OVERACTIVE BLADDER

PATHOPHYSIOLOGY
• Multifocal and exaggerated MICROMOTIONS
• Neurogenic hypothesis
• Myogenic hypothesis
• Integrative hypothesis
• Aging
• Female gender
• Bladder outlet obstruction
• Neurologic disease
• Metabolic syndrome
• IBS
• Fibromyalgia
• History, physical exam, and urinalysis.
• Must consider the possibility of malignancy, neurologic disease,
systemic disease, or a significant postvoid residual.
• Symptom assessment questionnaire.
• FVC is the principal method for evaluating frequency and nocturia in an
objective way.
• Urodynamics, cystoscopy, and diagnostic ultrasound KUB should not be
used in the initial workup of the uncomplicated patient.
• Unlike OAB, in BPS there is a steady increase in pain withfilling, more
consistent voided volumes, and the ability to defer voiding
 QUESTIONAIRES
• The urinary sensation scale (Abrams et al, 2005a)
• The urgency percentage scale (Cardozo et al, 2002)
• The Indevus “Urgency Severity Scale” (Bowden et al, 2003)
• “urgeometer” (Oliver et al, 2003)
• Incontinence Questionnaire (ICIQ) group (Abrams et al, 2006)
• Patient Perception of Intensity of Urgency Scale (PPIUS) (Cartwright et
al, 2011)
 UDE
• Detrusor overactivity. Detrusor overactivity is a generic term that
refers to the presence of involuntary detrusor contractions during
cystometry, which may be spontaneous or provoked
• Phasic DO
• Terminal DO
PHASIC DO
TERMINAL DO
TYPE 1 OAB
TYPE 2 OAB
TYPE 3 OAB
TYPE 4 OAB
• Surgical therapy sacral nerve stimulation, tibial nerve stimulation,
intravesical botulinum neurotoxin-A injections, augmentation
cystoplasty, and detrusor myectomy.
• Containment for intractable OAB, options are appliances, catheters
(urethral or suprapubic), urethral closure, and urinary diversion