Rigi10™ Malleable Penile Prosthesis
Also Known As
OAB, Overactive Bladder Syndrome, Urge Incontinence, Urgency-Frequency Syndrome, Detrusor Overactivity, Overactive Detrusor, Irritable Bladder
Definition
Overactive bladder (OAB) is a chronic urological condition characterized by a sudden, compelling urge to urinate that is difficult to control.1 It is defined by the International Continence Society as a condition with characteristic symptoms of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology.”2 OAB occurs when the bladder muscles contract involuntarily even when the volume of urine in the bladder is low, causing an urgent need to urinate.3 This condition affects the normal functioning of the bladder’s storage and emptying mechanisms, disrupting the complex interactions between the central and peripheral nervous systems that control micturition.4 The detrusor muscle, which is densely innervated, may become overactive or hypersensitive, leading to inappropriate contractions and the sensation of urgency.5
Clinical Context
Overactive bladder affects approximately 16.5% of the adult population, with prevalence increasing with age.1 It significantly impacts quality of life, affecting daily activities, work productivity, social interactions, sleep patterns, and psychological well-being.3
The clinical evaluation of OAB begins with a thorough patient history, focusing on urinary symptoms, their duration, severity, and impact on quality of life.3 Clinicians should inquire about urinary frequency (typically defined as voiding eight or more times in 24 hours), urgency (sudden compelling desire to urinate that is difficult to defer), nocturia (waking at night to void), and urgency incontinence (involuntary leakage accompanied by urgency).5 A bladder diary is often recommended to document voiding patterns, fluid intake, and incontinence episodes.3
Diagnostic workup includes urinalysis to rule out infection, blood tests to assess renal function and metabolic disorders, and in some cases, urodynamic studies to evaluate bladder function.3 Cystoscopy may be performed to exclude bladder pathology such as tumors or stones.3
Treatment follows a stepped approach, beginning with behavioral modifications such as fluid management, bladder training, and pelvic floor exercises.4 Pharmacotherapy typically involves antimuscarinic agents (such as oxybutynin, tolterodine, solifenacin) or β3-adrenergic receptor agonists (mirabegron), which target the underlying mechanisms of detrusor overactivity.4 For refractory cases, advanced therapies include botulinum toxin injections into the detrusor muscle, sacral neuromodulation, or posterior tibial nerve stimulation.5 Surgical interventions are reserved for severe, treatment-resistant cases.4
Patient selection for treatment depends on symptom severity, comorbidities, medication contraindications, and patient preferences.3 Expected outcomes vary, with most patients experiencing significant symptom improvement rather than complete resolution.4 Long-term management often requires a combination of approaches and ongoing adjustments to therapy.5