Surgery for the treatment of overactive bladder.
OBJECTIVE
To describe surgical options that may be indicated when conservative management of overactive bladder is unsuccessful.


METHODS
The literature on current endoscopic and open surgical procedures is reviewed.


RESULTS
The endoscopic approach of hydrodistention under anesthesia may be therapeutic, but normally offers only temporary relief of symptoms. Among open surgical procedures, cystolysis has not withstood the test of time and is no longer used. Partial rhizotomy can reduce reflex bladder contractility while preserving other important urogenital functions. Peripheral denervation via a vaginal approach appears effective in as many as 70% of patients with motor instability, but is not effective in interstitial cystitis or other sensory bladder disorders. Transvesical phenol injection is most effective for detrusor instability (DI) caused by multiple sclerosis. Enterocystoplasty is more helpful in intractable DI than in interstitial cystitis. Detrusor myomectomy has yielded excellent results in patients with neurogenic causes of DI. Urinary diversion is rarely required in DI, but may be preferable to enterocystoplasty when severe pelvic pain is present.


CONCLUSIONS
When appropriately chosen, surgical procedures can substantially improve the quality of life of some individuals with overactive bladder.
Appell
R A
RA
Section of Voiding Dysfunction and Female Urology, The Cleveland Clinic Foundation, Ohio 44195, USA.
D003558:Cystoscopy; D006801:Humans; D013514:Surgical Procedures, Operative / Q000379:methods; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*