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Abstract
Overactive bladder (OAB) is a symptom syndrome including urinary urgency with or without urinary incontinence, usually with frequency and nocturia. Urgency, defined as the compelling feeling of impending incontinence that is difficult to defer, is the cornerstone symptom of OAB. The diagnosis is based on symptoms alone and assumes no underlying pathology. Approximately 12.2% of the adult population experience OAB in Korea. The syndrome is now recognized as a chronic debilitating condition that negatively affects the quality of life. Often the patients have a restricted social life and an increased risk for depression. Despite increased awareness in recent years, OAB remains an underreported condition. Continued evolution of our understanding of the pathophysiology of OAB has identified contributory mechanisms, which has in turn established structured evidence-based managements. Treatment of OAB is aimed at relief of symptoms and improving quality of life. Conservative treatments combined with antimuscarinic drugs are the main treatment for OAB. There are many antimuscarinics available, with several under development, which have different specificities for the muscarinic receptors. Other drugs have also been tried but with limited success. Behavioral therapy combined with pharmacological therapy often will bring about acceptable outcomes for patients with OAB. Modalities such as botulinum toxin injections, neuromodulation, and various surgical interventions also are showing encouraging results in more refractory patients. Further research into the basic science of the condition is required to identify the true cause of OAB, allowing new targeted treatments to be established.
Figures and Tables
Fig. 1
Overactive bladder and urinary incontinence. SUI: stress urinary incontinence, MUI: mixed urinary incontinence, UUI: urge urinary incontinence.
Fig. 2
Detrusor module inputs.8 Ganglion has integrative circuit (1), that receives inputs from neighbouring modules (2), interstitial cells (3), afferent collaterals (4), and other pelvic organs (5). These inputs collectively affect the likelihood of contraction of module, which can thereby show autonomous activity, irrespective of the primary sacral efferents (6). SNS: sympathetic nervous system.
Fig. 5
Bladder effects of antimuscarinics. By inhibiting the effects of acetylcholine, generated from non-nervous sources (urothelium) or leaking from cholinergic nerves during the filling phase, antimuscarinics may inhibit detrusor overactivity and urgency.
Fig. 6
M3/M2 receptor selectivity for darifenacin compared with other antimuscarinics. *Inhibition constant ratio (Ki) muscarinic receptor subtypes.
Table 3
Drugs used to treat symptoms of overactive bladder*
*Not all drugs listed in this table have proven efficacy specifically for symptoms of overactive bladder. †Levels of evidence are based on the Oxford System: a score of 1 indicates evidence from randomized, controlled trials; a score of 2 evidence from good-quality prospective cohort studies; a score of 3 evidence from good-quality retrospective case-control studies; and a score of 4 evidence from good-quality case series. The grade of recommendations is based on the definitions used by the International Consultation on Urological Diseases: A indicates consistent level 1 evidence; B consistent level 2 or 3 evidence or major evidence from randomized, controlled trials; C level 4 evidence or major evidence from level 2 or 3 studies or expert opinion based on the Delphi method; and D inconclusive, inconsistent, or nonexistent evidence or evidence based on expert opinion only. ‡The rating is for symptoms of overactive bladder, not for overall symptoms of benign prostatic hyperplasia.
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