Imipramine hydrochloride : Improves bladder storage significantly.It appears to improve bladder hypertonicity or compliance rather than uninhibited contractions. It is useful in patients with enuresis. The side effects are anticholinergic, as well as tremor and fatigue. It can also cause orthostatic hypotension.
DDAVP : It decreases urine production. It is helpful in patients with troublesome nocturnal urinary symptoms. However, its use in the elderly and patients with heart problem is limited.
Important points to remember in drug therapy :
- Each drug should be given for at least 6 weeks before deeming it failure, as the onset of benefit may be delayed.
- Each drug must be titrated, based on subjective response and its side effects.
- If one drug is not beneficial, it is worth trying other drugs with different modes of action or combining drugs.
- Overactive bladder is a relapsing and remitting conditionSurgical Treatment It is only used as a last resort in the management of overactive bladder.
Overactive bladder can co-exist with genuine stress incontinence in up to 30% of patients. Medical management of the overactive bladder reduces the need for bladder continence surgery. If patients fail medical treatment, bladder neck surgery may be recommended. However, patients should understand that the post-operative course of bladder muscle instability is somewhat unpredictable. The may need to continue medical treatment for their overactive bladder.
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