Overactive Bladder: Non-neurogenic

Fig. 3.1

Detrusor overactivity

Findings

Filling Phase

First desire at 82 cm³.
Strong desire soon after.
Multiple detrusor contractions at 160, 175, 189, 197, and 200 cm³.
Large amplitude detrusor contractions starting at a volume of 160 cm³ with a maximum filling detrusor contraction pressure of 100 cm of H₂O
Normal compliance throughout filling.
No evidence of stress urinary incontinence despite coughs at 150 and 200 cm³.
EMG demonstrates activity during large DO event.

Voiding Phase

Patient voids to completion with 200 cm³ instilled and 210 cm³ voided.
Patient voids with an excellent flow with a maximum flow of 27.5 mL/s.

This urodynamic study shows a patient with early first desire at 82 cm³ with a strong desire soon after. She has urodynamic detrusor overactivity while filling. Her compliance is normal throughout filling. She has a large detrusor contraction at a bladder volume of 200 cm³. After this contraction dissipates, the patient is given permission to void. She empties to completion with a good flow and no evidence of obstruction .

3.2.1.5 Treatment Options

Observation—as the patient is significantly bothered by her symptoms, this is not the optimal option.
Trial of a different overactive bladder medication.
Percutaneous tibial nerve stimulation (PTNS) .
Onabotulinum toxin A injections (100 units).
Sacral neuromodulation .

3.2.2 Patient 2: Bladder Hypersensitivity

3.2.2.1 History

The patient is a 35-year-old woman with a history of obesity and GERD who complains of a 1-year history of worsening urinary frequency. She urinates every 30 min in the morning and then every hour during the afternoon. She complains of leakage but does not feel when it occurs and cannot tell if it happens with stress maneuvers. She notices intermittently that her underwear is damp and is unsure if this dampness is from urine. She has tried fluid management and some behavioral modification.