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JOURNAL READIN

FEBRUARI 2015

BAGIAN NEUROLO
GI

OVERACTIVE BLADDER

(Barkin J. Overactive Bladder. The Canadian Journal of
Urology; 18 (Supplement 1). 2011; 8-113)

Disusun oleh :
Jasmine F. Hatane
NIM. 2008-83-046
Pembimbing :
dr. Parningotan Yosi Silalahi, Sp.S

BACKGROUND
OABurgency with or without urge
incontinence, generally accompanied by
frequency & nocturia
OAB may be claassified as “wet” or “dry”
Incidence & prevalence of OAB  increases
with increasing age
Prevalence OAB  men = women, men are less
likely to have accompanying urge incontinence

6% without urge incontinence In Canada estimated that OAB affects 12-18% of populations.3% with urge incontinence & 7. & of these individual.9% of women had OAB (9.6 without urge incontinence .4 with urge incontinence & 3.A large national United States telephone survey that was part of the NOBLE program 16. one-third have wet OAB & two-thirds have dry OAB 16% of men had OAB (2.

interstitial cystitis. diabetes. Urethral stricture. genitourinary malignancy. painful bladder syndrome. atrophic vaginitis or vaginal prolapse (in women) Neuropathic process. UTI .Symptoms of OAB = LUTS BPH (in men). bladder stone.

DISCUSSIO N .

Impact of untreated OAB • Can have a profound negative impact on patient’s psychological well-being. quality of life. & physical health • Despite the negative impact of OAB symptoms in quality of lifepatients often don’t mention to physicians a normal part of aging or embarrassed to speak about them .

mixed incontinence . medication (diuretics.DIAGNOSING OAB patient’s historypresence of LUTS or (DM. enlarged prostate (determined by DRE) signs of neurological diseases. CHF. stress. or meatal stenosis Patients with incontinence urgency . constipation). neurological disease. phimosis. vaginal prolapse/atrophy.& antidepressants) dietary habit (excessive fluid/caffeine intake) Physical examinationdistended bladder.

family history) • Not responding therapy . & glucose DM Neurologic conditions A large prostate Frailness in elderlypoor bladder emptying • Hematuria • • • • • Pain • Recurrent UTIs • Risk factor bladder cancer (older age. smoker. male.Urinalisis (hematuria/si gns of UTI Ultrasound postvoid residual (PVR) Cytoscopy • RBCs. nitrites. WBCs.

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MANAGIN G OAB .

Behavioral Therapy Physiother apy Bladder retraining Fluid manageme nt .

Antimuscarinic agents • Mainstays pharmacotheraphy for OAB • Muscarinic receptor in bladderreduce amplitude of normal & involuntary bladder contractions • Improves the functional capacity of bladder  bladder’s storage volume at the first involuntary contraction • In bladder M3 muscarinic receptorstimulating detrusor muscular contraction (salivary gland & gut) dry mouth & constipation .

sweating . dry mouth & respiratory tract. impotence. & muscle weakness . changes in mental status. paralysis of lens accomodation. inhibition of GI motility • Higher dose/all long acting antimuscarinicganglion blockadeorthostatic hypotension. tachycardia.• M1 muscarinic receptor (brain)side effect: confusion • M5 muscarinic receptor (cardiac muscle)side effect : prolonged QT intervalaritmia • Side effects antimuscarinics : pupillary dilatation.

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& Preference” . Safety. improve efficacy ( frequency. & episode of incontinence) & fewer side effects • Various authors reportedantimuscarinic treated in elderly patientpotential CNS impairmentmemory deficits. confusion / hallucinations • When choosing antimuscarinic drugASTEP “Availability. sleep disruption. Efficacy.• IR Oxybutynincomparator drug during clinical trials • Patients showedimproved compliance. urgency. Tolerability.

tablet (0.1 mg/0.Nonmuscarinic agents May be used alone/in combination with antimuscarinic Desmopressin acetate (synhthetic form of ADH vasopressin Desmopressinas a “melt” (60mcg/12omcg).2mg). or nasal spray Other nonmuscarinic drugstrcyclic antidepressant imipramine (tofranil) & amitrityline (Elavil) .

Severe OAB • Not respond behavioral therapy • Can’t tolerate/respond conventional polypharmacologic agents Highly specialized. expensive therapies • Botulinum toxin A (BOTOX) injections • neuromodulator (nerve stimulator) implants • augmentation cystoplasty .

CONCLUSION In most cases. patient with OAB can be initially managed at the primary care level Prevalence of OAB  significantly with  age Behavioral modification & compliance with effective medical therapymost patient enjoy very satisfactory improvement their OAB symptoms Researchersstill searching most effective drug with the fewest/least bothersome /insignificant side effects .

Thank you  .