New Pharmacologic and Minimally Invasive Therapies for the Overactive Bladder

Michael Franks, MD, Emmanuel Chartier-Kastler, MD, Michael B. Chancellor, MD

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In This Article

Minimally Invasive Treatment of OAB

Surgery is rarely indicated in cases of refractory detrusor instability. Older therapies, such as denervation, myomectomy, diversion, and rhizotomy, are generally no longer considered acceptable. Hydrodistention may be of use in differentiating interstitial cystitis. Only patients failed by prolonged trials of more conservative therapies should be considered for surgery. When detrusor instability is relieved by surgical intervention, normal detrusor contractility is also sacrificed.

Subsequent bladder emptying generally requires abdominal straining or intermittent self-catheterization. Although abdominal straining appears easier and less invasive, daytime and nighttime urinary frequency and stress incontinence develop in a significant number of patients if the straining is prolonged. For this reason, intermittent self-catheterization is recommended. Before a patient consents to an irreversible surgical procedure, there should be a discussion with the person regarding the likelihood of detrusor areflexia, with the need for permanent intermittent self-catheterization. For paraplegics or those patients unable to perform self-catheterization through the urethra, continent urinary diversion or augmentation cystoplasty with a continent abdominal stoma is preferred.

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