["Pathophysiology and treatment of the overactive bladder"]

Area of Science:

• Urology
• Neurology
• Geriatrics

Context:

• Overactive bladder (OAB) is defined by the International Continence Society (ICS) as urinary urgency, with or without urge incontinence, often accompanied by frequency and nocturia.
• The etiology of OAB is complex, categorized as neurogenic or nonneurogenic, and can be challenging to ascertain in patients with coexisting conditions like bladder outlet obstruction and neurological disease.

Purpose:

• This debate examines the pathophysiology of OAB and evaluates optimal treatment strategies for patients presenting with multiple potential causes of OAB symptoms.
• To discuss treatment modalities for a 75-year-old male patient experiencing OAB symptoms post-cerebrovascular accident, complicated by urinary tract infection and elevated post-void residual volume.

Summary:

• A 75-year-old male presented with OAB symptoms, urgency, nocturia, and urge incontinence, exacerbated by turbid urine and a urinary tract infection (UTI).
• The patient exhibited significant post-void residual (84 ml), a prostate volume of 28 ml, and an International Prostate Symptom Score (IPSS) of 23, with storage symptoms predominating.
• Post-UTI treatment, the maximum flow rate was 9.4 ml/s, leading to a discussion on treatment options: transurethral resection of the prostate (TURP) versus pharmacotherapy.

Impact:

• Highlights the diagnostic and therapeutic challenges in managing OAB in elderly patients with multiple comorbidities.
• Emphasizes the importance of addressing complicating factors like UTIs and potential benign prostatic hyperplasia when managing OAB.
• Informs clinical decision-making regarding surgical versus medical management of OAB in complex cases.