Overactive bladder

1. Behavioral therapy, in the form of bladder retraining and biofeedback, seeks to reestablish cortical control of the bladder by having the patient ignore urgency and void only in response to cortical signals during waking hours.

2. Pharmacologic agents may be given empirically to women with symptoms of overactive bladder. Tolterodine (Detrol) and extended-release oxybutynin chloride (Ditropan XL) have largely replaced generic oxybutynin as a first-line treatment option for overactive bladder because of favorable side effect profiles. Oxybutynin transdermal may cause less dry mouth than the oral formulation.

3. ERT is also an effective treatment for women with overactive bladder. Even in patients taking systemic estrogen, localized ERT (ie, estradiol-impregnated vaginal ring) may increase inadequate estrogen levels and decrease the symptoms associated with overactive bladder.

4. Pelvic floor electrical stimulation is also effective in treating women with overactive bladder. Pelvic floor electrical stimulation results in a 50 percent cure rate of detrusor instability.

5. Neuromodulation of the sacral nerve roots through electrodes implanted in the sacral foramina is a promising new surgical treatment that has been found to be effective in the treatment of urge incontinence.

6. The FDA has recently approved extracorporeal magnetic innervation, a noninvasive procedure for the treatment of incontinence caused by pelvic floor weakness. Extracorporeal magnetic innervation may have a place in the treatment of women with both stress and urge incontinence.

References: See page 184.

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