Treatment of Overactive Bladder

Abstract

The lower urinary tract has two main functions: storage and periodic elimination of urine. These two functions are regulated by a complex neural control system involving a central pathway located in the spinal cord, pons and brain as well as by the peripheral autonomic and somatic neural pathways. Vesico-urethral dysfunction is a major problem in daily medical practice. Detrusor overactivity is characterized by involuntary detrusor contractions during the filling phase of a cystometrogram. But the definition is sometimes a symptom syndrome suggestive of lower urinary tract dysfunction characterized by urgency, usually with increased daytime frequency and nocturia. Neurogenic and idiopathic overactive bladder must be differentiated. In the case of a low risk for an upper urinary tract, conservative therapies are primarily discussed, and current pharmacological treatment involving the use of muscarinic receptor antagonists. Vanilloids drugs and botulinum toxin have shown promising results, but further injections may be required with repetitive catheterization. To restore retention (continence) and emptying (micturition), surgical techniques intervening in the peripheral or central nervous systems have always played an important role. Functional surgery such as the Brindley technique (anterior sacral root stimulation with posterior rhizotomy) is still the only technique for restoring bladder function, continence, and micturition. It is especially useful for patients with an overactive bladder, suffering from a complete spinal cord lesion. Sacral neuromodulation (sacral root stimulation with a low-frequency current) is indicated for idiopathic overactivity and sometimes for incomplete spinal lesions.