6: Intractable Overactive Bladder- Advanced Management Strategies
- Page ID
- 15604
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)\(\newcommand{\AA}{\unicode[.8,0]{x212B}}\)
- 6.1: Introduction
- The mainstay of treatment for Overactive Bladder is fluid management, bladder retraining and anticholinergic drug therapy. There are, however, a subset of women who do not respond to these standard treatment regimens and remain incontinent, their symptoms having a profound impact on their quality of life.
- 6.2: Botulinum Toxin
- Botulinum Toxin, which is produced by the bacterium, Clostridium Perfringens, is the most potent toxin known to man.
- 6.3: Sacral Nerve Stimulation (SNS)
- This device works by implanting a pacemaker-like neurostimulator in the lower back that sends mild electrical impulses to electrodes that are usually placed adjacent to the third sacral nerve root.
- 6.4: Posterior Tibial Nerve Stimulation
- Because of the technical and cost implications of SNS, indirect neuromodulation of S2,3 and 4 via stimulation of the posterior tibial nerve, was developed.
- 6.5: 6.5-Surgical Therapy
- Clam ileocystoplasty and augmentation procedures are usually reserved for patients with neurogenic detrusor overactivity and high pressure bladders with the potential of upper tract damage.
- 6.6: Alternative therapy
- A number of studies have shown acupuncture to be a useful adjunct to therapy.