confirm the treatment of OAB. It is worth noting that promethazine and other tricyclic
It should be noted that promethazine and other tricyclic antidepressants can cause postural hypotension and ventricular arrhythmias.
(4) Botulinum toxin type A: clinically, multi-point injection of botulinum toxin type A into the forced urinary muscle can block the release of acetylcholine from the cholinergic nerve terminals at the neuromuscular junction, thus causing paralysis of the forced urinary muscle. Studies have shown that intramuscular injection of botulinum toxin type A into the forced urinary muscle can improve bladder function.
Botulinum toxin type A can improve the clinical symptoms of OAB patients by increasing the bladder volume and decreasing the voiding pressure for 6-9 months. Local injections have few side effects and can be repeated, giving this treatment modality a promising future.
3.Neuromodulation therapy
Neuromodulation therapy is to regulate the function of the bladder and urethra by modulating the nerve function, which includes stimulating the peripheral nerves by various means. These include transcutaneous electrical stimulation or magnetic stimulation and invasive treatment with implanted devices. The mechanism of electrical stimulation may be to induce inhibition of the pelvic nerves through afferent stimulation of the pubic and submental nerves and to inhibit bladder contraction through efferent stimulation of the submental nerves. This modality also takes a long time and is difficult for most patients to accept.
4.Surgical treatment
The current surgical treatment of OAB is mainly cystoplasty, including autologous bladder enlargement and bowel bladder enlargement, for patients with small to medium volume hypocompliant bladder with OAB, and the efficacy is clearer for neurogenic detrusor overactivity.
In conclusion, OAB is a clinical syndrome that seriously affects the quality of life of patients, and clinical urologists should enhance their understanding of OAB and establish the correct clinical diagnosis through standardized diagnostic methods. Treatment is mostly a combination of behavioral and pharmacological therapies, and strict surgical indications should be mastered for patients undergoing surgical treatment.