Urination, overactive bladder

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],... 

The aforemehtiohed side effect of causing difficulty in urination has been used to advantage with the recent approval of several anticholinergic agents—darifenacin trospium, solifenacin, tolterodine, and oxybutynin—tor the treatment of overactive bladder. 

In UUI, the detrusor (bladder) muscle is overactive and contracts inappropriately during the filling phase. The amount of urine lost per episode can be as large as the entire contents of the bladder may empty. Sleep may be disrupted by nocturia and enuresis. 

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). 

Urethral overactivity and/or bladder underactivity is known as overflow incontinence. The bladder is filled to capacity but is unable to empty, causing urine to leak from a distended bladder past a normal outlet and sphincter. Common causes of urethral overactivity include benign prostatic hyperplasia (see Chap. 82) prostate cancer (see Chap. 65) and, in women, cystocele formation or surgical overcorrection after UI surgery. 

Case series Seven men and three women, aged 20-30 (mean 25) years, who had all abused ketamine for 1-4 years, developed dysuria, increased frequency (having to void once every 15 minutes), urgency, urge incontinence, and painful hematuria [58 ]. None had positive urine cultures. Functional bladder capacities were 30-100 ml. Urodynamic tests showed detrusor overactivity, with urinary leakage when the bladder was filled to a capacity of 30-50 ml. There was bilateral reflux in one case and unilateral reflux in two seven had bilateral hydronephrosis. [The title of this paper is confusing, since street ketamine is a term that is used to refer to phencyclidine however, in the paper the authors refer to ketamine.]... 

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