ABSTRACT
Overactive bladder (OAB) is a symptom complex in which urinary urgency, a sudden, compelling desire to pass urine which is difficult to defer, is the key symptom. Urgency may go with urgency urinary incontinence and is usually accompanied by frequency and nocturia. A myogenic and a neurogenic mechanism are customarily advanced to explain OAB. The myogenic hypothesis recognizes the fact that partial cholinergic denervation as seen after bladder outlet obstruction changes the expression of muscarinic receptors on the surface of smooth muscle cells leading to supersensitivity to acetylcholine. OAB management starts with conservative measures such as lifestyle modifications and pelvic floor physical therapy, which may be introduced alone in patients with mild symptoms causing little bother or together with other more invasive treatment options in patients with severe symptoms. Available pharmacotherapy, botulinum toxin A and electrical neuromodulation offer multiple possibilities for satisfactory symptom control in most patients.
