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Urogynaecology (Jeffery and de Jong)
6: Intractable Overactive Bladder- Advanced Management Strategies

6: Intractable Overactive Bladder- Advanced Management Strategies

Last updated

Sep 18, 2019
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- 5.9: The Future
- 6.1: Introduction

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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.

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