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Detrusor overactivity: an overview

  • General Gynecology
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Abstract

Detrusor overactivity (DO) is a common clinical problem having profound effects on the quality of life (QOL) of women. With the use of meshes in the antiincontinence surgery, a new onset of DO, de novo DO has become an important issue in postoperative QOL of women. A systematic review of English language literature was conducted from Pubmed and publications of the last 7 years were analyzed and presented in this review. Multiple pathological events in the urothelium, sub-urothelium and possibly in the detrusor muscle seem to underlie the pathophysiology of DO. A variety of approaches, from life style modification to minimal-invasive surgery are available to treat DO and it is the responsibility of the physician to properly select and apply these modalities with the ultimate aim in improving the QOL of the patients. It is imperative to know the various pathophysiological processes that underlie the causation of DO to select proper management approach.

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References

  1. Haylen BT, Ridder D, Freeman RM et al (2010) An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21(1):5–26

    Article  Google Scholar 

  2. Heslington K, Hilton P (1996) Ambulatory monitoring and conventional cystometry in asymptomatic female volunteers. Br J Obstet Gynaecol 103:434–441

    CAS  PubMed  Google Scholar 

  3. Abrams P (2003) Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology 62(5 Suppl 2):28–37

    Article  PubMed  Google Scholar 

  4. Ahlberg J, Edlund C, WikkelsÎ C, Rosengren L, Fall M (2002) Neurological signs are common in patients with urodynamically verified “idiopathic” bladder over activity. Neurourol Urodyn 21:65–70

    Article  PubMed  Google Scholar 

  5. Abrams P (1984) Bladder instability: concept, clinical associations and treatment. Scand J Urol Nephrol Suppl 87:7

    CAS  PubMed  Google Scholar 

  6. Swami SK, Abrams P (1996) Urge incontinence. Urol Clin North Am 23(3):417–426

    Article  CAS  PubMed  Google Scholar 

  7. Moolgaoker AS, Ardren GM, Smith JC et al (1972) The diagnosis and management of urinary incontinence in the female. Br J Obstet Gynaecol 79:481

    CAS  Google Scholar 

  8. Tseng LH, Liang CC, Lo HP, Lo TS, Lee SJ, Wang AC (2006) The prevalence of urinary incontinence and associated risk factors in Taiwanese women with lower urinary tract symptoms. Chang Gung Med J. 29(6):596–602

    PubMed  Google Scholar 

  9. Schimpf MO, O’Sullivan DM, LaSala CA, Tulikangas PK (2007) Anterior vaginal wall prolapse and voiding dysfunction in urogynecology patients. Int Urogyncol J 18(7):721–725

    Article  Google Scholar 

  10. Fowler CJ (2006) Integrated control of lower urinary tract—clinical perspective. Br J Pharmacol 147(Suppl 2):S14–S24

    Article  CAS  PubMed  Google Scholar 

  11. Wiseman OJ, Fowler CJ, Landon DN (2003) The role of the human bladder lamina propria myofibroblast. Br J Urol Int 91:89–93

    CAS  Google Scholar 

  12. Silva C, Riberio MJ, Cruz F (2002) The effect of intravesical resiniferatoxin in patients with idiopathic detrusor instability suggests that involuntary detrusor contractions are triggered by c-fiber input. J Urol 168(2):575–579

    Article  CAS  PubMed  Google Scholar 

  13. Ferguson D, Kennedy I, Buton T (1997) ATP is released from rabbit urinary bladder epithelial cells by hydrostatic pressure changes: a possible sensory mechanism. J Physiol 505:503–511

    Article  CAS  PubMed  Google Scholar 

  14. Rapp DE, Lyon MB, Bales GT, Cook SP (2005) A role for the P2X receptor in urinary tract physiology and in the pathophysiology of urinary dysfunction. Eur Urol 48(2):303–308

    Article  CAS  PubMed  Google Scholar 

  15. Fry CH, Sui GP, Severs NJ, Wu C (2004) Spontaneous activity and electrical coupling in human detrusor smooth muscle: implications for detrusor overactivity? Urology 63(3 Suppl 1):3–10

    Article  PubMed  Google Scholar 

  16. Elbadawi A, Yalla SV, Resnick NM (1993) Structural basis for geriatric voiding dysfunction 3: detrusor instability. J Urol 150(5 Pt 2):1668–1680

    CAS  PubMed  Google Scholar 

  17. Sui G, Fry CH, Malone-Lee J, Wu C (2009) Aberrant Ca2+ oscillations in smooth muscle cells from overactive human bladders. Cell Calcium 45(5):456–464

    Article  CAS  PubMed  Google Scholar 

  18. Fugimura T, Tamura K, Tsutsumi T et al (1999) Expression and possible functional role of β-3 adrenoceptor in human and rat detrusor muscle. J Urol 161(2):680–685

    Article  Google Scholar 

  19. Birder LA, Apodaca G, de Graoat WC, Kanai AJ (1998) Adrenergic and capsaicin evoked nitric oxide release from urothelium and afferent nerves in urinary bladder. Am J Physiol 275:F226–F229

    CAS  PubMed  Google Scholar 

  20. Yoshimura N, Seki S, de Graoat WC (2001) Nitric oxide modulates Ca2+ channels in dorsal root ganglion neurons innervating rat urinary bladder. J Neurophysiol 86:304–311

    CAS  PubMed  Google Scholar 

  21. Pandita RK, Mizusawa H, Anderson KE (2000) Intravesical oxyhemoglobin initiates bladder overactivity in conscious, normal rats. J Urol 164:545–550

    Article  CAS  PubMed  Google Scholar 

  22. Huang KH et al (2005) Concomitant pelvic organ prolapse surgery with TVT procedure. Int Urogynecol J 17:60–65

    Article  Google Scholar 

  23. Liapis A, Bakas P, Creastas G (2008) Long-term efficacy of tension-free vaginal tape in the management of stress urinary incontinence in women: efficacy at 5- and 7-year follow-up. Int Urogynecol J 19:1509–1512

    Article  CAS  Google Scholar 

  24. Alcalay M, Monga A, Stanton SL (1995) Burch colposuspension: a 10–20-year follow-up. Br J Obstet Gynecol 102:740–745

    CAS  Google Scholar 

  25. Tsui KP et al (2008) Outcomes of autologous fascial sling plasty procedure for treating female urinary incontinence. Int Urogynecol J 19:949–954

    Article  Google Scholar 

  26. Botros SM et al (2005) Following midurethral versus bladder sling procedures. AJOG 193(6):2144–2148

    Article  Google Scholar 

  27. Botros SM et al (2007) Detrusor overactivity and urge urinary incontinence following trans obturator versus midurethral slings. Neurourol Urodyn 26:42–45

    Article  PubMed  Google Scholar 

  28. Cardozo LD, Stanton SL, Williams JE (1979) Detrusor instability following surgery for genuine stress incontinence. Br J Urol 51:204–207

    Article  CAS  PubMed  Google Scholar 

  29. Holmgren C, Nilsson S, Lanner L, Hellberg D (2007) Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence: a long-term follow-up. Eur J Obstet Gynecol Reprod Biol 132(1):121–125

    Article  PubMed  Google Scholar 

  30. Bombieri L, Freeman RM, Perkins EP, Williams MP, Shaw SR (2003) Why do women have voiding dysfunction and de novo detrusor instability after colposuspension? Br J Obstet Gynecol 109(4):402–412

    Google Scholar 

  31. Steel SA, Cox C, Stanton SL (1986) Long term follow up of detrusor instability following the colposuspension operation. Br J Urol 58:138–142

    Article  CAS  PubMed  Google Scholar 

  32. Lockhart JL, Tirado A, Morillo G, Politano VA (1982) Vesicourethral dysfunction following cystourethropexy. J Urol 128:943–945

    CAS  PubMed  Google Scholar 

  33. Austin P et al (1996) Urethral obstruction after anti-incontinence surgery in women: evaluation, methodology, and surgical results. Urology 47(6):890–894

    Article  CAS  PubMed  Google Scholar 

  34. Cucchi A (1999) Sequential changes in voiding dynamics related to the development of detrusor instability in women with stress urinary incontinence. Neurourol Urodyn 18:73–80

    Article  CAS  PubMed  Google Scholar 

  35. Alperin M, Abrahams-Gesse S, Wakamatsu MM (2008) Development of de novo urge incontinence in women post sling: the role of preoperative urodynamics in assessing the risk. Neurourol Urodyn 27:407–411

    Article  PubMed  Google Scholar 

  36. Wang AC, Wu RC, Lin CT, Chen MC (2008) A microbiological and immunohistochemical analysis of periurethral and vaginal tissue in women with de novo urge symptoms after mid-urethral sling procedures: a prospective case-controlled study. Int Urogynecol J 19:1145–1150

    Article  CAS  Google Scholar 

  37. Roumeguère T, Quackels T, Bollens R, de Groote A, Zlotta A, Bossche MV, Schulman C (2005) Trans-obturator vaginal tape (TOT®) for female stress incontinence: one year follow-up in 120 patients. Eur Urol 48(5):805–809

    Article  PubMed  Google Scholar 

  38. Latthe PM, Foon R, Toozs-Hobson P (2007) Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. Br J Obstet Gynecol 114:522–531

    CAS  Google Scholar 

  39. Holmgren C, Nilsson S, Lanner L, Hellberg D (2007) Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence: a long-term follow-up. Eur J Obstet Gynecol Rep Biol 132(1):121–125

    Article  Google Scholar 

  40. Parsons M et al (2007) Bladder diary patterns in detrusor overactivity and urodynamic stress incontinence. Neurourol Urodyn 26:800–806

    Article  PubMed  Google Scholar 

  41. Kannan H, Radican L, Turpin RS, Bolge SC (2009) Burden of illness associated with lower urinary tract symptoms including overactive bladder/urinary incontinence. Urology 74(1):34–38

    Article  PubMed  Google Scholar 

  42. Romanzi LJ, Groutz A, Heritz DM, Blaivas JG (2001) Involuntary detrusor contractions: correlation of urodynamic data to clinical categories. Neurourol Urodyn 20:249–257

    Article  CAS  PubMed  Google Scholar 

  43. Kuo HC (2004) Urodynamic parameters for the diagnosis of bladder outlet obstruction in women. Urol Int 72:46–51

    Article  PubMed  Google Scholar 

  44. Robertson AS (1999) Behaviour of the human bladder during natural filling: the Newcastle experience of ambulatory monitoring and conventional artificial filling cystometry. Scand J Urol Nephrol Suppl 201:19–24

    Article  CAS  PubMed  Google Scholar 

  45. Bradshaw HD, Radley SC, Rosario DJ, Chapple CR (2005) Towards a better understanding of involuntary detrusor activity. BJU 95:799–803

    Article  Google Scholar 

  46. Wyman JF, Fantl JA, McClish DK, Bump RC (1998) Comparative efficacy of behavioral interventions in the management of female urinary incontinence: Continence Program for Women Research Group. Am J Obstet Gynecol 179:999–1007

    Article  CAS  PubMed  Google Scholar 

  47. Burgio KL, Kraus SR, Menefee S et al (2008) Behavioral therapy to enable women with urge incontinence to discontinue drug treatment: a randomized trial. Ann Intern Med 149(3):161–169

    PubMed  Google Scholar 

  48. Novara G, Galfano A, Secco S et al (2008) A systematic review and meta-analysis of randomized controlled trials with antimuscarinic drugs for overactive bladder. Eur Urol 54:740–764

    Article  CAS  PubMed  Google Scholar 

  49. Dmochowski RR, Sand PK, Zinner NR, for the Transdermal Oxybutynin Study Group et al (2003) Comparative efficacy and safety of transdermal oxybutynin and oral tolterodine versus placebo in previously treated patients with urge and mixed urinary incontinence. Urology 62:237–242

    Article  PubMed  Google Scholar 

  50. MacDiarmid SA (2009) The evolution of transdermal/topical overactive bladder therapy and its benefits over oral therapy. Rev Obstet Gynecol 2(2):116–121

    PubMed  Google Scholar 

  51. Stahl MMS, Eckstrom B, Sparf A et al (1995) Urodynamic and other effects of tolterodine: a novel antimuscarinic drug for the treatment of detrusor overactivity. Neurourol Urodyn 14:647–655

    Article  CAS  PubMed  Google Scholar 

  52. Doroshyenko O, Jetter A, Odenthal KP et al (2005) Clinical pharmacokinetics of trospium chloride. Clin Pharmacokinet 44:701–720

    Article  CAS  PubMed  Google Scholar 

  53. Staskin DR (2006) Trospium chloride: distinct among other anticholinergic agents available for the treatment of overactive bladder. Urol Clin North Am 33(4):465–473

    Article  PubMed  Google Scholar 

  54. Halaska M, Ralph G, Wiedemann A, Primus G, Ballering-Brühl B, Höfner K, Jonas U (2003) Controlled, double-blind, multicentre clinical trial to investigate long-term tolerability and efficacy of trospium chloride in patients with detrusor instability. World J Urol 20(6):392–399

    CAS  PubMed  Google Scholar 

  55. Ohtake A, Ukai M, Hatanaka T et al (2004) In vitro and in vivo tissue selectivity profile of solifenacin succinate (YM905) for urinary bladder over salivary gland in rats. Eur J Pharmacol 492:243–250

    Article  CAS  PubMed  Google Scholar 

  56. Chappel CR, Martinez-Garcia R, Selvaggi L et al (2005) A comparison of the efficacy and tolerability of solifenacin succinate and extended release tolterodine at treating overactive bladder syndrome: results of the STAR trial. Euro Urol 48(3):464–470

    Google Scholar 

  57. Nelson CP, Gupta P, Napier CM et al (2004) Functional selectivity of muscarinic receptor antagonists for inhibition of M3-mediated phosphoinositide responses in guinea pig urinary bladder and submandibular salivary gland. J Pharmacol Exp Ther 310(3):1255–1265

    Article  CAS  PubMed  Google Scholar 

  58. Steers WD (2006) Darifenacin: pharmacology and clinical usage. Urol Clin North Am 33(4):475–482

    Article  PubMed  Google Scholar 

  59. Zinner N, Kobashi KC, Ebinger U, Viegas A, Egermark M, Quebe-Fehling E, Koochaki P (2008) Darifenacin treatment for overactive bladder in patients who expressed dissatisfaction with prior extended-release antimuscarinic therapy. Int J Clin Pract 62(11):1664–1674

    Article  CAS  PubMed  Google Scholar 

  60. Ney P, Pandita RK, Newgreen DT, Breidenbach A, Stöhr T, Andersson KE (2008) Pharmacological characterization of a novel investigational antimuscarinic drug, fesoterodine, in vitro and in vivo. BJU Int 101(8):1036–1042

    Article  CAS  PubMed  Google Scholar 

  61. Sand PK, Morrow JD, Bavendam T, Creanga DL, Nitti VW (2009) Efficacy and tolerability of fesoterodine in women with overactive bladder. Int Urogynecol J 20:827–835

    Article  Google Scholar 

  62. Apostolidis A, Dasgupta P, Fowler CJ (2006) Hypothesis for the remarkable efficacy of injected botulinum toxin in the treatment of human detrusor overactivity (DO). Eur Urol 49(4):644–650

    Article  CAS  PubMed  Google Scholar 

  63. Apostolidis A, Dasgupta P, Denys P et al (2009) Recommendations on the use of botulinum toxin in the treatment of lower urinary tract disorders and pelvic floor dysfunctions: a European consensus report. Euro Urol 55:100–120

    Article  CAS  Google Scholar 

  64. de Groat WC, Nadelhaft I, Milne RJ, Booth AM, Morgan C, Thor K (1981) Organization of the sacral parasympathetic reflex pathways to the urinary bladder and large intestine. J Auton Nerv Syst 3(2–4):135–160

    PubMed  Google Scholar 

  65. Leng WW, Morrisroe SN (2006) Sacral nerve stimulation for the overactive bladder. Urol Clin N Am 33:491–501

    Article  Google Scholar 

  66. Weil EH, Ruiz-Cerdá JL, Eerdmans PH, Janknegt RA, Bemelmans BL, van Kerrebroeck PE (2000) Sacral root neuromodulation in the treatment of refractory urinary urge incontinence: a prospective randomized clinical trial. Eur Urol 37(2):161–171

    Article  CAS  PubMed  Google Scholar 

  67. Vandoninck V et al (2003) Tibial nerve stimulation in the treatment of urge incontinence. Neurourol Urodyn 22:17–23

    Article  PubMed  Google Scholar 

  68. George NK, Russel GL (1991) Clam ileocystoplasty. Br J Urol 68:487–489

    Article  CAS  PubMed  Google Scholar 

  69. Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB (2006) Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet 367(9518):1241–1246

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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  1. Department of Urogynecology, Chang-Gung Memorial Hospital, Linkou, Taiwan

    Kiran Ashok & Alex Wang

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  1. Kiran Ashok
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  2. Alex Wang
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Correspondence to Kiran Ashok.

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Ashok, K., Wang, A. Detrusor overactivity: an overview. Arch Gynecol Obstet 282, 33–41 (2010). https://doi.org/10.1007/s00404-010-1407-3

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