tailieunhanh - Ebook Atlas of urodynamics (2/E): Part 2

Part 2 book “Atlas of urodynamics” has contents: Overactive bladder, benign prostatic hyperplasia, bladder neck obstruction, and prostatitis, bladder outlet obstruction and impaired detrusor contractility in women, enterocystoplasty and neobladder, genital prolapse, stress incontinence in woman, and other contents. | 9 Overactive Bladder Overactive bladder (OAB) is defined by the International Continence Society (ICS) as “urgency, with or without urge incontinence, usually with frequency and nocturia . . . if there is no proven infection or other etiology.” [1] From a practical standpoint, though, we believe this definition to be much too restrictive and, in contradistinction to the ICS definition, we consider OAB to be a symptom complex caused by one or more of the following conditions: detrusor overactivity, sensory urgency, and low bladder compliance. Sensory urgency is a term, abandoned by the ICS, which refers to an uncomfortable need to void that is unassociated with detrusor overactivity. Conditions causing and/or associated with OAB are diverse and include urinary tract infection, urethral obstruction, pelvic organ prolapse, neurogenic bladder, sphincteric incontinence, urethral diverticulum, bladder stones/foreign body, and bladder cancer [2–13]. In patients with OAB, diagnostic evaluation should be directed at early detection of these conditions because in many instances the symptoms are reversible if the underlying etiology is successfully treated. Detrusor overactivity. Detrusor overactivity is a generic term that refers to the presence of involuntary detrusor contractions during cystometry, which may be spontaneous or provoked. The ICS further describes two patterns of detrusor overactivity: terminal and phasic. Terminal detrusor overactivity is defined as a single involuntary detrusor contraction occurring at cystometric capacity, which cannot be suppressed, and results in incontinence usually resulting in bladder emptying (Fig. ). Phasic detrusor overactivity is defined by a characteristic waveform, and may or may not lead to urinary incontinence (Fig. ). Involuntary detrusor contractions are not always accompanied by sensation. Some patients have no symptoms at all. Others void uncontrollably without any awareness. Still others may detect them as a first