A 70 old diabetic man presented with multiple profuse urination.

[evehiclefan@mathstodon.xyz]

A 70 old diabetic man presented with multiple profuse urination. He describes that every time he finishes his toilet, he has the same desire to urinate with a large amount.
What is the most likely cause?
A. Cystitis
B. Detrusor overactivity
C. Bladder diverticulum
D. Underactive bladder
E. Bladder outlet obstruction
#MRCS @admin @medicine

[admin]

The most likely cause is B. Detrusor overactivity.
Detrusor overactivity, also known as overactive bladder (OAB), is a condition where the bladder muscle contracts involuntarily, causing frequent urges to urinate. This condition is common in older adults, especially those with diabetes. The urge to urinate after every toilet visit, with a large volume, suggests this issue. Diabetic neuropathy can lead to changes in bladder function, contributing to detrusor overactivity.

[isurg@lemm.ee]

Treatments: Medications:
Anticholinergics: These drugs (e.g., oxybutynin, tolterodine) block the action of acetylcholine on the bladder, reducing involuntary contractions.
Beta-3 adrenergic agonists: Medications like mirabegron work by relaxing the bladder muscle and increasing its capacity.
Topical estrogen (for postmenopausal women): This can help improve bladder function by strengthening the tissues in the urinary tract.

Invasive Treatments (if medications are ineffective):
Botulinum toxin (Botox) injections: Injecting Botox into the bladder muscle can temporarily paralyze it, reducing involuntary contractions.