Different electrode positioning for transcutaneous electrical nerve stimulation in the treatment of urgency in women: a study protocol for a randomized controlled clinical trial

BACKGROUND

Urgency is a complaint of sudden, compelling desire to pass urine, which is difficult to defer, caused by involuntary contraction of the detrusor muscle during the bladder-filling stage. To enable detrusor inhibition, electrotherapy resources such as transcutaneous tibial nerve stimulation (TTNS) and parasacral transcutaneous electrical stimulation (PTES) have been used. The objective this study is to publish the study protocol that aims to investigate whether urgency decreases after treatment with both of the techniques.

METHODS

This randomized controlled clinical trial will include 99 women, aged more than 18 years old, with urgency (score ≥ 8 in the Overactive Bladder-Validated 8-Question Awareness Tool [OAB-V8]). Women will be randomly allocated into three groups: TTNS, PTES, and placebo. The following questionnaires will be applied: the Anamnesis Record, the Incontinence Questionnaire Overactive Bladder, the King's Health Questionnaire, the 24-Hour Voiding Diary, and the OAB-V8, at four different time points: at baseline prior to the first session, at the 6th session, the 12th session and at follow-up. The current used for the transcutaneous electrical stimulation will be a symmetrical balanced biphasic pulsed current, for 12 sessions, twice a week, for 20 minutes. Qualitative variables will be displayed as frequency and percentage, quantitative variables as mean and standard deviation. Comparison of urgency severity among groups will be performed with a repeated measures ANOVA, considering the effect of the three groups and the four evaluations, and interactions among them.

DISCUSSION

The present study aims to contribute evidence for a more in-depth discussion on electrode positioning for electrostimulation used in urgency treatment. It should be emphasized that, based on the possibility of confirming the hypothesis that urgency will decrease in a similar way after both treatments (TTNS and PTES), the PTES will be used as an option for positioning the electrodes alternatively to the tibial nerve region in special populations, such as amputees or people with severe lower limb sensory impairment.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9rf33n, date of registration: 17 May 2018.

Treatment Satisfaction with Flexible-dose Fesoterodine in Patients with Overactive Bladder who were Dissatisfied with Previous Anticholinergic Therapy: A Multicenter Single-Arm Clinical Study

PURPOSE

We investigated treatment satisfaction with flexible-dose fesoterodine in patients with overactive bladder (OAB) who were dissatisfied with previous anticholinergic therapy.

MATERIALS AND METHODS

The subjects were prescribed fesoterodine 4 mg for 4 weeks and fesoterodine 4 mg or 8 mg for another 8 weeks. The primary end point of this study was patients' satisfaction after 12 weeks of fesoterodine treatment on a five-point Likert scale. Secondary end points included a change in the number of daytime micturition, urgency incontinence episodes, urgency episodes, and nocturnal micturition in a 24-hour period from baseline to final assessment.

RESULTS

Overall, 84 patients were assigned to the treatment group in this study and 63 patients completed the 12-week treatment course. A final fesoterodine dose of 4 mg and 8 mg was used by 45 (71.4%) and 18 (28.6%) patients, respectively. The satisfaction and dissatisfaction rates at 12 weeks were 69.9% and 14.2%, respectively. Mean changes in the daytime micturitions (9.73 ± 4.72 vs. 7.76 ± 2.86), urgency episodes (7.73 ± 5.68 vs. 3.71 ± 4.09), and nocturnal micturitions (2.13 ± 1.36 vs. 1.68 ± 1.12) in 24 hours improved significantly with flexible-dose fesoterodine treatment (P < .05). Most adverse events were mild and none were severe.

CONCLUSION

The flexible dose fesoterodine represents an alternative treatment modality in patients with OAB who are dissatisfied with previous anticholinergic therapy in Korea.

Mirabegron Add-on Therapy to Tamsulosin for the Treatment of Overactive Bladder in Men with Lower Urinary Tract Symptoms: A Randomized, Placebo-controlled Study (MATCH)

BACKGROUND

Men with lower urinary tract symptoms (LUTS) treated with α-blockers (eg, tamsulosin) may experience overactive bladder (OAB) symptoms and receive add-on antimuscarinics. Mirabegron (a β3-adrenoreceptor agonist) is an alternative add-on therapy.

OBJECTIVE

To evaluate the efficacy of mirabegron versus placebo in men with OAB symptoms receiving tamsulosin for LUTS.

DESIGN, SETTING, AND PARTICIPANTS

Japanese and Korean men with OAB treated with tamsulosin for LUTS (January 2016-July 2017).

INTERVENTION

Single-blind, 4-wk screening: tamsulosin plus placebo orally once daily; double-blind, 12-wk treatment: patients randomized (n=568) to mirabegron 50mg or placebo, as add-on to tamsulosin.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Primary endpoint: baseline to end of treatment (EoT) change in the mean number of micturitions/24h, based on a 3-d voiding diary. Secondary endpoints: change in other diary variables and patient-reported outcomes from baseline to EoT. The primary endpoint was analyzed by analysis of covariance, including treatment group and region as fixed factors and baseline as a covariate.

RESULTS AND LIMITATIONS

Mirabegron add-on therapy was superior to placebo in improving the primary endpoint (adjusted mean difference [95% confidence interval] vs placebo -0.52 [-0.82 to -0.21]) and secondary endpoints, including mean volume voided/micturition (12.08 [6.33-17.84]), OAB symptom score (-0.65 [-1.04 to -0.26]), International Prostate Symptom Score total (-1.19 [-1.94 to -0.44]), storage (-0.78 [-1.13 to -0.43]), quality of life scores (-0.29 [-0.51 to -0.07]), OAB symptom bother (-4.52 [-6.91 to -2.13]), and total health-related quality of life (2.79 [1.13 to 4.44]). Differences, compared with placebo, in urgency, urgency urinary incontinence, and nocturia were not statistically significant. Mirabegron was well tolerated, with no major safety concerns. Limitations included a lack of antimuscarinic comparison.

CONCLUSIONS

The mirabegron add-on therapy to tamsulosin for 12 wk in men with LUTS and OAB symptoms demonstrated superior efficacy to placebo and was well tolerated.

PATIENT SUMMARY

We looked at the efficacy and safety of mirabegron compared with placebo in men being treated with tamsulosin but who still had overactive bladder symptoms. Mirabegron improved overactive bladder symptoms and patient-reported outcomes compared with placebo, and was well tolerated.

Urinary bladder hypertrophy and overactive bladder determine urinary continence after radical prostatectomy

BACKGROUND

Several clinical and biological factors exacerbate urinary incontinence (UI) and reduce the patient's quality of life after radical prostatectomy (RP).

OBJECTIVES

The purpose of this study was to evaluate the effects of urinary bladder hypertrophy and overactive bladder (OAB) on UI in patients after RP.

MATERIAL AND METHODS

Seventy patients were enrolled in the study and were divided into 2 groups: patients with bladder outlet obstruction (BOO) but without OAB (group I; n = 20) and patients with BOO and OAB (group II; n = 50). Before the RP procedure, all patients were administered IPSS and OAB symptom questionnaires and ultrasonography and uroflowmetry were performed. The follow-up visits were scheduled for 1, 3, 6, 9, and 12 months after the operation to evaluate postoperative continence.

RESULTS

The results show that patients with BOO and concurrent OAB experienced urinary bladder hypertrophy. Patients with OAB presented a normal desire to void with less urinary bladder capacity. The coexistence of OAB before RP resulted in more extensive UI, as measured with the ICIQ-UI-SF scores and postoperative daily pad usage. A gradual improvement in urinary continence was observed. Urinary incontinence was significantly less severe in successive check-ups (3, 6, 9, and 12 months after RP). Urgency was responsible for 1-15% or 16-29% of episodes of urinary leakage in 20% and 16% of cases, respectively.

CONCLUSIONS

Patients with preoperative OAB are at a higher risk of developing more severe UI after RP, and the restoration of pre-surgery urinary continence is limited.

Comparison of body composition and overactive bladder symptoms in overweight female university students

OBJECTIVES

To compare body composition in young overweight women with OAB compared to women without OAB, and to determine the severity of the symptoms of OAB, as well as to investigate the impact of OAB on quality of life.

STUDY DESIGN

Cross-sectional study. The sample consisted of 1932 enrolled women classed as overweight (BMI:25-29.9).From this sample, 276 women were recruited. Of these, 206 women with an average age of 30.6 ± 20.4 years and an average BMI of 25.8 ± 3.0 were confirmed to be overweight. We used the Voiding Diary, the Overactive Bladder Questionnaire(OAB-q),and the Incontinence Quality of Life (I-QoL) scale. Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis, with assessment of: skeletal muscle mass(kg)(SMM), body fat mass (kg)(BFM), body fat percentage (%)(BFP), visceral fat area (cm²/level)(VFA), and waist to hip ratio(WHR).

RESULTS

The voiding diary and OAB-q results confirmed OAB in 102 women. There was no significant difference in BMI between groups. The body composition analysis showed significant differences in BFP, VFA, and WHR, with higher values in the OAB group(p < 0.01). SMM, however, was higher in the group without OAB(p < 0.01). Recorded I-QoL scores showed worse parameters in the OAB group(p < 0.001). Women with a body fat percentage above 32% have a 1.95 times greater chance of developing OAB. Odds ratio [OR] = 1.95,(95%CI:1.09-3.52,p < 0.02).

CONCLUSION

Body fat percentage, visceral fat area, and waist to hip ratio were significantly higher in overweight women with OAB, compared with women without OAB and a comparable BMI.

Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis

OBJECTIVES

To assess the prevalence and interrelationship between lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis (MS).

METHODS

In a cross-sectional study, we evaluated 41 men (mean age 41.1±9.9 years) with MS from February 2011 to March 2013, who were invited to participate irrespective of the presence of lower urinary tract symptoms or sexual dysfunction. Neurological impairment was assessed with the Expanded Disability Status Scale; lower urinary tract symptoms were evaluated with the International Continence Society male short-form questionnaire, and sexual dysfunction was evaluated with the International Index of Erectile Function. All patients underwent transabdominal urinary tract sonography and urine culture.

RESULTS

The mean disease duration was 10.5±7.3 years. Neurological evaluation showed a median Expanded Disability Status Scale score of 3 [2-6]. The median International Continence Society male short-form questionnaire score was 17 [10-25]. The median International Index of Erectile Function score was 29 [15-46]. Twenty-nine patients (74.4%) had sexual dysfunction as defined by an International Index of Erectile Function score <45. Voiding dysfunction and sexual dysfunction increased with the degree of neurological impairment (r=0.02 [0.02 to 0.36] p=0.03 and r=-0.41 [-0.65 to -0.11] p=0.008, respectively). Lower urinary tract symptoms and sexual dysfunction also displayed a significant correlation (r=-0.31 [-0.56 to -0.01] p=0.04).

CONCLUSIONS

Most male patients with MS have lower urinary tract symptoms and sexual dysfunction. The severity of the neurological disease is a predictive factor for the occurrence of voiding and sexual dysfunctions.

[Not Available]

An overactive neurogenic detrusor and an non-neurogenic overactive bladder both exhibit symptoms such as urgency and frequency, both with and without urinary incontinence, and are often accompanied by nocturia. OnabotulinumtoxinA-Detrusorinjection has become well established as a second line therapy in cases where anticholinergic medication has failed. The procedure can be performed under general or local anesthesia, in both in- and outpatient settings. The side effects of the procedure are primarily urinary tract infections and - especially in neurogenic bladder patients - urinary retention. This article focuses on the approved indications and summarizes the current scientific data.

[Most recent findings of curative drugs for lower urinary tract symptoms in clinical practice]

As Japan enters into an aging society, aged patients with chief complaint of lower urinary tract symptoms (LUTS) have increased. The most common cause of LUTS in men older than 50 years is benign prostatic hyperplasia (BPH). In particular, LUTS associated with overactive bladder (OAB) symptoms was reported to have a significant negative impact on patient quality of life (QOL). In clinical practice, monotherapy with α1-blockers or PDE5 inhibitors is widely employed for the initial management of BPH accompanied by OAB (BPH/OAB). However, storage symptoms may persist in some patients. In patients with residual OAB symptoms despite α1-blocker or PDE5 inhibitor monotherapy, the addition of an anticholinergic agent or a β3-adrenergic receptor (β3-AR) agonist is recommended by the BPH guidelines. Although both agents have been shown to effectively improve OAB symptoms and bladder storage functions, it remains unclear which type of add-on therapy, anticholinergic agents or β3-AR agonists, is most effective for alleviating OAB symptoms and storage functions. Recently, detrusor underactivity (DU) is also considered to be a common cause of non-neurogenic LUTS in men. DU has been reported to be present in 9%-48% of men undergoing urodynamic evaluation for non-neurogenic LUTS. DU can lead to adverse health effects, in addition to significant burden and decreased QOL. Thus, development of a safe and effective treatment for patients with LUTS induced by DU is an urgent issue at present. In this paper, we will introduce most recent findings of curative drugs for LUTS, especially BPH/OAB and DU in clinical practice.

Painful Bladder Symptoms Related to Somatic Syndromes in a Convenience Sample of Community Women with Overactive Bladder Symptoms

PURPOSE

We investigated the relationship of painful bladder filling and urinary urgency to somatic and chronic pain symptoms in women with overactive bladder without an interstitial cystitis/bladder pain syndrome diagnosis.

MATERIALS AND METHODS

Women who met overactive bladder criteria based on symptoms were recruited, including 183 (83.9%) from the community and 35 (16.1%) from the urology clinic to complete validated questionnaires assessing urinary symptoms, somatic symptoms and pain syndromes. Participants were categorized into 1 of 3 groups, including 1) neither symptom, 2) either symptom or 3) both symptoms, based on their reports of painful urinary urgency and/or painful bladder filling. Multivariable regression analyses were performed to determine factors predictive of having painful urgency and/or painful filling.

RESULTS

Of 218 women with overactive bladder 101 (46%) had neither painful bladder filling nor urinary urgency, 94 (43%) had either symptom and 23 (11%) had both symptoms. When controlling for age, women with either or both urological pain symptoms were more likely to have irritable bowel syndrome, chronic pelvic pain and temporomandibular disorder than women in the neither group. Additionally, these women had higher pain intensity and somatic symptoms scores than women with neither symptom.

CONCLUSIONS

The majority of women with overactive bladder who had not been diagnosed with interstitial cystitis/bladder pain syndrome reported painful urgency and/or painful filling. Experiencing painful urgency and/or filling was associated with an increased somatic symptom burden and greater pain intensity. These findings support the hypothesis that overactive bladder and interstitial cystitis/bladder pain syndrome diagnoses may represent a continuum of bladder hypersensitivity.

Overactive bladder syndrome treatment with ospemifene in menopausal patients with vulvovaginal atrophy: improvement of sexuality?

The aim of this study was to assess the effectiveness of ospemifene in the improvement of sexual function in postmenopausal women with vulvovaginal atrophy (VVA) affected by overactive bladder syndrome (OAB) or urge urinary incontinence (UUI). One hundred five postmenopausal patients with VVA affected by OAB and/or UUI were enrolled for the study. All patients received ospemifene 60 mg for 12 weeks. Clinical examination, 3-d voiding diary and the vaginal health index (VHI) were performed at baseline and at 12 weeks. Patients completed the OAB-Q SF, FSFI, FSDS, and SF-36 questionnaires. The patient's satisfaction was also calculated. After 12 weeks, the reduction of urinary symptoms was observed. The OAB-Q symptoms, OAB-Q (HRQL) score were (55.34 ± 13.54 vs. 23.22 ± 9.76; p < .0001) and (22.45 ± 9.78 vs. 70.56 ± 15.49; p < .0001), before and after treatment. SF-36 questionnaire showed a significant improvement (p < .0001). VHI score increased and the women who regularly practice sexual activity increased after treatment. The total FSFI score increased significantly and the FSDS score changed after 12 weeks (p < .0001). The PGI-I after 12 weeks showed a total success rate of 90.5%. Ospemifene is an effective potential therapy for postmenopausal women with VVA affected by OAB or UUI improving sexual function and quality of life.

[Comparison of the symptoms of overactive bladder in women with mixed urinary incontinence and idiopathic urge urinary incontinence.]

INTRODUCTION

Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI.

OBJETIVES

To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI.

METHODS

A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed.

RESULTS

There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found.

CONCLUSIONS

There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery.

Cognitive functions and health-related quality of life in men with benign prostatic hyperplasia and symptoms of overactive bladder when treated with a combination of tamsulosin and solifenacin in a higher dosage

AIM

To study the cognitive functions and health-related quality of life (HRQoL) in individuals taking a combination of tamsulosin and solifenacin in a higher dosage.

METHODS

All patients (n = 262) were assigned to group A (N = 93, tamsulosin 0.4 mg + solifenacin 10 mg per day), group B (N = 83, tamsulosin 0.4 mg + solifenacin 20 mg), and control group C (N = 86; tamsulosin 0.4 mg + placebo). The lower urinary tract (LUT) condition was assessed on the scales International Prostate Symptom Score, Over Active Bladder Awareness Tool and uroflowmetry. The state of cognitive status was assessed on the scales Mini-mental State Examination, Controlled Oral Word Association Test, Wechsler Adult Intelligence Scale-Revised, Wechsler III, Color Trails Test, California Verbal Learning Test.

RESULTS

The values of cognitive function indicators in the individuals from all groups after treatment did not significantly differ from the respective values at the baseline (p > .05). The values of most HRQoL parameters of the functional state of the LUT significantly improved in groups A and B. A significant correlation between the state of cognitive status and HRQoL, as well as LUT was absent (r <0.3).

CONCLUSION

The combination of solifenacin in a double dosage along with tamsulosin can be recommended for elderly benign prostatic hyperplasia patients with overactive bladder symptoms.

Nocturia is more bothersome than daytime LUTS: Results from an Observational, Real-life Practice Database including 8659 European and American LUTS patients

PURPOSE

Lower urinary tract symptoms (LUTS) encompass several diagnoses, including overactive bladder (OAB) and benign prostatic hyperplasia (BPH). Nocturia is a standalone symptom, but also included in OAB and BPH. Current discussion addresses whether the overlap of the diagnoses is too broad, leading to misdiagnosis. This study explored the differences in level, causes and consequences for patients with a diagnosis of daytime LUTS compared with a diagnosis of nocturia, and discussed whether people are being treated for the symptoms that truly bother them the most.

PATIENTS AND METHODS

Data were drawn from a survey of physicians and patients in France, Germany, Spain, UK and USA. Physicians filled out patient record forms (PRFs) for patients with LUTS diagnosis. The patients completed the patient self-completion form (PSC). Three PRO questionnaires were included; the OAB-q SF, NI-Diary and WPAI. Patients were grouped based on the diagnoses assigned to them by their physicians in a real-life setting.

RESULTS

Eight thousand seven hundred and thirty eight patients had a LUTS diagnosis and 5335 completed a PSC. Patients diagnosed with night-time symptoms were significantly more bothered by their LUTS than only daytime LUTS patients (all questionnaires P < .0001). Patients with nocturia reported being tired "always" or "usually" more often than patients with daytime problems only (P < .0001). Only 13% of patients with nocturia had an initial sleep period of more than 2-3 hours.

CONCLUSION

In this population of real-life patients, those with a diagnosis of nocturia reported significantly higher impact on their quality of life than patients with a diagnosis of daytime LUTS only. The underlying causes of bother were related to sleep problems. It is essential that nocturia is understood, treated and monitored as a distinct problem from OAB and BPH, to ensure that patients are treated for their main symptom.

Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson's disease

OBJECTIVE

To assess the safety and efficacy of intradetrusor onabotulinum toxin A injections for the treatment of overactive bladder (OAB) in patients with Parkinson's disease (PD).

METHODS

All PD patients who underwent intradetrusor injections of onabotulinum toxin A (BoNT-A) for storage symptoms between 2010 and 2017 were included in a retrospective study. A 100 U dose of BoNT-A (Botox®, Allergan Irvine, CA) was used for the first injection in all patients. The primary endpoint was clinical success defined as any subjective improvement in OAB symptoms self-assessed by the patients 4 weeks after the injections.

RESULTS

Out of 24 patients analyzed, 19 reported improvement of their OAB symptoms 4 weeks after the first injection (79.2%) with complete resolution of urgency urinary incontinence in seven patients (29.1%; P < 0.001). The average post-void residual (PVR) increased significantly after the first injection from 17.6 to 125.3 mL (P < 0.001). Three of the patients had to start clean intermittent catheterization (CIC) after the first injection (12.5%). Out of 49 injections in total, only five caused incomplete bladder emptying requiring the use of CIC (10.2%). Higher pre-injection PVR was significantly associated with both a lower chance of symptomatic improvement (P = 0.04) and a higher risk of incomplete bladder emptying with institution of CIC (P = 0.047).

CONCLUSION

Intradetrusor injections of BoNT-A 100 U appeared as a safe and effective option in PD patients with OAB symptoms and a low PVR before the injection. Higher preoperative PVR was the strongest predictor of both treatment failure and postoperative urinary retention requiring CIC.

What are the additional signs and symptoms in patients with detrusor underactivity and coexisting detrusor overactivity?

AIMS

This study aimed to determine what difference the inclusion of patients with coexisting detrusor overactivity (DO) makes to the signs and symptoms of patients with detrusor underactivity (DU).

METHODS

A total of 250 male and 435 female urodynamic tests were analyzed retrospectively. Signs and symptoms which showed a statistically significant difference between DU without DO and DU with DO were identified.

RESULTS

Males with DO in addition to DU had higher age and number of daily micturitions, and were more likely to report urgency with or without urgency incontinence than males with DU without DO. They also had lower volumes for first desire to void, volume voided, and post void residual urine, lower abdominal pressure at Q_max and were less likely to report a history of retention or reduced bladder filling sensation than males with DU without DO. Females with DO in addition to DU had higher age and BMI, and were more likely to report urgency incontinence, higher day and night pad usage, constipation and have reduced anal tone than females with DU without DO. They also had lower volumes for first desire to void, volume voided, and post void residual urine, and lower abdominal pressure at Q_max than females who had DU without DO.

CONCLUSIONS

There are differences in signs and symptoms between patients who have DU without DO, compared to patients having DU with DO. This understanding will help future studies investigating treatment options for DU patients.

Female Voiding Dysfunction and Urinary Incontinence

Female voiding dysfunction and incontinence are common in the general population and symptoms have been shown to have a significant negative impact on health-related quality of life. This article highlights the epidemiology, evaluation, diagnosis, pharmacologic therapies, and surgical treatment for overactive bladder, stress urinary incontinence, and urogenital fistulas.

Structured behavioral treatment research protocol for women with mixed urinary incontinence and overactive bladder symptoms

AIMS

The primary aim is to provide detailed rationale and methodology for the development and implementation of a perioperative behavioral/pelvic floor exercise research protocol for women who self-chose surgical intervention and who may or may not have been offered behavioral treatments initially. This protocol is part of the ESTEEM trial (Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence Trial) which was designed to determine the effect of a combined surgical and perioperative behavioral/pelvic floor exercise intervention versus surgery alone on improving mixed urinary incontinence (MUI) and overactive bladder (OAB) symptoms.

METHODS

As part of a multi-site, prospective, randomized trial of women with MUI electing midurethral sling (MUS) surgical treatment, participants were randomized to a standardized perioperative behavioral/pelvic floor exercise intervention + MUS versus MUS alone. The specific behavioral intervention included: education on voiding habits, pelvic floor muscle training (PFMT), bladder training (BT), strategies to control urgency and reduce/prevent urinary symptoms, and monitoring/promoting adherence to behavioral recommendations. To ensure consistency across all eight research sites in the pelvic floor disorders network (PFDN), selective behavioral treatments sessions were audiotaped and audited for protocol adherence.

RESULTS

The behavioral intervention protocol includes individualization of interventions using an algorithm based on pelvic floor muscle (PFM) assessment, participant symptoms, and findings from the study visits. We present, here, the specific perioperative behavioral/pelvic floor exercise interventions administered by study interventionists.

CONCLUSIONS

This paper details a perioperative behavioral/pelvic floor exercise intervention research study protocol developed for women undergoing surgery for MUI.

Male Incontinence: The Etiology or Basis of Treatment

CONTEXT

Elderly men are an increasing proportion of the aging population in the 21st century. Urinary incontinence reduces the quality of life and increases the burden of care for the aging population.

OBJECTIVE

The primary objective of this review is to explore the etiopathology of common causes of incontinence in aging male patients. The focus is on the algorithm of the initial evaluation of these patients from both a primary care and a urologic standpoint.

EVIDENCE ACQUISITION

A nonsystematic review of the literature was performed in September 2017. The data and evidence of this paper have been obtained by a PubMed search, and through official statements and recommendations from the International Consultation on Incontinence. Our search incorporated terms such as elderly, urinary incontinence, male, urodynamics, bladder outlet obstruction, BPH, neurologic, urethral stricture, spinal shock, and urethral sphincter injury.

EVIDENCE SYNTHESIS

A total of 7204 papers were identified; 6838 were excluded for female populations and populations <65 yr. A broad differential diagnosis exists for urinary incontinence in aging male patients, and many patients will be found to have multifactorial incontinence, compounding the issue. Neurologic etiologies common in this population include cerebrovascular accidents, Parkinson's disease, and dementia. Spinal cord injuries and multiple sclerosis are less common. In this analysis, non-neurologic etiologies leading to incontinence are broadly grouped under bladder outlet obstruction, sphincter injury, overactive bladder, underactive bladder, polypharmacy, and urinary tract infections.

CONCLUSIONS

We provide a review of the differential diagnosis of incontinence in an elderly male patient. There is a need for understanding etiopathology and recognizing that many patients may have a combination of the above. The assessment algorithm, modified from the International Continence Society, provides a pathway for the provider in evaluating and treating elderly patients.

PATIENT SUMMARY

In this review, we have identified the sources of urinary incontinence in elderly male patients by neurologic and non-neurologic causes. We also discuss the basic evaluation and workup of an incontinent patient.

Influence of Daytime or Nighttime Dosing with Solifenacin for Overactive Bladder with Nocturia: Impact on Nocturia and Sleep Quality

We compared changes in nocturia and sleep-related parameters between daytime and nighttime solifenacin dosing in patents with overactive bladder (OAB) and nocturia. We comparatively analyzed the data of a 12-week prospective, open-label, multicenter, randomized study. All 127 patients who presented to 5 centers in Korea for the treatment of OAB with nocturia between January 2011 and December 2013 were enrolled in this study. The patients were divided into 2 groups by medication timing: group 1, daytime (n = 62); and group 2, nighttime (n = 65). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale (AIS) were used to assess OAB symptoms and sleep quality. We evaluated the parameter changes before and 12 weeks after daytime or nighttime solifenacin administration. Baseline data, which included sex, age, body mass index (BMI), total AIS, IPSS, and OABSS, did not differ between the 2 groups. Total IPSS, OABSS, and total AIS significantly improved after solifenacin administration regardless of timing (P < 0.001). After solifenacin administration, the number of nocturia episodes decreased in the group 1 and 2 (P < 0.001). There were no significant intergroup differences in changes in AIS, IPSS, OABSS, and number of nocturia episodes 12 weeks after solifenacin administration. Treating OAB with solifenacin may improve nocturia and sleep quality, but advantages did not differ significantly by medication timing.

Association Between Irritable Bowel Syndrome and Overactive Bladder: A Research Survey

OBJECTIVE

To investigate the relationship between irritable bowel syndrome (IBS) and overactive bladder (OAB) in men and women using questionnaires.

MATERIALS AND METHODS

This research survey was based on multicenter data (men and women older than 20 years). The Korean version of the Rome III criteria was used for the diagnosis of IBS, Overactive Bladder Symptom Score (OABSS) was used for screening OAB, Self-Rating Depression Scale was used for depressive symptoms, and International Prostate Symptom Score and Quality of Life were used to determine the degrees of lower urinary tract symptoms.

RESULTS

A total of 609 (men: 257, women: 352) people answered the questionnaire. The prevalence of IBS and OAB was 31.9% (men vs women: 27.3% vs 39.2%) and 19.2% (men vs women: 25.3% vs 18.5%), respectively. The OABSS values of patients with IBS and non-IBS patients were 1.70 ± 2.48 and 2.48 ± 2.79 (P <.001). On the Self-Rating Depression Scale, individuals with IBS had a higher score than non-IBS individuals (n = 201) (44.92 ± 13.71 vs 39.19 ± 10.39, P <.001). In men, non-IBS (n = 56) had higher OABSS and OABSS question number 3 responses than patients with IBS (OABSS: 2.56 ± 2.69 vs 1.57 ± 2.43, P = .01, OABSS Q3: 0.92 ± 1.26 vs 0.66 ± 1.13, P = .17). Also, in women, non-IBS (n = 214) had higher OABSS and OABSS question number 3 responses than patients with IBS (n = 138) (OABSS: 2.40 ± 2.87 vs 1.76 ± 2.52, P = .03, OABSS Q3: 0.83 ± 1.25 vs 0.70 ± 1.18, P = .32).

CONCLUSION

IBS in adults had no relationship with OAB in our study. These data suggest that more studies are needed to determine the relationship between IBS and OAB.

Prevalence of overactive bladder and its impact on quality of life in 1025 patients with type 2 diabetes in mainland China

AIMS

This study examined the prevalence of overactive bladder (OAB) and investigated the impact of OAB on quality of life (QOL) in patients with type 2 diabetes in Mainland China.

METHODS

A total of 1025 patients with type 2 diabetes were surveyed. Patients were grouped into no OAB, dry OAB, and wet OAB groups according to the presence of OAB and urge incontinence. Descriptive analyses, one-way analysis of variance (ANOVA) and multivariable regression models were conducted to assess the prevalence of OAB and the effect of OAB on QOL.

RESULTS

The prevalence of OAB among patients with type 2 diabetes was 13.9% (with dry OAB, 6.1%; with wet OAB, 7.8%). Multivariable regression models showed that OAB symptoms caused significant deterioration of the physical and mental aspects of QOL. Compared with dry OAB, wet OAB further decreased the mental aspect of QOL. Moreover, the effect sizes of the impacts of dry and wet OAB on QOL were larger than those of diabetic neuropathy or retinopathy, diabetes duration, or urinary tract infection history.

CONCLUSIONS

OAB is more common in patients with type 2 diabetes than in the general population and substantially decreases patient QOL.

Association between different anticholinergic drugs and subsequent dementia risk in patients with diabetes mellitus

BACKGROUND

The effects of oxybutynin, solifenacin and tolterodine on dementia risk in patients with diabetes mellitus (DM) remain unknown. We investigated the effects of oxybutynin, solifenacin and tolterodine on dementia risk in patients with DM.

METHODS

We conducted a cohort study by using the diabetes dataset of the Taiwan National Health Insurance Research Database from 1 January, 2002 to 31 December, 2013. We included 10,938 patients received one type of oxybutynin, solifenacin, or tolterodine, while 564,733 had not. We included a comparable number of patients not receiving oxybutynin, solifenacin, or tolterodine as controls through systematic random sampling matching by age, gender, and the year of the index date with 1 to 1 ratio. The dementia risk was estimated through multivariate Cox proportional hazard regression after adjustment for several confounding factors.

RESULTS

The dementia event rates were 3.9% in the oxybutynin group, 4.3% in the solifenacin group, 2.2% in the tolterodine group and 1.2% in the control group (P<0.001). The adjusted HRs compared to nonusers of anticholinergic drugs were 2.35 (95% CI, 1.96 to 2.81), 2.16 (95% CI, 1.81 to 2.58), and 2.24 (95% CI, 1.85 to 2.73), respectively, for patients receiving oxybutynin, solifenacin, or tolterodine.

CONCLUSION

Our study indicates an association between taking oxybutynin, solifenacin and tolterodine and the subsequent diagnosis of dementia in DM patients. Moreover, the patients using oxybutynin had highest risk. The impact of these three drugs on risk of dementia in non-diabetic populations is warrant.

Does Systemic Disease Aggravate the Severity of Dry Mouth by Anticholinergics in Overactive Bladder Patients?

PURPOSE

In overactive bladder (OAB) patients with systemic diseases, dry mouth tends to be more prominent owing to the effects of systemic diseases or related medications. We evaluated how systemic diseases affect dry mouth before and after anticholinergic treatment.

MATERIALS AND METHODS

OAB patients were enrolled in this study. The patients were divided according to the presence or absence of systemic diseases. Patients with systemic diseases were sub-grouped by the number of systemic diseases (only one or more than one disease). OAB symptoms score (OABSS), visual analogue scale (VAS) score for dry mouth, and body mass index (BMI) were measured. The statistical assessments were donewith independent T-tests and ANCOVAs.

RESULTS

One hundred and four OAB patients were enrolled in this study. Seventy (67.3%) patients had systemic diseases and thirty-four (32.7%) patients did not. Age and BMI were higher in the systemic diseases group. The baseline VAS score of OAB in the systemic diseases group (15.9 &plusmn; 19.5) was higher than that in the OAB without systemic diseases group (4.1 &plusmn; 6.4) (P = .002). Even after age and BMI adjustment, the difference was significant. The follow-up VAS score was also different (P = .028), but the change in VAS score was not different (P = .280). In a sub-analysis, the change in VAS score in the group with two or more systemic diseases (23.6 &plusmn; 18.1) was higher than that in the group with only one systemic disease (12.5 &plusmn; 13.2) (P = .012).

CONCLUSION

The severity of xerostomia after treatment with anticholinergics in OAB increases in patients with one systemic disease parallel to its severity before starting treatment. However, in patients with two or more systemic disease the magnitude of change in xedrostomia score is higher that we would expect in patients with no or one systemic diasese.

The effective tool for self-assessment of adherence to treatment in patients with benign prostatic obstruction and overactive bladder symptoms

PURPOSE

Study of validity of the Medication Adherence Self-Report Inventory (MASRI) for use in clinical practice to treat patients with benign prostatic obstruction (BPO) accompanied with overactive bladder (OAB) symptoms.

METHODS

During 12 weeks of the randomized study, 452 patients with BPO and OAB symptoms (mean age of 61.3 (12.7)) were studied for adherence to the treatment with Tamsulosin, Solifenacin and Trospium using the MASRI. External monitoring instruments included the Brief Medication Questionnaire (BMQ) and the visual remaining pill count. The state of the prostate gland and the lower urinary tract was monitored using questionnaires I-PSS, OAB Awareness Tool, uroflowmetry and voiding diaries.

RESULT

Correlation between the percentage of men non-adherent to treatment (MASRI) and the percentage of patients having a belief barrier on the screen of the BMQ was r = 0.89, p ≤0.05, r = 0.92, p ≤0.01, r = 0.85, p ≤0.05, a number of missed doses on the Regimen Screen of the BMQ was r = 0.79; p ≤0.05; r = 0.81; p ≤0.05; r = 0.75, p ≤0.05, a number of non-adherent patients according to the BMQ was r = 0.83 (p ≤0.05), r = 0.88 (p ≤0.05), r = 0.79, p ≤0.05, the results of the pill count were r = 0.65-0.76; p ≤0.05-0.01. These data confirm high validity of the MASRI.

CONCLUSION

The MASRI is a valid tool for rapid assessment of adherence to treatment of patients with BPO and OAB receiving Tamsulosin and antimuscarinic drugs and may be recommended for use in clinical practice.