From the Guidelines
Bladder dyskinesia, also known as overactive bladder (OAB), is best managed with a combination of behavioral therapy, pharmacotherapy, and minimally invasive treatment options, with sacral neuromodulation, tibial nerve stimulation, and/or intradetrusor botulinum toxin injection offered to patients who have an inadequate response to or have experienced intolerable side effects from first-line treatments 1.
Diagnostic Criteria
The diagnostic criteria for bladder dyskinesia typically involve symptoms of urinary urgency, frequency, and sometimes incontinence, along with urodynamic findings showing involuntary bladder contractions during the filling phase.
- Clinical evaluation
- Urodynamic testing
- Exclusion of other conditions
Treatment Options
Treatment begins with conservative approaches including:
- Behavioral modifications such as timed voiding, fluid management, and pelvic floor exercises First-line pharmacological treatment includes:
- Anticholinergic medications like oxybutynin (5mg 2-3 times daily), tolterodine (2-4mg daily), solifenacin (5-10mg daily)
- Beta-3 adrenergic agonists like mirabegron (25-50mg daily) For patients who don't respond to oral medications, more advanced options include:
- Botulinum toxin injections into the bladder wall (typically 100-200 units, repeated every 6-9 months)
- Sacral neuromodulation
- Posterior tibial nerve stimulation, as recommended by the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1 Patients should be monitored for medication side effects, particularly dry mouth, constipation, and cognitive effects with anticholinergics, and potential blood pressure increases with mirabegron.
Considerations
Treatment success should be evaluated based on symptom improvement, with consideration for changing therapies if inadequate response occurs after 4-8 weeks of treatment. The advantages and disadvantages of minimally invasive OAB therapies can have a wide range of implications for individual patients, and integrating patient preferences and values enables providers to craft personalized treatment plans aligned with patient goals, potentially enhancing the effectiveness of OAB management 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnostic Criteria for Bladder Dyskinesia
- The diagnostic criteria for bladder dyskinesia, also known as overactive bladder syndrome, include urgency with or without urge incontinence, usually with frequency and nocturia 2, 3.
- A thorough patient history and physical examination are required to establish a possible diagnosis, and frequency/volume charts form an important aid to the diagnosis 3.
- Urodynamic diagnosis is typically characterized by the presence of detrusor overactivity 2.
Treatment Options for Bladder Dyskinesia
- Conservative management forms the first line of treatment and includes lifestyle modifications, bladder training, and pelvic floor exercises 3.
- Pharmacotherapy, in the form of anticholinergic drugs such as oxybutynin, tolterodine, and trospium chloride, is initiated if conservative management fails 3.
- Other treatment options include functional electrical stimulation, pelvic floor training, and sacral nerve neuromodulation 2, 4.
- Nonantimuscarinic treatments, such as botulinum toxin A, acupuncture, and mirabegron, have also been shown to be effective in improving overactive bladder symptoms 4.
- In some cases, surgical interventions such as clam cystoplasty or ileal conduit may be necessary 5.
Specific Treatment Options
- Pelvic floor muscle training exercises, with or without biofeedback, have been shown to be effective in improving subjective and objective outcomes 4.
- Botulinum toxin A has been shown to improve urge incontinence episodes, urgency, frequency, quality of life, nocturia, and urodynamic testing parameters 4.
- Sacral neuromodulation has been shown to be more efficacious than antimuscarinic treatment for subjective improvement of overactive bladder and quality of life 4.
- Intravesical botulinum toxin injections and sacral neuromodulation have similar success rates, with approximately 70% of patients experiencing improvement in symptoms 5.