Overactive bladder (OAB) is a urological condition characterized by frequent urination, the need to urinate leading to disruption of sleep (nocturia), and urinating unintentionally with or without urge incontinence. OAB is often associated with overactivity of the bladder detrusor muscle, which represents the most common underlying idiopathic or neurogenic dysfunction. It has been estimated that about one in six adults (17%) have OAB, and the prevalence of OAB increases with age. Approximately 10% of children have symptoms that are severe enough to warrant a diagnosis of OAB. Treatment for OAB includes behavioral modifications, pelvic floor rehabilitation, pharmacological agents (e.g., oral medication, intravesical instillation), electrical stimulation, or reconstructive surgery. Intravesical instillation is a local drug delivery system though a catheter into the bladder that is widely used to treat bladder cancer and other conditions. However, some substances are not readily absorbed through the low permeability of the intact urothelium leading to limited effectiveness of the treatment.
Electromotive drug administration (EMDA) represents a minimally-invasive method of intravesical instillation of therapeutic agents without the need of general anesthesia. It employs a combination of iontophoresis, electrophoresis, and electroporation to deliver drugs into deep tissue layers using an electrical current created between two electrodes. The EMDA system consists of a current generator, catheter-electrodes, and accessories. The Physionizer 30 Mini is a pulse DC generator widely used for EMDA. Lidocaine and epinephrine are used for local anesthesia during the EMDA procedure. EMDA has been used to deliver drugs for a number of conditions including inflammation of the bladder (cystitis), inflammation of the prostate (prostatitis), bladder cancer, and OAB. Drug administration by EMDA in laboratory studies in the treatment of bladder pathologies and dysfunctions include botulinum toxin A, oxybutynin, mitomycin C, resiniferatoxin, verapamil, and dexamethasone. Botulinum toxin A, an acetylcholine release blocking agent, has been thought to reduce the detrusor overactivity through ephemeral detrusor smooth muscle paralysis. Delivery of verapamil and dexamethasone through EMDA has been used for treatment of Peyronie’s disease, an erectile dysfunction.
The aim of this report is to review the clinical effectiveness, safety and cost-effectiveness of EMDA for treatment of OAB.
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