Langbahn Team – Weltmeisterschaft

Overactive bladder

Overactive bladder
Other namesOveractive bladder syndrome
SpecialtyUrology
SymptomsFrequent feeling of needing to urinate, incontinence
ComplicationsUTIs, anxiety
Usual onsetMore common with age[1]
DurationChronic
TypesAge-related, or Secondary to other illness
CausesOld age; detrusor muscle injury; over-consumption of water and caffeine; UTI; pelvic injury
Risk factorsOld age, obesity, caffeine, constipation
Diagnostic methodBased on symptoms after ruling out other possible causes[2][1]
Differential diagnosisOther neurological conditions[2][1]
TreatmentPelvic floor exercises, bladder training, drinking moderate fluids, weight loss,[3] medications, Botox, surgery
MedicationAnticholinergic drugs, β3 agonists
PrognosisOften but not always incurable
Frequency~40% of elderly adults, increasing with age

Overactive bladder (OAB) is a common condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person's life.[2] The frequent need to urinate may occur during the day, at night, or both.[4] Loss of bladder control (urge incontinence) may occur with this condition.[1] This condition is also sometimes characterized by a sudden and involuntary contraction of the bladder muscles, in response to excitement or anticipation. This in turn leads to a frequent and urgent need to urinate.

Overactive bladder affects approximately 11% of the population and more than 40% of people with overactive bladder have incontinence.[5][6] Conversely, about 40% to 70% of urinary incontinence is due to overactive bladder.[7] Overactive bladder is not life-threatening,[1] but most people with the condition have problems for years.[1]

The cause of overactive bladder is unknown.[1] Risk factors include obesity, caffeine, and constipation.[5] Poorly controlled diabetes, poor functional mobility, and chronic pelvic pain may worsen the symptoms.[1] People often have the symptoms for a long time before seeking treatment and the condition is sometimes identified by caregivers.[1] Diagnosis is based on a person's signs and symptoms and requires other problems such as urinary tract infections or neurological conditions to be excluded.[2][1] Uroflowmetry is also a good diagnostic aid.[8]

The amount of urine passed during each urination is relatively small.[1] Pain while urinating suggests that there is a problem other than overactive bladder.[1]

Specific treatment is not always required.[1] If treatment is desired pelvic floor exercises, bladder training, and other behavioral methods are initially recommended.[3] Weight loss in those who are overweight, decreasing caffeine consumption, and drinking moderate fluids, can also have benefits.[3] Medications, typically of the anti-muscarinic type, are only recommended if other measures are not effective.[3] They are no more effective than behavioral methods; however, they are associated with side effects, particularly in older people.[3][9] Some non-invasive electrical stimulation methods appear effective while they are in use.[10] Injections of botulinum toxin into the bladder is another option.[3] Urinary catheters or surgery are generally not recommended.[3] A diary to track problems can help determine whether treatments are working.[3]

Overactive bladder is estimated to occur in 7–27% of men and 9–43% of women.[1] It becomes more common with age.[1] Some studies suggest that the condition is more common in women, especially when associated with loss of bladder control.[1] Economic costs of overactive bladder were estimated in the United States at US$12.6 billion and 4.2 billion Euro in 2000.[11]

Signs and symptoms

Overactive bladder is characterized by a group of four symptoms: urgency, urinary frequency, nocturia, and urge incontinence. Urge incontinence is not present in the "dry" classification.[12]

Urgency is considered the hallmark symptom of OAB, but there are no clear criteria for what constitutes urgency and studies often use other criteria.[1] Urgency is currently defined by the International Continence Society (ICS), as of 2002, as "Sudden, compelling desire to pass urine that is difficult to defer." The previous definition was "Strong desire to void accompanied by fear of leakage or pain."[13] The definition does not address the immediacy of the urge to void and has been criticized as subjective.[13]

Urinary frequency is considered abnormal if the person urinates more than eight times in a day. This frequency is usually monitored by having the person keep a voiding diary where they record urination episodes.[1] The number of episodes varies depending on sleep, fluid intake, medications, and up to seven is considered normal if consistent with the other factors.[citation needed]

Nocturia is a symptom where the person complains of interrupted sleep because of an urge to void and, like the urinary frequency component, is affected by similar lifestyle and medical factors. Individual waking events are not considered abnormal, one study in Finland established two or more voids per night as affecting quality of life.[14]

Urge incontinence is a form of urinary incontinence characterized by the involuntary loss of urine occurring for no apparent reason while feeling urinary urgency as discussed above. Like frequency, the person can track incontinence in a diary to assist with diagnosis and management of symptoms. Urge incontinence can also be measured with pad tests, and these are often used for research purposes. Some people with urge incontinence also have stress incontinence and this can complicate clinical studies.[1]

It is important that the clinician and the person with overactive bladder both reach a consensus on the term, 'urgency.' Some common phrases used to describe OAB include, 'When I've got to go, I've got to go,' or 'When I have to go, I have to rush, because I think I will wet myself.' Hence the term, 'fear of leakage,' is an important concept to people.[15]

Causes

The cause of OAB is usually unclear, and indeed there may be multiple causes.[16] It is often associated with overactivity of the detrusor urinae muscle, a pattern of bladder muscle contraction observed during urodynamics.[17] It is also possible that the increased contractile nature originates from within the urothelium and lamina propria, and abnormal contractions in this tissue could stimulate dysfunction in the detrusor or whole bladder.[18]

If bladder spasms occur or there is no urine in the drainage bag when a catheter is in place, the catheter may be blocked by blood, thick sediment, or a kink in the catheter or drainage tubing. Sometimes spasms are caused by the catheter irritating the bladder, prostate or penis. Such spasms can be controlled with medication such as butylscopolamine, although most people eventually adjust to the irritation and the spasms go away.[19]

Diagnosis

Diagnosis of OAB is made primarily on the person's signs and symptoms and by ruling out other possible causes such as an infection.[1] Urodynamics, a bladder scope, and ultrasound are generally not needed.[1][20] Additionally, urine culture may be done to rule out infection. The frequency/volume chart may be maintained and cystourethroscopy may be done to exclude tumor and kidney stones. If there is an underlying metabolic or pathologic condition that explains the symptoms, the symptoms may be considered part of that disease and not OAB.[citation needed]

Psychometrically robust self-completion questionnaires are generally recognized as a valid way of measuring a person's signs and symptoms, but there does not exist a single ideal questionnaire.[21] These surveys can be divided into two groups: general surveys of lower urinary tract symptoms and surveys specific to overactive bladder. General questionnaires include: American Urological Association Symptom Index (AUASI), Urogenital Distress Inventory (UDI),[22] Incontinence Impact Questionnaire (IIQ),[22] and Bristol Female Lower Urinary Tract Symptoms (BFLUTS). Overactive bladder questionnaires include: Overactive Bladder Questionnaire (OAB-q),[23] Urgency Questionnaire (UQ), Primary OAB Symptom Questionnaire (POSQ), and the International Consultation on Incontinence Questionnaire (ICIQ).

OAB causes similar symptoms to some other conditions such as urinary tract infection (UTI), bladder cancer, and benign prostatic hyperplasia (BPH). Urinary tract infections often involve pain and hematuria (blood in the urine) which are typically absent in OAB. Bladder cancer usually includes hematuria and can include pain, both not associated with OAB, and the common symptoms of OAB (urgency, frequency, and nocturia) may be absent. BPH frequently includes symptoms at the time of voiding as well as sometimes including pain or hematuria, and all of these are not usually present in OAB.[13] Diabetes insipidus causes high frequency and volume, though not necessarily urgency.

Classification

There is some controversy about the classification and diagnosis of OAB.[1][24] Some sources classify overactive bladder into two different variants: "wet" (i.e., an urgent need to urinate with involuntary leakage) or "dry" (i.e., an urgent need to urinate but no involuntary leakage). Wet variants are more common than dry variants.[25] The distinction is not absolute; one study suggested that many classified as "dry" were actually "wet" and that people with no history of any leakage may have had other syndromes.[26]

OAB is distinct from stress urinary incontinence, but when they occur together, the condition is usually known as mixed incontinence.[27]

Management

The usual first suggested treatment for a person with overactive bladder is a combination of lifestyle changes, exercises to strengthen the person's pelvic floor, and manage how much the person drinks and when during the day ("fluid management"). Patients who continue to experience incontinence episodes, or who express a desire for medication along with therapy, may be treated with several classes of drugs, notably anticholinergics. Patients who prove resistant to medications and therapy may then be treated with neurological interventions, such as treatment with botulinum toxin (Botox) and other minimally-invasive surgical procedures, such as sacral neuromodulation. As a last resort if all other treatment options fail, invasive surgical procedures may be performed.[28][29]

Lifestyle and behavioral therapy

Behavioral and lifestyle changes are commonly recommended as the first-line option for treating overactive bladder. These include bladder training, which involves scheduled voiding (urination) and gradually increasing the time between bathroom visits. Pelvic floor exercises, known as Kegel exercises, can help strengthen the muscles that control urination. Fluid management, which focuses on avoiding excessive caffeine and alcohol intake, is advised to reduce the rate at which the bladder fills and minimize irritation to the bladder. Weight management and maintaining a healthy diet contribute to overall bladder health, especially when weight loss is able to reduce abdominal compression of the bladder. Adopting these behavioral and lifestyle changes can often improve the condition and enhance the effectiveness of other treatment approaches.[28][30]

Most patients are not able to eliminate incontinence and other symptoms of OAB with lifestyle and behavioral modifications alone. However, numerous studies have demonstrated that these therapies are effective in improving quality of life, and some data shows that they increase the likelihood that medications can keep the OAB under control.[28]

Medications

Medications are a common treatment option for people with overactive bladder syndrome. A number of antimuscarinic drugs (e.g., darifenacin, hyoscyamine, oxybutynin, tolterodine, solifenacin, trospium, fesoterodine) are frequently used to treat overactive bladder.[17] Long term use, however, has been linked to dementia.[31] β3 adrenergic receptor agonists (e.g., mirabegron, vibegron) may be used, as well.[32]

Patients taking oxybutynin and other anticholinergic drugs experience a 70% reduction of incontinence episode frequency, on average. Approximately 1 in 4 patients experience complete dryness while taking oxybutynin. Therefore, medication management alone is sufficient for a substantial minority, but not the majority, of patients with overactive bladder.[33]

Comparison of overactive bladder medication
Agent Traits
Oxybutynin (short-acting)
  • well known by physicians
  • available in market longer than other drugs for OAB
  • many studies provide support of effectiveness
  • available as generic in places including the United States
  • more side effects than alternatives, including dry mouth and constipation
  • severe dry mouth more often reported
  • user takes 2-3 pills a day
Oxybutynin (extended release)
  • fewer side effects than short-acting Oxybutynin
  • 1 pill per day
Oxybutynin (transdermal patch)
  • no pill
  • patch changed every 3–4 days
  • lower rate of dry mouth as compared to pill form
  • patch commonly causes skin irritation which can be severe
Oxybutynin (Topical medication)
  • fewer side effects than short-acting Oxybutynin
  • topical gel applied to abdomen, arms, or thighs daily
  • new on market
  • little existing research on this drug
Tolterodine (short-acting)
  • fewer side effects than short-acting Oxybutynin
  • 2 pills per day
  • 10% of Caucasians and 19% of black people have a genetic difference which causes them to lack a certain enzyme. Lack of this enzyme makes the drug less effective.
Tolterodine (extended release)
  • fewer side effects than short-acting Oxybutynin
  • 1 pill per day
  • 10% of Caucasians and 19% of black people have a genetic difference which causes them to lack a certain enzyme. Lack of this enzyme makes the drug less effective.
Solifenacin
  • 1 pill per day
  • More effective for some symptoms than Tolterodine
  • higher rates of constipation and dry mouth than tolterodine
  • less researched for safety and efficacy than Tolterodine and Oxybutynin
Trospium (short acting)
  • severe dry mouth less common than with oxybutynin
  • less researched for safety and efficacy than Tolterodine and Oxybutynin
Trospium (extended release)
  • 1 pill per day
  • little existing research on this drug
Darifenacin
  • 1 pill per day
  • less researched for safety and efficacy than Tolterodine and Oxybutynin
Fesoterodine
  • same metabolite as Tolterodine, but does not require that enzyme to be active
  • it may avoid drug interactions of Tolterodine
  • little existing research on this drug

Procedures

Botulinum toxin A (Botox) is approved by the Food and Drug Administration in adults with neurological conditions, including multiple sclerosis and spinal cord injury.[34] Botulinum Toxin A injections into the bladder wall can suppress involuntary bladder contractions by blocking nerve signals and may be effective for up to 9 months.[35][36] The growing knowledge of pathophysiology of overactive bladder fueled a huge amount of basic and clinical research in this field of pharmacotherapy.[37][38][39]

Overactive bladder may be treated with electrical stimulation, which aims to reduce the contractions of the muscle that tenses around the bladder and causes urine to pass out of it. Both invasive and non-invasive electrical stimulation procedures may be used to treat overactive bladder.[10]

Invasive surgeries

If non-invasive and pharmacological approaches are not helpful, some people may be eligible for a surgical procedure to treat overactive bladder. Surgical options may include urinary diversion, sacral neuromodulation, or augmentation cystoplasty.[40]

One surgical intervention, called a cystoplasty, involves the enlargement of the bladder using tissue taken from the patient's ileum, which is part of the small intestine. This procedure is rarely performed, and is only done for patients who have proven resistant to all other forms of treatment. This procedure can greatly enlarge urine volume in the bladder.[41]

Prognosis

Because overactive bladder is most commonly associated with aging, the majority of patients experience symptoms (with or without incontinence) for the rest of their lives. A minority of age-related OAB cases may be cured or indefinitely suppressed by medications and behavioral modification. If the OAB is due to a different condition, such as a urinary tract infection, then symptoms should resolve after the underlying problem has been treated.[30]

Epidemiology

Earlier reports estimated that about one in six adults in the United States and Europe had OAB.[42][43] The number of people affected with OAB increases with age,[42][43] thus it is expected that OAB will become more common in the future as the average age of people living in the developed world is increasing. However, a recent Finnish population-based survey[44] suggested that the number of people affected had been largely overestimated due to methodological shortcomings regarding age distribution and low participation (in earlier reports). It is suspected, then, that OAB affects approximately half the number of individuals as earlier reported.[44]

The American Urological Association reports studies showing rates as low as 7% to as high as 27% in men and rates as low as 9% to 43% in women.[1] Urge incontinence was reported as higher in women.[1] Older people are more likely to be affected, and the number of symptoms increases with age.[1]

See also

References

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y American Urological Association (2014). "Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline" (PDF). Archived from the original (PDF) on 26 April 2015. Retrieved 1 June 2015.
  2. ^ a b c d Gormley EA, Lightner DJ, Faraday M, Vasavada SP (May 2015). "Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment". The Journal of Urology. 193 (5): 1572–80. doi:10.1016/j.juro.2015.01.087. PMID 25623739.
  3. ^ a b c d e f g h Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, Das AK, Foster HE, Scarpero HM, Tessier CD, Vasavada SP (December 2012). "Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline". The Journal of Urology. 188 (6 Suppl): 2455–63. doi:10.1016/j.juro.2012.09.079. PMID 23098785.
  4. ^ "Urinary Bladder, Overactive". Retrieved 1 June 2015.
  5. ^ a b Gibbs, Ronald S. (2008). Danforth's obstetrics and gynecology (10 ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 890–891. ISBN 9780781769372. Archived from the original on 2016-03-05.
  6. ^ Hargreaves, Emma; Baker, Katherine; Barry, Gill; Harding, Christopher; Zhang, Yingying; Kandala, Ngianga-Bakwin; Zhang, Xiaowen; Kernohan, Ashleigh; Clarkson, Carl E (2022-09-23). Cochrane Incontinence Group (ed.). "Acupuncture for treating overactive bladder in adults". Cochrane Database of Systematic Reviews. 2022 (9): CD013519. doi:10.1002/14651858.CD013519.pub2. PMC 9502659. PMID 36148895.
  7. ^ Ghosh, Amit K. (2008). Mayo Clinic internal medicine concise textbook. Rochester, MN: Mayo Clinic Scientific Press. p. 339. ISBN 9781420067514. Archived from the original on 2016-03-05.
  8. ^ Nowakowski Ł, Futyma K, Ziętek A, Bogusiewicz M, Gałczyński K, Rechberger T (2016). "Use of free uroflowmetry vs pressure-flow studies in the diagnosis of overactive bladder syndrome in females". Eur J Obstet Gynecol Reprod Biol. 207: 137–140. doi:10.1016/j.ejogrb.2016.10.054. PMID 27852010.
  9. ^ Ruxton K, Woodman RJ, Mangoni AA (August 2015). "Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis". British Journal of Clinical Pharmacology. 80 (2): 209–20. doi:10.1111/bcp.12617. PMC 4541969. PMID 25735839.
  10. ^ a b Stewart F, Gameiro LF, El Dib R, Gameiro MO, Kapoor A, Amaro JL (December 2016). "Electrical stimulation with non-implanted electrodes for overactive bladder in adults". The Cochrane Database of Systematic Reviews. 12 (2): CD010098. doi:10.1002/14651858.CD010098.pub4. hdl:2164/8446. PMC 6463833. PMID 27935011.
  11. ^ Abrams, Paul (2011). Overactive bladder syndrome and urinary incontinence. Oxford: Oxford University Press. pp. 7–8. ISBN 9780199599394. Archived from the original on 2016-03-05.
  12. ^ Lightner, Deborah J.; Gomelsky, Alexander; Souter, Lesley; Vasavada, Sandip P. (September 2019). "Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019". The Journal of Urology. 202 (3): 558–563. doi:10.1097/JU.0000000000000309. ISSN 1527-3792. PMID 31039103.
  13. ^ a b c Wein A (October 2011). "Symptom-based diagnosis of overactive bladder: an overview". Canadian Urological Association Journal. 5 (Suppl 2): S135–6. doi:10.5489/cuaj.11183. PMC 3193392. PMID 21989525.
  14. ^ Tikkinen KA, Johnson TM, Tammela TL, Sintonen H, Haukka J, Huhtala H, Auvinen A (March 2010). "Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland". European Urology. 57 (3): 488–96. doi:10.1016/j.eururo.2009.03.080. PMID 19361907.
  15. ^ Campbell-Walsh Urology, Tenth Edition, Chapter 66, Page 1948
  16. ^ Sacco E (2012). "[Physiopathology of overactive bladder syndrome]". Urologia. 79 (1): 24–35. doi:10.5301/RU.2012.8972. PMID 22287269. S2CID 39170650.
  17. ^ a b Sussman DO (September 2007). "Overactive bladder: treatment options in primary care medicine". The Journal of the American Osteopathic Association. 107 (9): 379–85. PMID 17908830.
  18. ^ Moro C, Uchiyama J, Chess-Williams R (December 2011). "Urothelial/lamina propria spontaneous activity and the role of M3 muscarinic receptors in mediating rate responses to stretch and carbachol". Urology. 78 (6): 1442.e9–15. doi:10.1016/j.urology.2011.08.039. PMID 22001099.
  19. ^ "Urinary catheters". MedlinePlus, the National Institutes of Health's Web site. 2010-03-09. Archived from the original on 2010-12-04. Retrieved 2010-12-01.
  20. ^ American Urogynecologic Society (May 5, 2015), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Urogynecologic Society, archived from the original on June 2, 2015, retrieved June 1, 2015
  21. ^ Shy M, Fletcher SG (March 2013). "Objective Evaluation of Overactive Bladder: Which Surveys Should I Use?". Current Bladder Dysfunction Reports. 8 (1): 45–50. doi:10.1007/s11884-012-0167-2. PMC 3579666. PMID 23439804.
  22. ^ a b Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (October 1994). "Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group". Quality of Life Research. 3 (5): 291–306. doi:10.1007/bf00451721. PMID 7841963. S2CID 22892631.
  23. ^ Coyne K, Schmier J, Hunt T, Corey R, Liberman J, Revicki D (March 2000). "PRN6: developing a specific HRQL instrument for overactive bladder". Value in Health. 3 (2): 141. doi:10.1016/s1098-3015(11)70554-x.
  24. ^ Homma Y (January 2008). "Lower urinary tract symptomatology: Its definition and confusion". International Journal of Urology. 15 (1): 35–43. doi:10.1111/j.1442-2042.2007.01907.x. PMID 18184169. S2CID 35527427.
  25. ^ "Overactive Bladder". Cornell University Weill Cornell Medical College Department of Urology. Archived from the original on 21 September 2013. Retrieved 25 Aug 2013.
  26. ^ Anger JT, Le TX, Nissim HA, Rogo-Gupta L, Rashid R, Behniwal A, Smith AL, Litwin MS, Rodriguez LV, Wein AJ, Maliski SL (November 2012). "How dry is "OAB-dry"? Perspectives from patients and physician experts". The Journal of Urology. 188 (5): 1811–5. doi:10.1016/j.juro.2012.07.044. PMC 3571660. PMID 22999694.
  27. ^ Harris, Shauna; Riggs, John (2024), "Mixed Urinary Incontinence", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30480967, retrieved 2024-03-07
  28. ^ a b c White, Nicola; Iglesia, Cheryl B. (2016-03-01). "Overactive Bladder". Obstetrics and Gynecology Clinics of North America. Medical and Advanced Surgical Management of Pelvic Floor Disorders. 43 (1): 59–68. doi:10.1016/j.ogc.2015.10.002. ISSN 0889-8545. PMID 26880508.
  29. ^ Hutchinson, Alexander; Nesbitt, Alexander; Joshi, Andre; Clubb, Adrian; Perera, Marlon (Sep 2020). "Overactive bladder syndrome: Management and treatment options". Australian Journal of General Practice. 49 (9): 593–598. doi:10.31128/AJGP-11-19-5142. hdl:10072/400893. ISSN 2208-7958. PMID 32864677.
  30. ^ a b Ouslander, Joseph; Reyes, Bernardo (2022). "Chapter 477: Caring for the Geriatric Patient". Harrison's Principles of Internal Medicine (21st ed.). New York: McGraw Hill. ISBN 978-1264268504.
  31. ^ Araklitis G, Cardozo L (November 2017). "Safety issues associated with using medication to treat overactive bladder". Expert Opinion on Drug Safety. 16 (11): 1273–1280. doi:10.1080/14740338.2017.1376646. PMID 28889761. S2CID 10862256.
  32. ^ Sacco E, Bientinesi R (December 2012). "Mirabegron: a review of recent data and its prospects in the management of overactive bladder". Therapeutic Advances in Urology. 4 (6): 315–24. doi:10.1177/1756287212457114. PMC 3491758. PMID 23205058.
  33. ^ Diokno, Ananias; Ingber, Michael (Nov 2006). "Oxybutynin in Detrusor Overactivity". Urologic Clinics of North America. 33 (4): 439–445. doi:10.1016/j.ucl.2006.06.003. PMID 17011379.
  34. ^ "FDA approves Botox for loss of bladder control". Reuters. 24 August 2008. Archived from the original on 24 September 2015.
  35. ^ Chancellor, Michael B; Christopher Smith (August 2011). Botulinum Toxin in Urology. Springer. ISBN 978-3-642-03579-1.
  36. ^ Sacco E, Paolillo M, Totaro A, Pinto F, Volpe A, Gardi M, Bassi PF (2008). "Botulinum toxin in the treatment of overactive bladder". Urologia. 75 (1): 4–13. doi:10.1177/039156030807500102. PMID 21086369. S2CID 208149855.
  37. ^ Sacco E, Bientinesi R (2012). "Future perspectives in pharmacological treatments options for overactive bladder syndrome". Eur Urol Review. 7 (2): 120–126.
  38. ^ Sacco E, Pinto F, Bassi P (April 2008). "Emerging pharmacological targets in overactive bladder therapy: experimental and clinical evidences". International Urogynecology Journal and Pelvic Floor Dysfunction. 19 (4): 583–98. doi:10.1007/s00192-007-0529-z. PMID 18196198. S2CID 23846583.
  39. ^ Sacco E, et al. (2009). "Investigational drug therapies for overactive bladder syndrome: the potential alternatives to anticholinergics". Urologia. 76 (3): 161–177. doi:10.1177/039156030907600301. PMID 21086288. S2CID 208148685.
  40. ^ "Overview | Urinary incontinence and pelvic organ prolapse in women: management | Guidance | NICE". www.nice.org.uk. 2 April 2019. Retrieved 2023-04-24.
  41. ^ Scarneciu, Ioan; Lupu, Sorin; Bratu, Ovidiu Gabriel; Teodorescu, Andreea; Maxim, Laurian Stefan; Brinza, Adrian; Laculiceanu, Alexandru Georgian; Rotaru, Ruxandra Maria; Lupu, Aura-Mihaela; Scarneciu, Camelia Cornelia (2021-10-14). "Overactive bladder: A review and update". Experimental and Therapeutic Medicine. 22 (6): 1444. doi:10.3892/etm.2021.10879. ISSN 1792-1015. PMC 8549091. PMID 34721686.
  42. ^ a b Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ (May 2003). "Prevalence and burden of overactive bladder in the United States". World Journal of Urology. 20 (6): 327–36. doi:10.1007/s00345-002-0301-4. hdl:2027.42/42170. PMID 12811491. S2CID 15994916.
  43. ^ a b Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ (June 2001). "How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study". BJU International. 87 (9): 760–6. doi:10.1046/j.1464-410x.2001.02228.x. PMID 11412210. S2CID 23650548.
  44. ^ a b Tikkinen KA, Tammela TL, Rissanen AM, Valpas A, Huhtala H, Auvinen A (February 2007). Madersbacher S (ed.). "Is the prevalence of overactive bladder overestimated? A population-based study in Finland". PLOS ONE. 2 (2): e195. Bibcode:2007PLoSO...2..195T. doi:10.1371/journal.pone.0000195. PMC 1805814. PMID 17332843. Open access icon
  • Sacco E, Bientinesi R, Marangi F, D'Addessi A, Racioppi M, Gulino G, Pinto F, Totaro A, Bassi P (2011). "[Overactive bladder syndrome: the social and economic perspective]". Urologia (in Italian). 78 (4): 241–56. doi:10.5301/RU.2011.8886. PMID 22237808. S2CID 36693916.
  • "Overactive Bladder". MedlinePlus. U.S. National Library of Medicine.
Quelle: https://en.wikipedia.org/wiki/Urge_incontinence