Non-invasive evaluation of autonomic nervous system dysfunction in idiopathic overactive bladder in woman

Abstract

Introduction. Overactive bladder (OAB) syndrome is characterized by urgency with or without urgency incontinence that is usually associated with increased daytime frequency and nocturia. The exclusion of urological (obstructive, infectious, neoplastic disease or lithiasis) or neurological disorders leads to the diagnosis of idiopathic OAB syndrome, being a common disorder, especially in women. The pathophysiology of iOAB remains unclear, but two main hypotheses currently being considered include myogenic and neurogenic dysfunction that involves a specific dysfunction of the autonomic nervous system. Aim of the study. To determine what are the different methods used in evidence for autonomic nervous system (ANS) dysfunction in females with iOAB. Materials and methods.. This study is a systematic review of data of publications of the last 10 years on the selected theme using PubMed system. According to a key phrase “autonomic nervous system in overactive bladder”, “evaluation of idiopathic overactive bladder” 90 publications were found, 32 publications were selected and analysed. Research includes data from15 publications. Results. The OAB symptom score, which goes from 0 to 15, is subjective and has limitations, and urodynamic investigations can be invasive and are time consuming. Here is a need for a reliable, objective, and non-invasive methods of measuring the activity of the nerve fibres that control the urge to urinate and urination. Autonomic dysfunction in the genital area can be assessed using sympathetic skin response (SSR). The absence of SSR may be a sign of autonomic dysfunction and also of iOAB. SSR tests can be used for the detection of early iOAB and assessing those likely to be refractory to anticholinergic drugs in iOAB. Autonomic cardiovascular testing in females are associated with iOAB without detrusor overactivity, and “sensory urgency” could be related to a sympathetic dysfunction. Measuring the heart rate variability (HRV) provides a non-invasive approach to detecting autonomic imbalances. The reductions of HRV values in patients with iOAB suggest that the autonomic nervous system is altered and may be a factor in disturbed bladder function. Was demonstrated that deep respiration heart rate variations increased in patients with iOAB. These results reflect parasympathetic hyperactivity. Functional studies such as pupillometry would be helpful for understanding the iOAB and serve as an aid to the development of therapeutic options. Conclusions. The researches presented in this review strongly support that dysfunction in the ANS balance could be involved in the pathophysiology of iOAB and further using the diagnostic methods to monitor treatment response and apply them to pharmacological or surgical treatment. And because of their non-invasiveness, these methods can also be used in children.