BAGIAN NEUROLO GI JOURNAL READING FEBRUARI 2015

OVERACTIVE BLADDER (Barkin J. Overactive Bladder. The Canadian Journal of Urology; 18 (Supplement 1).

2011; 8-113)

Disusun oleh :Jasmine F. Hatane NIM. 2008-83-046

Pembimbing :dr. Parningotan Yosi Silalahi, Sp.S

BACKGROUND

OABurgency with or without urge incontinence, generally accompanied by frequency & nocturia

OAB may be claassified as “wet” or “dry”

Incidence & prevalence of OAB increases with increasing age

Prevalence OAB men = women, men are less likely to have accompanying urge incontinence

A large national United States telephone

survey that was part of the NOBLE program

16.9% of women had OAB (9.3% with urge

incontinence & 7.6% without urge incontinence

16% of men had OAB (2.4 with urge incontinence & 3.6

without urge incontinence

In Canada estimated that OAB affects 12-18%

of populations, & of these individual, one-third have wet OAB &

two-thirds have dry OAB

Symptoms of OAB = LUTS

BPH (in men), Urethral stricture, bladder stone,

atrophic vaginitis or vaginal prolapse (in women)

Neuropathic process, interstitial cystitis, painful bladder syndrome,

diabetes, genitourinary malignancy, UTI

DISCUSSION

Impact of untreated OAB

• Can have a profound negative impact on patient’s psychological well-being, quality of life, & physical health

• Despite the negative impact of OAB symptoms in quality of lifepatients often don’t mention to physicians a normal part of aging or embarrassed to speak about them

DIAGNOSING OAB

patient’s historypresence of LUTS or (DM, CHF, neurological disease, constipation), medication (diuretics,& antidepressants) dietary habit (excessive fluid/caffeine intake)

Physical examinationdistended bladder, vaginal prolapse/atrophy, enlarged prostate (determined by DRE) signs of neurological diseases, phimosis, or meatal stenosis

Patients with incontinence urgency , stress, mixed incontinence

Urinalisis (hematuria/signs

of UTI

Ultrasound postvoid residual

(PVR)

Cytoscopy

• RBCs, WBCs, nitrites, & glucose

• DM• Neurologic conditions• A large prostate• Frailness in elderlypoor

bladder emptying• Hematuria• Pain• Recurrent UTIs• Risk factor bladder cancer (older age,

male, smoker, family history)• Not responding therapy

MANAGING

OAB

Behavioral Therapy

Physiotherapy

Bladder retraining

Fluid management

Antimuscarinic agents

• Mainstays pharmacotheraphy for OAB• Muscarinic receptor in bladderreduce amplitude

of normal & involuntary bladder contractions• Improves the functional capacity of bladder

bladder’s storage volume at the first involuntary contraction

• In bladder M3 muscarinic receptorstimulating detrusor muscular contraction (salivary gland & gut) dry mouth & constipation

• M1 muscarinic receptor (brain)side effect: confusion

• M5 muscarinic receptor (cardiac muscle)side effect : prolonged QT intervalaritmia

• Side effects antimuscarinics : pupillary dilatation, paralysis of lens accomodation, tachycardia, changes in mental status, sweating , dry mouth & respiratory tract, inhibition of GI motility

• Higher dose/all long acting antimuscarinicganglion blockadeorthostatic hypotension, impotence, & muscle weakness

• IR Oxybutynincomparator drug during clinical trials

• Patients showedimproved compliance, improve efficacy ( frequency, urgency, & episode of incontinence) & fewer side effects

• Various authors reportedantimuscarinic treated in elderly patientpotential CNS impairmentmemory deficits, sleep disruption, confusion / hallucinations

• When choosing antimuscarinic drugASTEP “Availability, Safety, Tolerability, Efficacy, & Preference”

Nonmuscarinic agents

May be used alone/in combination with antimuscarinic

Desmopressin acetate (synhthetic form of ADH vasopressin

Desmopressinas a “melt” (60mcg/12omcg), tablet (0.1

mg/0,2mg), or nasal spray

Other nonmuscarinic drugstrcyclic antidepressant imipramine

(tofranil) & amitrityline (Elavil)

• Not respond behavioral therapy

• Can’t tolerate/respond conventional polypharmacologic agents

Severe OAB

• Botulinum toxin A (BOTOX) injections

• neuromodulator (nerve stimulator) implants

• augmentation cystoplasty

Highly specialized, expensive therapies

CONCLUSION

In most cases, patient with OAB can be initially managed at the primary

care level

Prevalence of OAB significantly with age

Behavioral modification & compliance with effective medical therapymost patient enjoy very

satisfactory improvement their OAB symptoms

Researchersstill searching most effective drug with the fewest/least

bothersome /insignificant side effects

Thank you