Aşırı Aktif Mesane Epidemiyoloji, Etiyoloji, Patofizyoloji, Sınıflama, Tanı
Özet
Aşırı aktif mesane (AAM), idrar yolu enfeksiyonu veya başka belirgin bir patoloji olmaksızın, idrar kaçırma eşlik etsin ya da etmesin sıkışma hissi ile tanımlanan ve genellikle artmış işeme sıklığı ile noktüri ile birlikte görülen bir semptomlar bütünüdür. Tanısının semptom temelli olması ve diğer olası nedenlerin dışlanmasını gerektirmesi, AAM’yi klinik açıdan güç bir durum haline getirmektedir. Kadınlarda daha sık görülmekte olup, yaşam kalitesini önemli ölçüde olumsuz etkilemektedir. Patofizyolojisi multifaktöriyel olup; anormal afferent sinyalizasyon, detrüsör aşırı aktivitesi, merkezi sinir sistemi regülasyon bozuklukları ve ürotelyal disfonksiyon ile ilişkilidir. Etiyolojik faktörler arasında yaşlanma, kadın cinsiyeti, mesane çıkım tıkanıklığı, psikososyal durumlar ve barsak disfonksiyonları yer almaktadır. Klinik değerlendirmede ayrıntılı öykü, fizik muayene, valide edilmiş sorgulama formları ve mesane günlüğü temel yöntemlerdir. Ürodinamik incelemeler ise yalnızca seçilmiş olgularda kullanılmalıdır. Ayrıca semptom temelli klinik bir tanı olan AAM’nin, yalnızca ürodinamik bir bulgu niteliğindeki detrüsör aşırı aktivitesinden ayırt edilmesi gerekmektedir.
Referanslar
Haylen BT, de Ridder D, Freeman RM, et al., : An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction, Neurourol Urodyn 29:4–20, 2010.
Abrams P, Cardozo L, Fall M, et al., : The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society, Neurourol Urodyn 21:167–178, 2002.
D’Ancona C, Haylen B, Oelke M, et al., . The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2):433-477.
Coyne KS, Sexton CC, Bell JA, et al., : The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-POLL, Neurourol Urodyn 32:230–237, 2013a.
Irwin DE, Milsom I, Hunskaar S, et al., : Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study, Eur Urol 50:1306–1314, discussion 1314–1315, 2006.
Coyne KS, Margolis MK, Kopp ZS, et al., : Racial differences in the prevalence of overactive bladder in the United States from the epidemiology of LUTS (EpiLUTS) study, Urology 79:95–101, 2012.
Heidler S, Mert C, Temml C, et al., : The natural history of the overactive bladder syndrome in females: a long-term analysis of a health screening project, Neurourol Urodyn 30:1437–1441, 2011.
Hashim H, Abrams P Is the bladder a reliable witness for predicting detrusor overactivity?, J Urol 175191–194, discussion 194–195, 200, Hashim H, Abrams P: Is the bladder a reliable witness for predicting detrusor overactivity?, J Urol 175:191–194, discussion 194–195, 2006.
Birder L, Andersson K-E Urothelial signaling, Physiol Rev 93653–680, 201, Birder L, Andersson K-E: Urothelial signaling, Physiol Rev 93:653–680, 2013.
Birder L, de Groat W, Mills I, et al., : Neural control of the lower urinary tract: peripheral and spinal mechanisms, Neurourol Urodyn 29:128–139, 2010.
Andersson K-E, McCloskey KD Lamina propria the functional center of the bladder?, Neurourol Urodyn 339–16, 201, Andersson K-E, McCloskey KD: Lamina propria: the functional center of the bladder?, Neurourol Urodyn 33:9–16, 2014.
Malykhina AP, Wyndaele J-J, Andersson K-E, et al., : Do the urinary bladder and large bowel interact, in sickness or in health? ICI-RS 2011, Neurourol Urodyn 31:352–358, 2012.
Drake MJ, Fowler CJ, Griffiths D, et al., : Neural control of the lower urinary and gastrointestinal tracts: supraspinal CNS mechanisms, Neurourol Urodyn 29:119–127, 2010.
Drake MJ The integrative physiology of the bladder, Ann R Coll Surg Engl 89580–585, 200, Drake MJ: The integrative physiology of the bladder, Ann R Coll Surg Engl 89:580–585, 2007.
Griffiths DJ Use of functional imaging to monitor central control of voiding in humans, Handb Exp Pharmacol 81–97, 201, Griffiths DJ: Use of functional imaging to monitor central control of voiding in humans, Handb Exp Pharmacol 81–97, 2011.
Arya NG, Weissbart SJ, Xu S, et al., : Quantitative changes in cerebral perfusion during urinary urgency in women with overactive bladder, Biomed Res Int 2017:2759035, 2017.
Chapple C, Chapter 2: pathophysiology of neurogenic detrusor overactivity and the symptom complex of ‘overactive bladder.’, Neurourol Urodyn 33(Suppl 3):S6–S13, 2014.
Kanai AJ Afferent mechanism in the urinary tract, Handb Exp Pharmacol 171–205, 201, Kanai AJ: Afferent mechanism in the urinary tract, Handb Exp Pharmacol 171–205, 2011.
Yoshimura N, de Groat WC Increased excitability of afferent neurons innervating rat urinary bladder after chronic bladder inflammation, J Neurosci 194644–4653, 199, Yoshimura N, de Groat WC: Increased excitability of afferent neurons innervating rat urinary bladder after chronic bladder inflammation, J Neurosci 19:4644–4653, 1999.
Ashok K, Wang A, Detrusor overactivity: an overview. Arch Gynecol Obstet. 2010;282(1):33-41.
Keay SK, Birder LA, Chai TC Evidence for bladder urothelial pathophysiology in functional bladder disorders, Biomed Res Int 2014865463, 201, Keay SK, Birder LA, Chai TC: Evidence for bladder urothelial pathophysiology in functional bladder disorders, Biomed Res Int 2014:865463, 2014.
Rapp DE, Lyon MB, Bales GT, Cook SP (2005) A role for the P2X receptor in urinary tract physiology and in the pathophysiology of urinary dysfunction, Eur Urol 48(2):303–308.
Brading AF A myogenic basis for the overactive bladder, Urology 5057–67, discussion 68–73, 199, Brading AF: A myogenic basis for the overactive bladder, Urology 50:57–67, discussion 68–73, 1997.
Drake MJ, Fowler CJ, Griffiths D, et al., : Neural control of the lower urinary and gastrointestinal tracts: supraspinal CNS mechanisms, Neurourol Urodyn 29:119–127, 2010.
Drake MJ, Harvey IJ, Gillespie JI, et al., : Localized contractions in the normal human bladder and in urinary urgency, BJU Int 95:1002–1005, 2005.
Drake MJ, Mills IW, Gillespie JI Model of peripheral autonomous modules and a myovesical plexus in normal and overactive bladder function, Lancet 358401–403, 200, Drake MJ, Mills IW, Gillespie JI: Model of peripheral autonomous modules and a myovesical plexus in normal and overactive bladder function, Lancet 358:401–403, 2001.
Peyronnet, B, , Mironska, E., Chapple, C., Cardozo, L., Oelke, M., Dmochowski, R., Amarenco, G., Gamé, X., Kirby, R., Van Der Aa, F., & Cornu, J. N. (2019). A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment. European urology, 75(6), 988–1000.
Ustinova EE, Fraser MO, Pezzone MA Cross-talk and sensitization of bladder afferent nerves, Neurourol Urodyn 2977–81, 201, Ustinova EE, Fraser MO, Pezzone MA: Cross-talk and sensitization of bladder afferent nerves, Neurourol Urodyn 29:77–81, 2010.
Giamberardino MA, Costantini R, Affaitati G, et al., : Viscero-visceral hyperalgesia: characterization in different clinical models, Pain 151:307–322, 2010.
Gillespie JI, van Koeveringe GA, de Wachter SG, et al., : On the origins of the sensory output from the bladder: the concept of afferent noise, BJU Int 103:1324–1333, 2009.
Kashyap MP, Pore SK, de Groat WC, et al., : BDNF overexpression in the bladder induces neuronal changes to mediate bladder overactivity, Am J Physiol Renal Physiol 315:F45–F56, 2018.
Thomas-White KJ, Hilt EE, Fok C, et al., : Incontinence medication response relates to the female urinary microbiota, Int Urogynecol J 27:723–733, 2016.
Cameron AP, Chung DE, Dielubanza EJ, et al., . The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. J Urol. Published online April 23, 2024.
Harding CK, Lapitan MC, Arlandis S, et al., . Management of Non-Neurogenic Female Lower Urinary Tract Symptoms (LUTS), European Association of Urology 2024.
Reynolds WS, Joshua AC, Overactive Bladder, Partin AW, Dmochowski RR, Kavoussi LR, Peters CA. Campbell-Walsh-Wein Urology. 12th edition, Chapter 117, pp:2637-2649.e4.
Referanslar
Haylen BT, de Ridder D, Freeman RM, et al., : An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction, Neurourol Urodyn 29:4–20, 2010.
Abrams P, Cardozo L, Fall M, et al., : The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society, Neurourol Urodyn 21:167–178, 2002.
D’Ancona C, Haylen B, Oelke M, et al., . The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2):433-477.
Coyne KS, Sexton CC, Bell JA, et al., : The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-POLL, Neurourol Urodyn 32:230–237, 2013a.
Irwin DE, Milsom I, Hunskaar S, et al., : Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study, Eur Urol 50:1306–1314, discussion 1314–1315, 2006.
Coyne KS, Margolis MK, Kopp ZS, et al., : Racial differences in the prevalence of overactive bladder in the United States from the epidemiology of LUTS (EpiLUTS) study, Urology 79:95–101, 2012.
Heidler S, Mert C, Temml C, et al., : The natural history of the overactive bladder syndrome in females: a long-term analysis of a health screening project, Neurourol Urodyn 30:1437–1441, 2011.
Hashim H, Abrams P Is the bladder a reliable witness for predicting detrusor overactivity?, J Urol 175191–194, discussion 194–195, 200, Hashim H, Abrams P: Is the bladder a reliable witness for predicting detrusor overactivity?, J Urol 175:191–194, discussion 194–195, 2006.
Birder L, Andersson K-E Urothelial signaling, Physiol Rev 93653–680, 201, Birder L, Andersson K-E: Urothelial signaling, Physiol Rev 93:653–680, 2013.
Birder L, de Groat W, Mills I, et al., : Neural control of the lower urinary tract: peripheral and spinal mechanisms, Neurourol Urodyn 29:128–139, 2010.
Andersson K-E, McCloskey KD Lamina propria the functional center of the bladder?, Neurourol Urodyn 339–16, 201, Andersson K-E, McCloskey KD: Lamina propria: the functional center of the bladder?, Neurourol Urodyn 33:9–16, 2014.
Malykhina AP, Wyndaele J-J, Andersson K-E, et al., : Do the urinary bladder and large bowel interact, in sickness or in health? ICI-RS 2011, Neurourol Urodyn 31:352–358, 2012.
Drake MJ, Fowler CJ, Griffiths D, et al., : Neural control of the lower urinary and gastrointestinal tracts: supraspinal CNS mechanisms, Neurourol Urodyn 29:119–127, 2010.
Drake MJ The integrative physiology of the bladder, Ann R Coll Surg Engl 89580–585, 200, Drake MJ: The integrative physiology of the bladder, Ann R Coll Surg Engl 89:580–585, 2007.
Griffiths DJ Use of functional imaging to monitor central control of voiding in humans, Handb Exp Pharmacol 81–97, 201, Griffiths DJ: Use of functional imaging to monitor central control of voiding in humans, Handb Exp Pharmacol 81–97, 2011.
Arya NG, Weissbart SJ, Xu S, et al., : Quantitative changes in cerebral perfusion during urinary urgency in women with overactive bladder, Biomed Res Int 2017:2759035, 2017.
Chapple C, Chapter 2: pathophysiology of neurogenic detrusor overactivity and the symptom complex of ‘overactive bladder.’, Neurourol Urodyn 33(Suppl 3):S6–S13, 2014.
Kanai AJ Afferent mechanism in the urinary tract, Handb Exp Pharmacol 171–205, 201, Kanai AJ: Afferent mechanism in the urinary tract, Handb Exp Pharmacol 171–205, 2011.
Yoshimura N, de Groat WC Increased excitability of afferent neurons innervating rat urinary bladder after chronic bladder inflammation, J Neurosci 194644–4653, 199, Yoshimura N, de Groat WC: Increased excitability of afferent neurons innervating rat urinary bladder after chronic bladder inflammation, J Neurosci 19:4644–4653, 1999.
Ashok K, Wang A, Detrusor overactivity: an overview. Arch Gynecol Obstet. 2010;282(1):33-41.
Keay SK, Birder LA, Chai TC Evidence for bladder urothelial pathophysiology in functional bladder disorders, Biomed Res Int 2014865463, 201, Keay SK, Birder LA, Chai TC: Evidence for bladder urothelial pathophysiology in functional bladder disorders, Biomed Res Int 2014:865463, 2014.
Rapp DE, Lyon MB, Bales GT, Cook SP (2005) A role for the P2X receptor in urinary tract physiology and in the pathophysiology of urinary dysfunction, Eur Urol 48(2):303–308.
Brading AF A myogenic basis for the overactive bladder, Urology 5057–67, discussion 68–73, 199, Brading AF: A myogenic basis for the overactive bladder, Urology 50:57–67, discussion 68–73, 1997.
Drake MJ, Fowler CJ, Griffiths D, et al., : Neural control of the lower urinary and gastrointestinal tracts: supraspinal CNS mechanisms, Neurourol Urodyn 29:119–127, 2010.
Drake MJ, Harvey IJ, Gillespie JI, et al., : Localized contractions in the normal human bladder and in urinary urgency, BJU Int 95:1002–1005, 2005.
Drake MJ, Mills IW, Gillespie JI Model of peripheral autonomous modules and a myovesical plexus in normal and overactive bladder function, Lancet 358401–403, 200, Drake MJ, Mills IW, Gillespie JI: Model of peripheral autonomous modules and a myovesical plexus in normal and overactive bladder function, Lancet 358:401–403, 2001.
Peyronnet, B, , Mironska, E., Chapple, C., Cardozo, L., Oelke, M., Dmochowski, R., Amarenco, G., Gamé, X., Kirby, R., Van Der Aa, F., & Cornu, J. N. (2019). A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment. European urology, 75(6), 988–1000.
Ustinova EE, Fraser MO, Pezzone MA Cross-talk and sensitization of bladder afferent nerves, Neurourol Urodyn 2977–81, 201, Ustinova EE, Fraser MO, Pezzone MA: Cross-talk and sensitization of bladder afferent nerves, Neurourol Urodyn 29:77–81, 2010.
Giamberardino MA, Costantini R, Affaitati G, et al., : Viscero-visceral hyperalgesia: characterization in different clinical models, Pain 151:307–322, 2010.
Gillespie JI, van Koeveringe GA, de Wachter SG, et al., : On the origins of the sensory output from the bladder: the concept of afferent noise, BJU Int 103:1324–1333, 2009.
Kashyap MP, Pore SK, de Groat WC, et al., : BDNF overexpression in the bladder induces neuronal changes to mediate bladder overactivity, Am J Physiol Renal Physiol 315:F45–F56, 2018.
Thomas-White KJ, Hilt EE, Fok C, et al., : Incontinence medication response relates to the female urinary microbiota, Int Urogynecol J 27:723–733, 2016.
Cameron AP, Chung DE, Dielubanza EJ, et al., . The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. J Urol. Published online April 23, 2024.
Harding CK, Lapitan MC, Arlandis S, et al., . Management of Non-Neurogenic Female Lower Urinary Tract Symptoms (LUTS), European Association of Urology 2024.
Reynolds WS, Joshua AC, Overactive Bladder, Partin AW, Dmochowski RR, Kavoussi LR, Peters CA. Campbell-Walsh-Wein Urology. 12th edition, Chapter 117, pp:2637-2649.e4.
