What Is Involved in Surgery for Overactive Bladder?

Overactive bladder (OAB) is a syndrome characterized by urgency symptoms, often accompanied by frequent urination and nocturia, and may or may not be accompanied by urgent urinary incontinence, which significantly affects patients' daily life and social activities. Become a major disease that bothers people. In recent years, as China has entered an aging society and the growth of diabetes and neurologically damaging diseases, the incidence of secondary related diseases, such as overactive bladder, has also increased year by year.

Basic Information

English name

OveractiveBladder, OAB

Visiting department

Urology

Common symptoms

Urgency, urgency incontinence, frequent urination, nocturia

Contagious

no

Causes of overactive bladder

Its etiology is not yet clear. At present, the following 4 factors are believed to be related:

Detrusor instability

Caused by non-neurogenic factors, abnormal detrusor contractions during storage cause corresponding clinical symptoms.

2. Bladder hypersensitivity

The urge to urinate occurs at smaller bladder volumes.

3. The urethra and pelvic floor muscles are abnormal.

4. Other reasons

Such as mental behavior abnormalities, hormone metabolism disorders and so on.

Clinical manifestations of overactive bladder

Typical symptoms include urgency, daytime urination, nocturia, and urge incontinence.

Urgency

It refers to a sudden, strong desire to urinate, and it is difficult to be subjectively suppressed to delay urination.

2. Urgent incontinence

Refers to the phenomenon of urinary incontinence accompanied by or immediately after urgency.

3. Frequent urination

A main complaint is that the patient consciously urinates too often per day. On the basis of subjective feelings, the number of urination in adults reaches: no less than 8 times during the day and no less than 2 times during the night. Frequent urination is considered when the urine output is less than 200ml each time.

4. Nocturia

Refers to the main complaint that the patient urinates due to urination more than twice a night.

Overactive Bladder Treatment

Behavior therapy

(1) Bladder training The efficacy of bladder training in treating OAB is positive. Through bladder training, it can inhibit bladder contraction and increase bladder capacity. The main point of training is to drink plenty of water during the day, try to tolerate urine and prolong the interval between urination; stop drinking water at night, do not drink irritating and exciting drinks, and take appropriate amounts of sedative sleeping pills at night to sleep peacefully. Diuretic diary is recorded during treatment to enhance confidence in healing.

(2) Biofeedback treatment People consciously urinate and control urination because some biological information exists in the body. Biofeedback therapy is the application of biofeedback therapy instruments to amplify these in-vivo information for use by patients. Learn to incorporate these unnoticed information under the control of consciousness and actively urinate or control urination. The feedback therapy instrument placed in the anus or vagina records sounds of bladder in the form of sound, light, and image. When the patient has uninhibited or unstable contraction of the detrusor, the instrument emits specific sound, light and image And other information, so that patients can directly sense bladder activity and consciously gradually learn to control themselves to achieve the purpose of inhibiting bladder contraction.

(3) Pelvic floor muscle training Through biofeedback or other guidance methods, patients can learn to contract pelvic floor muscles to inhibit bladder contractions and other strategies to suppress urgency.

(4) Other behavioral treatments such as hypnosis.

2. Drug treatment

(1) M-receptor antagonist drug therapy is easily accepted by most OAB patients, and is therefore the most important and basic treatment method for OAB. Detrusor contraction is mediated by cholinergic (M receptor) activation. M receptor antagonists can inhibit detrusor contraction, improve bladder sensory function, and inhibit detrusor unstable contraction by antagonizing M receptor. Therefore, it is widely used in the treatment of OAB. The first-line drugs are tolterodine, triclosylamine, solinacin, etc. Other drugs include oxybutynin, propraneline, and profenoxine.

(2) Multiple areas of the central nervous system of sedative and anxiolytic drugs are involved in urination control, such as the cortex and mesencephalon, as well as the midbrain, medulla, and spinal cord. Neurotransmitters related to these neural pathways can be selected, such as -aminobutyric acid, serotonin, dopamine, and glutamic acid. Among the therapeutic drugs of OAB, imipramine is the most commonly used. It not only has anticholinergic and sympathomimetic effects, but also may have a central inhibitory effect on urination reflex. It is recommended to treat mixed urgency and stress urinary incontinence. However, the action of imipramine is slower, and it will not take effect until several weeks after taking it. Adverse reactions include orthostatic hypotension and arrhythmia. Duloxetine, another antidepressant, increases tension in the external urethral sphincter by inhibiting central serotonin and norepinephrine reuptake.

(3) Calcium channel blocker experiments have shown that calcium antagonists such as verapamil and nifedipine can inhibit the contraction of detrusor muscles of the bladder by blocking extracellular calcium ions inflow; potassium channel opener can pass Increase potassium outflow, cause hyperpolarization of cell membrane, and relax smooth muscle.

(4) Other drugs: prostaglandin synthesis inhibitors (indomethacin), flavonoids, etc.

3. Chinese medicine treatment

In recent years, traditional Chinese medicine has been tried for the treatment and adjuvant treatment of OAB. Its curative effect is accurate, and the adverse reactions are small. It is increasingly valued by doctors and accepted by patients. Including traditional Chinese medicine therapy, acupuncture therapy, massage therapy, bladder irrigation therapy, rectal medication, external treatment, incense therapy and so on.

4. Surgical treatment

Surgical treatment is only used for severe low-compliance bladder, bladder volume is too small, and it harms upper urinary tract function and is ineffective through other treatments. Including detrusor transection, autologous bladder enlargement, intestinal bladder enlargement, urinary diversion.

5. Other treatments

Including multi-point injection of type A botulinum toxin bladder detrusor, which is effective for severe detrusor instability. You can also inject bladder hyaluronidase or capsaicin. These substances can be involved in bladder sensory introduction. After infusion, it can reduce bladder sensory introduction. It can be tried for severe bladder hypersensitivity. Neuromodulation and sacral neuromodulation therapy are effective for some patients with recalcitrant urinary frequency, urgency and urgency incontinence.

In short, patients with OAB mostly use a combination of behavioral therapy and drug therapy. As the main method of treating OAB today, M receptor antagonists can reach 75%.