PATHOPHYSIOLOGY, MECHANISM AND MANAGEMENT OF OVERACTIVE BLADDER SYNDROME-A REVIEW
DOI:
https://doi.org/10.22159/ijpps.2018v10i7.25114Keywords:
Overactive bladder, Neural control, Detrusor muscle, Worldwide prevalence, Invasive therapiesAbstract
An overactive bladder (OAB) is a syndrome which causes an impulsive desire to pass the urine. This desire or urge may become difficult to control and eventually may lead to unintentional passage of urine. The marked increase in a number of patients who suffered with OAB feels very awkward and tries to isolate from societal-life. Such increase in a number of patients has drawn an attention of scientists to research on this area. The proper diagnosis and management of OAB can help the patient to get early relief and cure the symptoms. Looking at the rate of prevalence of OAB in patients, it is essential to understand the pathophysiology, available treatment and recent updates to direct the researchers for further investigation. This review article focuses on comprehensive information of normal bladder physiology, neural control, regulation of micturition, pathophysiology, and prevalence of overactive bladder. This article gives an information regarding diagnosis, different approaches for treatments and future perspective of OAB syndrome.
Downloads
References
Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int 2011;108:1132-8.
Barkin J. Overactive bladder. Can J Urol 2011;18 Suppl 1:8-13.
Blaivas GJ. Overactive bladder and the definition of urgency. Neurourol Urodyn 2007;26:757–8.
Kinsey D, Pretorius S, Glover L, Alexander T. The psychological impact of overactive bladder: a systematic review. J Health Psychol 2016;21:69–81.
Griffiths D. Neural control of micturition in humans: a working model. Nat Rev Urol 2015;12:695-705.
Morrison J, Birder L, Craggs M, De Groat W, Downie J, Drake M, et al. Neural control. In: Abrams P, Cardozo L, Khoury S, Wein A. editors. Incontinence. Jersey: Plymouth Health Publications Ltd; 2005. p. 363-422.
Fry CH, Brading AF, Hussain M. Cell biology. In: Abrams P, Cardozo L, Khoury S, Wein A. editors. Incontinence. Jersey: Plymouth Health Publications Ltd; 2005. p. 313-62.
Holstege G, Mouton LJ. Central nervous system control of micturition. Int Rev Neurobiol 2003;56:123-45.
Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci 2008;9:453–66.
Yamaguchi O. β3-adrenoceptors in human detrusor muscle. Urology 2002;59(5 Suppl 1):25-9.
Andersson KE. Pharmacology of lower urinary tract smooth muscles and penile erectile tissues. Pharmacol Rev 1993;45:253-308.
Chancellor MB, Yoshimura N. Neurophysiology of stress urinary incontinence. Rev Urol 2004;6 Suppl 3:S19-28.
Otsuka A, Shinbo H, Matsumoto R, Kurita Y, Ozono S. Expression and functional role of β-adrenoceptors in the human urinary bladder urothelium. Naunyn Schmiedebergs Arch Pharmacol 2008;377:473-81.
de Groat WC. The urothelium in overactive bladder: passive bystander or active participant? Urology 2004;64:7S-11S.
Lazzeri M. The physiological function of the urothelium–more than a simple barrier. Urol Int 2006;76:289–95.
Sasaki M. Morphological analysis of external urethral and external anal sphincter motoneurones of cat. J Comp Neurol 1994;349:269–87.
Andersson KE. Advances in the pharmacological control of the bladder. Exp Physiol 1999;84:195-213.
Pak KJ, Ostrom RS, Matsui M, Ehlert FJ. The M2-muscarinic receptor inhibits the development of streptozotocin-induced neuropathy in mouse urinary bladder. J Pharmacol Exp Ther 2010;335:239–48.
Andersson KE, Arner A. Urinary bladder contraction and relaxation: physiology and pathophysiology. Physiol Rev 2004;84:935–86.
Janig W, Morrison JF. Functional properties of spinal visceral afferents supplying abdominal and pelvic organs, with special emphasis on visceral nociception. Prog Brain Res 1986;67:87–114.
Fall M, Lindström S, Mazieres L. A bladder-to-bladder cooling reflex in the cat. J Physiol 1990;427:281–300.
Habler HJ, Janig W, Koltzenburg M. Activation of unmyelinated afferent fibres by mechanical stimuli and inflammation of the urinary bladder in the cat. J Physiol 1990;425:545–62.
Athwal BS, Berkley KJ, Hussain I, Brennan A, Craggs M, Sakakibara R, et al. Brain responses to changes in bladder volume and urge to void in healthy men. Brain 2001;124:369–77.
De Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol 2015;5:327–96.
Blok BF, de Weerd H, Holstege G. Ultrasound evidence for a paucity of projections from the lumbosacral cord to the pontine micturition centre or M-region in the cat: a new concept for the organization of the micturition reflex with the periaqueductal gray as a central relay. J Comp Neurol 1995;359:300-9.
De Groat WC, Yoshimura N. Afferent nerve regulation of bladder function in health and disease. Handb Exp Pharmacol 2009;194:91–138.
Rahn DD, Roshanravan SM. Pathophysiology of urinary incontinence, voiding dysfunction, and overactive bladder. Obstet Gynecol Clin North Am 2009;36:463-74.
Ouslander JG. Geriatric considerations in the diagnosis and management of overactive bladder. Urology 2002;60(5, Suppl 1):50-5.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29:4-20.
Brading AF. A myogenic basis for overactive bladder. Urology 1997;50:57-67.
Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology 2003;62 Suppl 5B:28–37.
Gillespie JI. Modulation of autonomous contractility activity in the isolated whole bladder of the guinea pig. BJU Int 2004;93:393-400.
Abrahms P, Andersson KE. Muscarinic receptor antagonists for overactive bladder. BJU Int 2007;100:987-1006.
Ouslander JG. Management of overactive bladder. N Engl J Med 2004;350:786-99.
Eapen RS, Radomski SB. Gender differences in overactive bladder. Can J Urol 2016;23 Suppl 1:2-9.
Milsom I. Overactive bladder: current understanding and future issues. Br J Obstet Gynaecol 2006;113 Suppl 2:2–8.
Tomaszewski J. Postmenopausal overactive bladder. Prz Menopauzalny 2014;13:313-29.
Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006;50:1306–15.
Dambros M, Dambros MC, Lorenzetti F, Ferreira FT, Palma PCR. Understanding the pathophysiology of the overactive bladder in elderly through the study of a specific muscle blocker on the bladder contractions. J Gerontol Geriatr Res 2016;5:270.
Irwin DE, Mungapen L, Milsom I, Kopp Z, Reeves P, Kelleher C. The economic impact of overactive bladder syndrome in six western countries. BJU Int 2009;103:202–9.
Marinkovic SP, Rovner ES, Moldwin RM, Stanton SL, Gillen LM, Marinkovic CM. The management of overactive bladder syndrome. Br Med J 2012;344:38-44.
Arnold J, McLeod N, Thani-Gasalam R, Rashid P. Overactive bladder syndrome: Management and treatment options. Aust Fam Physician 2012;41:878-83.
Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol 2012;188:2455-63.
Bilal C, Robert L, Elise D. Choice of antimuscarinic agents for overactive bladder in the older patient: focus on darifenacin. Clin Interv Aging 2008;3:503–9.
Burgio KL, Locher IL, Goode PS. Combined behavioral and drug therapy for urge incontinence in older women. J Am Geriatr Soc 2000;48:370-4.
Roe B, Ostaszkiewicz J, Milne J, Wallace S. Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings from data analysis and outcomes using metastudy techniques. J Adv Nurs 2007;57:15-31.
Yokoyama O, Yusup A, Miwa Y, Oyama N, Aoki Y, Akino H. Effects of tolterodine on an overactive bladder depend on suppression of C-fiber bladder afferent activity in rats. J Urol 2005;174:2032–6.
Hedlund P, Streng T, Lee T, Andersson KE. Effects of tolterodine on afferent neurotransmission in normal and resiniferatoxin-treated conscious rats. J Urol 2007;178:326–31.
De Laet K, De Wachter S, Wyndaele JJ. Systemic oxybutynin decreases the afferent activity of the pelvic nerve of the rat: new insights into the working mechanism of antimuscarinics. Neurourol Urodyn 2006;25:156–61.
Iijima K, De Wachter S, Wyndaele JJ. Effects of the M3 receptor selective muscarinic antagonist darifenacin on bladder afferent activity of the rat pelvic nerve. Eur Urol 2007;52:842-7.
Boy S, Schurch B, Nehring G, Knapp P, Karsentry G, Reitz A. The effect of tolterodine on sensations evoked by electrical stimulation and bladder filling sensations. Eur Urol Suppl 2006;5:223.
Andersson KE. Antimuscarinics for the treatment of overactive bladder. Lancet Neurol 2004;3:46–53.
Sai Pravin P, Devala Rao G, Jagathi V, Shaiba M, Manohar Babu CH. Spectroflourimetric method for the estimation of darifenacin in pure and pharmaceutical formulations. Asian J Pharm Clin Res 2011;4:44-6.
The electronic Medicines Compendium [Internet]. Pro-Banthine tablets. Summary of Product Characteristics; Available from https://www.medicines.org.uk/emc/print-document?documentId=18550. [Last accessed on 28 Dec 2017]
Barry J, McKay J, Fisher M. Propantheline. Prac Diab 2017; 34:104-5.
The electronic Medicines Compendium [Internet]. Urispas 200 mg Film-coated Tablets. Summary of Product Characteristics. Available from: https://www.medicines.org.uk/emc/print-document? documentId=19613. [Last accessed on 30 May 2016]
The electronic Medicines Compendium [Internet]. Detrunorm XL 30 mg Modified Release Capsules. Summary of Product Characteristics. Updated on 2016 Mar 18. Available from: https://www.medicines.org.uk/emc/print-document?documentId=18501. [Last accessed on 30 May 2016]
Sacco E, Bientinesi R. Mirabegron: a review of recent data and its prospects in the management of overactive bladder. Ther Adv Urol 2012;4:315–24.
Sacco E, Bientinesi R. Mirabegron, a novel, non-antimuscarinic drug for the overactive bladder: an up-to-date review. World J Obstet Gynecol 2013;2:65-73.
Sacco E, Bientinesi R, Tienforti D, Racioppi M, Gulino G, D’Agostino D, et al. Discovery history and clinical development of mirabegron for the treatment of overactive bladder and urinary incontinence. Expert Opin Drug Discovery 2014;9:1-16.
Badawi JK, Uecelehan H, Hatzinger M, Michel MS, Haferkamp A, Bross S. Relaxant effects of beta-adrenergic agonists on porcine and human detrusor muscle. Acta Physiol Scand 2005;185:151-9.
The electronic Medicines Compendium [Internet]. Betmiga 25 mg and 50 mg prolonged-release tablets. Summary of Product Characteristics. Available from https://www.medicines. org.uk/emc/medicine/27429. [Last Accessed on 15 Apr 2016]
Drugs@FDA: FDA Approved Drug Products [Internet]. MYRBETRIQ-Mirabegron 25 mg and 50 mg tablet, film coated, extended release. Highlights of Prescribing Information. Available from:https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm? event=overview.processandApplNo=202611. [Last accessed on 16 Aug 2016].
Dinan TG, O'Brien S, Lavelle E, Scott LV. Further neuroendocrine evidence of enhanced vasopressin V3 receptor responses in melancholic depression. Psychol Med 2004; 34:169-72.
Cachat F. Synthetic DDAVP for nocturnal enuresis and the risk of symptomatic hyponatremia: which treatment now? Which form? Paediatrica 2007;18:54-6.
Aladjem M, Wohl R, Boichis H, Orda S, Lotan D, Freedman S. Desmopressin in nocturnal enuresis. Arch Dis Child 1982;57:137-40.
Robson WL, Leung AK, Norgaard JP. The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis. J Urol 2007;178:24-30.
O'Flynn N. Nocturnal enuresis in children and young people: NICE clinical guideline. Br J Gen Pract 2011;61:360–2.
Geoffrion R, Lovatsis D, Walter JE, Chou Q, Easton W, Epp A, et al. Treatments for overactive bladder: focus on pharmacotherapy. J Obstet Gynaecol Can 2012;34:1092–101.
Roxburgh C, Cook J, Dublin N. Anticholinergic drugs versus other medications for overactive bladder syndrome in adults. Cochrane Database Syst Rev 2007:CD003190.
Orasanu B, Mahajan ST. The use of botulinum toxin for the treatment of overactive bladder syndrome. Indian J Urol 2013;29:2-11.
Hsieh PF, Chiu HC, Chen KC, Chang CH, Chou ECL. Botulinum toxin a for the treatment of overactive bladder. Toxins 2016;8:1-12.
Simpson L. Kinetic studies on the interaction between botulinum toxin type A and the cholinergic neuromuscular junction. J Pharmacol Exp Ther 1980;212:16-21.
Dolly J, Black J, Williams R, Melling J. Acceptors for botulinum neurotoxin reside on motor nerve terminals and mediate its internalisation. Nature 1984;307:457-60.
Mahajan ST, Brubaker L. Botulinum toxin: from a life-threatening disease to novel medical therapy. Am J Obstet Gynecol 2007;196:7-15.
The electronic medicines compendium [Internet]. BOTOX 100 Units. Summary of Product Characteristics. Available from: https://www.medicines.org.uk/emc/medicine/112. [Last accessed on 14 Mar 2017].
Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol 1988;140:1331–9.
Sanford MT, Suskind AM. Neuromodulation in neurogenic bladder. Transl Androl Urol 2016;5:117-26.
Sukhu T, Kennelly MJ, Kurpad R. Sacral neuromodulation in overactive bladder: a review and current perspectives. Res Rep Urol 2016;8:193–9.
Leng WW, Chancellor MB. How sacral nerve stimulation neuromodulation works. Urol Clin North Am 2005;32:11–8.
Spinelli MS, Sievert KD. Latest technologic and surgical developments in using inter stim therapy for sacral neuromodulation: impact on treatment success and safety. Eur Urol 2008;54:1287–96.
Kohli N, Patterson D. InterStim therapy: a contemporary approach to overactive bladder. Rev Obstet Gynecol 2009;2:18–27.
Siegel SW, Catanzaro F, Dijkema HE, Elhilali MM, Fowler CJ, Gajewski JB, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology 2000;56(6 Suppl 1):87–91.
Çetinel B, Kocjancic E, Demirdağ C. Augmentation cystoplasty in neurogenic bladder. Investig Clin Urol 2016;57:316-23.
Drake MJ, Apostolidis A, Emmanuel A, Gajewski J, Harrison SCW, Heesakkers J, et al. Neurologic urinary and faecal incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A. editors. Incontinence. 5th ed. Paris: ICUD-EAU; 2013. p. 827-954.
Johal NS, Hamid R, Aslam Z, Carr B, Cuckow PM, Duffy PG. Ureterocystoplasty: long-term functional results. J Urol 2008;179:2373-5.
Janicki JJ, Chancellor MB, Kaufman J, Gruber MA, Chancellor DD. Potential effect of liposomes and liposome-encapsulated botulinum toxin and tacrolimus in the treatment of bladder dysfunction. Toxins 2016;8:1-9.
Tyagi P, Wu PC, Chancellor M, Yoshimura N, Huang L. Recent advances in intravesical drug/gene delivery. Mol Pharm 2006;3:369–79.
Hung SY, Chancellor DD, Chancellor MB, Chuang YC. Role of the liposome in the treatment of overactive bladder and interstitial cystitis. Urol Sci 2015;26:3-6.
Nirmal J, Chuang YC, Tyagi P, Chancellor MB. Intravesical therapy for lower urinary tract symptoms. Urol Sci 2012;23:70-7.
Hsu CC, Chuang YC, Chancellor MB. Intravesical drug delivery for the dysfunctional bladder. Int J Urol 2013;20:552–62.
El-Sheikh R, Hassan WS, Gouda AA, El-Gabry MM. Sensitive spectrophotometric assay of muscarinic receptor antagonist tolterodine tartrate in bulk drug and pharmaceutical formulations. Asian J Pharm Clin Res 2017;10:346-52.
Sun F, Sui C, Zhou Y, Liu X, Shi Y, Wu Y, et al. Preparation, characterization and pharmacological evaluation of tolterodine hydrogels for the treatment of overactive bladder. Int J Pharm 2013;454:532-8.
Patil V, Belsare D. Development and evaluation of novel drug delivery system of tolterodine tartrate. Int J Appl Pharm 2017;9:29-32.