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  • Review Article
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Novel biomarkers for overactive bladder

Nature Reviews Urology volume 8, pages 139–145 (2011)Cite this article

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Abstract

Biomarkers constitute any objectively measurable indicator of a biological process. The classic biomarker used in the diagnosis of overactive bladder (OAB) has been detrusor overactivity, which is assessed urodynamically. In the search for a reliable, noninvasive alternative to urodynamics, interest has focused on genetic, imaging, and urinary factors. Along with other cytokines detectable in urine, prostaglandin E2 and nerve growth factor are indicators of low-grade inflammation. Although they correlate with OAB symptom severity, they have not been shown to have independent prognostic benefit. Imaging biomarkers have been investigated since the earliest days of video urodynamics. Despite extensive research on the ultrasonographic estimation of bladder wall thickness, further standardization of the technique is required before conclusions can be reached regarding diagnostic accuracy. Genetic factors contribute approximately half of the total risk for urgency incontinence. Functional polymorphisms of the cytochrome P450 IID6 gene significantly alter the metabolism of some commonly used anticholinergic drugs, but no genetic loci that influence risk of OAB have been definitively identified. The first genome-wide association studies for OAB are in progress, and should identify new susceptibility genes. Although current putative biomarkers correlate with OAB severity, much future work is required to assess their prognostic value, and establish their role in clinical practice.

Key Points

  • The classic biomarker used in the diagnosis of overactive bladder (OAB) has been detrusor overactivity, which is assessed using filling cystometry

  • Filling cystometry has considerable limitations as a clinical tool, with poor reliability and an uncertain relationship to OAB severity

  • Urinary biomarkers, including prostaglandin E2 and nerve growth factor, correlate well with OAB symptoms but have not received formal assessment of diagnostic accuracy or clinical validity

  • Bladder wall thickness is increased in patients with OAB; however, conflicting results have been reported in different populations using different measurement techniques

  • The genetic contributors to OAB are poorly understood; the rs4994 functional polymorphism in the β3-adrenoceptor has been suggested as a possible contributor

  • The first genome-wide association studies are in progress, and should identify new susceptibility genes for OAB

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Figure 1: Spinning top bladder neck.
Figure 2: Bladder wall thickness.

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Authors and Affiliations

  1. Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK

    Rufus Cartwright

  2. Department of Obstetrics and Gynaecology, Northwick Park Hospital, Watford Road, Harrow, London HA1 3UJ, UK,

    Iram Afshan

  3. Department of Urogynaecology, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK

    Alexandros Derpapas, Gopalan Vijaya & Vik Khullar

Authors
  1. Rufus Cartwright
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  2. Iram Afshan
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  3. Alexandros Derpapas
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  4. Gopalan Vijaya
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  5. Vik Khullar
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Contributions

R. Cartwright, I. Afshan, A. Derpapas and G. Vijaya each contributed to researching and drafting the manuscript. All authors provided substantial contribution to discussion and editing of the final content.

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Correspondence to Rufus Cartwright.

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Competing interests

R. Cartwright has received speakers bureau (honoraria) and grant/research support (inc. clinical trials) from Astellas. V. Khullar has received speakers bureau (honoraria) from Astellas and Pfizer, and grant/research support (inc. clinical trials) from Pfizer and Allergan.

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Cartwright, R., Afshan, I., Derpapas, A. et al. Novel biomarkers for overactive bladder. Nat Rev Urol 8, 139–145 (2011). https://doi.org/10.1038/nrurol.2011.7

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