Vol. 42 (2): 199-214, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0367


Overactive bladder – 18 years – Part II

Jose Carlos Truzzi 1, Cristiano Mendes Gomes 2, Carlos A. Bezerra 3, Ivan Mauricio Plata 4, Jose Campos 5, Gustavo Luis Garrido 6, Fernando G. Almeida 1, Marcio Augusto Averbeck 7, Alexandre Fornari 8, Anibal Salazar 9, Arturo Dell’Oro 10, Caio Cintra 3, Carlos Alberto Ricetto Sacomani 9, Juan Pablo Tapia 11, Eduardo Brambila 12, Emilio Miguel Longo 13, Flavio Trigo Rocha 2, Francisco Coutinho 12, Gabriel Favre 14, José Antonio Garcia 14, Juan Castaño 15, Miguel Reyes 12, Rodrigo Eugenio Leyton 16, Ruiter Silva Ferreira 17, Sergio Duran 12, Vanda López 18, Ricardo Reges 19

1 Escola Paulista de Medicina – EPM – Universidade Federal de São Paulo, SP, Brasil; 2 Departamento de Urologia, Universidade de São Paulo, SP, Brasil; 3 Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasi; 4 Departamento de Urología, Universidad de los Andes, Bogota, Colombia; 5 Departamento de Urología, Escuela Médico Militar, Cidade do México, Mexico; 6 Cátedra de Urologia, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina; 7 Departamento de Urologia, Mãe de Deus Center Hospital, Porto Alegre, RS, Brasil; 8 Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil; 9 Departamento de Urologia, AC Camargo Hospital, SP, Brasil; 10 Hospital Clinico de la Fuerza Area de Chile, Santiago, Chile; 11 Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico; 12 Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil; 13 Servicio de Urología, del Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina; 14 Centro Policlínico Valencia “La Viña”, Valencia, Venezuela; 15 Hospital Pablo Tobón Uribe, Medellin, Colômbia; 16 Servicio de Urología, Clinica Indisa, Providencia, Chile; 17 Centro de Reabilitação e Readaptação Dr. Henrique Santillo, Goiânia, Brasil; 18 Servicio de Urología, del Hospital Universitario de Caracas, Caracas, Venezuela; 19 Divisão de Urologia, Universidade Federal do Ceará, CE, Brasil


Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Keywords: Overactive Bladder; Muscarinic Antagonists; Beta-adrenergic agonists; Botulinum Toxin; Sacral neuromodulation; Urodynamics

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