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Clark CB, Ragam R, Das AK, Shenot PJ. Management of neurogenic detrusor overactivity. THE CANADIAN JOURNAL OF UROLOGY 2021; 28:33-37. [PMID: 34453427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED INTRODUCTION Neurogenic lower urinary tract dysfunction (NLUTD) refers to altered function of the urinary bladder, bladder outlet, and external urinary sphincter related to a confirmed neurologic disorder. Neurogenic detrusor overactivity (NDO) is a subset of NLUTD that frequently results in incontinence and may be associated with elevated bladder storage and voiding pressures resulting in upper urinary tract damage. MATERIALS AND METHODS This article provides an update on the evaluation and management of patients with NDO. Basic bladder physiology as well as classification of NLUTD, initial urologic evaluation, and management options ranging from the most conservative to surgical interventions will be covered. RESULTS NDO may be managed by conservative, pharmacologic, and surgical methods. Untreated or inadequately managed NDO may result in significant urologic morbidity and mortality, making careful evaluation and lifelong management necessary to optimize quality of life and prevent secondary complications. CONCLUSIONS Patients with NDO should have life-long urologic surveillance and follow up. The extent of regular evaluation and testing should be based on the principal of risk stratification. Treatment for NDO should be considered not only for clinical symptoms such as incontinence, but also aimed at preserving renal function.
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Hoffman V, Hallas J, Linder M, Margulis AV, Suehs BT, Arana A, Phiri K, Enger C, Horter L, Odsbu I, Olesen M, Perez-Gutthann S, Xu Y, Kristiansen NS, Appenteng K, de Vogel S, Seeger JD. Cardiovascular Risk in Users of Mirabegron Compared with Users of Antimuscarinic Treatments for Overactive Bladder: Findings from a Non-Interventional, Multinational, Cohort Study. Drug Saf 2021; 44:899-915. [PMID: 34236595 PMCID: PMC8280006 DOI: 10.1007/s40264-021-01095-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION During clinical trials, mirabegron, a β3-adrenoreceptor agonist, was associated with increased vital signs vs placebo in patients with overactive bladder. OBJECTIVE The purpose of this study was to compare incidence rates of adverse cardiovascular (CV) outcomes following mirabegron or antimuscarinic use. METHODS We conducted an observational post-marketing safety study utilising real-world data. The study population was identified within five sources: Danish and Swedish National Registers, Clinical Practice Research Datalink (UK), Optum (USA) and Humana (USA). Episodes of time when patients were new users of mirabegron or antimuscarinics (October 2012-December 2018) were sourced from prescriptions and matched on propensity scores. Occurrences of major adverse cardiovascular events (MACE), acute myocardial infarction (AMI), stroke, CV mortality and all-cause mortality were identified. Outcome incidence rates and hazard ratios from Cox models were estimated. RESULTS Overall, 152,026 mirabegron and 152,026 antimuscarinic episodes were matched. The population consisted of 63.1% women and 72.6% were ≥ 65 years old. There were no appreciable differences in the incidence rates of MACE, AMI or stroke between users of mirabegron and antimuscarinics. Incidence rates of CV mortality (hazard ratio 0.83, 95% confidence interval 0.73-0.95) and all-cause mortality (hazard ratio 0.80, 95% confidence interval 0.76-0.84) were no higher with mirabegron vs antimuscarinics. Results restricted to episodes at high risk for CV events or stratified by age (< 65 years, ≥ 65 years) or prior overactive bladder medication use were consistent with overall findings. CONCLUSIONS This large, multinational study found no higher risk of MACE, AMI, stroke, CV mortality or all-cause mortality among users of mirabegron relative to users of antimuscarinics.
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Philippova ES, Bazhenov IV, Ziryanov AV, Zhuravlev VN. [Overactive bladder: urodynamic characteristics of detrusor overactivity due to the etiology of low urinary tract dysfun- ction]. UROLOGIIA (MOSCOW, RUSSIA : 1999) 2021:39-44. [PMID: 34251099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED The aim of the study was to detect features of detrusor overactivity as an urodynamic phenomenon in patients with different etiology of low urinary tract dysfunction. MATERIALS AND METHODS The study included 283 patients (61% females and 39% males) aged 18-82 years (49.2+/-13.5) with neurogenic overactive bladder (n=197), idiopathic overactive bladder (n=41), radiation cystitis (n=8) and chronic pelvic pain (n=37). All patients underwent an urodynamic study (UDS) in Sverdlovsk Regional Clinical Hospital in the period from 2017 to 2020. RESULTS Detrusor overactivity was detected by UDS in 63.4% patients with idiopathic, 94.2% with neurogenic overactive bladder (OAB) and 2.7% in patients with pelvic pain. Maximal amplitude of detrusor pressure during involuntary bladder contraction was significantly higher in neurogenic dysfunction than in idiopathic (25.76+/-26.21 cm 2 and 10.1+/-3.4 cm 2 respectively, =0.003). According to the ROC-analysis, detrusor pressure amplitude has a high predictor value in the diagnosis of a neurogenic origin of overactive bladder (AUC=0.863, p=0.045). The sensitivity of pressure more than 9.5 cm 20 was 88%. Bladder volume at the time of first involuntary contraction was 137+/-120 ml and 218+/-120 ml (=0.07) for neurogenic and idiopathic OAB respectively. Neurogenic detrusor overactivity followed by urgency incontinence more often than idiopathic (59.5% vs 19.2%). CONCLUSION Neurogenic detrusor overactivity is characterized by larger amplitude and higher rate of urgency incontinence.
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Shenot PJ. Rethinking the approach to evaluation and management of overactive bladder. THE CANADIAN JOURNAL OF UROLOGY 2021; 28:10705. [PMID: 34129466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Blaivas JG, Li ESW, Dayan L, Edeson ME, Mathew J, O'Boyle AL, Amare BL, Chaikin DC, Weiss JP, Kreder KJ. Overactive bladder phenotypes: development and preliminary data. THE CANADIAN JOURNAL OF UROLOGY 2021; 28:10699-10704. [PMID: 34129465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The purpose of this study is to develop overactive bladder (OAB) phenotypes that can be used to develop diagnostic and treatment pathways and offer clues to the underlying etiologies of patients with OAB. MATERIALS AND METHODS This is a retrospective, multicenter study of patients with lower urinary tract symptoms (LUTS). Evaluation included a 24-hour bladder diary (24HBD), the lower urinary tract symptoms score (LUTSS) questionnaire, uroflowmetry (Q), and post-void residual urine (PVR) measurement. Patients completed the 24HBD and LUTSS on a smartphone application or paper. Those with an OAB symptom sub-score (OABSS) ≥ 8 were included. An expert panel developed a phenotype classification system based on variables considered to be important for treatment. RESULTS The following variables were selected for inclusion in the phenotype modeling: 24-hour voided volume (24HV), maximum voided volume (MVV), Qmax and PVR. Subjects were divided into three phenotypes based on the 24HV: polyuria (24HV > 2.5 L), normal (24 HV 1-2.5 L), and oliguria (24HV < 1 L). Each phenotype was subdivided based on MVV, Qmax & PVR, resulting in 18 sub-types. Five hundred thirty-three patients, 348 men and 185 women, completed the LUTSS and 24HBD. OAB was present in 399 (75%) - 261 men and 138 women. The prevalence of the primary phenotypes was polyuria (25%), normal (63%), and oliguria (11%). CONCLUSIONS Classification of OAB variants into phenotypes based on 24HV, MVV, Qmax, and PVR provides the substrate for further research into the diagnosis, etiology, treatment outcomes and development of granular diagnostic and treatment algorithms.
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Yang DY, Zhao LN, Qiu MX. Treatment for overactive bladder: A meta-analysis of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation. Medicine (Baltimore) 2021; 100:e25941. [PMID: 34011072 PMCID: PMC8137095 DOI: 10.1097/md.0000000000025941] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/25/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We aim to compare the safety and effectiveness of transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder. METHODS A systematical search on PubMed, Embase, clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials from January 1, 1999 to November 1, 2020 was performed. The primary outcomes were the changes in a 3-day voiding diary. Quality of life scores were also evaluated. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all statistical analyses. RESULTS A total of 4 trials (2 randomized controlled trials, 1 retrospective study, and 1 before-after study) with 142 patients were eventually enrolled. Compared with PTNS, TTNS had a similar performance in the voiding frequency in 24 hours (mean difference [MD] = -0.65, 95% confidence interval [CI]: -1.35 to 0.05, P = .07), the number of urgency episodes in 24 hours (MD = 0.13, 95% CI: -0.36 to 0.62, P = .60), the number of incontinence episodes in 24 hours (MD = 0.01, 95% CI: -0.13 to 0.14, P = .93), as well as in the nocturia frequency (MD = -0.14, 95% CI: -0.52 to 0.24, P = .47). Moreover, comparable results were observed regarding HRQL scores (P = .23) and incontinence quality of life scores (P = .10) in both groups. The total complication rate in the current study was 2.1% (3/142). No adverse events were identified in the TTNS group. CONCLUSION Current data supported that TTNS is as effective as PTNS for the treatment of overactive bladder, moreover, with no reported adverse events. However, the evidence is low-grade and well-designed prospective studies with a large sample size are warranted to verify our findings.
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Sawaqed F, Suoub M. Validating 7-items Overactive Bladder Symptom Score (OABSS) through Arabic linguistic version. Sci Rep 2021; 11:661. [PMID: 33436744 PMCID: PMC7804958 DOI: 10.1038/s41598-020-79974-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/11/2020] [Indexed: 11/09/2022] Open
Abstract
The scoring of the 7-item Overactive Bladder Symptom Score (OABSS) questionnaire is unusual because its scale varies with the same maximum and minimum scoring values and quantifies all aspects of OAB. The questionnaire also contains a graded response for urgency. The current study is mainly concerned with the development and validation of the OABSS questionnaire for Jordanian patients. The process of translating the English OABSS questionnaire into the Arabic language involved forward and backward translations. Afterward, a prospective study was conducted to validate the Arabic version of the OABSS questionnaire by examining 235 patients from the outpatient clinics of Karak Governorate Teaching Hospital. The Arabic OABSS questionnaire was completed by all the enrolled patients before and after three months of treatment with solifenacin 5 mg taken once daily. The study included 235 regular patients (152 females and 83 males) diagnosed with OAB in accordance with the definition of the International Continence Society (ICS). The results showed major and significant differences on all seven domains of the questions on the OABSS questionnaire before and after receiving treatment (p < 0.05). Confirmatory Factor Analysis was used to measure the reliability and the questionnaire was found to be highly reliable for the construct variables. The findings derived from the current study would be beneficial for local urologists and researchers, as the Arabic version of the OABSS questionnaire was proven to be a reliable instrument for use in the assessment of OAB. Future studies are needed to compare different translated questionnaires relating to OAB.Trial registration number: NCT04309890.
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Tannenbaum S, den Adel M, Krauwinkel W, Meijer J, Hollestein‐Havelaar A, Verheggen F, Newgreen D. Pharmacokinetics of solifenacin in pediatric populations with overactive bladder or neurogenic detrusor overactivity. Pharmacol Res Perspect 2020; 8:e00684. [PMID: 33231929 PMCID: PMC7685239 DOI: 10.1002/prp2.684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 06/18/2020] [Accepted: 07/13/2020] [Indexed: 01/18/2023] Open
Abstract
The aim of this investigation was to characterize and compare the pharmacokinetics (PK) of the antimuscarinic drug solifenacin in pediatric patients with overactive bladder (OAB) or neurogenic detrusor overactivity (NDO) utilizing data from three phase III trials. LION was a placebo-controlled, 12-week trial in children (5-<12 years) and adolescents (12-<18 years) with OAB. MONKEY and MARMOSET were open-label, 52-week trials in children and adolescents or younger children (6 months-<5 years), respectively, with NDO. During the trials, solifenacin doses could be titrated to weight-adjusted pediatric equivalent doses (PEDs) of 2.5, 5, 7.5, or 10 mg day-1 . Nonlinear mixed effects modeling was used to develop population PK models to characterize the PK in patients with either OAB or NDO. Overall, 194 children and adolescents received solifenacin. At the time of PK sampling, the majority (119/164 [72.6%] patients) were receiving PED10 once daily. All population models included first-order oral absorption, a lag time, and interindividual variability. PK analysis showed that apparent clearance was similar in both patient populations. Mean apparent oral plasma clearance (CL/F), apparent volume of distribution during the terminal phase (Vz /F), and terminal half-life (t1/2 ) were higher in adolescents than in children, but median time to maximum plasma concentration (tmax ) was similar. Dose-normalized exposure results were similar for both younger and older patients with OAB or NDO. In conclusion, population PK modeling was used to successfully characterize solifenacin PK in pediatric patients with OAB or NDO. Similar solifenacin PK characteristics were observed in both populations.
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Candido TA, Ribeiro BM, de Araújo CRC, Pinto RDMC, Resende APM, Pereira-Baldon VS. Effects of tibial and parasacral nerve electrostimulation techniques on women with poststroke overactive bladder: study protocol for a randomized controlled trial. Trials 2020; 21:936. [PMID: 33213488 PMCID: PMC7675399 DOI: 10.1186/s13063-020-04856-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/01/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Neurogenic bladder (NB) can affect people after stroke episodes. NB features changes in the normal voiding pattern at the bladder filling and emptying phases. Overactive NB is characterized by urgency symptoms, with or without urinary incontinence, caused by NB. This disorder affects many domains of life (physical, social, psychological, domestic, sexual) that limit personal autonomy and degrade the quality of life. Among the several treatments available, the conservative physical therapy intervention through tibial nerve electrostimulation (TNES) and parasacral electrostimulation (PSES) can help improve patient conditions with a smaller number of collateral effects than those of interventions based on medication. The aim of the present study is to compare the effects of TNES and PSES techniques in women with overactive NB after stroke episodes to assess the impact of urinary incontinence in these women, on their number of incontinence episodes, daytime and nocturnal urinary frequency, and quality of life. METHODS This is a prospective clinical study to compare two randomized groups based on parallel and blind conditions. Forty-four women who have had a stroke episode at least 30 days before the trial and who have developed overactive NB will be recruited for the trial. All patients will be subjected to initial evaluation and randomly divided into two groups, TNES and PSES. Subsequently, the two groups will be subjected to a 12-session intervention protocol, twice a week. A new evaluation will be performed after the intervention. DISCUSSION The results of this study will contribute to the physiotherapeutic treatment of women with NB after a stroke episode since such results will add information about the benefits of this treatment, urinary control, and the improvements in the quality of life of these women. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (REBEC) RBR-2bn2z4 . Registered on December 11, 2018.
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Turell W, Howson A, MacDiarmid SA, Rosenberg MT. Taking OAB seriously: A qualitative evaluation of primary care education on overactive bladder syndrome management. Int J Clin Pract 2020; 74:e13604. [PMID: 32659850 PMCID: PMC7685143 DOI: 10.1111/ijcp.13604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Overactive bladder (OAB) syndrome has a diverse etiology that disrupts quality of life domains in affected patients. OAB is significantly under-recognised and undertreated, especially in the primary care setting. In order to educate primary care providers about OAB recognition, evaluation and management, we created a virtual live-streamed and enduring education program. METHODS We evaluated the impact of education on provider knowledge and self-efficacy via qualitative interviews with a sample of education participants. We analysed participant responses via constant comparative method, an iterative approach that allows for exploration of a priori issues and identification of emergent themes. RESULTS We identified four key themes: (a) taking OAB seriously; (b) variations in therapy; (c) patient motivation; and (d) education value. Participants were proactive about screening for and managing OAB and recognised urgency as a key symptom; some participants used diagnostic tests that are not are not considered necessary in the workup of uncomplicated OAB patients. Participants varied in their descriptions of initial approaches to treatment and most participants described a longer-than-recommended follow-up window to monitor patients. Some participants characterised patients as looking for a "quick fix" in ways that could lead to provider inaction in relation to behavioural/lifestyle interventions. Overall, participants felt that the education validated their current practice and provided new knowledge about evaluation, initiating behavioural treatment, and combination therapy. CONCLUSIONS Participant responses were congruent with education messages, which likely reflect their "readiness to learn". The rationale for diagnostic tests and evidence on the effectiveness of behavioural regimens represent ongoing areas of unmet educational need.
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Greenberg DR, Sohlberg EM, Zhang CA, Santini VE, Comiter CV, Enemchukwu EA. Sacral Nerve Stimulation in Parkinson's Disease Patients With Overactive Bladder Symptoms. Urology 2020; 144:99-105. [PMID: 32681915 DOI: 10.1016/j.urology.2020.06.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the efficacy, safety, and outcomes of sacral nerve stimulation (SNS) for Parkinson's disease (PD) patients with overactive bladder symptoms. METHODS We retrospectively reviewed PD patients who underwent Stage I SNS. Demographics, urodynamic data, and baseline voiding function were analyzed. Efficacy and safety of treatment were determined by rate of progression to Stage II, explantation, and surgical revision. Long-term outcomes were assessed using voiding diaries and/or clinic notes. RESULTS Sixty percent (9/15) experienced ≥50% improvement in urinary parameters and proceeded to Stage II. There was no significant difference in age, body mass index, comorbidities, PD disease duration, or levodopa equivalent daily dose between successful and nonsuccessful Stage I patients. However, 100% of female patients experienced Stage I success compared to 44% of male PD patients (P = .04). Individuals with >12-month follow-up experienced an average reduction of 6 voids/day. No patients required revision or explantation of their device at latest clinic follow-up (22.2 ± 7.8 months). Higher maximal urethral closure pressures, detrusor pressure at maximum flow rate (PdetQmax), post-void residual volume, and mean bladder outlet obstruction index were observed in the Stage I trial failures. CONCLUSION At our institution, PD patients have a similar rate of progression to Stage II compared to the general population. SNS is an effective therapy that should be considered among the treatment options for PD patients with overactive bladder symptoms. Urodynamic parameters associated with obstruction may be predictive of SNS failure in PD patients and may help guide patient selection, however further studies are needed.
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Rada MP, Ciortea R, Măluţan AM, Doumouchtsis SK, Bucuri CE, Clim A, Roman A, Mihu D. The profile of urinary biomarkers in overactive bladder. Neurourol Urodyn 2020; 39:2305-2313. [PMID: 32813897 DOI: 10.1002/nau.24487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022]
Abstract
AIMS In overactive bladder (OAB) research, different biomarkers have been proposed as diagnostic tools and may be used to create individual patient profiles. Assessing the diagnostic performance of biomarkers would better outline their utility. Therefore, our aim was to investigate the diagnostic value of four urinary biomarkers: human brain derived neurotrophic factor (hBDNF), malondialdehyde (MDA), h nerve growth factor (hNGF) and h 8-hydroxydeoxyguanosine in women with OAB. These are neurotrophins/oxidative stress markers that have been linked to lower urinary tract symptoms. METHODS A total of 105 women were included in the study and distributed in two groups: a group with OAB (n = 53) and a control group (n = 50). The levels of the biomarkers were determined using enzyme-linked immunosorbent assay technique and they were compared between the groups. If the Mann-Whitney test demonstrated a statistically significant difference, receiver operating curves (ROC) analysis was undertaken. RESULTS When normalized to urinary creatinine, hBDNF, MDA, and hNGF showed significantly increased values in women with OAB as compared to controls, whereas 8-OHdG showed no significant difference. The diagnostic performance of these biomarkers was analyzed based on the area under the ROC curve (AUC). MDA had the highest AUC (0.75), followed by hNGF (0.69) and hBDNF (0.67). CONCLUSIONS Our findings suggest that MDA, a relatively novel biomarker in OAB research, has a fair performance as a diagnostic tool for OAB. Moreover, urinary neurotrophins (NGF and BDNF) as biomarkers may have a role in the diagnostic pathways of women with OAB symptoms.
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Castro-Diaz DM, Padilla-Fernández B, Correa Corchete MJ. [Symptoms severity profile and expectations in hyperactive bladder patients - VHEXPECTA Study.]. ARCH ESP UROL 2020; 73:523-533. [PMID: 32633247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To Evaluate the severity of symptoms in OAB patients and their outcomes expectations, symptoms management and Health-Related Quality of Life (HRQoL). MATERIAL AND METHODS Epidemiological, multicentre, non-interventional, cross-sectional study, conducted by 294 physicians in Spain in clinical practice. Female adult patients with OAB symptoms, newly diagnosed or during follow-up were included. B-SAQ, OABq-SF and an ad-hoc patient expectation questionnaire were completed. Association between expectations, symptom severity and prior treatments was analyzed using Chi- Square. The non-parametric Kruskal-Wallis test was used to analyze the relationship between the intensity of the urgency and the impact of OAB symptoms on HRQoL and between expectative and symptoms characteristics and HRQoL. RESULTS 1.107 patients were included. Mean age was 58 years. 60.6% were newly diagnosed and urinary urgency was the most frequent symptom reported (93.3%). According the B-SAQ score 58.7% suffered moderatedor severe OAB. Expectations in patients without previous treatment about " their symptoms will be cured permanently" were higher than in patients previously treated (p<0.005). The percentage of patients who expected a positive response to treatment decreased while the OAB symptom severity increased (73.9% mild symptoms, 32.5% very severe symptoms; p<0.005). Moreover, patients with higher symptom discomfort were less agreement with all expectations ( p<0.005), and HRQL was higher in patients with higher expectations (p<0.005). CONCLUSIONS The expectations of patients with OAB regarding their pathology and the expected outcomes of treatments are related to symptom severity and HRQL.
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Pell B, Thomas-Jones E, Bray A, Agarwal R, Ahmed H, Allen AJ, Clarke S, Deeks JJ, Drake M, Drinnan M, Dyer C, Hood K, Joseph-Williams N, Marsh L, Milosevic S, Pickard R, Schatzberger T, Takwoingi Y, Harding C, Edwards A. PRImary care Management of lower Urinary tract Symptoms in men: protocol for development and validation of a diagnostic and clinical decision support tool (the PriMUS study). BMJ Open 2020; 10:e037634. [PMID: 32606065 PMCID: PMC7328815 DOI: 10.1136/bmjopen-2020-037634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) is a bothersome condition affecting older men which can lead to poor quality of life. General practitioners (GPs) currently have no easily available assessment tools to help effectively diagnose causes of LUTS and aid discussion of treatment with patients. Men are frequently referred to urology specialists who often recommend treatments that could have been initiated in primary care. GP access to simple, accurate tests and clinician decision tools are needed to facilitate accurate and effective patient management of LUTS in primary care. METHODS AND ANALYSIS PRImary care Management of lower Urinary tract Symptoms (PriMUS) is a prospective diagnostic accuracy study based in primary care. The study will determine which of a number of index tests used in combination best predict three urodynamic observations in men who present to their GP with LUTS. These are detrusor overactivity, bladder outlet obstruction and/or detrusor underactivity. Two cohorts of participants, one for development of the prototype diagnostic tool and other for validation, will undergo a series of simple index tests and the invasive reference standard (invasive urodynamics). We will develop and validate three diagnostic prediction models based on each condition and then combine them with management recommendations to form a clinical decision support tool. ETHICS AND DISSEMINATION Ethics approval is from the Wales Research Ethics Committee 6. Findings will be disseminated through peer-reviewed journals and conferences, and results will be of interest to professional and patient stakeholders. TRIAL REGISTRATION NUMBER ISRCTN10327305.
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English K, Maiman R, Laudano M, Abraham N. Urodynamics less likely to change diagnosis and management in uncomplicated overactive bladder. THE CANADIAN JOURNAL OF UROLOGY 2020; 27:10244-10249. [PMID: 32544048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Given the invasive nature of urodynamics and its unclear impact on altering patient management, we aimed to determine whether performing a urodynamic study (UDS) resulted in a change in either patient diagnosis or treatment offered in women with uncomplicated urinary incontinence. MATERIALS AND METHODS A retrospective review was performed of all female patients who underwent UDS for urinary incontinence at our practice between January 2014 and 2017. Patients with neurogenic lower urinary tract dysfunction, incomplete emptying, urinary retention, or prior anti-incontinence surgery were excluded. We compared the ICD-10 diagnosis and primary treatment offered in the absence of UDS to their post-UDS diagnosis and recommended therapy. Descriptive statistics, chi-squared, and multivariable analyses were performed. RESULTS A total of 141 patient charts were analyzed. The indications for UDS were mixed urinary incontinence (MUI) (45.3%), stress urinary incontinence (SUI) (29.1%), and overactive bladder (OAB) (25.5%). A change in diagnosis following UDS was seen in 40.4% of the entire cohort including 53.1% of patients with MUI and 48.8% of those with SUI compared to 8.3% of those with OAB. A change in treatment was seen in 32.6% of patients including 54.9% with MUI, 41.7% with SUI, and 10% with OAB. When compared to patients with SUI on adjusted multivariate logistic regression, those with OAB were less likely to have a change in either diagnosis (OR 0.06 (0.01-0.31)) or management (OR 0.15 (0.04-0.62)). CONCLUSIONS Diagnosis and management are unlikely to change after UDS in patients presenting with uncomplicated OAB. Conversely, UDS provided important diagnostic information that often changed management in those presenting with MUI and SUI. Our results suggest that UDS may be omitted in patients with uncomplicated refractory OAB in favor of earlier initiation of third line therapies.
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Raju R, Linder BJ. Evaluation and Treatment of Overactive Bladder in Women. Mayo Clin Proc 2020; 95:370-377. [PMID: 32029089 DOI: 10.1016/j.mayocp.2019.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/28/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022]
Abstract
Overactive bladder (OAB) is a symptom complex that includes urinary urgency, frequency, urgency incontinence, and nocturia. It is highly prevalent, affecting up to 12% of the adult population, and can significantly impact quality of life. The diagnosis of OAB is made by history, physical examination, and a urinalysis to rule out underlying infection or other concerning potential etiologies. The need for additional testing is based on the initial evaluation findings, and is recommended in cases of underlying urinary tract infection, microscopic hematuria, obstructive voiding symptoms, and symptoms refractory to previous treatments. Initial management includes behavioral modification with attention to total daily fluid intake, avoidance of bladder irritants, treatment of constipation, weight loss, timed voiding, urge-suppression techniques, and pelvic floor physical therapy. Options for oral medications include antimuscarinic agents and β adrenergic agents, and can be used following or in conjunction with behavioral treatment. For patients refractory to behavioral therapy and oral medications, consideration should be given to referral to a specialist (eg, a urologist or urogynecologist) for discussion of more advanced therapies such as sacral neuromodulation, percutaneous tibial nerve stimulation, and intradetrusor injection of onabotulinumtoxinA. These more advanced treatments have favorable efficacy compared with oral agents in randomized trials, although each has a unique risk/benefit profile and shared decision-making with the individual patient is crucial. Here, we review pertinent considerations in the clinical evaluation and management of OAB in women.
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Jacomo RH, Alves AT, Lucio A, Garcia PA, Lorena DCR, de Sousa JB. Transcutaneous tibial nerve stimulation versus parasacral stimulation in the treatment of overactive bladder in elderly people: a triple-blinded randomized controlled trial. Clinics (Sao Paulo) 2020; 75:e1477. [PMID: 31939564 PMCID: PMC6943254 DOI: 10.6061/clinics/2020/e1477] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS Both groups' symptoms improved as measured by the ICIQ-OAB (G1 = <0.001; G2 = <0.001) and ICIQ-SF (G1 = <0.001; G2 = <0.001). In the 3-day bladder diary assessments after treatment, G1 showed a reduced number of nocturia (p<0.001), urgency (p<0.001) and urge urinary incontinence episodes (p<0.001), whereas G2 showed only a reduced number of nocturia episodes (p<0.001). No difference between groups was found. CONCLUSION Both of the proposed treatments were effective in the improvement of OAB symptoms, but TTNS showed a reduction in a greater number of symptoms as measured by the 3-day bladder diary. No differences were found between groups.
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Hagovska M, Švihra J, Buková A, Horbacz A, Dračková D, Lupták J, Švihra J. The Relationship between Overweight and Overactive Bladder Symptoms. Obes Facts 2020; 13:297-306. [PMID: 32396899 PMCID: PMC7445551 DOI: 10.1159/000506486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several authors have investigated the relationship between obesity - assessed only by body mass index (BMI) - and overactive bladder (OAB) symptoms. OBJECTIVES The objective of this study was to determine the relationship between body fat percentage (BFP) and the severity of OAB symptoms with an impact on quality of life. DESIGN Cross-sectional study. The sample consisted of 206 overweight women; they were university students (BMI = 25.8 ± 3.0) with an average age of 30.6 ± 2.4 years. Body composition analysis was used, including assessment of BFP, visceral fat area (cm2/level), and other parameters. OAB symptoms were evaluated with an OAB questionnaire (OAB-q), voiding diary, and quality of life scale (I-QoL). RESULTS Ninety women had a BFP >32% and 116 had a BFP <32%. The voiding diary and OAB-q confirmed significant differences in 24-h daytime and nighttime frequency of voiding and average urine volume during the day. The OAB-q symptom score was lower in the group with BFP <32%. I-QoL recorded significantly worse parameters in the group with BFP >32% (p < 0.01). The Patient Perception of Intensity of Urgency Scale significantly correlated with BFP (r = 0.466, p < 0.001). Women with a BFP above 32% had a 1.95 times greater chance of developing OAB (odds ratio = 1.95, 95% CI = 1.09-3.52, p < 0.02). CONCLUSION Young women with a BFP >32% were 95% more likely to have OAB than other young women with a BPF <32%.
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Blanker MH, Alma HJ, Devji TS, Roelofs M, Steffens MG, van der Worp H. Determining the minimal important differences in the International Prostate Symptom Score and Overactive Bladder Questionnaire: results from an observational cohort study in Dutch primary care. BMJ Open 2019; 9:e032795. [PMID: 31874883 PMCID: PMC7008409 DOI: 10.1136/bmjopen-2019-032795] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the minimal important difference (MID) of the International Prostate Symptom Score (IPSS) and the Overactive Bladder Questionnaire short form (OAB-q SF) assessed in primary care among patients treated for lower urinary tract symptoms (LUTS). DESIGN Single-arm, open-label observational cohort study with a 6-week follow-up. SETTING Twenty-two pharmacies in the Netherlands. PARTICIPANTS We enrolled Dutch men with uncomplicated LUTS who received a new alpha-blocker prescription from their general practitioner or urologist. PRIMARY AND SECONDARY OUTCOMES The IPSS and OAB-q SF were completed before and after 6 weeks of therapy. At 6 weeks, men also completed the Patient Global Impression of Improvement (PGI-I). The mean change scores of the IPSS and OAB-q SF were calculated for each PGI-I outcome category, with the category 'a little better' used to determine the MID. The SE of measurement (SEM) was calculated for each questionnaire. RESULTS In total, 165 men completed follow-up. The MID was 5.2 points (95% CI 3.9 to 6.4; SEM 3.6) for the IPSS and 11.0 points (95% CI 7.1 to 14.9; SEM 9.7) for the OAB-q SF. For both questionnaires, CIs showed an overlap with the no-change categories. However, the MID for the IPSS was higher in men with severe baseline symptoms (7.1; 95% CI 5.3 to 9.0) than in men with moderate baseline symptoms (3.2; 95% CI 1.7 to 4.8). CONCLUSION In this study, the MID for the IPSS was considerably higher than the MID of 3.1 reported in the only other study on this topic, but may be due to methodological differences. Interpretation of the MID for the OAB-q SF is hampered by the overlap with the SEM. Future studies are needed to confirm our results because correlations between the PGI-I and symptom questionnaires were suboptimal.
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Mossa AH, Shamout S, Cammisotto P, Campeau L. Urinary metabolomics predict the severity of overactive bladder syndrome in an aging female population. Int Urogynecol J 2019; 31:1023-1031. [PMID: 31813035 DOI: 10.1007/s00192-019-04175-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/30/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To identify urinary metabolites that can facilitate the diagnosis and the characterization of the underlying pathophysiology of the association between the overactive bladder syndrome (OAB) and metabolic syndrome. METHODS We used gas chromatography-mass spectrometry to compare the urinary metabolome of 20 females of 50-80 years of age with OAB to that of 20 controls of the same age group. We performed urinary metabolomic analysis and obtained serum markers of metabolic syndrome for each subject. Participants completed a clinical evaluation and validated self-reported questionnaires of lower urinary tract symptoms as well as a one-day voiding diary. RESULTS In the OAB subjects, we identified increased urinary levels of markers of mitochondrial dysfunction (itaconate, malate and fumarate), oxidative stress (L-pyroglutamate and α-hydroxyglutarate) and ketosis (α-hydroxybutyrate and α-hydroxyisobutyrate). The increased levels of these markers correlated significantly with the OAB symptoms score on questionnaires. We found, using a multiple linear regression model, that age, blood glucose and urine metabolites (malate, fumarate and α-hydroxyisobutyrate) were significant predictive factors of OAB severity. Fumarate had high sensitivity as a biomarker of OAB due to metabolic syndrome, based on a statistically significant receiver-operating characteristic (ROC) curve, indicating its potential as a diagnostic tool. CONCLUSIONS Altogether, these findings establish that urinary metabolites of mitochondrial dysfunction, ketosis and oxidative stress can be potential biomarkers of OAB severity and diagnosis.
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Zhu Y, Zhu Z, Chen J. Risk factors associated with the progression of overactive bladder among patients with type 2 diabetes. Int J Clin Pract 2019; 73:e13395. [PMID: 31332892 PMCID: PMC6851595 DOI: 10.1111/ijcp.13395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/20/2019] [Accepted: 07/18/2019] [Indexed: 01/19/2023] Open
Abstract
AIM To investigate the risk factors specific to diabetes mellitus that influence the progression of overactive bladder in Chinese population. METHODS A total of 457 patients who were diagnosed with overactive bladder and diabetes mellitus at the Department of Endocrinology and Urinary Surgery Center of Zhejiang University Jinhua Hospital were enrolled from July 2015 to July 2018. Patients were assessed using a questionnaire and then divided into two groups according to the severity score: mild overactive bladder group and the moderate-severe overactive bladder group. Logistic analysis was performed to evaluate the risk factors associated with the progression of overactive bladder in diabetic patients. RESULT Among the 457 patients with diabetes mellitus and overactive bladder, there was a significant difference in the severity of overactive bladder, age, diabetes duration, symptomatic diabetic peripheral neuropathy as well as ankle reflex (P < .05) between the two groups. Moreover, multivariate analysis revealed that age (OR: 1.59, P = .036), duration of diabetes (OR: 1.41, P = .049) and symptomatic diabetic peripheral neuropathy (OR: 2.39, P = .012) were independent risk factors for the progression of overactive bladder. CONCLUSION In Chinese diabetic patients, overactive bladder progression is closely related with the severity of diabetes mellitus. Age, diabetic duration and symptomatic diabetic peripheral neuropathy are independent predictors of the severity of overactive bladder. Patients with symptomatic diabetic peripheral neuropathy are at risk of overactive bladder.
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Juszczak K, Ostrowski A, Adamowicz J, Maciukiewicz P, Drewa T. Urinary bladder hypertrophy and overactive bladder determine urinary continence after radical prostatectomy. ADV CLIN EXP MED 2019; 28:1329-1337. [PMID: 30880375 DOI: 10.17219/acem/104532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
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.
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Murphy A, Teplitsky S, Das AK, Leong JY, Margules A, Lallas CD. Medical evaluation and management of male and female voiding dysfunction: a review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2019; 57:220-232. [PMID: 30990789 DOI: 10.2478/rjim-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 06/09/2023]
Abstract
A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.
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MESH Headings
- Cystitis, Interstitial/diagnosis
- Cystitis, Interstitial/etiology
- Cystitis, Interstitial/therapy
- Female
- Humans
- Male
- Prostatism/diagnosis
- Prostatism/etiology
- Prostatism/therapy
- Urinary Bladder, Overactive/diagnosis
- Urinary Bladder, Overactive/etiology
- Urinary Bladder, Overactive/therapy
- Urinary Bladder, Underactive/diagnosis
- Urinary Bladder, Underactive/etiology
- Urinary Bladder, Underactive/therapy
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/therapy
- Urination Disorders/diagnosis
- Urination Disorders/etiology
- Urination Disorders/therapy
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Reitz A, Hüsch T, Haferkamp A. Persistent storage symptoms after TURP can be predicted with a nomogram derived from the ice water test. Neurourol Urodyn 2019; 38:1844-1851. [PMID: 31286547 DOI: 10.1002/nau.24068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/20/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE To predict the persistence of storage symptoms after transurethral resection of the prostate (TURP) using a nomogram derived from the ice water test (IWT). METHODS The IWTs of 73 men with lower urinary tract symptoms and prostatic bladder outlet obstruction were retrospectively analyzed. The strength of the detrusor contraction was approximated by using the detrusor gradient of Δpdet /Δt at maximum detrusor pressure and the area under the curve. The parameters were utilized in a nomogram, which facilitated a severity categorization from 1 to 10. Patients with a positive IWT in the categories 1 to 2 were assigned to group A, categories 3 to 4 to group B and categories 5 and higher to group C. After TURP, patients with persisting storage symptoms were offered a botulinum toxin injection. RESULTS There were 32 patients (44%) with negative and 41 patients (56%) with positive IWTs. Patients with negative IWTs were classified in category 1. Regarding patients with positive IWTs, 14 (34%) were correlated to group A, 14 (34%) to group B, and 13 (32%) to group C. The necessity of a subsequent botulinum toxin injection correlated significantly with a higher nomogram category (P < .001) as well as higher severity categorization (P < .001). In multivariate analysis, the nomogram category was an independent predictor for botulinum toxin injection (P = .002, OR, 6.9, CI, 2.0-23.9). CONCLUSION The quantification of the detrusor contraction during the IWT allowed stratification of patients in risk categories for persistent storage symptoms after TURP and the potential need for later botulinum toxin injections.
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Antunes-Lopes T, Cruz F. Urinary Biomarkers in Overactive Bladder: Revisiting the Evidence in 2019. Eur Urol Focus 2019; 5:329-336. [PMID: 31231010 DOI: 10.1016/j.euf.2019.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/24/2019] [Accepted: 06/10/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT In overactive bladder (OAB), after an initial outbreak of research, it is more consensual that biomarkers may be better used to phenotype patients. Herein, we revisit this topic, including some of the most promising biomarkers. OBJECTIVE To provide a comprehensive analysis of the actual role of biomarkers in OAB. EVIDENCE ACQUISITION A PubMed-based literature search was conducted, including the most relevant articles published in the last 15 yr, on nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), adenosine triphosphate (ATP), genomics, and microbiota as OAB biomarkers. Articles with no full text available or not written in English were excluded. Additional reviews were included. EVIDENCE SYNTHESIS Urinary NGF, BDNF, and ATP are increased in many OAB patients. These biomarkers can help identify OAB phenotypes and select the ideal candidates for new therapies directed to neurotrophic and purinergic pathways. Circulating urinary miRNA may be useful for establishing the ideal moment for bladder outlet obstruction relief and will eventually lead to the development of therapeutic agents that inhibit or reverse fibrotic pathways in the bladder. Urinary microbiota seems to be related to OAB symptoms, in particular urgency urinary incontinence, and may have strong implications in the prevention, diagnosis, and treatment of OAB. CONCLUSIONS In the future, physicians may consider the use of biomarkers to identify distinct OAB phenotypes, with distinct causal mechanisms, selecting patients for specific target therapies with expected better outcomes. PATIENT SUMMARY Overactive bladder biomarkers can be useful for phenotype patients and for selecting more effective target therapies.
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