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Li M, Xu M, Zhou H, Pan Y, Liu X. The association between different levels of depression and overactive bladder: A cross-sectional study of the 2005-2018 National Health and Nutrition Examination Survey. Neurourol Urodyn 2024. [PMID: 39032101 DOI: 10.1002/nau.25563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND There is growing evidence of a possible correlation between depression and overactive bladder (OAB). However, few studies have classified depression according to its severity. Whether there is an association between different levels of depression and OAB symptoms remains unclear. METHODS Participants with complete information about depression, OAB, and covariates in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. Depression symptoms were assessed by the Patient Health Questionnaire-9. OAB symptoms were evaluated by the Overactive Bladder Symptom Score. Weighted multivariate logistic regression models were applied to analyze the relationship between depression and OAB. RESULTS A total of 30 359 participants were included in this study, consisting of 6245 OAB patients and 24 114 non-OAB participants. The multivariate logistic regression suggested depression independently correlated with OAB (odds ratio [OR] = 2.764, 95% confidence interval [CI] = 2.429-3.146, p < 0.001). Further, mild (OR = 2.355, 95% CI = 2.111-2.627, p < 0.001), moderate (OR = 3.262, 95% CI = 2.770-3.841, p < 0.001), and moderately severe to severe depression (OR = 3.927, 95% CI = 3.246-4.752, p < 0.001) were all associated with OAB. Additionally, depression was also correlated with urgency urinary incontinence (OR = 2.249, 95% CI = 1.986-2.548, p < 0.001) and nocturia (OR = 2.166, 95% CI = 1.919-2.446, p < 0.001). CONCLUSION This study indicated different levels of depression, even mild depression, were independent risk factors for OAB. Given the frequent coexistence and potential interactions between depression and OAB, clinicians should be aware of the importance of assessing both physical and psychological symptoms in these patients. Early diagnosis and holistic treatment may improve the treatment outcomes, particularly for those suffering from both conditions.
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Affiliation(s)
- Muwei Li
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingming Xu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hang Zhou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Pan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Tan MY, Mo CY, Zhao Q. Efficacy and safety of acupuncture in the treatment of urinary incontinence after prostate surgery: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e072516. [PMID: 37597872 PMCID: PMC10441104 DOI: 10.1136/bmjopen-2023-072516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/02/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a common complication after prostate surgery. Acupuncture treatment (AT) has been proposed as an alternative therapy for this condition. The purpose of this protocol aims to outline a systematic review and meta-analysis that aims to evaluate the effectiveness and safety of AT in patients with postprostate surgery UI. METHODS We will search for randomised controlled trials (RCTs) in eight databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang database, SinoMed and VIP database. Additionally, we will search two clinical trial registration platforms, namely the WHO's International Clinical Trials Registry Platform and the Chinese Clinical Trial Registry. The search will include articles from the inception of these databases until 30 September 2023. The extracted data will then be imported into the Stata V.15.0 software. Two authors will independently review the literature, collect data and use the Grades of Recommendation, Assessment, Development and Evaluation and the Cochrane Risk of Bias 2 tool to evaluate the risk of bias and the quality of the evidence. Outcomes for RCTs will include at least one of the following: International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form, Individualised Care for People with long-term health conditions-Capability measure for Adults, Score of Frequency Incontinence Quality of Life Questionnaire, Patient Global Impression of Improvement, Visual Analogue Scale, Numeric Rating Scale, 1- hour pad test, Self-Rating Anxiety Scale, total efficiency and adverse event. We will use random or fixed effect models to analyse data according to heterogeneity. If significant heterogeneity exists along with sufficient data, we will perform subgroup analyses to identify the source of heterogeneity. ETHICS AND DISSEMINATION Ethical approval is not required for this study because the data we will extract are from published articles. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022382806.
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Affiliation(s)
- Mo-Yao Tan
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| | - Chao-Yue Mo
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Zhao
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
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3
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Fernández Chadily S, de Rijk MM, Janssen JMW, van den Hurk J, van Koeveringe GA. Assessment of Brainstem Functional Organization in Healthy Adults and Overactive Bladder Patients Using Ultra-High Field fMRI. Biomedicines 2023; 11:biomedicines11020403. [PMID: 36830937 PMCID: PMC9952946 DOI: 10.3390/biomedicines11020403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
The pathophysiological mechanisms of overactive bladder syndrome (OAB) remain largely unknown, with major involvement of the central nervous system (CNS). The periaqueductal gray (PAG) is a brainstem area which is indicated to play an essential role in bidirectional communication between the bladder and the CNS. We aimed to assess consistency of PAG functional organization across different bladder sensory states in OAB patients. We propose, that PAG functional organization patterns across sensory states will differ between controls and OAB patients. We analyzed fMRI scans at 7 Tesla from six controls and two OAB patients. The Louvain module detection algorithm was applied to parcellate the PAG in empty and full bladder states. We assessed within-subject consistency and investigated differences in this consistency between both groups. High within-subject agreement of PAG parcellations between empty and full bladder states was demonstrated in both groups. Additionally, we showed that the correlations between PAG clusters in both bladder states were significantly different in patients compared to controls (p = 0.039). The methods introduced here offer a promising tool to assess functional organization of the PAG and understand the underlying pathology and the role of this region in OAB syndrome.
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Affiliation(s)
- Susana Fernández Chadily
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Mathijs M. de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center+ (MUMC+), 6229 HX Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-043-388-1839
| | - Janine M. W. Janssen
- Department of Urology, Maastricht University Medical Center+ (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Job van den Hurk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Scannexus Ultra High-Field MRI Center, 6229 EV Maastricht, The Netherlands
| | - Gommert A. van Koeveringe
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center+ (MUMC+), 6229 HX Maastricht, The Netherlands
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Liu P, Li Y, Shi B, Zhang Q, Guo H. Comparison of different types of therapy for overactive bladder: A systematic review and network meta-analysis. Front Med (Lausanne) 2022; 9:1014291. [PMID: 36341256 PMCID: PMC9633225 DOI: 10.3389/fmed.2022.1014291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/04/2022] [Indexed: 12/02/2022] Open
Abstract
To compare the efficacy and safety of different interventions [including antimuscarinics, mirabegron, OnabotulinumtoxinA, sacral neuromodulation (SNM) and peripheral tibial nerve stimulation (PTNS)] for treating idiopathic overactive bladder (OAB). PubMed, Embase, Cochrane Library, and other sources were searched for randomized controlled trials (RCTs) comparing interventions for overactive bladder from 1 January 2000 to 19 April 2021. A systematic review and network meta-analysis were performed by two authors independently. Fifty-five RCTs involving 32,507 patients were included in this analysis. Overall, antimuscarinics, mirabegron, OnabotulinumtoxinA, sacral neuromodulation, and peripheral tibial nerve stimulation were more efficacious than placebo, and sacral neuromodulation showed the best effect for reducing micturition frequency, urgency episodes and urgency urinary incontinence episodes. OnabotulinumtoxinA was the best intervention for achieving reductions of 100 and ≥50% in the number of urinary incontinence episodes/day, and peripheral tibial nerve stimulation was the best intervention for reducing urinary incontinence episodes. Antimuscarinics, mirabegron and peripheral tibial nerve stimulation had a similar efficacy for reducing micturition frequency, urinary incontinence episodes and urgency urinary incontinence episodes. The results revealed that all interventions examined herein were efficacious for managing adult overactive bladder syndrome compared with placebo. Furthermore, sacral neuromodulation and OnabotulinumtoxinA were the most efficient treatments for overactive bladder. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251966], identifier [CRD42021251966].
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Affiliation(s)
| | | | | | - Qiujie Zhang
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hu Guo
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Chartier-Kastler E, Normand LL, Ruffion A, Saussine C, Braguet R, Rabut B, Ragni E, Perrouin-Verbe MA, Pierrevelcin J, Rousseau T, Gamé X, Tanneau Y, Dargent F, Biardeau X, Graziana JP, Stoica G, Brassart E, Fourmarier M, Yaghi N, Capon G, Ferchaud J, Berrogain N, Peyrat L, Pecoux F, Bryckaert PE, Melotti A, Abouihia A, Keller DUJ, Cornu JN. Sacral Neuromodulation with the InterStim System for Overactive Bladder: 3-Year Results from the French Prospective, Multicenter, Observational SOUNDS Study. Eur Urol Focus 2022; 8:1399-1407. [PMID: 34334342 DOI: 10.1016/j.euf.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND SOUNDS strengthens the evidence basis of sacral neuromodulation (SNM) for overactive bladder (OAB) through real-world data. OBJECTIVE To analyze diary-based effectiveness, quality of life (QoL), disease severity, symptom bother, and safety data for SNM with the InterStim system up to 3 yr after implantation. DESIGN, SETTING, AND PARTICIPANTS Twenty-five representative French sites enrolled 291 patients with OAB followed according to the local standard of care. Overall, 229 patients received a de novo or replacement InterStim implant and had four follow-up visits, two within the first yr and annually thereafter. A total of 190 patients completed the fourth follow-up visit after a mean of 33.7 ± 3.7 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The effectiveness outcomes measured were changes in daily voids and leaks and the therapy responder rates. Other outcomes included validated QoL data (Ditrovie and EuroQol 5-dimension 5-level questionnaires), disease severity (Urinary Symptom Profile [USP]), symptom bother rated using a numeric rating scale (NRS), and safety data. Follow-up data were compared to baseline results using the Wilcoxon signed-rank test. RESULTS AND LIMITATIONS Average daily voids and leaks were significantly reduced at all time points up to 3 yr after implantation (p < 0.05) except for voids at 21 mo in the group receiving a replacement device. The therapeutic response for urinary urge incontinence at the fourth follow-up was 72% for the de novo group and 86% for the replacement group. Disease-specific QoL (Ditrovie), OAB-specific symptom severity (USP domain 2), and NRS-rated disease bother were significantly improved at all visits (p < 0.001). Device- or procedure-related adverse events occurred in 49% of patients, with 68% of the events classified as minor (Clavien-Dindo grade I or II). Surgical revisions were performed in 33% of patients, including permanent removal in 13%, over a mean exposure time of 44.4 ± 15.3 mo. CONCLUSIONS This study confirms the safety and effectiveness of SNM for OAB and improvements in QoL and disease bother in real life. PATIENT SUMMARY Our study in French patients with overactive bladder showed that disease symptoms and bother were significantly reduced and quality of life was significantly improved over a study duration of approximately 3 yr after implantation of a device to stimulate nerves that control the bladder. This trial is registered at ClinicalTrials.gov as NCT02186041.
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Affiliation(s)
| | | | | | | | | | | | - Evelyne Ragni
- Hôpital de la Timone, Centre Hôspitalier Universitaire de Marseille, Marseille, France
| | | | | | | | - Xavier Gamé
- CHU Toulouse Hôpital Rangueil, Toulouse, France
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Deng C, Chen Y, Dai R. Re: Safety and short-term efficacy of mirabegron in children with valve bladder: a pilot study. Pediatr Surg Int 2022; 38:949-950. [PMID: 35362797 DOI: 10.1007/s00383-022-05120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
Abstract
Overactive bladder (OAB) is a common lower urinary tract dysfunction syndrome. A stepwise approach is a prudent choice. Urotherapy is recommended by the International Children's Continence Society (ICCS) as the first-line treatment for OAB.
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Affiliation(s)
- Changkai Deng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Yue Chen
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, China
| | - Rong Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, China
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Martins de Almeida R, Mateu Arrom L, Ortíz Núñez A, Covernton PJO, Mora Blazquez AM. Resource use and healthcare costs in patients with overactive bladder who initiate treatment with mirabegron or antimuscarinic monotherapy in Catalonia: the MIRACAT study. Actas Urol Esp 2022; 46:184-192. [PMID: 35305956 DOI: 10.1016/j.acuroe.2021.12.007] [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: 09/09/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND AIM Overactive bladder (OAB) negatively impacts patient quality of life and may be associated with high resource use. Our aim was to describe the resource use, costs and persistence associated with mirabegron (MB) or antimuscarinic (AM) treatment in patients with OAB. MATERIALS AND METHODS Observational retrospective study of medical records in adult patients initiating OAB treatment with MB or AM in Catalonia. Healthcare resource use (visits, hospital stays, tests, medication, absorbent pads) in the first year after treatment initiation was collected. Associated costs were estimated (є, reference year 2019), as well as treatment persistence. Treatment discontinuation was defined as the absence of prescription for at least 45 days or treatment change. RESULTS The mean cost per patient (SD) was є 1,640.20 (є 1,227.60) with MB and є 2,159.20 (є 2,264.40) with AM; the associated healthcare resource use cost was lower with MB compared to AM, except for OAB drug costs. Persistence after 12 months of treatment initiation was higher in MB (42.1%) compared to AM (33.0%), as was the median time until treatment discontinuation: 299 (95% CI: 270-328) vs 240 days (95% CI: 230-250). CONCLUSIONS Lower healthcare resource use was observed with MB compared to AM in the first year of index treatment, resulting in a lower mean direct cost per patient and year, despite its higher acquisition cost. Increased treatment persistence, as well as rational use of available treatments improves OAB management and, in return, patients' quality of life.
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8
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Martins de Almeida R, Mateu Arrom L, Ortíz Núñez A, Covernton P, Mora Blazquez A. Uso de recursos y costes sanitarios en pacientes con vejiga hiperactiva que inician tratamiento con mirabegrón o un antimuscarínico en monoterapia en Cataluña: estudio MIRACAT. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Przydacz M, Chłosta M, Belch Ł, Czech AK, Wiatr T, Gronostaj K, Lipinski M, Chłosta P. Treatment patterns for lower urinary tract symptoms and overactive bladder in an Eastern European country: a nationwide population-representative survey. Cent European J Urol 2021; 74:382-387. [PMID: 34729230 PMCID: PMC8552947 DOI: 10.5173/ceju.2021.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/06/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to establish at the population level the treatment patterns for lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in Poland. Material and methods We used data from LUTS POLAND, a survey representative of the entire Polish population classified by age, sex, and place of residence. The treatment patterns we considered were lifestyle changes, physiotherapy, non-prescription drugs, prescription drugs, and surgical treatment. Results We obtained 6,005 completed interviews. About one-third of respondents who reported LUTS or OAB were seeking treatment, and many of these persons received treatment. Men were more proactive in seeking treatment than women, and men more often received treatment. Management with prescription drugs was the most common treatment modality of LUTS and OAB respondents. There were some disparities in distribution of other treatment options between LUTS and OAB persons, but, disappointingly, non-invasive and low-cost management strategies were rarely reported as being used. Specialists (mainly urologists) provided most of the treatments. We did not identify differences between urban and rural areas in treatment seeking, treatment receiving, and the treatment methods that were used. Conclusions In Poland, the scale was low for seeking treatment for LUTS and OAB. As well, there was little reliance on non-invasive and low-cost management strategies for LUTS and OAB. Our findings underline the need for education of patients and physicians about LUTS and OAB, and for greater healthcare and financial resources for LUTS and OAB patients.
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Affiliation(s)
- Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Chłosta
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Łukasz Belch
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Anna K Czech
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Wiatr
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Gronostaj
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Marek Lipinski
- 2 Department of Urology, Medical University of Łódź, Łódź, Poland
| | - Piotr Chłosta
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
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Kreydin EI, Gomes CM, Cruz F. Current pharmacotherapy of overactive bladder. Int Braz J Urol 2021; 47:1091-1107. [PMID: 34003613 PMCID: PMC8486454 DOI: 10.1590/s1677-5538.ibju.2021.99.12] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/10/2021] [Indexed: 11/23/2022] Open
Abstract
Overactive bladder is a symptom complex consisting of bothersome storage urinary symptoms that is highly prevalent among both sexes and has a significant impact on quality of life. Various antimuscarinic agents and the beta-3 agonists mirabegron and vibegron are currently available for the treatment of OAB. Each drug has specific pharmacologic properties, dosing schedule and tolerability profile, making it essential to individualize the medical treatment for the patient's characteristics and expectations. In this manuscript, we review the most important factors involved in the contemporary pharmacological treatment of OAB.
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Affiliation(s)
- Evgenyi I. Kreydin
- University of Southern CaliforniaKeck School of MedicineDepartment of UrologyLos AngelesCAUSADepartment of Urology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Cristiano M. Gomes
- Faculdade de Medicina da Universidade de São PauloDepartamento de CirurgiaDivisão de UrologiaSão PauloSPBrasilDivisão de Urologia, Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Francisco Cruz
- Faculdade de Medicina do PortoHospital de S. JoãoDepartamento de UrologiaPortoPortugalDepartamento de Urologia, Hospital de S. João, Faculdade de Medicina do Porto, Porto, Portugal
- i3S Instituto para Investigação e Inovação em SaúdePortoPortugali3S Instituto para Investigação e Inovação em Saúde, Porto, Portugal
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Khan Z, Healey GD, Paravati R, Berry N, Rees E, Margarit L, Gonzalez D, Emery S, Conlan RS. Chronic Urinary Infection in Overactive Bladder Syndrome: A Prospective, Blinded Case Control Study. Front Cell Infect Microbiol 2021; 11:752275. [PMID: 34660348 PMCID: PMC8515879 DOI: 10.3389/fcimb.2021.752275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives To investigate whether women with overactive bladder (OAB) symptoms and no evidence of clinical infection by conventional clean-catch midstream urine cultures have alternative indicators of sub-clinical infection. Patients/Subjects Materials & Methods The study was a prospective, blinded case-control study with 147 participants recruited, including 73 OAB patients and 74 controls. The OAB group comprised female patients of at least 18 years of age who presented with OAB symptoms for more than 3 months. Clean-catch midstream urine samples were examined for pyuria by microscopy; subjected to routine and enhanced microbiological cultures and examined for the presence of 10 different cytokines, chemokines, and prostaglandins by ELISA. Results The mean age and BMI of participants in both groups were similar. No significant difference in the number of women with pyuria was observed between OAB and control groups (p = 0.651). Routine laboratory cultures were positive in three (4%) of women in the OAB group, whereas the enhanced cultures isolated bacteria in 17 (23.2%) of the OAB patients. In the control group, no positive cultures were observed using routine laboratory cultures, whereas enhanced culture isolated bacteria in 8 (10.8%) patients. No significant differences were observed in the concentrations of PGE2, PGF2α, MCP-1, sCD40L, MIP-1β, IL12p70/p40, IL12/IL-23p40, IL-5, EGF and GRO-α between the OAB and control groups. Conclusions Patients with OAB symptoms have significant bacterial growth on enhanced culture of the urine, which is often not detectable through routine culture, suggesting a subclinical infection. Enhanced culture techniques should therefore be used routinely for the effective diagnosis and management of OAB.
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Affiliation(s)
- Zainab Khan
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom
| | - Gareth D Healey
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Roberta Paravati
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Nidhika Berry
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom
| | - Eugene Rees
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom
| | - Lavinia Margarit
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom.,Cwm Taf Morgannwg University Health Board, Obstetrics Gynecology Department, Princess of Wales Hospital, Bridgend, United Kingdom
| | - Deyarina Gonzalez
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Simon Emery
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom
| | - Robert Steven Conlan
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
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12
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Yang E, Hu SW, Chen SL, Chen GD, Ng SC. A 3-year longitudinal survey of overactive bladder in community-dwelling male residents aged 40 years and above. Low Urin Tract Symptoms 2021; 13:356-360. [PMID: 33594797 DOI: 10.1111/luts.12375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the short-term evolution and risk factors of overactive bladder (OAB) in community-dwelling male residents aged 40 years and above in central Taiwan. METHODS This was a 3-year longitudinal cohort study. From January 2012 to December 2012, community residents aged 40 years and above, living in central Taiwan, were invited to participate in this study. A yearly Overactive Bladder Symptom Score (OABSS) questionnaire was used to assess the prevalence, incidence, remission, persistence, and relapse of OAB for three consecutive years. OAB was defined as total OABSS ≧4 and urgency score ≧2. RESULTS Nine hundred forty-one male residents aged ≧40 years were recruited. The prevalence of OAB was 15%. The male residents with OAB were older, had a history of urological surgery, were unemployed, had lower educational levels, and lower yearly incomes compared with male residents without OAB. The prevalence increased with age when stratified into different age cohorts (40-49, 7%; 50-59, 12.7%; 60-69, 18.2%; ≧70, 32%; P < .001). Age ≧60 (odds ratio [OR] 2.58; 95% CI, 1.62-4.11) and history of urological surgery (OR 2.85; 95% CI, 1.29-6.30) were the major risk factors after multivariable logistic regression analysis. Eight hundred participants completed all the 3 years' questionnaires. The second- and third-year incidence rates of OAB were 10% (69/691) and 6.2% (42/674), respectively. The remission rates were 47.7% (52/109) and 46% (58/126), respectively. The two-year OAB persistence rate was 30.3% (33/109). CONCLUSIONS The prevalence and yearly incidence of OAB are high in community-dwelling male residents aged ≧40 years in central Taiwan. Age is an important risk factor.
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Affiliation(s)
- Evelyn Yang
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Suh-Woan Hu
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Sung-Lang Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Gin-Den Chen
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Soo-Cheen Ng
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Are Beta 3 Adrenergic Agonists Now the Preferred Pharmacologic Management of Overactive Bladder? Curr Urol Rep 2020; 21:49. [PMID: 33090278 DOI: 10.1007/s11934-020-01003-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OF THE REVIEW This paper discusses the recent evidence supporting beta 3 adrenergic agonists as the preferred pharmacological management of overactive bladder syndrome. RECENT FINDINGS Mirabegron has a similar efficacy profile to first-line antimuscarinics with favorable adverse effects profile. Treatment of OAB with beta-3 adrenergic agonist should be favored in patients at higher risk of anticholinergic adverse events. The efficacy and tolerability of beta-3 adrenergic agonists are consistently reported in older OAB patients, whether used alone or with other antimuscarinics. Mirabegron is cost-effective in treating OAB unless the symptoms were severe or refractory. Combination therapy of mirabegron and other pharmacotherapy has proven to be efficient in controlling OAB symptoms without inducing serious add-on adverse effects. While beta-3 adrenergic agonists bear favorable advantages in OAB treatment, physicians should perform a thorough and careful pre-treatment planning to optimize treatment benefits and adherence.
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Chartier-Kastler E, Le Normand L, Ruffion A, Dargent F, Braguet R, Saussine C, Tanneau Y, Graziana JP, Ragni E, Rabut B, Rousseau T, Biardeau X, Gamé X, Pierrevelcin J, Brassart E, Fourmarier M, Stoica G, Berrogain N, Yaghi N, Pecoux F, Capon G, Ferchaud J, Peyrat L, Bryckaert PE, Karsenty G, Melotti A, Abouihia A, Keller DUJ, Cornu JN. Sacral Neuromodulation with the InterStim™ System for Intractable Lower Urinary Tract Dysfunctions (SOUNDS): Results of Clinical Effectiveness, Quality of Life, Patient-Reported Outcomes and Safety in a French Multicenter Observational Study. Eur Urol Focus 2020; 7:1430-1437. [DOI: 10.1016/j.euf.2020.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
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OnabotulinumtoxinA is a well tolerated and effective treatment for refractory overactive bladder in real-world practice. Int Urogynecol J 2020; 32:65-74. [PMID: 32719964 PMCID: PMC7788019 DOI: 10.1007/s00192-020-04423-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022]
Abstract
Introduction and hypothesis In randomized clinical trials onabotulinumtoxinA was demonstrated to be an effective and well-tolerated treatment for overactive bladder (OAB) with urinary incontinence (UI). However, data reporting onabotulinumtoxinA use in everyday clinical practice are limited. Here, we present the results from a large, first-of-its-kind real-world study in patients with OAB. Methods This was a prospective, observational, multinational study (GRACE; ClinicalTrials.gov, NCT02161159) performed in four European countries. Patients (N = 504) aged ≥ 18 years with OAB inadequately managed with ≥ 1 anticholinergic received onabotulinumtoxinA per their physician’s normal clinical practice. Results Physicians primarily used rigid cystoscopes for onabotulinumtoxinA injection; anesthesia/analgesia was utilized during most treatment procedures. Significant reductions in UI episodes/day from baseline to weeks 1 and 12 were observed as well as in micturition, urgency, and nocturia episodes/day. These improvements in urinary symptoms corresponded to higher scores on the treatment benefit scale at week 12. The use of other OAB medications dropped from baseline to weeks 1 and 12 and was sustained to week 52, which paralleled a reduction in the number of incontinence products used during that time frame. Adverse reactions were reported in 2.6% of patients throughout the study. Conclusions In this real-world study, significant improvements in urinary symptoms were seen following onabotulinumtoxinA treatment as early as week 1 and sustained to at least week 12. This was accompanied by a reduced reliance upon incontinence products and reduction in concomitant OAB medication use. OnabotulinumtoxinA was well tolerated with no new safety signals. Electronic supplementary material The online version of this article (10.1007/s00192-020-04423-0) contains supplementary material, which is available to authorized users.
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Harries F. Introduction to sacral neuromodulation therapy for urinary bladder dysfunction using an InterStim system. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S23-S26. [PMID: 32407234 DOI: 10.12968/bjon.2020.29.9.s23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sacral neuromodulation is an internationally endorsed therapy recognised by the National Institute for Health and Care Excellence for patients who have refractory overactive bladder symptoms and/or idiopathic non-obstructive urinary retention when conservative treatments have failed or when patients have been unable to tolerate them. The Medtronic InterStim System used at the Queen Elizabeth Hospital Birmingham received CE mark approval in 1995 for bladder indications. To date, over 300 000 patients worldwide have been treated, with 61-90% reporting satisfaction with treatment (Sutherland et al, 2007; Leong et al, 2011). It is a safe and effective intervention that can positively impact upon the management of both of these conditions, in particular overactive bladder. This highly prevalent condition is distressing to the individual and has an economic burden to society comparable in magnitude with that of breast cancer and osteoporosis (Hu and Wagner, 2005).
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Affiliation(s)
- Frances Harries
- Urology Nurse Specialist, The Queen Elizabeth Hospital Birmingham
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Ibrahim H, Shouman AM, Ela W, Ghoneima W, Shoukry AI, ElSheemy M, Morsi H, Badawy H, Eissa M, Kotb S. Percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children: Is it effective? AFRICAN JOURNAL OF UROLOGY 2019. [DOI: 10.1186/s12301-019-0009-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To assess the efficacy and durability of percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children.
Results
Twenty patients with a mean age of 7 ± 3.3 years were included in the study. Subjective success was found in 12 patients (60%) who considered their situation to be better and requested to continue therapy to maintain the response which was considered as a therapeutic success, while eight patients (40%) patients chose not to continue therapy because they did not have symptomatic improvement.
Conclusion
Posterior tibial nerve stimulation is an effective, minimally invasive method for treatment and is easily applied to induce improvement in overactive bladder symptoms and objective urodynamic changes with negligible side effects.
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Overactive bladder in men: a practical approach. Br J Gen Pract 2019; 68:298-299. [PMID: 29853598 DOI: 10.3399/bjgp18x696593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/15/2017] [Indexed: 10/31/2022] Open
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Lee MJ, Moon JH, Lee HK, Cho CH, Choi SH, Im WB. Pharmacological characterization of DA-8010, a novel muscarinic receptor antagonist selective for urinary bladder over salivary gland. Eur J Pharmacol 2019; 843:240-250. [PMID: 30502343 DOI: 10.1016/j.ejphar.2018.11.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 10/31/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
Several antimuscarinics have been commonly used for overactive bladder patients, but dry mouth as a major anticholinergic side effect remains a shortcoming to limit long-term use. The aim of this study was to elucidate the pharmacological properties of DA-8010, a novel muscarinic receptor antagonist selective for urinary bladder over salivary gland. DA-8010 exhibited a high binding affinity for human muscarinic M3 receptor with pKi of 8.81 ± 0.05 and great potencies for human M3 receptor and rat bladder preparation. The potency of DA-8010 for bladder smooth muscle cells was 3.6-fold higher than that for salivary gland cells isolated from mice. Intravenous administration of DA-8010 dose-dependently inhibited rhythmic urinary bladder contractions induced by distension in rats, indicating the most potent activity (ID30 = 0.08 mg/kg) among the antimuscarinics tested. Taken together with the inhibitory effects of DA-8010 and other antimuscarinics on carbachol-induced salivary secretion in rats, the in vivo functional selectivity of DA-8010 for urinary bladder over salivary gland was 3.1-fold, 3.2-fold and 5.2-fold greater than those observed for solifenacin, oxybutynin and darifenacin, respectively. Furthermore, oral administration of DA-8010 in mice resulted in more selective and persistent binding for muscarinic receptors in the bladder rather than in the submaxillary gland, in comparison with other antimuscarinics. These findings suggest that DA-8010 is a potent muscarinic M3 receptor antagonist to be highly selective for bladder over salivary gland, which might be a promising agent with greater efficacy and less dry mouth in the treatment of overactive bladder.
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Affiliation(s)
- Min Jung Lee
- Dong-A ST Research Institute, Yongin 17073, Republic of Korea.
| | - Jun-Hwan Moon
- Dong-A ST Research Institute, Yongin 17073, Republic of Korea
| | - Hyung Keun Lee
- Dong-A ST Research Institute, Yongin 17073, Republic of Korea
| | - Chong Hwan Cho
- Dong-A ST Research Institute, Yongin 17073, Republic of Korea
| | - Sung Hak Choi
- Dong-A ST Research Institute, Yongin 17073, Republic of Korea
| | - Weon-Bin Im
- Dong-A ST Research Institute, Yongin 17073, Republic of Korea
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de Sá Dantas Bezerra D, de Toledo LGM, da Silva Carramão S, Silva Rodrigues AF, Dmockowski R, Auge APF. A prospective randomized clinical trial comparing two doses of AbobotulinumtoxinA for idiopathic overactive bladder. Neurourol Urodyn 2018; 38:660-667. [PMID: 30525226 DOI: 10.1002/nau.23884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 10/01/2018] [Indexed: 11/06/2022]
Abstract
AIMS To compare 300 U versus 500 U of abobotulinumtoxinA (ABO) intravesical injections for the treatment of idiopathic overactive bladder (OAB) refractory to first and second-line treatments. METHODS A prospective, randomized, single blind study was performed in female patients with symptoms of OAB, who had failed conservative treatment. Patients were treated with 300 or 500 U of ABO injected into 30 sites, avoiding the trigone. All treatments were evaluated by voiding diary, ICIQ-OAB questionnaire, urodynamic test, visual analogue scale (VAS) for treatment satisfaction and patient global impression of improvement (PGI-I). The primary outcome was change in maximum cistometric capacity (MCC). Secondary outcome included changes in urgency, complete continence, subjective success (VAS and PGI-I), and adverse events (urinary retention, UTI, and CIC). RESULTS Twenty-one patients were included. MCC has increased from 185.0 to 270.9 mL (300 U) and from 240.8 to 311.7 mL (500 U), comparing the baseline with 12 weeks, without statistical difference between the groups (P = 0.270). At 12 weeks, 91% of patients were dry in both groups. At 24 weeks, episodes of incontinence had returned in 50% (300 U) and 0% (500 U) (P = 0.013). Patients were better or much better (PGI-I) in70% (300 U) and 88.9% (500 U) at 12 w; and 50% (300 U) and 100% (500 U), at 24 w (P = 0.027). The peak of PVR was at 4 w, being 71.7 mL (300 U) and 96.5 mL (500 U). General UTI incidence was 35.7%. One patient (500 U) required CIC for 2 weeks. CONCLUSIONS Intravesical ABO injection at 500 U improves symptoms and quality of life for longer period of time than 300 U for idiopathic OAB.
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Affiliation(s)
| | | | - Silvia da Silva Carramão
- Department of Obstetrics and Gynecology, Division of Urogynecology Santa Casa de Sao Paulo School of Medical Sciences, SP, Brazil
| | - Antonio F Silva Rodrigues
- Department of Surgery, Division of Female Urology Santa Casa de Sao Paulo School of Medical Sciences, SP, Brazil
| | - Roger Dmockowski
- Department of Urology, Vanderbilt University, Nashville, Tennessee
| | - Antonio P F Auge
- Department of Obstetrics and Gynecology, Division of Urogynecology Santa Casa de Sao Paulo School of Medical Sciences, SP, Brazil
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Errando-Smet C, Müller-Arteaga C, Hernández M, Roset M. Diagnosis and treatment of male patients with lower urinary tract symptoms in Spain - The MERCURY Study. Do urologists follow the recommendations of the European guidelines? Actas Urol Esp 2018; 42:323-330. [PMID: 29428420 DOI: 10.1016/j.acuro.2017.12.003] [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: 10/24/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the management of lower urinary tract symptoms (LUTS) in men in Spain and assess the compliance with recommendations established in the European Association of Urology (EAU) guidelines. MATERIAL AND METHODS MERCURY was an epidemiological and cross-sectional study which involved 227 Urology Units across Spain assessing adult male patients with mixed LUTS and persisting storage symptoms. Sociodemographic, clinical and resource use data for the 6 months prior to study inclusion were collected. Additionally, through a theoretical clinical case, clinicians described their attitude toward the diagnostic and therapeutic management of males with mixed LUTS and persisting storage symptoms during the first and second visits. Answer options given to clinicians about LUTS management were aligned with those recommended by EAU guidelines. RESULT 610 patients included in the study were evaluated. 87.7% of them consumed some health resource mainly due to: urologist visits (79.7%), PSA determination (76.6%) and treatment with alpha-blockers (37.5%) and alpha-blockers plus antimuscarinics (37.2%). According to the theoretical clinical case, urologists preference toward diagnostic tools and pharmacological treatment in first visit were mainly PSA determination (97.7%), digital rectal examination (91.4%) and treatment with alphablockers as monotherapy (56.6%), whereas in the second visit uroflowmetry (48.9%), voiding diary (40.3%) and treatment with alpha-blockers plus antimuscarinics (70.6%) were mainly preferred. CONCLUSIONS Urologists attitude toward management of male patients with mixed LUTS and persisting storage symptoms is aligned with that recommended in the EAU guidelines.
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Affiliation(s)
- C Errando-Smet
- Unidad de Urología Funcional y Femenina, Servicio de Urología, Fundació Puigvert, Barcelona, España.
| | - C Müller-Arteaga
- Departamento de Urología, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - M Hernández
- Departamento Médico de Urología, Astellas Pharma S. A., Madrid, España
| | - M Roset
- Health Economics and Outcomes Research, IQVIA, Barcelona, España
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Tsui A, Kuh D, Cardozo L, Davis D. Vascular risk factors for male and female urgency urinary incontinence at age 68 years from a British birth cohort study. BJU Int 2018; 122:118-125. [PMID: 29512315 PMCID: PMC6221119 DOI: 10.1111/bju.14137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To investigate the prevalence of urgency urinary incontinence (UUI) at age 68 years and the contribution of vascular risk factors to male and female UUI pathogenesis in addition to the associations with raised body mass index (BMI). Subjects and methods In all, 1 762 participants from the Medical Research Council (MRC) National Survey for Health and Development birth cohort who answered the International Consultation on Incontinence Questionnaire short form (ICIQ‐SF), at age 68 years, were included. Logistic regression was used to estimate associations between UUI and earlier life vascular risk factors including: lipid status, diabetes, hypertension, BMI, previous stroke or transient ischaemic attack (TIA) diagnosis; adjusting for smoking status, physical activity, co‐presentation of stress UI symptoms, educational attainment; and in women only, type of menopause, age at period cessation, and use of hormone replacement therapy (HRT). Results UUI was reported by 12% of men and 19% of women at age 68 years. Female sex, previous stroke or TIA diagnosis, increased BMI and hypertension (in men only) at age 60–64 years were independent risk factors for UUI. Female sex, increased BMI, and a previous diagnosis of stroke/TIA increased the relative risk of more severe UUI symptoms. Type and timing of menopause and HRT use did not alter the estimated associations between UUI and vascular risk factors in women. Conclusion Multifactorial mechanisms lead to UUI and vascular risk factors may contribute to the pathogenesis of bladder overactivity in addition to higher BMI. Severe UUI appears to be a distinct presentation with more specific contributory mechanisms than milder UUI.
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Affiliation(s)
- Alex Tsui
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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Powell LC, Szabo SM, Walker D, Gooch K. The economic burden of overactive bladder in the United States: A systematic literature review. Neurourol Urodyn 2018; 37:1241-1249. [DOI: 10.1002/nau.23477] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/29/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Lauren C. Powell
- Broadstreet Health Economics and Outcomes ResearchVancouverBritish ColumbiaCanada
| | - Shelagh M. Szabo
- Broadstreet Health Economics and Outcomes ResearchVancouverBritish ColumbiaCanada
| | - David Walker
- Astellas Pharma Global Development, Inc.NorthbrookIllinois
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Nobrega R, Greenwell TJ, Pickard R, Ockrim JL, Harding CK. Sacral nerve stimulation versus intravesical botulinum toxin injections for medically refractory overactive bladder: A contemporary review of UK treatment from both clinician and patients’ perspectives. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817742565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: In the UK, 10,000 refractory overactive bladder patients per year receive intravesical onabotulinum toxin A treatment and 300 receive sacral nerve stimulation implants. Current National Institute for Health and Care Excellence guidelines propose using onabotulinum toxin A before sacral nerve stimulation whilst the European Association of Urology (EAU) and American Urological Association (AUA) suggests both be offered with equipoise. The aim of this study was to ascertain both patients and clinician views regarding these two treatments. Subjects/methods: Fifty consecutive overactive bladder patients who were refractory to behavioural and medical therapy anonymously completed a structured questionnaire about their treatment preferences. Additionally, 100 UK consultant urologists anonymously completed a separate questionnaire about their treatment preferences and which treatment modalities they had available for use in their Trusts. Results: Of patients, 60% preferred sacral nerve stimulation over onabotulinum toxin A, of whom 80% would happily randomise into a trial between the two treatments. Ninety-seven per cent of 100 consultant urologists in the UK have access to onabotulinum toxin A in their hospitals, but only 39% have access to sacral nerve stimulation. Of clinicians given access to all available options, 71% would use onabotulinum toxin A as their first choice treatment for refractory overactive bladder. Conclusion: There appears to be a significant disparity between current UK overactive bladder guidance, National Health Service accessibility to onabotulinum toxin A and sacral nerve stimulation therapies, the views of clinicians, and patient preferences for treatment. Level of evidence: 5
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Affiliation(s)
- R Nobrega
- Department of Female, Functional and Restorative Urology, University College London Hospital, UK
| | - TJ Greenwell
- Department of Female, Functional and Restorative Urology, University College London Hospital, UK
| | - R Pickard
- Department of Urology, Freeman Hospital, UK
| | - JL Ockrim
- Department of Female, Functional and Restorative Urology, University College London Hospital, UK
| | - CK Harding
- Department of Urology, Freeman Hospital, UK
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Ng SC, Hu SW, Chen GD. A community-based epidemiological survey of overactive bladder and voiding dysfunction in female Taiwanese residents aged 40 years and above. Taiwan J Obstet Gynecol 2017; 56:811-814. [DOI: 10.1016/j.tjog.2017.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 10/18/2022] Open
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Thomas D, Chughtai B. Re: Lower Urinary Tract Symptoms and Incident Falls in Community Dwelling Older Men: The Concord Health and Ageing in Men Project. Eur Urol 2017; 72:472-473. [DOI: 10.1016/j.eururo.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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Yilmaz-Oral D, Bayatli N, Gur S. The Beneficial Effect of Fesoterodine, a Competitive Muscarinic Receptor Antagonist on Erectile Dysfunction in Streptozotocin-induced Diabetic Rats. Urology 2017; 107:271.e1-271.e7. [DOI: 10.1016/j.urology.2017.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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Yoshida S, Orimoto N, Tsukihara H, Noma T, Hakozaki A, Sasaki E. TAC-302 promotes neurite outgrowth of isolated peripheral neurons and prevents bladder denervation related bladder dysfunctions following bladder outlet obstruction in rats. Neurourol Urodyn 2017; 37:681-689. [PMID: 28745805 DOI: 10.1002/nau.23375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/30/2017] [Indexed: 11/09/2022]
Abstract
AIMS To evaluate the ability of TAC-302, a cyclohexenoic fatty alcohol derivative, to enhance neurite outgrowth in cultured rat dorsal root ganglion (DRG) neurons, and the preventive effects of TAC-302 on bladder denervation-related storage and voiding dysfunctions in rats with bladder outlet obstruction (BOO). METHODS Rat DRG neurons were cultured in the presence of TAC-302. Cell numbers and neurite lengths were quantified after a 24 h culture. BOO was achieved by partial ligature of the proximal urethra in female rats. BOO rats were divided into three groups and orally treated with vehicle of 3 or 30 mg/kg TAC-302 twice a day for 4 weeks. Cystometry was performed under conscious conditions. Immunohistochemical staining using anti-PGP9.5 of the bladder muscle layer was performed, and the innervation area was scored. RESULTS TAC-302 significantly and dose-dependently increased neurite outgrowth in cultured DRG neurons. BOO rats showed a decreased innervation area in the urinary bladder compared to sham-operated rats. BOO-induced denervation of the urinary bladder was partially prevented by oral treatment with TAC-302. TAC-302 significantly reduced the frequency of non-voiding contraction (NVC) and residual urine volume (RUV) compared with the BOO vehicle group (P < 0.05). The innervation area score exhibited significant negative correlations with NVC and RUV, indicating that they increased according to the progression of denervation. CONCLUSIONS Our data indicate that TAC-302 promotes neurite outgrowth in vitro. In addition, TAC-302 prevents BOO-induced bladder dysfunction in rats, and has a protective effect on bladder denervation.
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Affiliation(s)
- Shohei Yoshida
- Taiho Pharmaceutical Co. Ltd., Tsukuba Research Center, Tsukuba, Japan
| | - Naoki Orimoto
- Taiho Pharmaceutical Co. Ltd., Tsukuba Research Center, Tsukuba, Japan
| | - Hiroshi Tsukihara
- Taiho Pharmaceutical Co. Ltd., Tsukuba Research Center, Tsukuba, Japan
| | - Takahisa Noma
- Taiho Pharmaceutical Co. Ltd., Tsukuba Research Center, Tsukuba, Japan
| | - Atsushi Hakozaki
- Taiho Pharmaceutical Co. Ltd., Tsukuba Research Center, Tsukuba, Japan
| | - Eiji Sasaki
- Taiho Pharmaceutical Co. Ltd., Tsukuba Research Center, Tsukuba, Japan
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Moazzam Z, Yoo PB. Electrical stimulation of the saphenous nerve in anesthetized rats: a novel therapeutic approach to treating overactive bladder. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:3125-3128. [PMID: 28268971 DOI: 10.1109/embc.2016.7591391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Posterior Tibial Nerve Stimulation (PTNS) is a minimally invasive yet effective therapy for treating overactive bladder (OAB) symptoms with electrical stimulations applied at 20 Hz coupled with amplitudes approximating the foot-twitch threshold (T). However, pre-clinical studies indicate that PTNS-evoked bladder reflexes require stimulation amplitudes exceeding 2T. The objective of this work was to evaluate the presence of secondary low-threshold sensory pathways in the hind-limb region that can be a potential target of activation during clinical PTNS set-up. Given the close proximity of the electrode tip and the cutaneous branches in the lower leg, we hypothesized the concomitant activation of saphenous nerve (SAFN) afferents during percutaneous PTNS. To this end, urodynamic model was established in ten anesthetized rats to investigate (1) the isolated role of SAFN trunk in modulating bladder activity and (2) characterize frequency-dependent changes in inhibitory response at low stimulation amplitudes. Our pre-clinical findings suggest that direct stimulation of SAFN can elicit robust and consistent inhibitory effects at 20 Hz. This novel inhibitory reflex may rationalize the therapeutic effects of clinical PTNS therapy and support the feasibility of enhancing the current algorithm of incontinence care.
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Errando-Smet C, Müller-Arteaga C, Hernández M, Lenero E, Roset M. Healthcare resource utilization and cost among males with lower urinary tract symptoms with a predominant storage component in Spain: The epidemiological, cross-sectional MERCURY study. Neurourol Urodyn 2017; 37:307-315. [PMID: 28464366 DOI: 10.1002/nau.23293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/21/2017] [Indexed: 01/22/2023]
Abstract
AIMS To assess the relationship between storage-predominant LUTS and healthcare resource consumption and cost among males in Spain. METHODS In this non-interventional, cross-sectional study, urologists enrolled males with storage-predominant LUTS and recorded the consumption of healthcare resources (medical visits, diagnostic tests/monitoring, treatment, and hospitalizations) within the previous 6 months. The cost of healthcare resources was calculated from unit costs extracted from a Spanish eHealth database. Severity of LUTS was assessed by the Bladder Self-Assessment Questionnaire (BSAQ) and patients were stratified by symptom score (<6 or ≥6) to assess the relationship between LUTS severity and healthcare resource consumption and cost. RESULTS Among 610 enrolled patients (BSAQ symptom score <6, n = 191; BSAQ symptom score ≥6, n = 419), the majority (87.7%) consumed healthcare resources during the previous 6 months in the form of medical visits (86.2%), diagnostic tests/monitoring (83.4%), and treatment (85.9%). Patients with BSAQ symptom scores ≥6 used more healthcare resources compared with patients with BSAQ symptom scores <6. The most common treatments for LUTS were α-blockers used as monotherapy (n = 229 [37.5%]) or in combination with antimuscarinics (n = 227 [37.2%]). The estimated median annual cost was €1070 per patient, consisting of diagnostic tests/monitoring (54.6%), medical visits (20.5%), and treatment (29.6%), and was higher in patients with BSAQ symptom score ≥6 (€1127) than in patients with BSAQ symptom score <6 (€920; P < 0.001). CONCLUSIONS More severe LUTS are associated with higher healthcare consumption and cost. These findings highlight the importance of symptom management in LUTS patients to help minimize healthcare consumption and cost.
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Affiliation(s)
| | - Carlos Müller-Arteaga
- Department of Urology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Marta Hernández
- Department of Medical Affairs, Astellas Pharma Europe B.V., Madrid, Spain
| | - Enrique Lenero
- Medical Affairs Global Development, Astellas Pharma, Northbrook, Illinois
| | - Montse Roset
- Health Economics and Outcomes Research, IMS Health, Barcelona, Spain
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Sung HH, Ko KJ, Suh YS, Kim JC, Choi JB, Song YS, Lee KS. Tailoring pharmacotherapy for male lower urinary tract symptoms: A prospective, multicenter, observational trial. Int J Clin Pract 2017; 71. [PMID: 28508459 DOI: 10.1111/ijcp.12947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/08/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the pattern of tailoring and efficacy of several types of pharmacotherapy in male LUTS. METHODS Prospectively 404 male subjects were included who were over 40 years old, had at least 3 months symptom duration, and 12 or higher international prostate symptom score (IPSS). Subjects were treated with several types of pharmacotherapy for 6 months and were evaluated with IPSS/QoL at every follow-up. Subjects were subdivided into storage (44%), nocturia (18.5%), and voiding symptom (37.5%) groups according to the most bothersome symptom. RESULTS At 6 months, 188 subjects (46.5%) completed the study. The mean age was 64.2±8.5 years, and symptom duration was 30.6±32.6 months. PSA was 2.98±7.96 ng/mL, and prostate size was 32.8±14.2 cc. IPSS continually decreased from baseline (18.7) to last follow-up (10.8). Combination therapy increased from 33.0% to 52.7% at last follow-up (P=.006). However, there was no difference of IPSS changes between combination and monotherapy groups (P>.05). Only antimuscarinic prescription significantly increased from 15.4% to 28.2% (P=.004). Mean number of visits to the clinic was 3.6±1.3 and the number of treatment changes was 0.31±0.47. The nocturia (0.47±0.51) group changed treatment more than voiding group (0.21±0.41, P=.003). However, the voiding group (-9.4) had significantly more improvement than e storage (-6.4) and nocturia (-7.8) groups (P=.011). CONCLUSIONS Male LUTS continually improved over 6 months with customised treatment. Pharmacotherapy for male LUTS should be tailored by symptom type and alteration of symptoms during treatment.
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Affiliation(s)
- Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Seok Suh
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Joon Chul Kim
- Department of Urology, Bucheon St.Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Jong Bo Choi
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Yun-Seob Song
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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Ruff L, Bagshaw E, Aracil J, Velard ME, Pardhanani G, Hepp Z. Economic impact of onabotulinumtoxinA for overactive bladder with urinary incontinence in Europe. J Med Econ 2016; 19:1107-1115. [PMID: 27266958 DOI: 10.1080/13696998.2016.1199430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Overactive bladder (OAB) is a common condition that has a significant impact on patients' health-related quality-of-life and is associated with a substantial economic burden to healthcare systems. OnabotulinumtoxinA has a well-established efficacy and safety profile as a treatment for OAB; however, the economic impact of using onabotulinumtoxinA has not been well described. METHODS An economic model was developed to assess the budget impact associated with OAB treatment in France, Germany, Italy, Spain and the UK, using onabotulinumtoxinA alongside best supportive care (BSC)-comprising incontinence pads and/or anticholinergic use and/or clean intermittent catheterisation (CIC)-vs BSC alone. The model time horizon spanned 5 years, and included direct costs associated with treatment, BSC, and adverse events. RESULTS Per 100,000 patients in each country, the use of onabotulinumtoxinA resulted in estimated cost savings of €97,200 (Italy), €71,580 (Spain), and €19,710 (UK), and cost increases of €23,840 in France and €284,760 in Germany, largely due to day-case and inpatient administration, respectively. Projecting these results to the population of individuals aged 18 years and above gave national budget saving estimates of €9,924,790, €27,458,290, and €48,270,760, for the UK, Spain, and Italy, respectively, compared to cost increases of €12,160,020 and €196,086,530 for France and Germany, respectively. Anticholinergic treatment and incontinence pads were the largest contributors to overall spending on OAB management when onabotulinumtoxinA use was not increased, and remained so in four of five scenarios where onabotulinumtoxinA use was increased. This decreased resource use was equivalent to cost offsets ranging from €106,110 to €176,600 per 100,000 population. CONCLUSIONS In three of five countries investigated, the use of onabotulinumtoxinA, in addition to BSC, was shown to result in healthcare budget cost savings over 5 years. Scenario analyses showed increased costs in Germany and France were largely attributable to the treatment setting rather than onabotulinumtoxinA acquisition costs.
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Affiliation(s)
- Lewis Ruff
- a Covance - Market Access Services , Butlers Wharf , London , UK
| | - Emma Bagshaw
- a Covance - Market Access Services , Butlers Wharf , London , UK
| | - Javier Aracil
- b Allergan Holdings Limited - Pricing Reimbursement and Market Access , Marlow , UK
| | - Marie-Eve Velard
- b Allergan Holdings Limited - Pricing Reimbursement and Market Access , Marlow , UK
| | - Gianni Pardhanani
- b Allergan Holdings Limited - Pricing Reimbursement and Market Access , Marlow , UK
| | - Zsolt Hepp
- b Allergan Holdings Limited - Pricing Reimbursement and Market Access , Marlow , UK
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Basu M, Doumouchtsis SK. Are voiding parameters a marker for the severity of quality of life impairment in women with overactive bladder symptoms? Neurourol Urodyn 2016; 36:1577-1581. [PMID: 27778361 DOI: 10.1002/nau.23152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/14/2016] [Indexed: 11/08/2022]
Abstract
AIMS There is evidence of an association between voiding parameters and the presence of overactive bladder symptoms. The aim of this study was to evaluate whether there is any association between pressure flow study parameters and the degree of health related quality of life impairment in women with OAB symptoms. The null hypothesis is that there is no significant correlation between quality of life domain scores and pressure flow study parameters. METHODS One hundred and sixty-seven consecutive women with overactive bladder symptoms underwent evaluation with a quality of life assessment plus filling and voiding cystometry. These data were used to evaluate for any correlation between pressure flow study parameters and quality of life domain scores. RESULTS Fifty-six out of 167 women had proven detrusor overactivity (DO). There were no differences in voiding parameters or quality of life scores between women with DO and women without DO. There was no consistent correlation identified between quality of life domain scores and pressure flow variables. CONCLUSIONS There is no evidence of an association between increasing quality of life impairment and voiding parameters in this cohort.
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Affiliation(s)
- Maya Basu
- Department of Urogynaecology, St. George's Hospital, London, United Kingdom
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Cost effectiveness analysis of fesoterodine compared to mirabegron in first-line therapy setting for overactive bladder with urge urinary incontinence, from the Spanish National Health System perspective. Actas Urol Esp 2016; 40:513-22. [PMID: 26988624 DOI: 10.1016/j.acuro.2015.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/26/2015] [Accepted: 11/26/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of first-line treatment of Overactive Bladder (OAB) with fesoterodine relative to mirabegron, from the Spanish National Health System (NHS) perspective. METHODS A decision tree model was developed to represent a typical clinical process of 52-week of treatment for an OAB patient with urge urinary incontinence (UUI) initiating first-line therapy with fesoterodine 4mg, including optional titration to 8mg, vs.mirabegron 50mg. Efficacy data were obtained from a Bayesian indirect treatment meta-analysis. Patients with UUI of less than one episode/day were defined as treatment responder and persistence was assessed at weeks 4, 12 and 24. At week 12, non-responders discontinued treatment permanently. Quality-adjusted life years (QALYs) were calculated based on time spent in responder and non-responder states. OAB-related drug and medical care costs including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections and depression) were modeled and expressed in €2015. RESULTS At week 52, the percentage of responders was 20.8% for patients starting on fesoterodine 4mg who optionally titrated to 8mg and 19.4% for patients treated with mirabegron. QALYs were slightly higher with fesoterodine than mirabegron (0.7703vs. 0.7668, difference=0.0035). Fesoterodine treatment also had slightly higher total costs than mirabegron (3,296€vs. 3,217, difference=79€), resulting in a cost of 22,523/QALY€ gained for fesoterodine versus mirabegron. Probabilistic sensitivity analysis confirmed the slight advantage of fesoterodine with a 61.1% probability of being cost-effective at the 30,000€ willingness-to-pay for 1QALY threshold. CONCLUSIONS Given the relatively small 1-year cost difference between the two treatments, fesoterodine can be considered a cost-effective option relative to mirabegron for the first-line management of OAB with UUI in Spain.
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Perk S, Wielage RC, Campbell NL, Klein TM, Perkins A, Posta LM, Yuran T, Klein RW, Ng DB. Estimated Budget Impact of Increased Use of Mirabegron, A Novel Treatment for Overactive Bladder. J Manag Care Spec Pharm 2016; 22:1072-84. [PMID: 27579830 PMCID: PMC10397927 DOI: 10.18553/jmcp.2016.22.9.1072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oral pharmacological treatment for overactive bladder (OAB) consists of antimuscarinics and the beta-3 adrenergic agonist mirabegron. Antimuscarinic adverse events (AEs) such as dry mouth, constipation, and blurry vision can result in frequent treatment discontinuation rates, leaving part of the OAB population untreated. Antimuscarinics also contribute to a patient's anticholinergic cognitive burden (ACB), so the Beers Criteria recommends cautious use of antimuscarinics in elderly patients who take multiple anticholinergic medications or have cognitive impairment. Since mirabegron does not affect the cholinergic pathways, it is unlikely to contribute to a patient's ACB. OBJECTIVE To estimate the health care costs associated with the pharmacological treatment of OAB with mirabegron and antimuscarinics from U.S. commercial payer and Medicare Advantage perspectives, using a budget impact model. METHODS For this budget impact model, 2 analyses were performed. The primary analysis estimated the budgetary impact of increasing the use of mirabegron in a closed patient cohort treated with oral pharmacological treatments. The secondary analysis modeled the economic impact in an open cohort by allowing untreated patients to begin treatment with mirabegron after potential contraindication, intolerance, or lack of effectiveness of antimuscarinics. The analyses were performed over a 3-year time horizon. The economic impact of increased mirabegron use was quantified using direct medical costs, including prescription costs and health resource utilization (HRU) costs. Costs of comorbidities included pharmacy and medical costs of treating OAB-related urinary tract infections (UTI), skin rashes, and depression. An analysis of a large single-site integrated health network database was commissioned to quantify ACB-related HRU in terms of the increases in yearly outpatient and emergency department visits. Based on this analysis, the model associated each unit increase in ACB score with increased HRU and probability of mild cognitive impairment. Clinical outcomes of increased use of mirabegron were presented as the number of AEs and comorbidity episodes that could be avoided. One-way sensitivity analyses were performed to quantify the expected budget impact over the range of uncertainty for the key input variables. RESULTS Primary analysis calculated the impact of increasing the use of mirabegron from 4.5% to 5.3%, 7.1%, and 9.4% in years 1, 2, and 3, respectively, among oral pharmacological OAB treatments that included generic and branded antimuscarinics: oxybutynin, tolterodine, trospium, darifenacin, fesoterodine, and solifenacin. For a 1 million-member U.S. commercial payer plan, the total prescription costs increased, and the total medical costs decreased during the 3-year time horizon, yielding increases of $0.005, $0.016, and $0.031 from current per member per month (PMPM) costs and $0.90, $2.92, and $5.53 from current per treated member per month (PTMPM) costs, an average of less than 2% of current OAB treatment costs. For the Medicare Advantage plan, the resulting incremental PMPM costs were $0.010, $0.034, and $0.065, and the incremental PTMPM costs were $0.93, $3.04, and $5.76; all were less than 4% of the current cost. The secondary analysis estimated the budgetary effects of reducing the untreated population by 1% annually by initiating treatment with mirabegron. For a commercial payer, this resulted in PMPM cost increases of $0.156, $0.311, and $0.467 from the current value, while the incremental PTMPM cost increased by $6.17, $11.67, and $16.61. For the Medicare Advantage plan, the incremental increases in PMPM costs were $0.277, $0.553, and $0.830, and in PTMPM costs were $6.42, $12.15, and $17.29. Clinically, treating more OAB patients resulted in fewer OAB-related comorbidities from both health plan perspectives, since most events associated with nontreatment could be avoided. In the Medicare Advantage population of the secondary analysis, the total numbers of avoided events were predicted as 452 UTIs, 2,598 depression diagnoses, and 3,020 skin rashes during the time horizon of the model. CONCLUSIONS Mirabegron addresses an unmet need for therapy for certain OAB patients, for whom antimuscarinics are not recommended because of a risk of cognitive impairment and who are intolerant to the anticholinergic AEs. Using mirabegron involves moderate additional economic cost to a commercial or Medicare Advantage health plan for which medical cost savings can offset a substantial part of increased pharmacy costs. DISCLOSURES Funding for this study was provided by Astellas. Perk, Wielage, T. Klein, and R. Klein are employed by Medical Decision Modeling, a contract research company that was paid to perform the described outcomes research and build the model contained in this study. Campbell and Perkins are employed by the Regenstrief Institute, which conducted a database analysis for this research. Campbell reports consultancy fees from Astellas, as well as pending grants from Merck, Sharpe, and Dohme Corp. Posta, Yuran, and Ng are employed by Astellas Pharma Global Development, the developer of mirabegron. Study concept and design were contributed by Perk, Wielage, R. Klein, and Ng. Campbell, T. Klein, and Perkins took the lead in data collection, assisted by Perk, Wielage, and Ng. Data interpretation was performed by Posta and Yuran, along with Perk, Wielage, R. Klein, Ng, Campbell, and Perkins. The manuscript was written by Perk and R. Klein, along with Wielage, T. Klein, Posta, Yuran, and Ng, and revised by all the authors.
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Affiliation(s)
- Sinem Perk
- 1 Medical Decision Modeling, Indianapolis, Indiana
| | | | - Noll L Campbell
- 2 Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, and Purdue University College of Pharmacy, West Lafayette, Indiana
| | | | - Anthony Perkins
- 3 Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana
| | - Linda M Posta
- 4 Medical Affairs, Americas, Astellas Pharmaceutical Global Development, Northbrook, Illinois
| | - Thomas Yuran
- 4 Medical Affairs, Americas, Astellas Pharmaceutical Global Development, Northbrook, Illinois
| | | | - Daniel B Ng
- 4 Medical Affairs, Americas, Astellas Pharmaceutical Global Development, Northbrook, Illinois
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Perk S, Wielage RC, Campbell NL, Klein TM, Perkins A, Posta LM, Yuran T, Klein RW, Ng DB. Estimated Budget Impact of Increased Use of Mirabegron, A Novel Treatment for Overactive Bladder. J Manag Care Spec Pharm 2016. [DOI: 10.18553/jmcp.2016.22.9.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Contreras-Sanz A, Krska L, Balachandran AA, Curtiss NL, Khasriya R, Kelley S, Strutt M, Gill HS, Taylor KM, Mansfield KJ, Wu C, Peppiatt-Wildman CM, Malone-Lee J, Duckett J, Wildman SS. Altered urothelial ATP signaling in a major subset of human overactive bladder patients with pyuria. Am J Physiol Renal Physiol 2016; 311:F805-F816. [PMID: 27358056 DOI: 10.1152/ajprenal.00339.2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 06/24/2016] [Indexed: 01/23/2023] Open
Abstract
Overactive Bladder (OAB) is an idiopathic condition, characterized by urgency, urinary frequency, and urgency incontinence, in the absence of routinely traceable urinary infection. We have described microscopic pyuria (≥10 wbc/μl) in patients suffering from the worst symptoms. It is established that inflammation is associated with increased ATP release from epithelial cells, and extracellular ATP originating from the urothelium following increased hydrostatic pressure is a mediator of bladder sensation. Here, using bladder biopsy samples, we have investigated urothelial ATP signaling in OAB patients with microscopic pyuria. Basal, but not stretch-evoked, release of ATP was significantly greater from the urothelium of OAB patients with pyuria than from non-OAB patients or OAB patients without pyuria (<10 wbc/μl). Basal ATP release from the urothelium of OAB patients with pyuria was inhibited by the P2 receptor antagonist suramin and abolished by the hemichannel blocker carbenoxolone, which differed from stretch-activated ATP release. Altered P2 receptor expression was evident in the urothelium from pyuric OAB patients. Furthermore, intracellular bacteria were visualized in shed urothelial cells from ∼80% of OAB patients with pyuria. These data suggest that increased ATP release from the urothelium, involving bacterial colonization, may play a role in the heightened symptoms associated with pyuric OAB patients.
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Affiliation(s)
| | - Louise Krska
- Medway School of Pharmacy, Universities of Kent and Greenwich, Kent, United Kingdom
| | | | - Natasha L Curtiss
- Obstetrics and Urogynaecology, Medway Maritime Hospital, Kent, United Kingdom
| | | | - Stephen Kelley
- Medway School of Pharmacy, Universities of Kent and Greenwich, Kent, United Kingdom
| | - Matthew Strutt
- Department of Microbiology, East Kent Hospitals University Foundation Trust, Kent, United Kingdom
| | - Hardyal S Gill
- Department of Pharmaceutics, UCL School of Pharmacy, London, United Kingdom
| | - Kevin M Taylor
- Department of Pharmaceutics, UCL School of Pharmacy, London, United Kingdom
| | - Kylie J Mansfield
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; and
| | - Changhao Wu
- Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | | | - James Malone-Lee
- Division of Medicine, UCL Medical School, London, United Kingdom
| | - Jonathan Duckett
- Obstetrics and Urogynaecology, Medway Maritime Hospital, Kent, United Kingdom
| | - Scott S Wildman
- Medway School of Pharmacy, Universities of Kent and Greenwich, Kent, United Kingdom;
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Staubli SE, Mordasini L, Engeler DS, Sauter R, Schmid HP, Abt D. Economic Aspects of Morbidity Caused by Ureteral Stents. Urol Int 2016; 97:91-7. [DOI: 10.1159/000443379] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
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Vignozzi L, Gacci M, Maggi M. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nat Rev Urol 2016; 13:108-19. [PMID: 26754190 DOI: 10.1038/nrurol.2015.301] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Epidemiological studies have shown that age is the principal unmodifiable risk factor of lower urinary tract symptoms (LUTS). Until the past decade, the process of lower urinary tract ageing was, therefore, considered unmodifiable - as ageing per se. However, the traditional dogma that BPH-related LUTS (BPH-LUTS) is an immutable consequence of old age is no longer acceptable. Results from multiple preclinical and clinical studies indicate that several modifiable, age-related metabolic aberrations (metabolic syndrome, obesity, dyslipidaemia, diabetes) are important determinants in both the development and the progression of BPH-LUTS. Metabolic syndrome and its related comorbidities, such as sex steroid alterations and low-grade inflammation, have been related to BPH-LUTS development and progression. With the correct treatment and recommended lifestyle changes, many individuals with metabolic syndrome might be able to prevent or delay the onset of metabolic-syndrome-related complications; however, whether promoting healthier lifestyles can really alter a man's propensity to develop BPH-LUTS remains to be clarified.
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Affiliation(s)
- Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Mauro Gacci
- Urology Department, Careggi Hospital, Largo Brambilla, 50134 Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Sicras-Mainar A, Navarro-Artieda R, Ruiz-Torrejón A, Sáez-Zafra M, Coll-de Tuero G. Impact of Loss of Work Productivity in Patients with Overactive Bladder Treated with Antimuscarinics in Spain: Study in Routine Clinical Practice Conditions. Clin Drug Investig 2015; 35:795-805. [PMID: 26464261 DOI: 10.1007/s40261-015-0342-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Overactive bladder (OAB) is a syndrome characterized by presenting symptoms of urgency, with or without urge incontinence, and normally accompanied by day and night frequency. OBJECTIVE The aim of this study was to evaluate the impact of lost work productivity [number of days of sick leave] in patients treated with fesoterodine versus tolterodine and solifenacin to treat OAB in Spain. METHODS A retrospective, observational study was carried out using the records (digital databases) of actively working patients (2008-2013). The study population comprised of patients from two autonomous communities; 31 primary care centres agreed to participate. Patients who began first treatment with antimuscarinics (fesoterodine, solifenacin or tolterodine) and who met certain inclusion/exclusion criteria were included in the study. Follow-up lasted for 1 year. The main outcome measures were comorbidity, medication possession ratio (MPR), treatment persistence, and number of days of sick leave and associated costs. Indirect costs were considered to be those related to lost work productivity (number of days of sick leave, exclusively), (1) due to OAB and (2) overall total. The cost was expressed as the average cost per patient (cost/unit). Multivariate analyses (Cox, ANCOVA) were used to correct the models. RESULTS A total of 3094 patients were recruited into the study; 43.0 % were treated with solifenacin, 29.2 % with tolterodine, and 27.8 % with fesoterodine. The average age of patients was 54 years (standard deviation 9.2), and 62.2 % were women. The comparison of fesoterodine versus solifenacin and tolterodine showed a higher MPR (90.0 vs. 87.0 and 86.1 %, respectively), higher treatment persistence (40.2 vs. 34.7 and 33.6 %), lower use of sick leave (22.8 vs. 52.9 and 36.7 %), total number of days of sick leave (5.1 vs. 9.7 and 9.3 days) and costs corrected for covariates (€371 vs. €703 and €683); p < 0.05. CONCLUSIONS Despite the possible limitations of this study, active patients who began treatment with fesoterodine to treat OAB (compared with solifenacin or tolterodine) had fewer days of sick leave, resulting in lower costs due to lost productivity.
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Affiliation(s)
- Antoni Sicras-Mainar
- Badalona Serveis Assistencials, Calle Gaietà Soler, 6-8 entlo, 08911, Badalona, Barcelona, Spain.
| | - Ruth Navarro-Artieda
- Medical Documentation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Abstract
Costs of neurogenic bladder vary widely and depend on a number of factors including severity of disease, symptomatology, patient insurance, and devices required. Recognition of how each treatment strategy will impact the patient financially could help guide selection of treatment as well as improve compliance with the chosen regimen. We have attempted to provide an overview of long term cost considerations for the neurogenic bladder patient. Armed with this information, the practitioner can better help the patient select a bladder care regimen that balances the desire to both minimize symptoms now and preserve urinary tract integrity for the future, yet still remain cost effective.
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Solberg M, Alræk T, Mdala I, Klovning A. A pilot study on the use of acupuncture or pelvic floor muscle training for mixed urinary incontinence. Acupunct Med 2015; 34:7-13. [PMID: 26362793 PMCID: PMC4789711 DOI: 10.1136/acupmed-2015-010828] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/13/2022]
Abstract
Objectives To determine the feasibility and acceptability of traditional Chinese medicine (TCM) acupuncture and pelvic floor muscle training (PFMT) in reducing symptoms and bothersomeness in women with mixed urinary incontinence (MUI); and to estimate the sample size for a full scale trial. Methods Thirty-four women with MUI were randomly assigned to either 12 sessions of TCM acupuncture, 12 sessions of PFMT, or to a waiting list control group. Outcome measures included an assessment of interest to participate in the trial, identification of successful recruitment strategies, the appropriateness of eligibility criteria, and compliance with treatment. Clinical outcomes were assessed at baseline and 12 weeks, and included the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI SF), expectations of treatment effect, and adverse events. Results Recruitment was feasible and randomisation worked adequately by means of SurveyMonkey. SurveyMonkey does not permit stratification by ICIQ-UI SF baseline score. Fourteen of 22 women found the treatment options acceptable. The dropout rate was high, especially in the control group (6/12). Outcome forms were completed by 20 of 34 women. The median (IQR) changes of the ICIQ-UI SF scores in the acupuncture, physiotherapy, and waiting list group were 5.5 (2.3 to 6.8), 1.0 (−3.0 to 4.5), and 1.5 (−1.5 to 3.0), respectively, suggesting the need for a full scale trial. Conclusions Women with MUI were willing to participate in this study. There is a need for adjusting eligibility criteria. A sample size of 129 women, 43 in three arms, is required. No major adverse events occurred.
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Affiliation(s)
- Mona Solberg
- Faculty of Medicine, Department of Health Sciences, Institute of Health and Society, University of Oslo, Norway
| | - Terje Alræk
- Faculty of Health Science, Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, NAFKAM, UiT The Arctic University of Norway, Tromsø, Norway Norwegian School of Health Sciences, Kristiania University College Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Atle Klovning
- Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Ginsberg DA, Schneider LK, Watanabe TK. Improving Outcomes in Patients With Refractory Idiopathic and Neurogenic Detrusor Overactivity: Management Strategies. Arch Phys Med Rehabil 2015; 96:S341-57.e1. [PMID: 26318392 DOI: 10.1016/j.apmr.2015.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/18/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
Neurogenic detrusor overactivity (NDO) is a lower urinary tract dysfunction commonly seen in rehabilitation settings. The emotional, medical, and financial consequences of NDO can be substantial and management typically requires a multidisciplinary team approach. Physiatrists need to be able to identify patients who require referral to specialists for diagnostic testing or higher-tiered treatment and need to engender open lines of communication between their patients and all treating clinicians. This requires an understanding of the evaluation, diagnosis, and treatment of neurogenic lower urinary tract dysfunctions.
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Affiliation(s)
- David A Ginsberg
- Department of Urology, University of Southern California, Los Angeles, CA; Rancho Los Amigos National Rehabilitation Center, Downey, CA.
| | | | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, Temple University School of Medicine, Philadelphia, PA; Drucker Brain Injury Center, Moss Rehab at Elkins Park, Elkins Park, PA
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Lee KS, Choo MS, Seo JT, Oh SJ, Kim HG, Ng K, Lee KJ, Tan JT, Kim JC. Impact of overactive bladder on quality of life and resource use: results from Korean Burden of Incontinence Study (KOBIS). Health Qual Life Outcomes 2015; 13:89. [PMID: 26113125 PMCID: PMC4480453 DOI: 10.1186/s12955-015-0274-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/25/2015] [Indexed: 01/22/2023] Open
Abstract
Background To evaluate the impact of overactive bladder (OAB) on quality of life (QOL), resource use and productivity loss in patients recruited from six hospitals in Korea. Methods This cross-sectional survey recruited 625 OAB patients between July to December 2013. Patients were categorised into four groups based on the average number of urinary incontinence (UI) episodes over the past three days (0, 1, 2–3 and ≥4 UI/day). QOL was measured using the Incontinence-Specific Quality of Life Instrument (I-QOL), the Overactive Bladder Questionnaire (OAB-q), and a generic health-related utility instrument (EQ-5D). Information on hospital and clinic visit frequency, and continence pads use were also collected. Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Between group differences were assessed using ANOVA. Multivariable regression analyses were performed to examine the independent effects of OAB symptoms on QOL. Results Severity of UI showed a significant linear relationship with QOL, with clinically meaningful differences between each UI severity category. Compared to the dry category, patients in the most severe category (≥4 UI/day) had significantly lower I-QOL scores (69.8 vs 42.6; p < 0.0001), greater symptom bother on the OAB-q (30.4 vs 64.6; p < 0.0001), and poorer EQ-5D utility (0.848 vs 0.742; p < 0.001). Multivariable analyses showed that UI severity, frequency, urgency, and nocturia are independently associated with poorer QOL. Incontinence severity is also significantly associated with cost of incontinence pads (p < 0.0001), and a greater interference with work and regular activities (p = 0.001), however, no significant difference in hospital and clinic visits were observed. Conclusion Severity of UI is a key contributor to the disease burden of OAB in Korean patients, even after taking into account the impact of other symptoms associated with OAB. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0274-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyu Sung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, South Korea.
| | - Myung Soo Choo
- Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, South Korea.
| | - Ju Tae Seo
- Cheil General Hospital, Dankoo University College of Medicine, 1-19 Mukjeong-Dong, Jung-Gu, Seoul, South Korea.
| | - Seung June Oh
- Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, South Korea.
| | - Hyeong Gon Kim
- Konkuk University School of Medicine, Konkuk University Medical Center, Gwangjin-Gu, Seoul, South Korea.
| | - Kwong Ng
- Allergan APAC, Pasir Panjang Road, MBC, West Building #09-25, Singapore, 117439, Singapore.
| | - Kyung Jin Lee
- Allergan Korea, GT Tower 14F, 1317-23, Seocho-dong, Seocho-gu, Seoul.
| | - Jonathan T Tan
- Allergan APAC, Pasir Panjang Road, MBC, West Building #09-25, Singapore, 117439, Singapore.
| | - Joon Chul Kim
- Bucheon St.Mary's Hospital, 2 Sosa-Dong, Wonmi-Gu, Gyeonggido, South Korea.
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Wagg A, Oelke M, Angulo JC, Scholfield D, Arumi D. Review of the efficacy and safety of fesoterodine for treating overactive bladder and urgency urinary incontinence in elderly patients. Drugs Aging 2015; 32:103-25. [PMID: 25673122 DOI: 10.1007/s40266-014-0237-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Overactive bladder (OAB) is a common condition, with prevalence rates increasing with advancing age. Symptoms of OAB, including urgency urinary incontinence (UUI), are associated with various co-morbidities in elderly individuals (e.g., falls and fractures, functional impairment, and depression). The current mainstay of pharmacological therapy for OAB is antimuscarinic agents. Until recently, few studies had specifically evaluated the efficacy and safety of antimuscarinics in the treatment of OAB symptoms in elderly patients. This review summarises available evidence from the medical literature on the efficacy and safety of fesoterodine in elderly patients with OAB symptoms, including UUI. The data from unique placebo-controlled fesoterodine trials of elderly and vulnerable elderly patients, together with age-stratified data from post hoc analyses of fesoterodine trials, demonstrate that treatment with fesoterodine 4 or 8 mg results in statistically and clinically significant improvements in OAB symptoms and patient-reported outcomes in many elderly patients. The data indicate that the efficacy of fesoterodine in elderly patients is comparable with that in younger patients. Fesoterodine is generally well tolerated in elderly and vulnerable elderly patients, with low rates of urinary retention and little evidence of central nervous system events or impaired cognition. The data support a favourable benefit-to-risk ratio for fesoterodine in elderly and medically complex vulnerable elderly patients with OAB.
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Affiliation(s)
- Adrian Wagg
- University of Alberta, 1-116 Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB, T6G 2P4, Canada,
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Cuervo J, Castejón N, Khalaf KM, Waweru C, Globe D, Patrick DL. Development of the Incontinence Utility Index: estimating population-based utilities associated with urinary problems from the Incontinence Quality of Life Questionnaire and Neurogenic Module. Health Qual Life Outcomes 2014; 12:147. [PMID: 25288099 PMCID: PMC4196092 DOI: 10.1186/s12955-014-0147-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/15/2014] [Indexed: 01/18/2023] Open
Abstract
Background Generic utility instruments may not fully capture the impact and consequences of urinary problems. Condition-specific preference-based measures, developed from previously validated disease-specific patient-reported outcomes instruments, may add relevant information for economic evaluations. The aim of this study was to develop a condition-specific preference-based measure, the Incontinence Utility Index (IUI), for valuing health states associated with urinary problems. Methods A two-step process was implemented. First, an abbreviated health state classification system was developed from the Incontinence Quality of Life Questionnaire (I-QOL) and Neurogenic Module by applying Rasch modelling, classical psychometrical testing and expert criteria to data from two pivotal trials comprised of neurogenic detrusor overactivity (NDO) patients. Criterion, convergent validity and concordance with the original instrument was assessed in the abbreviated version. Then, a multi-attribute utility function (MAUF) was estimated from a representative sample of the UK non-institutionalized adult general population. Visual analogue and time-trade off (TTO) evaluations were applied in the elicitation process. Predictive validity of the MAUF was tested comparing estimated and direct utility scores. Results The abbreviated health state classification system generated from the NDO sample contained 5 attributes with 3 levels of response and had adequate psychometrical properties: significant differences in scores according to the reduction in the frequency of urinary incontinence episodes [UIE] (p < 0.001); Spearman correlation coefficient with number of daily UIE = −0.43; p < 0.01 and Intraclass Correlation Coefficient (ICC, 95% CI) with the original version = 0.90 (0.89-0.91; p < 0.001). Next, 442 participants were interviewed (398 cases were valid, generating 2,388 TTO evaluations) to estimate the social preferences for derived health states. Mean age was 44.75 years (interquartile range 33.5-55.5) and 60.1% were female. An overall algorithm for the IUI was estimated and transformed onto a dead = 0.00 and full health = 1.00 scale. Model fits were acceptable (R-squared = 0.923 and 0.978). Predictive validity was adequate: ICC (95% CI) = 0.928 (0.648-0.985) and Mean of Absolute Differences = 0.038. Conclusions The newly developed IUI is a preference-based measure for urinary problems related to NDO that provides general population-based utility scores with adequate predictive validity. Trial registration ClinicalTrials.gov: NCT00461292, NCT00311376. Electronic supplementary material The online version of this article (doi:10.1186/s12955-014-0147-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesús Cuervo
- LASER Analytica, C/Azcárraga 12 A, Oviedo, 33010, Asturias, Spain.
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Kaplan SA, Cardozo L, Herschorn S, Grenabo L, Carlsson M, Arumi D, Crook TJ, Whelan L, Scholfield D, Ntanios F. Efficacy and safety of fesoterodine 8 mg in subjects with overactive bladder after a suboptimal response to tolterodine ER. Int J Clin Pract 2014; 68:1065-73. [PMID: 24898471 PMCID: PMC4265241 DOI: 10.1111/ijcp.12464] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/11/2014] [Indexed: 11/28/2022] Open
Abstract
AIMS To assess fesoterodine 8 mg efficacy over time and vs. placebo in subjects with overactive bladder (OAB) who responded suboptimally to tolterodine extended release (ER) 4 mg. METHODS In a 12-week, double-blind trial, subjects with self-reported OAB symptoms for ≥ 6 months, mean of ≥ 8 micturitions and ≥ 2 to < 15 urgency urinary incontinence (UUI) episodes/24 h, and suboptimal response to tolterodine ER 4 mg (defined as ≤ 50% reduction in UUI episodes during 2-week run-in) were randomised to fesoterodine (4 mg for 1 week, 8 mg for 11 weeks) or placebo once daily. Change from baseline to week 12 in UUI episodes (primary end-point) was analysed in step-wise fashion: first, baseline vs. week 12 for fesoterodine; if significant, then change from baseline to week 12 for fesoterodine vs. placebo. RESULTS By week 12, subjects receiving fesoterodine 8 mg had significantly greater improvement from baseline vs. placebo in UUI episodes, urgency episodes and scores on the Patient Perception of Bladder Control, Urgency Perception Scale and OAB Questionnaire Symptom Bother and Health-Related Quality of Life scales and domains (all p < 0.05). 50% and 70% UUI responder rates were also significantly higher with fesoterodine 8 mg vs. placebo at week 12 (p < 0.05). Dry mouth (placebo, 4%, 12/301; fesoterodine, 16.6%, 51/308) and constipation (placebo, 1.3%, 4/301; fesoterodine, 3.9%, 12/308) were the most frequent adverse events. CONCLUSIONS Subjects who responded suboptimally to tolterodine ER 4 mg showed significant improvements in UUI and other OAB symptoms and patient-reported outcomes, with good tolerability, during treatment with fesoterodine 8 mg vs. placebo.
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Affiliation(s)
- S A Kaplan
- Weill Cornell Medical College, Cornell University, New York, NY, USA
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Jimenez-Cidre M, Costa P, Ng-Mak D, Sahai A, Degboe A, Smith CP, Tsai K, Herschorn S. Assessment of treatment-seeking behavior and healthcare utilization in an international cohort of subjects with overactive bladder. Curr Med Res Opin 2014; 30:1557-64. [PMID: 24762033 DOI: 10.1185/03007995.2014.918028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Abstract Objective: To assess the association between incontinence severity, treatment-seeking behavior, and healthcare resource utilization (HRU) among participants with overactive bladder (OAB) in eight countries. RESEARCH DESIGN AND METHODS A cross-sectional online survey of subjects ≥18 years old in Australia, Europe, and North America, who had a past OAB diagnosis and/or experienced ≥1 urinary incontinence (UI) episode in the preceding 12 months, were eligible to participate. Subjects contacted for the survey were primarily from a voluntary medication monitoring registry, MediGuard. Predominantly stress incontinence subjects were excluded. Incontinence severity was assessed by the number of UI episodes over 3 days and grouped as 0 ('dry'), 1-2, 3-4, and ≥5 UI episodes/day. Subject demographics, employment status, comorbidities, treatment-seeking behavior (past OAB diagnosis; spoken to healthcare provider [HCP]), and HRU (diagnostic tests; HCP visits in 6 months before screening) were analyzed by incontinence severity. RESULTS Overall, 1341 subjects with OAB (mean age 54.5 years; 70.7% female) were surveyed; 20.2%, 47.7%, 18.8%, and 13.3% of subjects reported 0, 1-2, 3-4, and ≥5 UI episodes/day, respectively. Employment status and comorbidities were significantly (p < 0.05) associated with incontinence severity. The two measures of treatment-seeking behavior were significantly (p < 0.05) associated with incontinence severity groups; the proportion of subjects with a past diagnosis of OAB were 35.8%, 44.8%, 52.4%, and 64.0% in the 0, 1-2, 3-4, and ≥5 UI episodes/day groups, respectively; and 59.0%, 63.6%, 65.9%, and 78.1% of subjects in the respective UI severity groups talked to a HCP about their OAB symptoms. Multivariate linear regression analyses showed a positive and consistent association between incontinence severity and HRU; subjects reported a mean of 2.7, 4.1, 4.4, and 7.7 diagnostic tests overall (p < 0.001), and a mean of 1.4, 2.2, 2.7, and 4.0 HCP visits in the 0, 1-2, 3-4, and ≥5 UI episodes/day groups, respectively (p < 0.001). A potential limitation of the study is the cross-sectional survey methodology which limits the ability to draw causal inferences from the results. Additionally, since this is a web-based survey it is possible respondents who have access to/are familiar with technology were more likely to be enrolled. CONCLUSIONS Incontinence severity was positively associated with both treatment-seeking behavior and HRU among subjects with OAB.
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Tang DH, Colayco DC, Khalaf KM, Piercy J, Patel V, Globe D, Ginsberg D. Impact of urinary incontinence on healthcare resource utilization, health-related quality of life and productivity in patients with overactive bladder. BJU Int 2014; 113:484-91. [PMID: 24528881 DOI: 10.1111/bju.12505] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the impact of urinary incontinence (UI) on healthcare resource utilization (HRU), health-related quality of life (HRQoL) and productivity measures in patients with overactive bladder (OAB). PATIENTS AND METHODS This retrospective, cross-sectional study used data from the Adelphi OAB/UI Disease Specific Programme, a multinational survey of patient- and physician-reported data, fielded between November 2010 and February 2011. The primary patient groups of interest were those with OAB, both with and without UI. Health-related quality of life and productivity measures were derived from the EuroQoL-5D, the Incontinence Quality of Life questionnaire, the Overactive Bladder Questionnaire, and the Work Productivity and Activity Impairment Questionnaire. Measures of HRU included OAB-related surgeries, OAB-related hospitalizations, incontinence pads, anticholinergic use and physician visits. Multivariate linear regression models and literature-based minimal clinically important differences were used to assess statistically significant and clinically meaningful differences in HRQoL and productivity measures between patients with OAB with UI and those without UI. RESULTS A total of 1 730 patients were identified, with a mean age of 60.7 years, and 77.0% of them were women, 84.2% were non-Hispanic whites, and 71% were incontinent. Bivariate analyses showed that HRU was significantly higher among patients with OAB with UI than among those without UI in all categories except for the number of OAB-related physician visits. In both bivariate and multivariate analyses, incontinent patients presented with clinically and statistically significantly lower HRQoL and productivity measures with respect to all study endpoints, except for percentage of work time missed due to their OAB/UI. CONCLUSIONS Urinary incontinence was associated with significantly higher HRU and lower HRQoL and productivity in this population of patients with OAB from five different countries. In addition to clinical considerations, the economic and humanistic impact of UI should be taken into account when evaluating treatment options for patients with OAB.
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Affiliation(s)
- Derek H Tang
- The University of Arizona College of Pharmacy, Tucson, AZ, USA
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Chapple C, Schneider T, Haab F, Sun F, Whelan L, Scholfield D, Dragon E, Mangan E. Superiority of fesoterodine 8 mg vs 4 mg in reducing urgency urinary incontinence episodes in patients with overactive bladder: results of the randomised, double-blind, placebo-controlled EIGHT trial. BJU Int 2014; 114:418-26. [PMID: 24552358 DOI: 10.1111/bju.12678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the superiority of fesoterodine 8 mg vs 4 mg for improvement in urgency urinary incontinence (UUI) episodes and other diary variables, diary-dry rate (proportion of patients with >0 UUI episodes on baseline diary and 0 UUI episodes on post-baseline diary), and improvements in measures of symptom bother, health-related quality of life (HRQL), and other patient-reported outcomes (PROs). PATIENTS AND METHODS This was a 12-week, randomised, double-blind, placebo-controlled, multinational trial of men and women aged ≥18 years with overactive bladder (OAB) symptoms including UUI (ClinicalTrials.gov ID NCT01302067). Patients were randomised (2:2:1) to receive fesoterodine 8 mg, fesoterodine 4 mg, or placebo once daily; those randomised to fesoterodine 8 mg started with fesoterodine 4 mg once daily for 1 week, then 8 mg once daily for the remaining 11 weeks. Patients completed bladder diaries at baseline and weeks 4 and 12 and the Patient Perception of Bladder Condition (PPBC), Urgency Perception Scale (UPS), and Overactive Bladder Questionnaire (OAB-q) at baseline and week 12. The primary endpoint was change from baseline to week 12 in UUI episodes per 24 h. RESULTS At week 12, patients receiving fesoterodine 8 mg (779 patients) had significantly greater reductions from baseline in UUI episodes, micturitions, and urgency episodes than patients receiving fesoterodine 4 mg (790) or placebo (386); diary-dry rate was significantly higher in the fesoterodine 8-mg group vs the fesoterodine 4-mg and placebo groups (all P < 0.05). At week 12, patients receiving fesoterodine 8 mg also had significantly greater improvements in scores on the PPBC, UPS, and all OAB-q scales and domains than patients receiving fesoterodine 4 mg or placebo (all P < 0.01). Patients receiving fesoterodine 4 mg had significantly greater improvements in UUI episodes, urgency episodes, and micturitions; significantly higher diary-dry rates; and significantly greater improvement in PPBC scores and OAB-q scores than patients receiving placebo (all P < 0.05). Dry mouth was the most commonly reported adverse event (AE) in the fesoterodine groups (placebo group, 3.4%; fesoterodine 4-mg group, 12.9%; fesoterodine 8-mg group, 26.1%); most cases were mild or moderate in all treatment groups. Rates of serious AEs and discontinuations due to AEs were low in all groups. CONCLUSIONS In a 12-week, prospectively designed, superiority trial, fesoterodine 8 mg showed statistically significantly superior efficacy vs fesoterodine 4 mg and placebo, as measured by reductions in UUI episodes and other diary variables, diary-dry dry rate, and improvements in measures of symptom bother, HRQL, and other PROs; clear evidence of dose-dependent efficacy is unique to fesoterodine among antimuscarinics and other oral agents for the treatment of OAB. Fesoterodine 4 mg was significantly more effective than placebo on all outcomes except for improvements in UPS scores. These data support the benefit of having two doses of fesoterodine in clinical practice, with the recommended starting dose of 4 mg for all patients and the fesoterodine 8-mg dose available for patients who require a higher dose to achieve optimal symptom relief.
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