Current literature suggests that several pathophysiological factors and mechanisms might be responsible for the nonspecific symptom complex of overactive bladder (OAB).
To provide a comprehensive ...analysis of the potential pathophysiology underlying detrusor overactivity (DO) and OAB.
A PubMed-based literature search was conducted in April 2018, to identify randomised controlled trials, prospective and retrospective series, animal model studies, and reviews.
OAB is a nonspecific storage symptom complex with poorly defined pathophysiology. OAB was historically thought to be caused by DO, which was either “myogenic” (urgency initiated from autonomous contraction of the detrusor muscle) or “neurogenic” (urgency signalled from the central nervous system, which initiates a detrusor contraction). Patients with OAB are often found to not have objective evidence of DO on urodynamic studies; therefore, alternative mechanisms for the development of OAB have been postulated. Increasing evidence on the role of urothelium/suburothelium and bladder afferent signalling arose in the early 2000s, emphasising an afferent “urotheliogenic” hypothesis, namely, that urgency is initiated from the urothelium/suburothelium. The urethra has also recently been regarded as a possible afferent origin of OAB—the “urethrogenic” hypothesis. Several other pathophysiological factors have been implicated, including metabolic syndrome, affective disorders, sex hormone deficiency, urinary microbiota, gastrointestinal functional disorders, and subclinical autonomic nervous system dysfunctions. These various possible mechanisms should be considered as contributing to diagnostic and treatment algorithms.
There is a temptation to label OAB as “idiopathic” without obvious causation, given the poorly understood nature of its pathophysiology. OAB should be seen as a complex, multifactorial symptom syndrome, resulting from multiple potential pathophysiological mechanisms. Identification of the underlying causes on an individual basis may lead to the definition of OAB phenotypes, paving the way for personalised medical care.
Overactive bladder (OAB) is a storage symptom syndrome with multiple possible causes. Identification of the mechanisms causing a patient to experience OAB symptoms may help tailor treatment to individual patients and improve outcomes.
There is a temptation to label overactive bladder (OAB) as “idiopathic” without obvious causation as “idiopathic”, given the poorly understood nature of its pathophysiology. However, OAB should be seen as a complex multifactorial syndrome, resulting from multiple potential pathophysiological mechanisms. Identification of the underlying causes on an individual basis may lead to the definition of OAB phenotypes, paving the way for personalised medical care.
Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions that often co-exist. One way of managing women with both conditions is to perform a combined surgical approach ...with a tension-free vaginal tape (TVT) placed at the time of pelvic floor repair. Raised awareness of complications associated with mesh in the UK has led to a pause in TVT procedures meaning there is no widely available one-step surgical procedure for these patients. We aim to investigate whether peri-urethral bulking with polyacrylamide hydrogel (Bulkamid®) performed at the time of pelvic floor repair is a safe procedure and whether it improves stress urinary incontinence.
Validated questionnaires (ICIQ-UI-SF and ICIQ-VS) were completed by women undergoing peri-urethral bulking alone for stress urinary incontinence (SUI), and women undergoing concomitant pelvic floor repair and peri-urethral bulking for POP and SUI. The scores from questionnaires pre- and post-operatively, and any surgical complications were documented and compared.
Both control and study groups showed overall improvement in continence scores with the average improvement in the study group being 7.24 and in the control group being 4.73. Statistical analysis showed that the difference in ICIQ-UI SF scores between the two groups was not statistically significant) (p = 0.059). Using the global impression questionnaire, 80% of women from the study group and 65.4% in the control group reported improvement in their incontinence symptoms.
Peri-urethral bulking performed at the time of pelvic floor repair improves urinary symptoms and is a safe procedure.
The urogenital tract and lower urinary tract are sensitive to the effects of estrogen and progesterone throughout adult life. Epidemiologic studies have implicated estrogen deficiency in the etiology ...of lower urinary tract symptoms that occur after menopause. Although the role of estrogen replacement therapy in the management of postmenopausal urinary incontinence (UI) remains controversial, its use in the treatment of women with urogenital atrophy is now well established. This review summarizes recent evidence of the urogenital effects of hormone therapy, particularly emphasizing management of postmenopausal UI and recurrent lower urinary tract infections. Estrogen therapy alone has little effect in the management of urodynamic stress UI, although in combination with an α-adrenergic agonist, it may improve urinary leakage. Estrogen therapy may be of benefit for the irritative symptoms of urinary urgency, frequency, and urge UI, although this effect may result from reversal of urogenital atrophy rather than a direct action on the lower urinary tract. The role of estrogen replacement therapy in the treatment of women with recurrent lower urinary tract infections remains to be determined, although there is now some evidence that vaginal administration may be efficacious. Low-dose, vaginally administered estrogens have a role in the treatment of urogenital atrophy in postmenopausal women and appear to be as effective as systemic preparations.
OBJECTIVE
To determine the impact of overactive bladder (OAB) symptoms on issues related to employment, social interactions, and emotional well‐being in a population aged 40–64 years.
SUBJECTS AND ...METHODS
The study comprised a cross‐sectional population‐based survey of 11 521 individuals aged 40–64 years, conducted in France, Germany, Italy, Spain, Sweden, and the UK. The survey involved a two‐stage screening procedure. Initially, individuals with any lower urinary tract symptoms were identified. Those whose only symptom/(s) was suggestive of a urinary tract infection, stress incontinence, or prostate obstruction were excluded from further study. Respondents were asked questions about the impact that their symptoms had on their emotional well‐being, social interactions and productivity at home and at work.
RESULTS
Of those with OAB, ≈ 32% (1272) reported that having these symptoms made them feel depressed, and 28% reported feeling very stressed. There were statistically significant differences in reported feelings of stress and depression when OAB symptoms were stratified by OAB with incontinence (OAB+) vs those with OAB with no incontinence (OAB−), with values for emotional stress of OAB+ 36.4% vs OAB− 19.6%, for depression of OAB+ 39.8% vs OAB− 23.3%. Participants with OAB+ were significantly more likely than those with OAB− to express worry about having accidents and concern about participating in activities away from home because of their bladder symptoms. In addition, those with OAB+ were significantly more likely to report that these bladder symptoms were a source of great concern and made them feel uncomfortable in social situations compared to those with OAB−. Men were significantly more likely than women to report OAB+ having an impact on their daily work life, including worry about interrupting meetings, impact on decisions about work location and hours, and voluntary termination or early retirement. This effect was primarily in men reporting OAB+.
CONCLUSION
OAB symptoms have a significant effect on the emotional well‐being and productivity of those affected, both at home and at work.
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