pathofisiology overactive bladder
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Prof. dr. H. Yunizaf, SpOG(K)
Division of Urogynecology Reconstructive
Deptment of Obstetrics and Gynecology
Faculty of Medicine University of Indonesia
Jakarta
BLADDER FUNCTION
Storage
Voiding
Detrusor muscle
Sympathetic and parasympathetic
Central nerves system
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Muscarinic receptor
Detrusor muscle
asetilkolin
Five pharmacologically defined receptors, M1- M5 Sigala et al 2002
Predominance of M2 and M3 receptors Yamaguchi et al 1996,
Sigala et al 2002
M2 receptors predominanc 3:1 over M3 receptors
Muscarinic receptors found
Urotelial cells
Suburotelial nerves
Interstitial cells
Chess-Williams 2002, Gillespie et al 2003
Filling Cystometry
(CMG) (Normal)
Namiki M, 1998
Namiki M, 1998
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Detrusor overactivity is a urodynamic observation characterised by
involuntary detrusor contractions during the filling phase which may be
spontaneous or provoked.
1. Neurogenic detrusor overactivity
When there is a relevant neurogical condition
This term replaces the term detrusor hyperreflexia
2. Idiopathic detrusor overactivity
When there is no defined cause Non-neurogenic
This term replaces the term detrusor instability
Unstable detrusor (what is called Unstable bladder, =Detrusor instability) in
the previous version (1989) Deleted
Abrams P, Cardozo L et al Neurourol Urodyn 2002;21:167-178 (Page 173 L&R)
Overactive Bladder (OAB) is a symptom syndrome suggestive of lower
urinary tract dysfunction
It is specifically defined as:
Urgency, with or without urge incontinence, Usually with frequency and nocturia
Standardisation Subcommittee of the International Continence Society
(ICS)
OAB is used in the absence of proven infection or other obvious pathology
Usually suggestive of detrusor overactivity, but can be due to other urethro-vesical dysfunction.
Abrams P, Cardozo L, Fall M et al Neurourol Urodyn 2002;21:167-178
Urgency A sudden compelling desire to pass
urine, which is difficult to defer
Incontinence Any involuntary leakage of urine
Frequency Voiding too often usually defined as 8
or more times in 24 hours
Nocturia Waking more than once at night to void
Abrams P, Cardozo L, Fall M et al Neurourol Urodyn 2002;21:167-178
Urgency Frequency Nocturia Incontinence urge
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Increased Frequency
and Reduced
Intervoid Interval
Nocturia
Urgency
Incontinence
Reduced Volume Voided per Micturition
2 2
1. Proven direct effect 2. Effect correlated with urgency but inconsistent due to
multifactorial etiology of the symptom
Chapple C. ICI poster, June 2004
Frequency
Urgency
Overactive bladder
Urge
incontinence
SYMPTOM OVERACTIVE
BLADDER
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1. HISTORY
2. PHYSICAL EXAMINATION
3. LABORATORY TEST
4. URINARY DIARY
5. URODYNAMICS
DIAGNOSTIC OVERACTIVE
BLADDER (OAB)
Fantl JA et al. Agency for Healthcare Policy and Research;
1996; AHCPR Publication No. 96-0686.
Urinalysis
to rule out hematuria, pyuria, bacteriuria, glucosuria, proteinuria
Blood work as appropriate
glucose
prostate specific antigen
others
Time
Drinks Urination Accidental Leaks
Did you feel
a strong
urge to go?
What were you doing
at the time?
What
kind?
How
much?
How many
times?
How much?
(fill in amount:
small, medium, large)
How much?
(fill in amount:
small, medium, large)
Sneezing, exercising,
having sex, lifting, etc.
Sample coffee 2 cups 12 large large yes laughing
67 AM
78 AM
89 AM
910 AM
1011 AM
1112 PM
121 PM
12 PM
23 PM
34 PM
45 PM
This diary will help you and your healthcare team. Bladder diaries help show the causes of bladder control trouble. The sample line (below) will show you how to use the diary.
Your name: J. Doe Date: March 31, 2003
CONTOH DAFTAR HARIAN BERKEMIH
KARTU CATATAN BUANG AIR KECIL Tgl
Hari ke-I y y y y m m d d
Interval waktu Buang air kecil
Biasa Mengompol
Keinginan buang air kecil Keadaan
Tengah malam 1.00
1.00-2.00
2.00-3.00
3.00-4.00
4.00-5.00
5.00-6.00
6.00-7.00
7.00-8.00
8.00-9.00
9.00-10.00
10.00-11.00
12.00-13.00
13.00-14.00
14.00-15.00
16.00-16.00
16.00-17.00
17.00-18.00
18.00-19.00
19.00-20.00
20.00-21.00
21.00-22.00
22.00-23.00
23,00-24.00
Conservative
Operative
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1. Konservatif 1. Obat obatan 2. Bladder drill 3. Pesikotrapi 4. Perubahan prilaku 5. Akupunktur 6. Pampers
2. Operatif Neoromudulasi Cystoplasty
THANK YOU
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