Rigi10™ Malleable Penile Prosthesis
Also Known As
Overactive detrusor muscle, Involuntary bladder contractions, Uninhibited bladder contractions
Definition
Detrusor overactivity (DO) is a urodynamic diagnosis characterized by involuntary detrusor contractions during the filling phase of cystometry, which may be spontaneous or provoked. These contractions can lead to symptoms such as urinary urgency, frequency, nocturia, and urgency urinary incontinence. DO is a key component of Overactive Bladder (OAB) syndrome, which is a clinical diagnosis based on these symptoms in the absence of urinary tract infection or other obvious pathology.¹ The pathophysiology of DO is not fully understood but is thought to involve neurogenic, myogenic, autonomous bladder, and afferent signaling theories.² The detrusor muscle, which is the smooth muscle found in the wall of the bladder, normally contracts to empty the bladder during urination. In DO, this muscle contracts involuntarily during bladder filling, leading to a sudden and compelling desire to urinate, even when the bladder volume is low.¹² Its purpose in urology is to identify a specific bladder dysfunction that can be targeted with various treatment modalities aimed at reducing these involuntary contractions and alleviating associated symptoms.¹
Clinical Context
Detrusor overactivity (DO) is clinically relevant in the evaluation of patients presenting with symptoms of overactive bladder (OAB) syndrome, which include urinary urgency, frequency, nocturia, with or without urgency incontinence.¹ It is a common finding in patients over 40 years old, and its prevalence increases with age.¹ The diagnosis of DO is made through urodynamic studies, specifically cystometry, which measures bladder pressure during filling and voiding. This investigation is typically considered when initial conservative treatments for OAB symptoms fail, or when the diagnosis is unclear, or prior to invasive treatments.¹
Patient selection criteria for urodynamic testing to diagnose DO include individuals with refractory OAB symptoms, those with neurological conditions (neurogenic detrusor overactivity, e.g., in spinal cord injury, multiple sclerosis, Parkinson’s disease), or when surgical intervention is contemplated.¹² For non-neurogenic DO, the clinical context often involves ruling out other causes of bladder symptoms such as urinary tract infections, bladder stones, or tumors.¹
Surgical procedures are generally not the first line for DO itself but may be considered for refractory OAB. Treatments for DO/OAB range from behavioral therapies (bladder training, pelvic floor muscle exercises), pharmacological treatments (antimuscarinics, beta-3 agonists), to more invasive options like botulinum toxin injections into the detrusor muscle, sacral neuromodulation, or percutaneous tibial nerve stimulation for patients who do not respond to or cannot tolerate conservative measures.¹² Expected outcomes of treatment aim to reduce involuntary detrusor contractions, thereby alleviating symptoms of urgency, frequency, and incontinence, and improving the patient’s quality of life.¹ Success rates vary depending on the treatment modality and patient characteristics.¹