Bladder overactivity

SUR2B/Kir6.2 Efforts have also focused on the development of selective KAXP channel openers for vascular and nonvascular indications including angina, airway hyperactivity, bladder overactivity, and erectile... 

BKCa The diversity of BKCa channels can be attributed to the assembly of pore-forming a subunit together with four different auxiliary subunits ((31 -(34). BMS-204352 has been identified as a BKCa channel opener for the treatment of acute ischemic stroke although it has also been shown as an M-channel activator. Therapeutic applications for channel openers include epilepsy, bladder overactivity, asthma, hypertension, and psychosis. Other known BKCa channel openers include NS-8, NS-1619, NS-4, and certain aminoazaindole analogs. 

In most patients, the cause of bladder overactivity is unknown (idiopathic). Clearly-established risk factors for UUI include ... 

Urine leakage with physical activity (volume is proportional to activity level). No Ul with physical inactivity, especially when supine (no nocturia). May develop urgency and frequency as a compensatory mechanism (or as a separate component of bladder overactivity). 

Can have bladder overactivity and Ul without urgency, if sensory input from the lower urinary tract is absent. 

Bladder overactivity is known as urge UI (UUI) and is associated with increased urinary frequency and urgency, with or without urge incontinence. The detrusor muscle is overactive and contracts inappropriately during the filling phase. 

Mixed incontinence includes the combination of bladder overactivity and urethral underactivity. 

Differentiating Bladder Overactivity from Urethral Underactivity... 

Ban Xia, which is pungent and warm, can disperse the Qi stagnation and directly soothe the Stomach-Qi, thereby reducing the Qi obstruction caused by the Gall Bladder overacting on the Stomach. 

The adverse effects of tolterodine and other antimuscarinic anticholinergic drugs have been reviewed in patients with incontinence and bladder overactivity (3-6). 

Anticholinergic/antispasmodic agents are the therapies of choice for bladder overactivity (urge incontinence). 

Most patients with overactive bladder and UUI have no identifiable underlying etiology. In fact, the most common cause of bladder overactivity and UUI is idiopathic. Clearly identifiable risk factors for UUI include normal aging, neurologic disease (including stroke, Parkinson s disease, multiple sclerosis, and spinal cord injury), and bladder outlet obstruction (e.g., due to benign prostatic hyperplasia [BPH] or prostate cancer). 

Various types of UI may coexist in the same patient. The combination of bladder overactivity and urethral underactivity is termed mixed incontinence. This is often a difficult diagnosis to make because of the often-confusing array of presenting symptoms. Bladder overactivity may also coexist with impaired bladder contractility. This is most common in the elderly and is termed detrusor hyperactivity with impaired contractility. ... 

CLINICAL PRESENTATION OF URINARY INCONTINENCE RELATED TO BLADDER OVERACTIVITY... 

UI may present in the setting of concurrent, seemingly unrelated illnesses. New-onset UI may be the initial manifestation of certain systemic illnesses such as diabetes meUitus, metastatic malignancies, multiple sclerosis, and other neurologic illnesses. Central nervous system disease, or injury above the level of the pons, generally results in symptoms of bladder overactivity and UUI. Spinal cord injury or disease may manifest as bladder overactivity and UUI or as overflow incontinence, depending on the spinal level and completeness of the injury or disease. 

Use of electronic or mechanical instruments to display visual or auditory information about neuromuscular or bladder activity used to teach correct pelvic floor muscle contraction and/or urge inhibition Application of electrical current to sacral and pudendal afferent fibers through vaginal, anal, or surface electrodes used to inhibit bladder overactivity and to improve awareness, contractility, and efficiency of pelvic muscle contraction... 

TABLE 83—5. Efficacy of First-Choice Drugs for Bladder Overactivity in Placebo-Controlled Trials ... 

Altogether, it should be underlined that a slightly modified VCU technique allows the diagnosis of unstable bladder (overactive bladder) to be made in centers without urodynamic facilities with similar accuracy. Therefore, modified VCU is recommended in all children for the evaluation of symptoms of persistent and severe nonneurogenic bladder-sphincter dysfunction, in particular with (febrile) UTI and breakthrough infections and in all neonates and infants for the evaluation of upper urinary tract dilatation and extended ultrasound signs indicative of VUR. 

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