Detrusor muscle overactive

The expression of TRPVl in the bladder is, however, not restricted to afferent nerves urothelium, detrusor muscle and fibroblasts also express TRPVl in the human bladder [140]. The implication of these findings for intravesical vanilloid therapy is unclear [141], but the increase in TRPVl immunoreactivity in the urothelium in patients with neurogenic detrusor overactivity (that occurs in concert with increased TRPVl in bladder af-ferents) is a very intriguing finding [142]. In the male urogenital system, TRPVl is also present in testicles, prostate and scrotal skin [143], and it was postulated that TRPVl ligands may be beneficial in the treatment of benign prostatic hyperplasia [144]. 

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. 

Oxybutynin chloride is an anticholinergic that increases bladder capacity, diminishes frequency of uninhibited contractions of detrusor muscle and delays initial desire to void. It is indicated in the treatment of symptoms of bladder instability associated with voiding in patients with uninhibited and reflex neurogenic bladder (e.g., urinary leakage, dysuria) and treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. 

Some patients have characteristics that dictate compelling indications for certain drugs or combinations. Patients with hypertension and ischemic heart disease, diabetic nephropathy, or cardiac failure may benefit from combinations of drug classes that target both diseases. As hypertension is more common as patients get older, there are often multiple co-morbidities that influence the treatment options. In elderly men hypertension may co-exist with prostate disease, the latter being associated with a variety of lower urinary tract symptoms related to an overactive bladder and/or bladder outlet obstruction. Calcium channel blockers may have beneficial effects on the overactive bladder by reducing detrusor muscle tone, and this has been investigated in a trial of amlodipine plus terazosin compared with terazosin alone in men with mild to moderate hypertension and lower urinary tract symptoms [5 ]. Combination treatment was associated with notable improvement in overactive bladder symptoms and better control of hypertension. 

This chapter discusses drug s used to treat urinary tract infections (UTIs) and certain miscellaneous drag > used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle). Structures of the urinary system that may be affected include the bladder (cystitis), prostate gland (prostatitis), the kidney, or the urethra (see Pig. 47-1). These drug s also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. 

The miscellaneous drugp are used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle)... 

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