The overactive bladder

The overactive bladder is associated with symptoms of urinary frequency, ur gency and/or urge incontinence. The embarrassing nature of these symptoms m eans that patients are often reluctant to seek medical help, and as a conse quence, there is under-reporting. Epidemiological studies are difficult to perform but appear to show that incidence increases with age and that the o veractive bladder is the commonest cause of male urinary incontinence. The aetiology is still much debated, with reasoned arguments for both neurogeni c and myogenic causes, though in truth, the likely explanation is multifact orial rather than a single underlying pathological process. There is an evo lution in the terminology used to describe this common condition in men and women which causes significant morbidity in sufferers and great financial expense to health care providers. The definitive diagnosis (detrusor overac tivity) can be made only on urodynamic testing, although treatment is often initiated with a presumptive diagnosis. Before deciding on suitable treatm ent, the clinician must assess the disease severity and also its impact on the patient's quality of life: perceived improvement in quality of life mus t outweigh any potential morbidity associated with treatment. Pharmacothera py is based on blocking bladder muscarinic receptors. Unfortunately, most d rug therapies are associated with some degree of unwanted systemic antichol inergic effects. Surgical treatment often involves a degree of bladder dene rvation to reduce bladder activity. This can consequently produce voiding d ifficulties which make it necessary for patients to self-catheterize on a l ong-term basis. Tolterodine is a recently introduced antimuscarinic agent w hich has effects on the bladder equipotent to those of oxybutynin, but poss esses lower affinity for muscarinic receptors in the salivary gland. This d rug is better tolerated, and is associated with higher patient compliance, than oxybutynin. Tolterodine is licensed for the treatment of overactive bl adder in the USA and currently for the treatment of unstable bladder in Eur ope.