Detrusor overactivity

Urodynamic detrusor overactivity is defined as the urodynamic observation of involuntary detrusor contractions during the filling phase that may be spontaneous or provoked associated with urgency. The most common symptoms are urgency, nocturia, frequency and urge incontinence. Causes include idiopathic, neurological and iatrogenic, and the diagnosis by definition requires urodynamic investigations. Treatment comprises conservative measures such as lifestyle changes and bladder retraining. The most commonly used medical management is anticholinergic medication, but this is of limited efficacy due to the side effects of dry eyes, dry mouth and constipation. Any role of conventional surgery is diminishing with the advent of botulinum A toxin therapy and tends to be reserved for patients in whom all other forms of treatment have failed and quality of life is severely affected. In the future, sympathetic modulators or purinergic blockade may offer treatment with fewer side effects.