Treatment of overactive bladder syndrome and detrusor overactivity

The overactive bladder syndrome is a relatively new-term defined by the International Continence Society in 2002. Previous definitions were based on urodynamic diagnoses; however, the overactive bladder syndrome is a symptomatic diagnosis with urgency as the cornerstone symptom, thus allowing treatment to be initiated by primary care physicians before embarking on complex investigations. It affects millions of people worldwide and has considerable economic costs. Its aetiology is unknown but some people suggest that it may be a nerve-related problem while others suggest that it may be a muscle-related problem. The true cause probably lies somewhere between the two theories. With this in mind, treatment is aimed at relief of symptoms and improving quality of life. Conservative treatments combined with antimuscarinic drugs are the main treatment for overactive bladders. There are many antimuscarinics available, with several under development, which have different specificities for the muscarinic receptors. Other drugs have also been tried but with limited success.

If conservative and oral medical treatments fail, the options include intravesical therapy, neuromodulation or major surgery. However, urodynamics are essential for patients referred for these treatments, which are mainly initiated by specialists rather than primary care physicians. The aim of this review is to give an overview of the overactive bladder and detrusor overactivity, their diagnosis and treatment options.