Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Urinary Bladder, Overactive”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 577 records · Page 32Linked to original sources
PubMed2006

Voiding dysfunction and the Williams-Beuren syndrome: a clinical and urodynamic investigation.

PURPOSE: WBS is an autosomal dominant disorder that includes features such as developmental delay, cardiovascular anomalies, mental retardation and characteristic facial appearance. We systematically investigated the prevalence and spectrum of voiding dysfunction in this population. MATERIALS AND METHODS: We prospectively evaluated 16 boys and 12 girls with WBS, with a mean age of 9.7 years (range 3 to 19). Urological evaluation included history of urinary symptoms and impact on quality of life, voiding diary, urodynamics and radiological evaluation with urinary tract sonography, voiding cystourethrography and renal scintigraphy. RESULTS: A total of 22 patients (78.6%) were symptomatic, including 15 (53.6%) with a significant negative impact on the quality of life. Increased urinary frequency was the most common complaint, present in 17 patients (60.7%), followed by enuresis (50%) and urge incontinence (42.8%). A total of 14 patients (50%) had urinary tract abnormalities, with bladder diverticula as the predominant anomaly (10 of 23 patients, or 43.5%). Urodynamics revealed detrusor overactivity in 17 patients (60.7%), detrusor-sphincter dyssynergia with detrusor overactivity in 4 (14.3%) and detrusor-sphincter dyssynergia without detrusor overactivity in 2 (7.1%). An average reduction of 28.3% of the cystometric capacity in comparison to expected capacity for age was found (p <0.001). Urodynamic abnormalities were significantly associated with the presence of voiding symptoms (p = 0.003) and bladder diverticula (p = 0.001). CONCLUSIONS: Children with the Williams-Beuren syndrome are at high risk for presenting with voiding dysfunction and structural abnormalities, and should undergo a minimum evaluation that includes voiding history and urinary tract sonography, while urodynamics, VCUG and additional studies should be performed in symptomatic patients or those whose initial evaluation shows significant abnormalities.

Adolescent↗
PubMed2006

[Urinary incontinence and descensus genitalis--the silent sickness].

In the last few years, urogynaecology has become a very innovative gynaecological subspecialty. New findings have led to a multitude of different medicinal and operative therapy options. Stress incontinence can be improved by sling procedures in more than 80% of patients. Likewise, new drugs to treat stress incontinence have been available for some time. Injections of botulinum toxin A into the detrusor muscle are a promising treatment strategy in cases of therapy-resistant overactive bladder.

Female↗
PubMed1995

[Physiopathology of BPH obstruction].

The underlying BPH related mechanisms of outlet obstruction are outlined (modification of the shape of the bladder neck, failure of funnel formation, geometric variations of the urethra, alpha 1 adrenoceptors mediated sympathetic hyperactivity at the level of the lower genito-urinary tract). Bladder voiding dysfunction in response to prostate obstruction is also discussed and correlated to ultrastructural patterns and clinical symptoms. Finally, a pathogenetic mechanism for detrusor overactivity in obstructed bladder is suggested.

Humans↗
PubMed2005

Intraoperative recording of sacral root nerve signals in humans.

Electroneurographic signals were intraoperatively recorded from the S3 sacral nerve root in two SCI patients. The aim of this study was to record afferent nerve signals in response to mechanical stimulation of the urinary bladder, rectum, and dermatome. Such signals could be used in an implantable neuroprosthesis to treat neurogenic detrusor overactivity. In both patients a neural response was recorded from the dermatome and the rectum, but from the bladder only in one patient. The results were consistent with results from animal and other human studies. Further studies are however, needed because the number of subjects investigated remains low.

Adult↗
PubMed2006

Transdermal oxybutynin: sticking to the facts.

OBJECTIVES: This article critically reviews all the available published and presented data about transdermal oxybutynin to provide a summary of its efficacy, tolerability, and acceptability. RESULTS: For patients with urge incontinence or mixed incontinence, transdermal oxybutynin offers equivalent efficacy to variable dose oral oxybutynin IR and tolterodine LA 4 mg/d. At present no data are available for patients with frequency and urgency but without incontinence (overactive bladder [OAB] dry). Transdermal oxybutynin offers marked improvements compared with placebo in incontinence episodes, daily urinary frequency, and nocturia. These objective improvements are matched by improvements in quality of life. The rate of anticholinergic side-effects is lower than that for oral anticholinergic preparations. This benefit is offset by a rate of local skin reactions. CONCLUSIONS: The balance of efficacy and tolerability suggests that transdermal oxybutynin should be considered as a potential first-line therapy in OAB or mixed incontinence.

Administration, Cutaneous↗
PubMed2003

Clinical efficacy and tolerability of extended-release tolterodine and immediate-release oxybutynin in Japanese and Korean patients with an overactive bladder: a randomized, placebo-controlled trial.

OBJECTIVE: To compare extended-release (ER) tolterodine and immediate-release (IR) oxybutynin with placebo in Japanese and Korean patients with an overactive bladder (OAB). PATIENTS AND METHODS: Men and women aged >or= 20 years with symptoms of urinary urgency, urinary frequency (>or= 8 micturitions/24 h), urge incontinence (>or= 5 episodes/week) and symptoms of OAB for >or= 6 months were randomized to double-blind treatment with tolterodine ER 4 mg once daily, oxybutynin IR 3 mg three times daily or placebo for 12 weeks. Efficacy assessments included changes from baseline in numbers of incontinence episodes per week, voids/24 h and mean volume voided/void. Patient perceptions of bladder condition, urgency and treatment benefit were also assessed. RESULTS: In all, 608 patients were randomized to treatment with tolterodine (240), oxybutynin (246) or placebo (122). More patients prematurely withdrew on oxybutynin (23%) than with tolterodine (10.4%) or placebo (16.4%). After 12 weeks of treatment, the median number of incontinence episodes/week was reduced significantly more in the tolterodine (79%; P= 0.0027) and oxybutynin groups (76.5%; P= 0.0168) than on placebo (46.4%). There were also significantly greater improvements in the number of voids/24 h and volume voided/void with tolterodine and oxybutynin than with placebo. More patients in the tolterodine and oxybutynin than in the placebo groups reported improvements in perceived bladder condition, ability to hold urine and treatment benefit. Patients treated with oxybutynin reported more adverse events than those treated with tolterodine or placebo. Dry mouth was significantly more common with oxybutynin than with tolterodine (53.7% vs. 33.5%; P < 0.001), and occurred in 9.8% of placebo patients. CONCLUSION: Tolterodine ER has similar efficacy but is better tolerated than oxybutynin IR in Japanese and Korean patients with OAB.

Adult↗
PubMed2004

Stating the case for overactive bladder: a nurse practicioner's perspective.

Overactive bladder (OAB) is a widespread syndrome characterized by symptoms of urgency, with or without urge urinary incontinence, frequency of micturition, and nocturia. Urgency is a sudden, intense, difficult-to-defer desire to pass urine and must be differentiated from normal urge or desire to void that can be deferred. It is the core symptom of OAB in the International Continence Society definition. Many misconceptions surround OAB, including that it is a normal part of aging; these contribute to the barriers to OAB diagnosis. Women are more likely than men to have OAB with incontinence; these women report diminished quality of life and are more susceptible to sleep disorders, fractures, and infections. The nurse practitioner plays an important role in diagnosing OAB during examination by eliciting specific information about symptoms from patients in their care, and in determining which treatment approaches (i.e., behavioral, pharmacologic, or a combination of both) will help them achieve optimal outcomes.

Age Distribution↗
PubMed2006

The prevalence of overactive bladder and nocturnal enuresis in Japanese early adolescents: a questionnaire survey.

To assess the prevalence of overactive bladder (OAB) and nocturnal enuresis (NE) in early adolescents, we distributed an anonymous questionnaire about urinary symptoms to 624 middle school students aged 13 and 15 years. The questionnaire included items regarding age, gender, past and present diseases, urinary symptoms and bowel habits. OAB was defined as symptoms of increased daytime frequency occurring more than eight times during the daytime and/or urge incontinence occurring at least once a month. The overall response rate to the questionnaire was 32.4%, and the mean age +/- SD of all respondents was 13.9 +/- 0.89 years. The prevalence of OAB was 15.3% of all respondents (95% CI, 10.4-20.3%; 4.2-16.1% of boys and 12.5-28.3% of girls). The prevalence of OAB decreased with age from 17.6% of respondents aged 13-year-olds to 11.8% of 15-year-olds. The mean daytime frequency was 5.0 +/- 2.2 times. Increased daytime frequency was found in 10.4% (95% CI, 6.2-14.6%; 2.7-13.5% of boys and 6.1-19.0% of girls) and nocturia in 4.0% (95% CI, 1.3-6.7%). The prevalence of NE was 3.0% (95% CI, 0.65-5.4%; three boys and three girls). The results of this study demonstrate that some early adolescents had OAB or NE. Further large-scale studies would be required to investigate the prevalence and natural history of OAB and NE.

Adolescent↗
PubMed1991

The bladder cooling test for urodynamic assessment: analysis of 400 examinations.

The clinical significance of the bladder cooling test as one part of a standard urodynamic examination was studied in 375 consecutive patients and 25 controls. Inability to perceive cold sensation in the bladder was common in cases of neurogenic lesions and present in nearly half of the patients with outlet obstruction, some with no urodynamic abnormalities and some of the normal subjects. The bladder contractions provoked by the test were clearly associated with detrusor overactivity, as in those patients with upper motor neuron lesions of motor urgency, but 27% of such patients showed no response. In 7 cases the iced water provoked detrusor contractions when cystometry showed no overactivity. This clinical series confirms that the cold receptors found recently in animal experiments are also present in the human urinary bladder. The bladder cooling test is not an alternative to cystometry, but its inclusion as an integral part of the urodynamic examination seems to be useful, especially in cases where there is also a need to study the sensibility of the bladder at the same time.

Adolescent↗
PubMed2007

Correlation between urodynamics and perineal ultrasound in female patients with urinary incontinence.

AIMS: We performed urodynamics and perineal ultrasound in female patients with urinary incontinence to assess morphology and function of the bladder base-urethra complex and of the detrusor muscle, and to find the correlation between these investigations in the diagnosis of (a) bladder neck and urethral hypermobility and (b) detrusor overactivity; we wanted to compare the tolerabililty of the urodynamic investigation and of the perineal ultrasound. METHODS: We considered 66 female patients referred to our outpatient clinic for urinary incontinence; we also studied 14 healthy control patients. After accurate case-history collection and physical examination, urodynamic investigation and perineal ultrasound were performed, with recording of parameters specific to both investigations. The statistical analysis was performed by ANOVA, Bonferroni post hoc test, and Spearman correlation test. The tolerability index between the diagnostic investigations performed was assessed by a 3-point scale suggested by the patient. RESULTS: In patients with stress incontinence the posterior urethro-vesical angle, the angle of urethral inclination, and the proximal pubo-urethral distance are significantly different under stress compared to the resting phase; in patients with urge incontinence, the detrusor wall is thicker and is accompanied by an increase in opening detrusor pressure and detrusor pressure at maximum flow; it is also accompanied by detrusor overactivity with increased urethral functional length. Increased urethral functional length is suggested on axial US images by alteration of its normal characteristic target-like appearance with four concentric rings of different echogenicity. In all cases the tolerability of perineal ultrasound has been higher than that of urodynamics. CONCLUSIONS: There is a good correlation between urodynamic and perineal ultrasound in the diagnosis of bladder neck and urethral hypermobility; perineal ultrasound can also be useful in the diagnosis of urge incontinence. Functional compressive urethral obstruction can be diagnosed on the basis of the ultrasound aspect of the urethral sphincter.

Adult↗
PubMed2002

Effect of spinal cord abnormalities on the function of the lower urinary tract in patients with anorectal abnormalities.

PURPOSE: We evaluated the effect of spinal cord abnormalities on lower urinary tract function in patients with anorectal abnormalities. MATERIALS AND METHODS: We examined 30 patients with anorectal anomalies mainly because of fecal or urinary incontinence. All patients underwent spinal magnetic resonance imaging and urodynamic investigation. RESULTS: Major lumbosacral abnormalities were detected in 57% of patients, including 13, 4 and 3 with a tethered cord, syringomyelia and caudal regression, respectively. Significant dysfunction of the lower urinary tract in 57% of the cases involved an overactive detrusor in 11, detrusor-sphincter dyssynergia in 4, distended bladder in 4 and lazy bladder in 1. When the spinal cord was normal, 54% of the patients had abnormal urodynamic findings but when the spinal cord was abnormal, 59% had abnormal urodynamics. When the bony spine was normal, 33% of the patients had an abnormal spinal cord but when the bony spine was abnormal, 69% had an abnormal spinal cord. CONCLUSIONS: Patients with anorectal abnormalities and fecal or urinary incontinence problems often have an abnormal spinal cord and abnormal urodynamic findings. However, the state of the spinal cord is not the only factor explaining lower urinary tract function. Thus, the possibility of lower urinary tract dysfunction should be considered in each patient with anorectal abnormalities. If the patient has symptoms or findings suggesting abnormal lower urinary tract function urodynamic evaluation should be performed.

Adolescent↗
PubMed2004

[Comparative study of tension-free vaginal tape and fascia lata for stress urinary incontinence].

OBJECTIVE: To compare the efficacy of surgically managing stress urinary incontinence (SUI) with tension-free vaginal tape (TVT) and autologous fascia lata pubovaginal sling (Lata). METHODS: Sixty-seven patients suffering from SUI entered this prospective study. The patients were divided into two groups randomly, 48 in TVT group and 19 in Lata group. The average follow-up time post-operation was 20 months in TVT group and 37 months in Lata group. RESULTS: The operating time was (27 +/- 5) min in TVT and (125 +/- 13) min in Lata. The volume of blood loss during surgery was: (27 +/- 6) ml in TVT and (67 +/- 11) ml in Lata. The post-operative recovery period in the hospital was: TVT, 1.8 days and Lata, 7.2 days. The differences between the two groups for these three parameters were statistically significant (P < 0.01). The 3-month cure rate post-operations was 94% (45/48) for TVT and 95% (18/19) for Lata. The surgical complications included 1 case of vesical perforation and 2 cases of overactive bladder in TVT group. CONCLUSIONS: TVT and Lata are both effective and safe surgical treatments for stress urinary incontinence. TVT has the benefits of being minimally invasive with a shorter operating time and a quicker recovery for the patients. A disadvantage is that the tape used in TVT is expensive, making the operation rather costly. Lata on the other hand is cheaper and may result in fewer complications, but the operation is not as easy for the patient.

Aged↗
PubMed2003

Botulinum toxin treatment of urethral and bladder dysfunction.

Botulinum toxin (BTX) is the most lethal naturally occurring toxin known to mankind. Injection of BTX into the urethral sphincter or bladder is an effective treatment for lower urinary tract dysfunction. We reviewed the literature on the mechanisms of action and clinical efficacy of BTX treatment in urologic diseases, with a focus on lower urinary tract dysfunction. Injection of BTX is safe and effective in the treatment of detrusor-sphincter dyssynergia, non-neurogenic pelvic floor spasticity, and refractory overactive bladder. Urodynamic assessment after sphincter injection with BTX reveals a decrease of bladder voiding pressure, urethral pressure profile, and post-void residual urine. An increase of the functional bladder capacity and a decrease of the bladder voiding pressure can be seen after bladder injection with BTX. Clinical improvement was found in a moderate percentage of treated patients in most reported series and lasted for 3 to 14 months without significant adverse effects. In addition, BTX-A treatment inhibits afferent-nerve-mediated bladder contraction. This analgesic effect may expand the application of BTX in the localized genitourinary tract pain syndrome, such as interstitial cystitis and prostatodynia. In conclusion, application of BTX is a promising treatment for lower urinary tract dysfunction with profound basic and clinical implications.

Anti-Dyskinesia Agents↗
PubMedDate not supplied

Experimental models to study the physiology, pathophysiology, and pharmacology of the lower urinary tract.

The lower urinary tract is subject to a number of functional disorders, the most common of which, in humans, is bladder overactivity. To understand its pathophysiological basis, several in vitro and in vivo methodologies have been developed. In vitro tension recording from multicellular strips is in widespread use, and alternative experimental arrangements to a conventional organ bath are described, the relative merits are discussed, and the different experimentally derived variables are evaluated. Other methodologies, such as skinned fibres and whole bladder preparations, are also described. Electromyography in the isolated bladder is now feasible, and its potential uses discussed. The use of isolated smooth muscle cells is presented, especially with respect to the measurement of intracellular ion concentrations and electrophysiological parameters. The development of methods to prepare other cell types from the lower urinary tract is also introduced. A large-scale culture of urothelial and smooth muscle cells is possible, and their use as experimental tools, as well as a substrate for the development of surgical implants, is presented. Finally, different in vivo models of the lower urinary tract are presented, with reference to their investigation of clinical problems. These include models of bladder outflow obstruction, bladder ischaemia, bladder denervation, and congenital abnormalities and their influence on foetal development of the lower urinary tract.

Animals↗