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Pathophysiology of refractory overactive bladder.

Authors
  • Chen, Li-Chen1, 2
  • Kuo, Hann-Chorng3
  • 1 Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan. , (Taiwan)
  • 2 Department of Medicine, Mackay Medical College, Taipei, Taiwan. , (Taiwan)
  • 3 Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan. , (Taiwan)
Type
Published Article
Journal
Lower urinary tract symptoms
Publication Date
Sep 01, 2019
Volume
11
Issue
4
Pages
177–181
Identifiers
DOI: 10.1111/luts.12262
PMID: 30900373
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Overactive bladder (OAB) is a common condition. The International Continence Society defines OAB as a symptom complex characterized by urgency with or without urge incontinence, usually with frequency and nocturia. The first-line treatment for OAB includes behavioral therapy, such as caffeine reduction, fluid intake modification, weight reduction, bladder training, and pelvic floor muscle training, as well as treatment with antimuscarinic or β3 -adrenoceptor agonist medications. However, less than half of all cases achieve satisfactory outcomes following first-line treatment. Second-line therapy considered if satisfactory responses are not achieved after 8 to 12 weeks treatment with first-line therapy include intradetrusor botulinum toxin injection, neuromodulation, and surgical treatment. Patients with refractory OAB may have more severe symptoms or underlying pathophysiologies that were not resolved by the initial medication. The pathophysiologies of refractory OAB include occult neurogenic bladder, undetected bladder outlet obstruction, urethral-related OAB, urothelial dysfunction with aging, chronic bladder ischemia, chronic bladder inflammation, central sensitization, and autonomic dysfunction. This article discusses the possible pathophysiologies of refractory OAB. © 2019 John Wiley & Sons Australia, Ltd.

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