The Role of Antimuscarinics in the Treatment of Neurogenic Detrusor Overactivity in Patients with Stroke, Spinal Cord Injury and Parkinson's Disease

Voiding dysfunction with nocturia, frequency, and urgency with or without incontinence are common clinical manifestations in patients with cerebrovascular accident, Parkinson's disease and spinal cord injury. Neurogenic overactive bladder (OAB) is usually associated with detrusor overactivity (DO) with or without sphincter dysfunction and is caused by various diseases or events affecting central and peripheral nervous system control of the lower urinary tract. The International Continence Society (ICS) (2002) defined neurogenic detrusor overactivity (NDO) as ”a urodynamic observation characterized by involuntary detrusor contractions during the filling stage, which may be spontaneous or provoked.” A diagnosis of neurogenic detrusor overactivity depends on a detailed history, physical examination and urodynamic studies. Urodynamic study is the best tool to assess and classify detrusor activity. The goals of treatment are reduction of both intravesical pressure and the postvoid residual in order to restore urinary continence and lower urinary tract function, to prevent upper tract damage and to improve the patient's quality of life. Treatment strategy is based on whether the patient has urinary storage failure, impaired emptying function or a combination of both problems. Flexible doses of antimuscarinics, with additional clean intermittent catheterization (CIC), are effective in symptom relief and prevention of deterioration of upper tract function. Close monitoring of the postvoid residual is recommended among patients with NDO and impaired contraction. This article will review the pathogenesis of NDO and discuss the role of antimuscarinics in its optimal treatment.

並列關鍵字

cerebrovascular accident ； neurogenic detrusor overactivity ； overactive bladder ； Parkinson's disease ； spinal cord injury ； urinary incontinence

國際替代計量

全文下載

主題瀏覽