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Detrusor Overactivity Updated 4/2010

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BASICS

  • Description
  • Epidemiology
  • Risk Factors
  • General Prevention
  • Pathophysiology
  • Associated Conditions

DIAGNOSIS

  • Signs and Symptoms
  • Tests
  • Differential Diagnosis

TREATMENT

  • Medication (Drugs)
  • Surgery

Ongoing Care

  • Prognosis
  • Complications
  • Follow-Up Recommendations
The following is an excerpt....
BASICS
Description
  • OAB syndrome presents with symptoms of urinary urgency, usually combined with frequency and nocturia:
    • Either associated with urinary incontinence (OAB wet) or without urinary incontinence (OAB dry)
    • Key symptom is urinary urgency.
    • Urgency is defined as a sudden compelling desire to void that is difficult to defer.
  • DO is a urodynamic observation characterized by involuntary detrusor (bladder muscle) contractions during bladder filling:
    • DO is classified as neurogenic when associated with a relevant neurologic condition and idiopathic when there is no defined cause.
Epidemiology

Current population-based estimates from Europe and the US suggest 11–17% of adults display OAB symptoms.

ALERT: Geriatric Considerations
  • Prevalence of OAB increases with age, with over 1/3 of the population over 75 ...

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Figure 29.5. Surgical therapy for urinary incontinence. (A1-A3) Anterior vaginal wall repair, the Kelly-Kennedy procedure. (A1) Anterior vaginal wall is opened and undermined. (A2) Paraurethral tissue lateral to the urethrovesical (UV) junction is sutured. (A3) This creates a firm bar of tissue that supports the UV junction. (B1-B4) Retropubic suspension procedures, the Marshall-Marchetti-Krantz procedure. (B1) The suture is placed in the periurethral tissue and then into the pubic periosteum so that (B2) the urethra may be advanced upward into an intra-abdominal position. (B3) The Burch procedure, by which the tissue adjacent to the UV angle is sutured to the iliopectineal (Coopers) ligament. (B4) The Richardson paravaginal repair, by which the sutures are placed between the superior sulcus of the vagina and lateral pelvic side wall at the level of the iliopectineal line. (C1-C3) Sling procedures. (C1) The Pereyra procedure, by which a needle is guided transabdominally into the paraurethral tissue and back through (C2) to be tied suprapubically, thus supporting the UV angle. (C3) The Stamey procedure, by which a Dacron support material is used in the paraurethral tissue to buttress the tissue. Credit: From Beckmann CRB M.D., M.H.P.E., Ling FW M.D., Laube DW M.D., M.ED., Smith RP M.D., Barzansky BM PH.D., M.H.P.E., and Herbert WNM.D.. Obstetrics and Gynecology, 4th Edition. Baltimore: Lippincott Williams & Wilkins, 2002.
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