Paper Title: Overactive Bladder (OAB) New Concepts on its Patho-physiology

Author(s) - *Abdel Karim M. El Hemaly FRCS, MRCOG, Laila AES. Mousa MD, Ibrahim M. Kandil, Muhammad R. Morad MD, Mervat M. Ibrhaim, Fatma S. Al Sokkary MD & Mona M. Ragab

 DOI: - 10.23958/isroj/vol03-i02/03


Abstract:

Overactive bladder (OAB) is a common problem after middle age in men and women, yet its management is still confusing. Its main presentation is frequency and urgency. The amount of voided urine is usually small.

The functions of the urinary bladder are filling, storage of urine and emptying after being full at suitable social circumstances. Toilet training induces and keeps high sympathetic tone at the internal urethral sphincter (IUS) that maintains its contraction and keeping the urethra empty and closed all the time. The IUS is a collagen-muscle tissue cylinder that extends from the bladder neck to the perineal membrane in men and women. Urinary continence depends on a closed and empty urethra.

An open upper part of the urethra allows some urine to enter the urethra leading to two actions, a compelling desire to void otherwise urine will leak; also, it leads to increased activity in the detrusor muscle as seen in urodynamic study. In women childbirth trauma causes lacerations in the collagen chassis of the IUS and a week IUS which cannot stand rises of abdominal pressure. In men prostatic hyperplasia and enlargement causes uneven compression of the upper part of the urethra with bizarre dilatation of the bladder neck allowing some urine to enter the urethra causing urgent need to void.

Medical imaging with ultrasound (3DUS) and MRI will show the dilatation of the bladder neck; and the torn IUS in women.