Bladder urgency

Specialty: Nephrology and urology.

• bladder straining
• persistent urge to urinate
• unsatisfied sensation of bladder evacuation

Why it occurs

• Acute bacterial cystitis (bacterial infection of the bladder urothelium that generates detrusor hypersensitivity)
• Interstitial cystitis (painful bladder syndrome of chronic non-infectious inflammatory etiology)
• Benign prostatic hyperplasia (growth of the transition zone with post-micturition residue that stimulates stretch receptors)
• Bladder carcinoma in situ (neoplasia that irritates the bladder mucosa simulating a chronic infectious process)
• Intravesical foreign body (free bladder lithiasis or double J catheter that rubs against the bladder trigone)

Initial workup

Systematic analysis of urine with sediment and urine culture with antibiogram; vesicoprostatic ultrasound to evaluate the presence of lithiasis, masses or thickening of the bladder wall, also determining the volume of post-void urinary residue; diagnostic cystoscopy with biopsy if the sediment shows persistent microhematuria or suspicion of malignancy.

Standard management

• Phenazopyridine — topical urinary analgesic, 100-200 mg every 8 hours orally for a maximum of 2 days to relieve urothelial irritation; warn the patient that it stains the urine a deep orange color
• Tamsulosin — alpha-1 blocker, 0.4 mg daily orally to relax the smooth muscle fibers of the bladder neck and prostate
• Mirabegron (beta-3 adrenergic receptor agonist, 50 mg daily to relax the detrusor in cases of tenesmus associated with overactive bladder).