{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T15:13:20Z","timestamp":1774624400145,"version":"3.50.1"},"reference-count":56,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T00:00:00Z","timestamp":1655337600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Parallel with the demographic ageing crisis, is a disabling overactive bladder (OAB) crisis (urgency\/frequency\/nocturia), 30% prevalence in older women, pathogenesis stated as unknown and, according to some learned societies, incurable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis\/Aims<\/jats:title><jats:p>To review International Continence Society and Integral System paradigms to test our thesis that OAB per se\u00a0is not a pathological condition, rather, a prematurely activated uncontrolled micturition; pathogenesis being anatomical damage in a nonlinear feedback control system comprising cortical and peripheral (muscle\/ligament) components.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We examined studies from basic science, anatomy, urodynamics, ultrasonic and video xrays, ligament repairs, from which we created a nonlinear binary model of bladder function. We applied a Chaos Theory feedback equation, X<jats:sub>next<\/jats:sub>\u2009=\u2009Xc(1\u2009\u2212\u2009X) to test our hypothesis against existing concepts and hypotheses for OAB pathogenesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The bladder has ONLY two modes, EITHER closed OR open (micturition). Closure is reflexly controlled cortically and peripherally: muscles contracting against ligaments stretch the vagina to suppress afferent signals to micturate from urothelial stretch receptors. \u201cOAB\u201d can be caused by anatomical damage anywhere in the model, by childbirth or age\u2010weakened ligaments, which can be repaired to cure all three OAB symptoms. Urodynamic \u201cDO\u201d graphs are interpreted anatomically and by the feedback equation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>OAB is in crisis. Our thesis of OAB as an uncontrolled micturition from anatomical defects in the bladder control system provides fresh directions for further development of new treatments, nonsurgical and surgical, to help break the crisis and bring hope and cure to 600 million women sufferers.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nau.24990","type":"journal-article","created":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T12:44:38Z","timestamp":1655383478000},"page":"1281-1292","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Defining urge as an uncontrolled micturition explains pathogenesis, informs cure and helps solve the burgeoning OAB crisis"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9611-3258","authenticated-orcid":false,"given":"Peter","family":"Petros","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering School of Engineering and Mathematical Sciences, The University of Western Australia  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rgen","family":"Quaghebeur","sequence":"additional","affiliation":[{"name":"Department of Anatomy Faculty of Medicine and Health Sciences, University of Antwerp Edegem Belgium  Antwerp Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0879-6854","authenticated-orcid":false,"given":"Jean\u2010Jacques","family":"Wyndaele","sequence":"additional","affiliation":[{"name":"Department of Anatomy Faculty of Medicine and Health Sciences, University of Antwerp Edegem Belgium  Antwerp Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,6,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.10052"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.0580"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.1976.tb02739.x"},{"key":"e_1_2_10_5_1","unstructured":"van Waalwijk van Doorn E.S.C. 209 (Rijksuniversiteit Limburg Maastricht 1993)."},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2019.02.038"},{"key":"e_1_2_10_7_1","first-page":"1","article-title":"An integral theory and its method for the diagnosis and management of female urinary incontinence","volume":"153","author":"Petros PE","year":"1990","journal-title":"Acta Obstet Gynecol Scand Suppl"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.1930120305"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6777(1999)18:2<81::AID-NAU3>3.0.CO;2-Z"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02764821"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02764822"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(95)90227-9"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)03069-X"},{"key":"e_1_2_10_14_1","first-page":"210","article-title":"A mechanical model for the opening of the human female urethra","volume":"00","author":"Bush MB","year":"2005","journal-title":"Biomed Eng"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.1930140406"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9290(97)00050-X"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01982218"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2004.08.063"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-3356(21)00669-5"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.13598"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-004-1122-3"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001920170006"},{"key":"e_1_2_10_23_1","first-page":"89","article-title":"The posterior fornix syndrome: a multiple symptom complex of pelvic pain and abnormal urinary symptoms deriving from laxity in the posterior fornix","volume":"27","author":"Petros PE","year":"1993","journal-title":"Scand J Urol Nephrol"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02765483"},{"key":"e_1_2_10_25_1","first-page":"99","article-title":"Vaginal apical prolapse repair using two different sling techniques improves chronic pelvic pain, urgency and nocturia: a multicentre study of 1420 patients","volume":"35","author":"Wagenlehner F","year":"2016","journal-title":"Pelviperineol"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1159\/000500329"},{"key":"e_1_2_10_27_1","first-page":"84","article-title":"Surgical cure of chronic pelvic pain, associated bladder & bowel symptoms by posterior sling in 198 patients validates the Pescatori Iceberg principle of pelvic symptom co\u2010occurrence","volume":"36","author":"Goeschen K","year":"2017","journal-title":"Pelviperineol"},{"key":"e_1_2_10_28_1","first-page":"53","article-title":"Is overactive bladder in the female surgically curable by ligament repair?","volume":"70","author":"Liedl B","year":"2017","journal-title":"Cent European J Urol"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.13413"},{"key":"e_1_2_10_30_1","first-page":"79","article-title":"The TFS minisling restores major pelvic organ prolapse and symptoms in aged Japanese women by repairing damaged suspensory ligaments 12\u201048 month data","volume":"34","author":"Inoue H","year":"2015","journal-title":"Pelviperineol"},{"key":"e_1_2_10_31_1","first-page":"118","article-title":"Study No. 12: role of the uterosacral ligaments in the causation of rectal intussusception, abnormal bowel emptying, and fecal incontinence. A prospective study","volume":"27","author":"Abendstein B","year":"2008","journal-title":"Pelviperineol"},{"key":"e_1_2_10_32_1","first-page":"52","article-title":"TFS posterior sling improves overactive bladder, pelvic pain and abnormal emptying, even with minor prolapse. A prospective urodynamic study","volume":"29","author":"Petros PEP","year":"2010","journal-title":"Pelviperineol"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04440-z"},{"key":"e_1_2_10_34_1","first-page":"92","article-title":"Surgical cure of nocturia using 4 different methods based on strengthening the structural supports of the vaginal apex\u2014a short review","volume":"34","author":"Richardson P","year":"2015","journal-title":"Pelviperineol"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.14453"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/44.1.23"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrn2401"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.bmb.a071584"},{"key":"e_1_2_10_39_1","first-page":"55","article-title":"Mechanical support of the posterior fornix relieved urgency and suburethral tenderness","volume":"32","author":"Chen YJ","year":"2013","journal-title":"Pelviperineol"},{"key":"e_1_2_10_40_1","first-page":"307","article-title":"A four month squatting\u2010based pelvic exercise regime cures day\/night enuresis and bowel dysfunction in children aged 7\u201011 years","volume":"73","author":"Garcia\u2010Fernandez A","year":"2020","journal-title":"Cent European J Urol"},{"key":"e_1_2_10_41_1","first-page":"436","article-title":"Retention of urine in women is alleviated by uterosacral ligament repair: implications for Fowler's syndrome","volume":"71","author":"Petros P","year":"2018","journal-title":"Cent European J Urol"},{"key":"e_1_2_10_42_1","first-page":"372","article-title":"Native tissue repair of cardinal\/uterosacral ligaments cures overactive bladder and prolapse, but only in pre\u2010 menopausal women","volume":"74","author":"Shkarupa D","year":"2021","journal-title":"Cent European J Urol"},{"key":"e_1_2_10_43_1","first-page":"490","article-title":"A low cost artisan tension\u2010free tape technique cures pelvic organ prolapse and stress urinary incontinence\u2014proof of concept","volume":"73","author":"Pi\u00f1ango\u2010Luna S","year":"2020","journal-title":"Cent European J Urol"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.21023"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2011.12.013"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.21092"},{"key":"e_1_2_10_47_1","first-page":"59","volume-title":"Clinical epidemiology","author":"Sackett D","year":"1985"},{"issue":"153","key":"e_1_2_10_48_1","first-page":"1","article-title":"An integral theory of female urinary incontinence","volume":"00","author":"Petros PE","year":"1990","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_10_49_1","unstructured":"KuhnTThe structure of scientific revolutions University of Chicago Press Chicago (1962)."},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2016.13"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00281-018-0674-0"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.22604"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2014.05.023"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.21100"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11934-013-0358-1"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-021-04920-w"},{"key":"e_1_2_10_57_1","unstructured":"PetrosPE. Editorial The Emperor has no clothes. International Urogynecology Journal 202in press."}],"container-title":["Neurourology and Urodynamics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.24990","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/nau.24990","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.24990","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T12:58:44Z","timestamp":1706705924000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/nau.24990"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,16]]},"references-count":56,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.1002\/nau.24990"],"URL":"https:\/\/doi.org\/10.1002\/nau.24990","archive":["Portico"],"relation":{},"ISSN":["0733-2467","1520-6777"],"issn-type":[{"value":"0733-2467","type":"print"},{"value":"1520-6777","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,16]]},"assertion":[{"value":"2022-03-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}