Abstract
Overactive bladder (OAB) is a common disorder that negatively affects the quality of life of our patients and carries a large socioeconomic burden. According to the International Continence Society, it is characterized as urinary urgency, with or without urge incontinence, usually, with frequency and nocturia in the absence of causative infection. The pathophysiology of this disease entity varies between neurogenic, myogenic, or idiopathic factors. This paper provides a review of the contemporary theories behind the pathophysiology of OAB.
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References
Kreder KJ, Dmochowski RR (2007) The overactive bladder: evaluation and management. Informa Healthcare, London
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol 187:116–126
van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S, Jennum P, Johnson T, Lose G, Mattiasson A, Robertson G, Weiss J (2002) The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:179–183
Wyndaele JJ (2001) The overactive bladder. BJU Int 88:135–140
Ouslander JG (2004) Management of overactive bladder. N Engl J Med 350:786–799
Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ (2001) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 87:760–766
Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ (2003) Prevalence and burden of overactive bladder in the United States. World J Urol 20:327–336
Goepel M, Hoffmann JA, Piro M, Rubben H, Michel MC (2002) Prevalence and physician awareness of symptoms of urinary bladder dysfunction. Eur Urol 41:234–239
Steers WD (2002) Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol 4(Suppl 4):S7–S18
Chu FM, Dmochowski R (2006) Pathophysiology of overactive bladder. Am J Med 119:3–8
Shefchyk SJ (2001) Sacral spinal interneurones and the control of urinary bladder and urethral striated sphincter muscle function. J Physiol 533:57–63
Yoshimura N, Chancellor MB (2003) Neurophysiology of lower urinary tract function and dysfunction. Rev Urol 5(Suppl 8):S3–S10
Miller J, Hoffman E (2006) The causes and consequences of overactive bladder. J Womens Health (Larchmt) 15:251–260
Andersson KE, Pehrson R (2003) CNS involvement in overactive bladder: pathophysiology and opportunities for pharmacological intervention. Drugs 63:2595–2611
Chancellor MB (2002) New frontiers in the treatment of overactive bladder and incontinence. Rev Urol 4(Suppl 4):S50–S56
Andersson KE (1997) The overactive bladder: pharmacologic basis of drug treatment. Urology 50:74–84, discussion 5–9
Andersson KE (2004) Antimuscarinics for treatment of overactive bladder. Lancet Neurol 3:46–53
Morrison J, Steers WD, Brading AF et al (2002) Neurophysiology and neuropharmacology. In: Abrams P, Cardoza L, Khoury S, Wein A (eds) Incontinence, 2nd edn. Health Publications, Plymouth, pp 86–163
Fetscher C, Fleichman M, Schmidt M, Krege S, Michel MC (2002) M(3) muscarinic receptors mediate contraction of human urinary bladder. Br J Pharmacol 136:641–643
Chancellor MB, Yoshimura N (2004) Neurophysiology of stress urinary incontinence. Rev Urol 6(Suppl 3):S19–S28
de Groat WC, Booth AM, Yoshirnura N (1993) Neurophysiology of micturition and its modification in animal models of human disease. In: Maui CA (ed) The autonomic nervous system. Harwood Academic Publishers, London, pp 227–289
Payne CK (1998) Epidemiology, pathophysiology, and evaluation of urinary incontinence and overactive bladder. Urology 51:3–10
Rick BF, Holstege A (1999) Two pontine micturition centers in the cat are not interconnected directly: implications for the central organization of micturition. J Comp Neural 402:209–218
Fowler CJ (2001) Urinary disorders in Parkinson's disease and multiple system atrophy. Funct Neurol 16:277–282
Blaivas JG (1982) The neurophysiology of micturition: a clinical study of 550 patients. J Urol 127:958–963
Marinkovic SP, Badlani G (2001) Voiding and sexual dysfunction after cerebrovascular accidents. J Urol 165:359–370
Yokoyama O, Yoshiyama M, Namiki M, de Groat WC (2000) Role of the forebrain in bladder overactivity following cerebral infarction in the rat. Exp Neurol 163:469–476
Yokoyama O, Yoshiyama M, Namiki M, de Groat WC (1999) Glutamatergic and dopaminergic contributions to rat bladder hyperactivity after cerebral artery occlusion. Am J Physiol 276:R935–R942
Yokoyarna, Yoshiyama M, Narniki M et al (2002) Changes in dopaminergic and glutamatergic excitatory mechanisms of micturition reflex after middle cerebral artery occlusion in conscious rats. Exp Neurol 173:129–135
Kodama K, Yokoyama O, Komatsu K, Yotsuyanagi S, Niikura S, Namiki M (2002) Contribution of cerebral nitric oxide to bladder overactivity after cerebral infarction in rats. J Urol 167:391–396
Kanie S, Yokoyama O, Komatsu K, Kodama K, Yotsuyanagi S, Niikura S, Nagasaka Y, Miyamoto KI, Namiki M (2000) GABAergic contribution to rat bladder hyperactivity after middle cerebral artery occlusion. Am J Physiol Regul Integr Comp Physiol 279:R1230–R1238
Singer C (1998) Urinary dysfunction in Parkinson's disease. Clin Neurosci 5:78–86
Fowler O (1999) Neurological disorders of micturition and their treatment. Brain 122:1213–1231
Berger Y, Blaivas JG, DeLaRocha ER, Salinas JM (1987) Urodynamic findings in Parkinson's disease. J Urol 138:836–838
Litwiller SE, Frohman EM, Zimmern PE (1999) Multiple sclerosis and the urologist. J Urol 161:743–757
Fernandez O (2002) Mechanisms and current treatments of urogenital dysfunction in multiple sclerosis. J Neurol 249:1–8
Shefchyk SJ (2002) Spinal cord neural organization controlling the urinary bladder and striated sphincter. Prog Brain Res 137:71–82
Wiseman OJ, Brady CM, Hussain IF, Dasgupta P, Watt H, Fowler CJ, Landon DN (2002) The ultrastructure of bladder lamina propria nerves in healthy subjects and patients with detrusor hyperreflexia. J Urol 168:2040–2045
Fowler CJ (2002) Bladder afferents and their role in the overactive bladder. Urology 59:37–42
Yoshida M, Miyamae K, Iwashita H, Otani M, Inadome A (2004) Management of detrusor dysfunction in the elderly: changes in acetylcholine and adenosine triphosphate release during aging. Urology 63:17–23
Harrison SC, Hunnam GR, Farman P, Ferguson DR, Doyle PT (1987) Bladder instability and denervation in patients with bladder outflow obstruction. Br J Urol 60:519–522
Brading AF (1997) A myogenic basis for the overactive bladder. Urology 50:57–67, discussion 8–73
Steers WD, De Groat WC (1988) Effect of bladder outlet obstruction on micturition reflex pathways in the rat. J Urol 140:864–871
Levin RM (1997) Potential future pharmacological approaches. Urology 50:87–88
Steers WD, Creedon DJ, Tuttle JB (1996) Immunity to nerve growth factor prevents afferent plasticity following urinary bladder hypertrophy. J Urol 155:379–385
Steers WD, Kolbeck S, Creedon D, Tuttle JB (1991) Nerve growth factor in the urinary bladder of the adult regulates neuronal form and function. J Clin Invest 88:1709–1715
Sibley GN (1997) Developments in our understanding of detrusor instability. Br J Urol 80(Suppl 1):54–61
Mills IW (1999) The pathophysiology of detrusor instability and the role of bladder ischemia in its etiology. Oxford University, Oxford
Semins MJ, Chancellor MB (2004) Diagnosis and management of patients with overactive bladder syndrome and abnormal detrusor activity. Nat Clin Pract Urol 1:78–84, quiz 109
Elbadawi A, Hailemariam S, Yalla SV, Resnick NM (1997) Structural basis of geriatric voiding dysfunction. VII. Prospective ultrastructural/urodynamic evaluation of its natural evolution. J Urol 157:1814–1822
Elbadawi A, Yalla SV, Resnick NM (1993) Structural basis of geriatric voiding dysfunction. III. Detrusor overactivity. J Urol 150:1668–1680
Lackner TE, Wyman JF, McCarthy TC, Monigold M, Davey C (2008) Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence. J Am Geriatr Soc 56:862–870
Dupont MC, Spitsbergen JM, Kim KB, Tuttle JB, Steers WD (2001) Histological and neurotrophic changes triggered by varying models of bladder inflammation. J Urol 166:1111–1118
Vizzard MA, Erdman SL, de Groat WC (1996) Increased expression of neuronal nitric oxide synthase in bladder afferent pathways following chronic bladder irritation. J Comp Neurol 370:191–202
Clemow DB, McCarty R, Steers WD, Tuttle JB (1997) Efferent and afferent neuronal hypertrophy associated with micturition pathways in spontaneously hypertensive rats. Neurourol Urodyn 16:293–303
Archer JS (1999) NAMS/Solvay Resident Essay Award. Relationship between estrogen, serotonin, and depression. Menopause 6:71–78
Zhu Q, Ritchie J, Marouf N, Dion SB, Resnick NM, Elbadawi A, Kuchel GA (2001) Role of ovarian hormones in the pathogenesis of impaired detrusor contractility: evidence in ovariectomized rodents. J Urol 166:1136–1141
Nishizawa S, Benkelfat C, Young SN, Leyton M, Mzengeza S, de Montigny C, Blier P, Diksic M (1997) Differences between males and females in rates of serotonin synthesis in human brain. Proc Natl Acad Sci U S A 94:5308–5313
Wolfe F, Russell IJ, Vipraio G, Ross K, Anderson J (1997) Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population. J Rheumatol 24:555–559
Zorn BH, Montgomery H, Pieper K, Gray M, Steers WD (1999) Urinary incontinence and depression. J Urol 162:82–84
Read KE, Sanger GJ, Ramage AG (2003) Evidence for the involvement of central 5-HT7 receptors in the micturition reflex in anaesthetized female rats. Br J Pharmacol 140:53–60
Nygaard I (2010) Clinical practice. Idiopathic urgency urinary incontinence. N Engl J Med 363:1156–1163
Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE (2008) What type of urinary incontinence does this woman have? JAMA 299:1446–1456
Artibani W (1997) Diagnosis and significance of idiopathic overactive bladder. Urology 50(6A Suppl):25–32, discussion 33–5
Holmes DM, Stone AR, Barry PR (1983) Bladder training 3 years on. Br J Urol 55:660–664
Burgio KL, Locher JL, Goode PS et al (1998) Behavioural vs drug treatment for urge urinary incontinence in older women. JAMA 280:1995–2000
Payne CK (2000) Behavioral therapy for overactive bladder. Urology 55(5 Suppl 1):3–6
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Banakhar, M.A., Al-Shaiji, T.F. & Hassouna, M.M. Pathophysiology of overactive bladder. Int Urogynecol J 23, 975–982 (2012). https://doi.org/10.1007/s00192-012-1682-6
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DOI: https://doi.org/10.1007/s00192-012-1682-6