[Impact of urinary incontinence and overactive bladder syndrome on health-related quality of life of working middle-aged patients and institutionalized elderly patients]

INTRODUCTION

Health-related quality of life (HRQoL) is considered by patients with urinary symptoms as the main outcome variable. Descriptive data about HRQoL in patients with urinary incontinence (UI) and/or overactive bladder (OAB) are reported. These data may serve as a reference for comparison purposes.

MATERIALS AND METHODS

Data were taken from EPICC, a national, multicenter, observational, epidemiological study. Data from representative samples of four population groups were analyzed: working patients of both sexes aged 50-64 years, and institutionalized elderly patients of both sexes with no cognitive impairment. In addition to demographic and clinical data, HRQoL data from the Overactive Bladder Questionnaire (OAB-q SF) and the SF-12 Health Survey were also analyzed.

RESULTS

Of the total patients in the EPICC study, 26.53% completed the HRQoL questionnaires. Patients with both UI and OAB symptoms had poorer scores than those with OAB or UI respectively in the PCS (41.34 vs. 47.17 and 45) and MCS (46.01 vs. 49.04 and 47.78) of the SF-12, and in the symptom (32.21 vs. 19.19 and 16.65) and quality of life (82.32 vs. 86.72 and 89.45) dimensions of the OAB-q SF. Impact of OAB and UI on HRQoL was higher in men over 65 years of age as compared to women of the same age (76.76 vs. 82.79).

CONCLUSIONS

Concurrent symptoms of both UI and VH have a greater impact on HRQoL than those of either UI or VH alone. Impact on HRQoL is similar in middle-aged men and women, but higher in elderly men.

Uropharmacology in primary care: 2010 update

Many disorders such as erectile dysfunction, overactive bladder, hypogonadism and benign prostatic hypertrophy have traditionally been managed primarily by urologists. The development of newer agents to treat many of these conditions has allowed the primary care provider to manage many of these common conditions. The use of these newer medications has become commonplace in the primary care setting. This article will update some of the most commonly used urologic medications to optimize patient management strategies by the primary care provider or in coordination with the urologist.

Overactive bladder symptoms in women: current concepts in patient management

The symptoms of overactive bladder (OAB) -- urinary urgency, frequency, and urge incontinence -- can cause significant lifestyle limitations. Social isolation, depression, employment difficulties, and relationship stress are common findings in patients with this condition. This article focuses on women with OAB who are seen in primary care. Occasionally, OAB (or detrusor overactivity) may be the result of neurological disease, metabolic disease, or urinary tract abnormalities. Primary care practitioners can play a key role in identifying affected individuals by including a focused question in every annual patient physical assessment. Investigation and treatment can then be initiated, beginning with behavioral modification strategies (such as modifying fluid intake) and adding antimuscarinic pharmacotherapy or possibly local estrogen therapy where needed. Only patients with certain concurrent diseases or those who are refractory to conventional management will require referral to a specialist.

[Solifenacin in treatment of the overactive bladder syndrome--diagnosis, clinical management and results]

The overactive bladder syndrome (OAB) is a pathological condition that affects millions of people round the world. Its incidence increases with ageing. The main therapeutic option for OAB nowadays is anti-muscarinic drug therapy.

AIM

To define and implement the diagnostic criteria, clinical guidelines in our country and to evaluate the results of Solifenacin therapy in patients with OAB.

MATERIAL AND METHODS

Along a three years period (2006-2009) 163 OAB patients were analyzed followed and treated. In our group of patients 106 (65.2%) are females and 57 (34.8%)--males. The diagnosis is based mainly on the complaints of the patient, evaluated thoroughly with a detail anamnesis and questionnaires. Urodynamic studies were performed In some of the patients. The efficacy of Solifenacin therapy has been validated with the same methods used in SUNRISE and VENUS studies.

RESULTS AND DISCUSSION

The mean age of female patients in our group is 63.8 years, and 65.6 years for males. The most commonly observed symptoms of OAB are urgency--88.3% and frequency--92%. Urge-incontinence is observed in 48.8% of the cases. Therapy with Solifenacin 5 and 10 mg has alleviated urgency in 82% and urge-incontinence in 88.9%. Mean number of pads used for 24 hours has decreased from 2.6 to 0.4 after therapy.

CONCLUSION

Urgency is the main mandatory symptom for the diagnosis OAB. Therapy with Solifenacin 5 and 10 mg guarantees very good clinical results, and high degree of compliance of the patients.

Botulinum a toxin/dimethyl sulfoxide bladder instillations for women with refractory idiopathic detrusor overactivity: a phase 1/2 study

We completed a phase 1/2 trial to evaluate the safety and potential efficacy of direct intravesical instillation of a botulinum type A toxin/dimethyl sulfoxide (DMSO) solution for treatment of idiopathic detrusor overactivity in women. Twenty-five women with medication-resistant, urodynamic-confirmed idiopathic detrusor overactivity were enrolled. A total of 9 patients were treated in phase 1 of the study. Three patients were given a 66% dosing of solution; 22 patients received the full 300 units of botulinum toxin and 50 mL of DMSO (50% concentration). Adverse effects, 24-hour pad weights, episodes of incontinence, postvoid residuals, and scores on the Blaivas-Groutz anti-incontinence scale, Indevus Urgency Severity Scale, Incontinence Impact Questionnaire-short form, and Urogenital Distress Inventory (6 items) questionnaire were recorded at baseline, 1 month, and 3 months after instillation. No serious adverse effects or clinically important increases in postvoid residual occurred. Among the 21 women who completed phase 2 of the study, the median number of incontinent episodes decreased from 4 at baseline to 2 at 1 month (P=.004) and increased to 4 at 3 months (P=.81). Median scores improved from baseline to 1 month on the Incontinence Impact Questionnaire (from 13 to 7; P=.007) and Urogenital Distress Inventory (from 10 to 5; P=.003). Although 11 women (52%) reported severe urgency based on the Indevus Urgency Severity Scale at baseline, only 1 (5%; P<.001) and 3 (14%; P=.004) women reported severe scores at 1 and 3 months, respectively. Direct instillation of botulinum toxin/DMSO solution is safe. Its promising clinical effect warrants further evaluation in a randomized, placebo-controlled phase 3 setting.

Botulinum a toxin/dimethyl sulfoxide bladder instillations for women with refractory idiopathic detrusor overactivity: a phase 1/2 study

We completed a phase 1/2 trial to evaluate the safety and potential efficacy of direct intravesical instillation of a botulinum type A toxin/dimethyl sulfoxide (DMSO) solution for treatment of idiopathic detrusor overactivity in women. Twenty-five women with medication-resistant, urodynamic-confirmed idiopathic detrusor overactivity were enrolled. A total of 9 patients were treated in phase 1 of the study. Three patients were given a 66% dosing of solution; 22 patients received the full 300 units of botulinum toxin and 50 mL of DMSO (50% concentration). Adverse effects, 24-hour pad weights, episodes of incontinence, postvoid residuals, and scores on the Blaivas-Groutz anti-incontinence scale, Indevus Urgency Severity Scale, Incontinence Impact Questionnaire-short form, and Urogenital Distress Inventory (6 items) questionnaire were recorded at baseline, 1 month, and 3 months after instillation. No serious adverse effects or clinically important increases in postvoid residual occurred. Among the 21 women who completed phase 2 of the study, the median number of incontinent episodes decreased from 4 at baseline to 2 at 1 month (P=.004) and increased to 4 at 3 months (P=.81). Median scores improved from baseline to 1 month on the Incontinence Impact Questionnaire (from 13 to 7; P=.007) and Urogenital Distress Inventory (from 10 to 5; P=.003). Although 11 women (52%) reported severe urgency based on the Indevus Urgency Severity Scale at baseline, only 1 (5%; P<.001) and 3 (14%; P=.004) women reported severe scores at 1 and 3 months, respectively. Direct instillation of botulinum toxin/DMSO solution is safe. Its promising clinical effect warrants further evaluation in a randomized, placebo-controlled phase 3 setting.

Patients’ experience with ambulatory urodynamics

OBJECTIVE

To assess emotional variables in patients who underwent ambulatory urodynamic monitoring (AUM).

MATERIAL AND METHODS

A total of 33 females and 7 males aged 23-72 years with an overactive bladder who had undergone three consecutive AUM sessions were included in the study on a prospective basis. Patients completed a self-administered questionnaire before and immediately after each procedure. Answers were given using a visual analog scale.

RESULTS

The pre-procedural level of anxiety did not differ significantly with respect to sex, age, education level or income. The degree of bother experienced by patients aged > or = 50 years was higher than for those aged < 50 years: 5 vs 2.5 (p = 0.030). As income increased, the degrees of pain (p = 0.016), bother (p = 0.013) and boredom (p = 0.010) decreased. Other emotional aspects did not differ significantly according to age or income (p > 0.05). Only the subjective bother score influenced the examiner-rated degree of intolerance during AUM (p = 0.007). A total of 34 patients (85.0%) indicated that they would be willing to return for a further session of AUM. The degree of intolerance decreased at the second (p = 0.006) and third (p = 0.049) AUM sessions, whereas other parameters were not significantly different.

CONCLUSION

Our results demonstrate that AUM is acceptable and well tolerated by patients with bladder dysfunction.

[Blood lymphocytes and mast cells of the detrusor as diagnostic markers of overactive urinary bladder and its immune inflammation]

To identify clinico-laboratory symptoms and pathogenetic factors of overactive bladder syndrome (OBS), we used cytochemical analysis of peripheral blood lymphocyte enzymes in 88 males and females aged 50-75 years with this syndrome (70 patients) and control (18 subjects). Biopsy of the anterior wall of the bladder with examination of detrusor myocytes was made in 28 of 70 patients. OBS patients were found to have reduced aerobic respiration in blood lymphocytes and detruzor cells, dystrophy and atrophy of myocytes, moderate interstitial cell infiltration of the detrusor in increasing number and activity of mast cells, T-lymphocytes (CD4, CD8) and macrophages (CD11). We came to the conclusion that development and symptoms of OBS are caused by low energetic activity of the detrusor in line with dysfunction of the bladder mast cells and immunity factors. This is important for diagnosis of OBS severity and choice of energotropic therapeutic measures.

Bother related to bladder control and health care seeking behavior in adults in the United States

PURPOSE

We measured patient reported bother due to overactive bladder syndrome, patterns of physician consultation and prescription medication use for overactive bladder symptoms in adults in the United States.

MATERIALS AND METHODS

A survey sample was derived from a consumer panel of 600,000 American households developed to match the United States Census of 260,000 adults. The survey included the Overactive Bladder-Validated 8 awareness tool, which includes 8 questions that measure the degree of bother due to specific bladder symptoms. A score of 8 or greater denotes probable overactive bladder. Additional questions probed treatment patterns, health care consultation, overactive bladder diagnosis, treatment type and prescription treatment used. A nonrespondent telephone survey in 1,004 participants was done to evaluate differences between mail survey respondents and nonrespondents.

RESULTS

The response rate was 63% (162,906 respondents). Women represented 55.1% of the sample and 21.8% of respondents were 65 years old or older. Symptom bother, as determined by an Overactive Bladder-Validated 8 score of 8 or greater, was reported by 26.6% of the total sample, including 23.7% of men and 28.9% of women. The percent of men and women reporting bother increased with age. Of respondents with probable overactive bladder only 45.7% had discussed the symptoms with a medical provider, 22.5% had previously used prescription medication for overactive bladder, 13.5% had used overactive bladder medication in the last 12 months and 8.1% were currently on treatment.

CONCLUSIONS

A substantial proportion of adults in the United States reported some degree of bother due to overactive bladder symptoms. The degree of bother was associated with age and gender. Overall less than half of patients with probable overactive bladder discussed the symptoms with a health care provider. A small proportion was prescribed medication and an even smaller proportion was currently on treatment.

[Overactive bladder syndrome. How to manage it]

Overactive bladder syndrome (OAB) is a chronic and distressing condition characterized by urinary urgency and increased frequency of micturition with or without urge incontinence. Such symptoms can exert a negative impact on many aspects of quality of life, including social function and interaction, physical activity and psychological well-being. In a survey of some 4500 people aged more than 40 years old in Japan, the prevalence of OAB was 12.4%. Even though OAB is prevalent and troublesome, many patients with OAB never seek medical help for their symptoms because of embarrassment and misconception about bladder control problems. Thus, it is important to broaden the actual knowledge about OAB among community-based people. We hope that this citizen joint symposium would help the participants to understand the useful information about OAB.

Psychometric equivalence of the OAB-q in Danish, German, Polish, Swedish, and Turkish

OBJECTIVE

Patient-reported outcomes (PROs) are measures of patients' health status provided directly by patients and when utilized in clinical trials, multiple language versions may be needed. The overactive bladder questionnaire (OAB-q), a self-administered PRO assessing symptom bother and health-related quality of life (HRQL) in patients with OAB, was developed in US English and has been translated into more than 40 languages. This analysis evaluated the psychometric equivalence of five language versions of the OAB-q.

METHODS

The Disease Management Study (DMS) was a multicenter, double-blind, placebo-controlled, parallel group, randomized study in adults with OAB. Participants completed the OAB-q, 3-day micturition diaries, and the patient's perception of bladder condition (PPBC) at baseline and weeks 1 and 12 of treatment.

RESULTS

Data from 398 patients from five countries were analyzed: Denmark (N = 71), Germany (N = 127), Poland (N = 60), Sweden (N = 94), and Turkey (N = 46). Participants were a mean of 57.4 years old; 31% were male; and almost all were Caucasian. Cronbach alphas for the OAB-q symptom bother subscale = 0.71 to 0.83 and 0.82 to 0.94 for the HRQL subscales (concern, coping, sleep, and social) across all five languages. OAB-q subscales were significantly correlated with PPBC in all languages. Mean baseline to week 12 change scores = -21.4 to -30.3 for symptom bother and 5.2 to 36.0 for the HRQL subscales. Effect sizes for the symptom bother subscale = 0.92 to 2.79 and 0.21 to 1.30 for the HRQL subscales.

CONCLUSION

OAB-q language versions of Danish, German, Polish, Swedish, and Turkish demonstrated acceptable psychometric characteristics, including internal consistency reliability, construct validity, and responsiveness.

Management of refractory overactive bladder in adults

Urologists experience frustration in the treatment of refractory overactive bladder for a multitude of reasons. Clinical failure experienced in managing these patients can lead to long office interactions and feelings of inadequacy for both patient and provider. With newer, technically straightforward interventions, this population can be approached with confidence. Appropriately timed diagnostics are essential in identifying neoplastic, neurogenic, and infectious causes for refractory overactive bladder. When approached in an efficient, stepwise fashion, outcomes can be highly satisfactory for both the patient and the provider.

[The practice guideline 'Urinary incontinence' (first revision) from the Dutch College of General Practitioners; a response from the perspective of urology]

The revised practice guideline 'Urinary incontinence' of the Dutch College of General Practitioners contains some important changes. Urodynamic investigation is not mandatory for differentiating between types of incontinence in the general practice setting. Physical examination including a valsalva leak point test is considered important. From a urological point ofview it remains to be seen whether the history-taking and the physical examination described in the revised guideline will be enough to accurately differentiate between the possible incontinence types. The practice guideline underlines a role for the general practitioner in teaching bladder training or pelvic floor exercises. The benefits of this compared to exercises taught by specialized physiotherapists will have to be determined. Another new feature is that antimuscarinic drugs are mentioned as proper treatment for people suffering from overactive bladder complaints. The practice guideline advises referral of male incontinence patients only if the incontinence is not related to prostate surgery. However, patients with postoperative incontinence should also be referred as there are good diagnostic and therapeutic options available.

Changing treatments for overactive bladder

Overactive bladder is a common urological diagnosis which is often untreated as patients fail to seek help for this embarrassing problem. Elizabeth Waine and Mark Stott summarise the symptoms and investigations for overactive bladder and provide an overview of the treatments available.

Does the patient's position influence the detection of detrusor overactivity?

AIMS

The demonstration of preoperative detrusor overactivity (DO) with associated overactive bladder symptoms (OAB) is known to have an adverse effect on surgery performed for stress incontinence or for prostatic obstruction. The purpose of this review is to examine the best position, when filling the bladder during urodynamics, to demonstrate detrusor overactivity and reproduce the OAB symptoms, when the demonstration of DO might be important.

MATERIALS AND METHODS

MEDLINE and PUBMED literature searches were performed, spanning the period from 1956 to August 2005 using the keywords "detrusor overactivity" or "detrusor instability" combined with "posture or position or standing or sitting" and "urodynamics." Other studies were identified by reviewing secondary references in the original citations.

RESULTS

Sixteen studies looked at the effect of position on the detection rate of DO. There is good consistency between the studies analyzed. All but two [Ramsden et al., Br J Urol 49:633-9, 1977; Choe et al., J Urol 161:1541-4, 1999] showed a clear effect, with an increase in DO when the patient is filled in the vertical position or is asked to sit or stand, with a full bladder, after being filled supine. Performing the urodynamics (UDS) in the supine position would have missed a large proportion of DO diagnoses ranging from 33% to 100%.

CONCLUSIONS

This review confirms that the patient's position is a significant variable during urodynamics and that supine cystometry will fail to detect a significant percentage of patients with DO. We suggest that all patients should be filled sitting or standing, unless physically disabled. It seems desirable for the International Continence Society (ICS) to extend its "Good urodynamic practice guideline" [Schafer et al., Neurourol Urodyn 21:261-74, 2002] to cover this important issue.

Overactive bladder

Overactive bladder (OAB) is a common condition (prevalence 14%-18% of Canadians) and has a significant negative impact on quality of life. OAB may be idiopathic or may occur with other common conditions such as bladder outlet obstruction, neurological disease, or stress incontinence. Primary care physicians may safely diagnose this condition by history and physical exam with a minimum of widely available lab tests. Management with behavioral therapies and pharmacotherapy is generally quite successful and warranted. Multiple anticholinergic medications are available and have been shown to be effective. Subtle differences in structure and mechanism of these agents may yield improved therapeutic benefit or tolerability and thus it is reasonable to try more than one drug to achieve the optimal results. For patients that fail behavioral and initial pharmacotherapy or when other complicating conditions are identified, referral to a specialist is indicated; however, the majority of patients with OAB do not require cystoscopy or urodynamics. Successful treatments for OAB do exist and it is worth screening for these disabling complaints at the primary care level.

Pediatric voiding dysfunction: a case study

A 14-year-old male was evaluated and treated for frequent urination associated with straining to void, a sensation of incomplete emptying, and nocturia. Treatment and outcomes are presented in this article.

A journey to continence: a case study of overactive bladder syndrome

Overactive bladder is a problem that many women experience and suffer with in silence for years. This is a case study about one such woman. Anna had problems with incontinence for more than five years when she sought treatment. This article presents the story of her journey and perseverance to achieve control of her bladder.

Diagnosis and treatment of lower urinary tract symptoms suggestive of overactive bladder and bladder outlet obstruction among men in general practice in the UK

OBJECTIVE

To assess the epidemiology and treatment of storage symptoms suggestive of overactive bladder (OAB) and voiding symptoms suggestive of bladder outlet obstruction (BOO) because of benign prostatic hyperplasia in UK general practice.

PATIENTS AND METHODS

This was a retrospective analysis of data collected between 2000 and 2006 and entered in The Health Improvement Network general practice database, containing medical records for > 1 million men (aged >or= 18 years) in the UK. Using Read codes, we analysed the prevalence of storage and voiding lower urinary tract symptoms (LUTS) as well as prescribing trends for 5alpha-reductase inhibitors (5ARIs) and alpha-blockers for LUTS secondary to BOO and antimuscarinics for OAB.

RESULTS

In 2006, the prevalence of diagnosed LUTS/OAB was only 0.3% and the recorded prevalence of LUTS/BOO was only 2.2%. Treatment rates also remained low throughout the study period. In the 12 months before 1 January 2006, only 25% of men diagnosed with OAB and 6-7% of men with storage LUTS received antimuscarinics, whereas 36% of men with a record of LUTS/BOO received alpha-blockers and/or 5ARIs. Alpha-blockers were prescribed to approximately 10% of men diagnosed with OAB or storage LUTS who did not have any recorded BOO diagnosis or symptoms.

CONCLUSION

Diagnosis of both storage and voiding LUTS occurs at much lower rates than indicated by prevalence estimates. Despite the availability of effective prescription therapies, many men with storage and/or voiding LUTS may not be receiving appropriate treatment in UK general practice.