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Overactive bladder (OAB): a failed concept needing revision to accommodate an external anatomical control system
Peter Petros1, Jörgen Quaghebeur2,3, Jean-Jacques Wyndaele2
1School of Mechanical and Mathematical Engineering, University of Western Australia Stirling Highway, Crawley, WA, 6009, Australia. pp@kvinno.com.
World Journal of Urology
|February 22, 2022
Summary
Overactive bladder (OAB) and detrusor overactivity (DO) are better understood through the Integral Theory paradigm, linking ligament laxity to premature micturition and enabling improved diagnosis and treatment for urinary incontinence.
Area of Science:
- Urology
- Gynecology
- Pelvic Floor Disorders
Background:
- The current urodynamic system for overactive bladder (OAB) and detrusor overactivity (DO) has limitations in addressing the pathogenesis and cure of symptoms like urinary urge incontinence, frequency, and nocturia over 45 years.
- Existing definitions and practices fail to adequately explain the underlying causes and effective treatments for these common urinary issues.
Purpose of the Study:
- To analyze overactive bladder (OAB) syndrome using the Integral Theory paradigm's (ITS) binary feedback system.
- To introduce the ITS Clinical Assessment Pathway for understanding the relationship between structural damage (prolapse), ligament laxity, and urinary dysfunction (symptoms).
Main Methods:
- Analysis of OAB syndrome within the Integral Theory paradigm's (ITS) binary feedback system.
- Viewing female OAB as a prematurely activated micturition, primarily due to ligament damage/laxity.
- Introduction of the ITS Clinical Assessment Pathway detailing structural damage, ligaments, and symptom relationships.
Main Results:
- The ITS provides an anatomical explanation for OAB pathophysiology via a binary model, clarifying detrusor overactivity (DO) as a reflex struggle.
- The relationship between urethral diameter and flow explains obstructive patterns and leakage without pressure.
- Mechanical support of ligaments during urodynamics improved urethral pressure, reduced negative pressure during coughing, and diminished urge symptoms, transforming urodynamics into a predictive test for continence surgery.
Conclusions:
- The Integral Theory paradigm's concept of prematurely activated micturition validates OAB symptoms as a syndrome.
- This new understanding explains OAB pathogenesis and offers novel approaches to diagnosis, treatment, and research.
- High cure rates for OAB through ligament repair support the validity of the ITS binary system.
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