Cornu J N
Tenon Hospital, Paris, France.
Minerva Urol Nefrol. 2013 Mar;65(1):21-35.
Overactive bladder (OAB) is defined by its hallmark symptom, urgency. It can be associated with urge urinary incontinence (UUI), and dramatically impact the patients' quality of life. Etiologies of OAB are numerous, and under this common wording, virtually all the population is covered (men as well as women, patients with or without neurogenic disease, and all age categories). OAB and UUI management have been historically based on non-interventional therapies, antimuscarinics, and surgery. In the last decade, innovations in the treatment of this highly prevalent condition have been multiple, and further insights came from various horizons (drug invention, innovative use of existing drugs, new medical devices, tissue engineering, gene and cell therapy). Notably, the use of BoNT and neuromodulation techniques have deeply modified the algorithm of specialized OAB management, delaying surgery indications and offering mini-invasive alternatives to patient refractory to behavioral and medical treatment. Whilst some of these techniques are about to reach maturity, numerous questions remain unsolved about their indications, long term effects, rank in the armamentarium, cost-effectiveness, hypothetical combination or sequential use. The present review depicts the actual wide range of options available for OAB management in adults, focusing on the latest evolutions. When relevant, a distinction was made between genders and OAB subtypes (idiopathic vs neurogenic) regarding treatment outcomes.
膀胱过度活动症（OAB）由其标志性症状——尿急来定义。它可能与急迫性尿失禁（UUI）相关，并且会显著影响患者的生活质量。OAB的病因众多，在这个通用术语下，几乎涵盖了所有人群（男性和女性、有或没有神经源性疾病的患者以及所有年龄段）。OAB和UUI的管理历来基于非介入性疗法、抗胆碱能药物和手术。在过去十年中，针对这种高度流行疾病的治疗有多项创新，并且从各个领域有了进一步的见解（药物发明、现有药物的创新使用、新的医疗设备、组织工程、基因和细胞疗法）。值得注意的是，肉毒毒素（BoNT）的使用和神经调节技术深刻改变了OAB专科管理的方案，推迟了手术指征，并为行为和药物治疗无效的患者提供了微创替代方案。虽然其中一些技术即将成熟，但关于它们的适应症、长期效果、在治疗手段中的地位、成本效益、假设的联合使用或序贯使用等众多问题仍未解决。本综述描述了目前成人OAB管理可用的实际广泛选择，重点关注最新进展。在相关情况下，根据治疗结果对性别和OAB亚型（特发性与神经源性）进行了区分。
