Overactive Bladder

Overactive bladder (OAB) is a term used for a voiding dysfunction characterized by any or all of the following symptoms: urinary frequency (bothersome urination eight or more times a day or two more times at night), urinary urgency (the sudden, strong need to urinate immediately), urge incontinence (leakage or gushing of urine that follows a sudden strong urge) and nocturia (awakening two or more times at night to urinate). It can be associated with neurologic conditions, such as Parkinson’s disease or multiple sclerosis, but in most cases the cause is unknown. OAB can significantly impact quality of life; it can impact physical functioning, sexual function and social interactions.

Overactive bladder syndrome affects approximately 17% of the adult population of the USA with an estimated worldwide prevalence of 50 million. (1)

The standard treatments for overactive bladder include lifestyle changes, bladder training, pelvic floor muscle training and anticholinergic (anti-muscarinic) drugs. Additional treatments for some types of incontinence include pessary placement and surgery. Sacral nerve stimulation has also been tried.

Although sacral nerve stimulation can improve symptoms of incontinence, the implantable sacral nerve stimulators are somewhat invasive. Currently many studies are focusing on a less invasive approach, percutaneous tibial nerve stimulation (PTNS). (2, 3)

PTNS was developed as a less invasive alternative to sacral nerve stimulation, and is thought to interrupt abnormal reflex arcs that may affect bladder dysfunction. (2)

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When the bladder is working well, it is easy to take for granted. When there is difficulty, however, the effects can be life-altering . . .


References:

  1. Krames ES, Peckham H, Rezai AR (eds): Neuromodulation. Philadelphia, Elsevier, 2009, p. 7.

  2. Bolton JF, Harrison SC. Neuromodulation 10 years on: how widely should we use this technique in bladder dysfunction? Curr Opin Urol. Jul 2009;19(4):375-379.

  3. Peters KM, Carrico DJ, Macdiarmid SA, et al. Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study. Neurourol Urodyn. Jun 5 2012.

Reviewed Feb. 2, 2013
Magdy Hassouna, MD, PhD, FRCSC
Member, International Neuromodulation Society
Professor of Surgery (Urology), University of Toronto, Toronto, Canada

Last Updated on Tuesday, April 25, 2017 11:21 AM