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KMID : 0978920020030030017
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Korean Journal of Clinical Geriatrics
2002 Volume.3 No. 3 p.17 ~ p.27
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Update of overactive bladder
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Lee You-Sik
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Abstract
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The overactive bladder is defined by the international Continence Society as a disorder of filling/storage in which involunt앙y bladder contraction 따e demonsσated while the patient is attempting to inhibit. If the involuntary bladder contraction 따e secondary to a known neurologic disease, the condition is known as deσusor hyperreflexia, If the involuntary bladder contraction 없e not due to a known neurologic disease, then the condition is known as detrusor instability. The symptom of the overactive bladder consist of urgency anψor frequency anψor nocturia and/or urge incontinence. These may exit singly or combination with one another. The overactive bladder can be manifested by any one or a combination or these symptoms. Treatment modalities of overactive blader will involve intervention along the whole route of the micturition reflex, and different modalities will be combined. Although it is well known that estrogen and progesterone receptors are present in the vagina, lower urinary tract and pelvic floor, and that s”nptomatic, cytologic, and urodynanlic changes in the lower urinary πact had been demonstrated during the menstrual cycle, and following menopause, there have been few controlled studied of estrogen therapy on the overactive bladder. Peripheral targets for the drug treatment of the overactive bladder may be in the bladder, urethra, prostate or peripheral nerve. Antomuscarinic drugs are still the most widely used agents for the σeatment of the bladder overactivity. Currently used 따ug, however, lack of sensitivity for the bladder, and this limits their usefulness. Currently, the musc따inic receptors remain a main target for drug used to σeat the overactive bladder. However, the complexity ofmuscarinic receptor functions in the bladder and elsewhere in the body makes it difficult to predict the optimal profile of subtype selectivity for the treatment of bladder overactivity. Since M3 receptors are located not only in the bladder but also in the salivary glands and the intestine, the concept of selected M3 receptor antagonism may not offer a therapeutic advantage, since two of the most common side effects, dry mouth and constipation, would not be avoid. If the subηpes of receptors which mediate bladder conσactions and those which produce the main side effects of the anti-muscarinic agents were entirely known, more effective agents with fewer side effects for the σeatment of bladder overactivity might be obtainable. Ph따macologic treatment will be directed not only at function but at structure, and the concept of uroselectivity will assume greater importance.
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KEYWORD
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Overactive bladder, Urgency, Frequency, Incontin
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