- 期刊
Intravesical Treatment for Overactive Bladder Refractory to Antimuscarinics
並列摘要
Overactive bladder (OAB) is a symptom syndrome characterized by urgency frequency with or without urgency incontinence. The pathophysiology of OAB may involve parasympathetic efferent activity or afferent nerves which cause detrusor overactivity (DO) and sensory urgency. The traditional medication for OAB is antimuscarinic agents which target the muscarinic receptors not only on detrusor muscles but also on the sensory afferent nerves of the bladder. Intravesical treatment to inhibit abnormal receptor expression or transmitter release in the sensory nerve terminals in the suburothelial space might provide good therapeutic effects in the treatment of refractory OAB. Intravesical administration of antimuscarinics such as oxybutynin and tolterodine has been shown effective in increasing bladder capacity and decreasing incontinence episodes in patients with OAB. However, the need of daily intermittent transurethral catheterization and short therapeutic duration limited its wide application. Intravesical resiniferatoxin (RTX) instillation and intravesical botulinum toxin A (BTX-A) injection are two treatment alternatives for refractory OAB and have been demonstrated to have long-term effects. RTX at low concentrations can decrease sensory urgency without influencing detrusor contractility. BTX-A, however, has a substantial effect on detrusor contractility resulting in a large postvoid residual after injections.
延伸閱讀
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