Overactive urinary bladder

Goldenberg, M.M. 1999. An extended-release formulation of oxybutynin chloride for the treatment of overactive urinary bladder. Clin Ther 21 634. 

Pharmacology Tolterodine is a competitive muscarinic receptor antagonist for overactive bladder. Urinary bladder contraction and salivation are mediated via cholinergic muscarinic receptors. 

Mechanism of Action A urinary antispasmodic agent that acts as a direct antagonist at muscarinic receptor sites in cholinergically innervated organs. Blockade of the receptors limits bladder contractions. Therapeutic Effect Reduces symptoms of bladder irritability and overactivity improves bladder capacity. 

Bladder overactivity—inclnding bladder filling and nrinary storage characterized by involnntary bladder contractions—is termed urge urinary incontinence (UUI). Symptoms of bladder overactivity ocenr because the detrusor muscle is overactive and contracts inappropriately during the filling phase. 

Overactive urinary bkuMer disease can be successfully treated with muscarinic antagonists, primarily tolterodine and trospium chloride, which lower intravesicular pressure, increase capacity, and reduce the frequency of contractions by antagonizing parasympathetic control of the bladder. Oxybu-tynin is used as a transdermal system (oxytrol) that delivers 3.9 mg/day and is associated with a lower incidence of side effects than the oral immediate- or extended-release formulations. Tolterodine is metabolized by CYP2D6 to a 5-hydroxymethyl metabolite since this metabolite possesses similar activity to the parent drug, variations in CYP2D6 levels do not affect the duration of drug action. Trospium is as effective as oxybutynin, with better tolerability. Solifenacin is newly approved for overactive bladder with a favorable efficacy side effect ratio. Stress urinary incontinence has been treated with some success with duloxetine (YENTREVE), which acts centrally to influence 5-HT and NE levels. 

Ozkan B, Demirkesen 0, Durak H et al (2005) Which factors predict upper urinary tract deterioration in overactive neurogenic bladder dysfunction Urology 66 99-104 Palmer LS, Richards I, Kaplan WE (1997) Age-related bladder capacity and bladder capacity growth in children with myelomeningocele. J Urol 158 1261-1264 Rickwood AMK, Thomas DC, Philip NH et al (1982) A system of management of the congenital neuropathic bladder based upon combined urodynamic and radiological assessment. Br J Urol 54 507-511 Seki N, Masuda K, Kinukawa N et al (2004) Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization. Int J Urol 11 973-977... 

Discuss the uses, general drug actions, adverse reactions, contraindications, precautions, and interactions of the drugs used to treat infections and symptoms associated with urinary tract infections or an overactive bladder. 

Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking a drug for a urinary tract infection or an overactive bladder. 

Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of drugs used to treat a urinary tract infection or symptoms associated with an overactive bladder. 

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. 

Overflow Urinary Incontinence (OUI) (Urethral Overactivity and/or Bladder Underactivity)4... 

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

Clinical Presentation of Urinary Incontinence Related to Urethral Overactivity and/or Bladder Underactivity4 ... 

Urethral overactivity and/or bladder underactivity is a rare, but important, cause of UI. Patients complain of lower abdominal fullness, hesitancy, straining to void, decreased force of stream, interrupted stream, and sense of incomplete bladder emptying. Patients can also have urinary frequency, urgency, and abdominal pain. 

Bladder instability/Overactive bladder For the relief of symptoms of bladder instability/treatment of overactive bladder associated with voiding in patients with uninhibited and reflex neurogenic bladder (eg, urgency, freguency, urinary leakage, urge incontinence, dysuria). 

Overactive bladder Treatment of patients with an overactive bladder with symptoms of urinary frequency, urgency, or urge incontinence. 

Overactive bladder For the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary freguency. 

Geriatric Considerations - Summary Flavoxate has anticholinergic activity and has the potential to cause adverse effects in the older adult, including urinary retention, hypotension, and confusion. There are no well controlled studies that show efficacy over placebo in the treatment of the overactive bladder. The potential for adverse effects limits the usefulness of this drug for older adults. 

Solifenacin Succinate Tablet For overactive bladder with urge urinary incontinence urgency urinary frequency... 

Trospium is a QTA in which the tropine N-atom is part of two alkyl ring structures (Fig. 1). This drug acts as an antimuscarinic agent that is clinically used as orally administered first-line urinary antispasmodic to treat overactive bladder (OAB) [34], Due to the absence of significant biotransformation, trospium is excreted mainly unchanged into urine allowing to exhibit primarily local activity [84],... 

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