It constitutes a program of scheduled voiding with progressive increase in the interval between each void. The cure rate of 80% has been reported. A 12-week program is anticipated.
It stimulates the pelvic floor and urethral muscles, and inhibits detrusor muscle contractility. A 50% cure rate has been reported. The main difficulty is with patient acceptance.
It is the most popular mode of treatment in patients with overactive bladder. However, the response is often dose-related and side effects are common at effective doses. In general, drugs improve detrusor instability by inhibiting the contractile activity of the bladder.
The maximum dose is usually determined by patient tolerance to the side effects.
Imipramine hydrochloride: It improves bladder storage significantly. It appears to improve bladder hypertonicity or compliance rather than uninhibited contractions. It is useful in patients with enuresis. The side effects are anticholinergic, as well as tremor and fatigue. It can also cause orthostatic hypotension.
DDAVP: It decreases urine production. It is helpful in patients with troublesome nocturnal urinary symptoms. However, its use in the elderly and patients with heart problem is limited.
It is only used as a last resort in the management of overactive bladder.
Overactive bladder can co-exist with stress urinary incontinence / urodynamics stress incontinence in up to 30% of patients. Medical management of the overactive bladder reduces the need for bladder continence surgery. If patients fail medical treatment, bladder neck surgery may be recommended. However, patients should understand that the post-operative course of detrusor instability is somewhat unpredictable. They may need to continue medical treatment for their overactive bladder.
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