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English version

The case report of Marti et al. highlights the interest of behavioral and cognitive therapy (BCT) in the treatment of urinary disorders, specially in overactive bladder (OAB). Despite BCT efficacy, and other similar techniques , this therapeutic option is not often used probably for 3 reasons: poor patient acceptance for a such treatment, cost of the BCT, and finally, lack of knowledge of this technique in urologic community. This paper may encourage the different specialists in the field of pelvic floor disorders to consider more frequently this safe and effective treatment in the therapeutic management of OAB.

Marti et al. emphasize that many lower urinary tract dysfunctions remain unexplained after urodynamic testing. Indeed, more than 90% of OAB patients have normal cystometry without uninhibited detrusor contraction. However, all these patients cannot be considered having a “functional etiology” since numerous and various pathophysiological mechanisms are described in OAB. Indeed, motor abnormalities characterized on cystometry by overactive detrusor do not resume all the etiologies of OAB: urothelial alterations, loss of central sensory signal modulation, “micro-motion”, “afferent noise” are the most common factors currently discussed. No “shortcut” between normal cystometry and “functional disorder” can be accepted specially in idiopathic overactive bladder.

Another point is the blurred concept of “functional disorder”. In many cases, and for many practitioners, this vague assertion is often assimilated to a psychogenic alteration and nay, to a psychiatric condition.

However, this term reflects a specific alteration of the integration and the control of the different afferent-efferent bladder pathways, and sometimes a definitive or transitory modification of sensory-motor signals treatment. The intervention of cortical and subcortical structures in the modulation of bladder function does not imply a psychogenic cause, even if such etiology can modify bladder behavior or can be the consequence of a chronic lower urinary dysfunction. The complex relationship between autonomic nervous system, bladder control, general cognitive functions and behavior are also a confusing factor .

Further studies must be conducted in order to precise all these relationships and the right place of BCT in the therapeutic strategy of OAB. Indeed, other treatments are also safe and effective without side effects. Thus, pelvic floor rehabilitation and posterior tibial nerve stimulation are good therapeutic options and well validated in OAB treatment. In comparison with irritable bowel syndrome, hypnotherapy is probably another good option with a high level of evidence .

The future of OAB is not only drugs…