SURGERY FOR THE TREATMENT OF OVERACTIVE BLADDER

Objectives. To describe surgical options that may be indicated when co nservative management of overactive bladder is unsuccessful. Methods. The literature on current endoscopic and open surgical procedures is r eviewed. Results. The endoscopic approach of hydrodistention under ane sthesia may be therapeutic, but normally offers only temporary relief of symptoms. Among open surgical procedures, cystolysis has not withst ood the test of time and is no longer used. Partial rhizotomy can redu ce reflex bladder contractility while preserving other important uroge nital functions. Peripheral denervation via a vaginal approach appears effective in as many as 70% of patients with motor instability, but i s not effective in interstitial cystitis or other sensory bladder diso rders. Transvesical phenol injection is most effective for detrusor in stability (DI) caused by multiple sclerosis. Enterocystoplasty is more helpful in intractable DI than in interstitial cystitis. Detrusor myo mectomy has yielded excellent results in patients with neurogenic caus es of DI. Urinary diversion is rarely required in DI, but may be prefe rable to enterocystoplasty when severe pelvic pain is present. Conclus ions. When appropriately chosen, surgical procedures can substantially improve the quality of life of some individuals with overactive bladd er. (C) 1998, Elsevier Science Inc. All rights reserved.