New insights into the diagnosis and treatment of the overactive bladder (OAB) were examined at the opening plenary session today with experts from both sides of the Atlantic discussing bladder control, biomarkers, neuromodulation, complications in female incontinence and genetic tendency for Stress Urinary Incontinence (SUI).
“There is increasing evidence to support a genetic basis for the development of SUI,” said Prof. Gopal Badlani, of the Wake Forest University School of Medicine (Winston-Salem, USA), Secretary-elect of the American Urological Association (AUA) in his lecture on stress incontinence and prolapse.
Badlani explained that there are abnormanilites in expression of extracellular matrix (ECM) proteins in the expression of leading to changes in the composition of the ECM. Several studies have identified candidate genes that encode ECM proteins, which are thought to lead to SUI. He cited an Israeli study which showed that there is “a three-fold prevalence of SUI among first-degree relatives of female patients with urinary stress incontinence.”
“Patients with severe pelvic organ prolapse (grade > or =3) have a significant reduction in the mRNA expression of lysyl oxidase as compared to asymptomatic controls,” added Badlani. In another lecture, Martin Michel (Netherlands) spoke on bladder control and the role of detrusor smooth muscle and afferent nerves.
“Physiological voiding and OAB may involve afferent mechanisms,” said Michel, adding that although these mechanisms can contribute to overactivity, their relative roles are still unclear. Meanwhile, Prof. Dirk De Ridder (Belgium) discussed in his state-of-the-art lecture the role of biomarkers in OAB. “Nerve growth factor (NGF) looks promising but needs less cumbersome sample handling and needs to improve specificity for OAB,” said De Ridder.
He noted that there are many other candidate biomarkers but “much work is still needed.” Two case discussions were held with Jean-Jacques Wyndaele moderating the discussion on refractory overactive bladder, and another session moderated by John Heesakkers on managing complications of female incontinence. The use of botox and surgery, drugs and neuromodulation in OAB were assessed, whilst complications in managing female incontinence were discussed in relation to clinical practice.
By Joel Vega