The association of diet and other lifestyle factors with the onset of overactive bladder: a longitudinal study in men

Obesity is associated with a more severe overactive bladder disease state that is effectively treated with once-daily administration of trospium chloride extended release

AIMS

Obesity is an established risk factor for urinary incontinence, yet no information exists as to the efficacy of antimuscarinic agents in this population. The goal of this study is to examine the efficacy of once daily trospium chloride (Sanctura) XR in overweight and obese patients with the overactive bladder syndrome.

METHODS

The primary and secondary end-points of the 1,165 study subjects from the integrated trospium chloride XR pivotal trials were stratified by World Health Organization (WHO) obesity levels I and II.

RESULTS

Obesity (WHO level I, II criteria) was associated with a more severe baseline OAB disease state (P < 0.01). Trospium chloride XR was more effective than placebo at reducing the primary endpoints (toilet voids, UUI, P < 0.0001) and at improving the secondary end-points (percent patients continent and urgency severity, P < 0.0001) for WHO obesity levels I and II.

CONCLUSIONS

Obesity is associated with a more severe OAB disease state. Once daily trospium chloride XR is efficacious in the obese patient with the OAB syndrome.

Prevalence of overactive bladder, its under-diagnosis, and risk factors in a male urologic veterans population

PURPOSE

We assess the prevalence of overactive bladder (OAB) and its risk factors in a male urologic veterans population.

MATERIALS AND METHODS

Validated self-administered questionnaire was prospectively given.

RESULTS

Among 1086 patients, OAB was present in 75%, of which 48% had not been diagnosed/treated. The risk of OAB increased with age. OAB was not associated with BMI, smoking, race, diabetes, CHF, and COPD.

CONCLUSIONS

The prevalence of OAB in this population is under-diagnosed and under-treated.

New once-daily formulation for trospium in overactive bladder

AIMS We examined the relative efficacy and safety of trospium 20 mg bid and 60 mg extended release formulations and position this drug against other antimuscarinic agents.

METHODS

Data were identified on the pharmacology and pharmacokinetics of trospium chloride. Key publications on trospium 20-mg and 60-mg clinical studies in patients with overactive bladder (OAB) were identified and efficacy and safety compared between these formulations as well as other antimuscarinic agents.

RESULTS

Trospium offers the principal advantage over other antimuscarinic agents that, as it is a quaternary amine, it does not cross the blood-brain barrier and is therefore less likely to cause central nervous system effects observed with several other agents. Moreover, with its minimal liver metabolisation, independent of the main cytochrome pathways, trospium has a low risk of drug-drug interaction in patients taking multiple pharmacological agents. Trospium 60 mg ER is as effective as trospium 20 mg bid in improving the key outcome parameters associated with OAB, but with a lower rate of dry mouth, the most common side effect of these agents. Trospium has comparable efficacy and safety to the other antimuscarinic agents currently marketed.

DISCUSSION

Good patient persistence with treatment has been reported with trospium. There are currently a large number of antimuscarinic drugs on the market without clear evidence to distinguish one agent from another in terms of efficacy, provided that an adequate dose is used in the clinical setting.

CONCLUSION

The new formulation of trospium is certainly worth considering as a pharmacological treatment of patients with OAB, particularly in the elderly, in whom one wants to avoid the potential for cognitive dysfunction.

Do gender, age or lifestyle factors affect responses to antimuscarinic treatment in overactive bladder patients?

AIMS

Gender, age, obesity, smoking and alcohol or caffeine intake have been shown or proposed to be risk factors for the prevalence and/or severity of the overactive bladder symptom complex (OAB) or related parameters. We have explored whether any of these factors affect the therapeutic response to a muscarinic receptor antagonist during routine clinical use.

METHODS

Data were analysed from 3766 OAB patients (77.1% woman, age 62.6 +/- 12.8 years) participating in an observational, open-label postmarketing surveillance study of the safety and efficacy of darifenacin. Multiple logistic regression models were applied to explore the effect of potential OAB risk factors on the darifenacin treatment-associated improvement of OAB symptoms, patient's subjective rating of bladder problems and global efficacy and tolerability.

RESULTS

Age and (less consistently) gender were statistically significantly correlated with efficacy parameters, but the extent of their impact was judged to be too small to be clinically relevant. Except for a very small effect of body mass index on urgency episode improvement, none of the lifestyle-associated factors had significant effects on the efficacy of darifenacin. Except for a very small age effect, none of the potential risk factors had significant effects on global tolerability.

DISCUSSION AND CONCLUSIONS

We conclude that the efficacy and tolerability of a muscarinic receptor antagonist, such as darifenacin is largely independent of potential OAB risk factors, such as gender, age, obesity, smoking and alcohol or caffeine intake.

Dynamic progression of overactive bladder and urinary incontinence symptoms: a systematic review

CONTEXT

Overactive bladder (OAB) and urinary incontinence (UI) are worldwide public health problems. Longitudinal epidemiologic studies that assess the natural history of OAB and UI are valuable in making accurate prognoses, determining causes and consequences, and predicting resource utilization.

OBJECTIVE

Our aim was to assess whether the severity of OAB and UI symptoms progress dynamically over time, with the secondary aim of assessing factors that may be associated with symptom progression and regression.

EVIDENCE ACQUISITION

A systematic review of English articles published between January 1, 1990, and September 20, 2009, was conducted using PubMed and Embase. Search terms included longitudinal, natural history, overactive bladder, incontinence, progression, remission, and regression. Eligibility was assessed by Dr. Irwin with editorial assistance. Studies were required to be longitudinal and population based; meeting abstracts and conference proceedings were excluded. Results were assessed qualitatively.

EVIDENCE SYNTHESIS

Overall, the 7 longitudinal studies of OAB and 14 longitudinal studies of UI reviewed reported an increase in the incidence and remission/regression of both OAB and UI symptoms over time that varied across studies (eg, OAB incidence, 3.7-8.8%; UI incidence, 0.8-19%). The studies provide evidence for a dynamic progression of OAB and UI symptoms (eg, among women with OAB without urge urinary incontinence [UUI], 28% reported OAB with UUI 16 yr later) and also show that although symptom severity progresses dynamically, for many individuals symptoms also persist over long time periods.

CONCLUSIONS

The results support the hypothesis that OAB and UI symptom severity progress dynamically and are also sustained over time. However, the variations in symptom definitions and methods used across studies prevent statistical determinations of overall incidence rates. The recognition of OAB and UI as progressive conditions allows for a shift from the current treatment paradigm of symptom control alone to one of symptom management.

Medical management of overactive bladder

Overactive bladder (OAB), as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. OAB syndrome has an incidence reported from six European countries ranging between 12-17%, while in the United States; a study conducted by the National Overactive Bladder Evaluation program found the incidence at 17%. In Asia, the prevalence of OAB is reported at 53.1%. In about 75%, OAB symptoms are due to idiopathic detrusor activity; neurological disease, bladder outflow obstruction (BOO) intrinsic bladder pathology and other chronic pelvic floor disorders are implicated in the others. OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat.

Urinary incontinence, overactive bladder, and other lower urinary tract symptoms: a longitudinal population-based survey in men aged 45-103 years

BACKGROUND

Lower urinary tract symptoms (LUTS) such as urinary incontinence (UI) and overactive bladder (OAB) are highly prevalent conditions, but there are few studies describing progression and remission of LUTS in men, especially over the long term.

OBJECTIVE

To describe the prevalence of UI, OAB, and LUTS using current International Continence Society definitions in the same men studied longitudinally over time.

DESIGN

Prospective, population-based, longitudinal study.

SETTING AND PARTICIPANTS

In 1992, 10 458 men aged 45-99 yr, resident in the city of Gothenburg, were selected at random from the Population Register.

MEASUREMENTS

The men received a postal questionnaire about the presence of LUTS, as well as questions on social, medical, health-related quality of life (HRQoL), and demographic data. Responders in 1992 were reassessed 11 yr later in 2003 using a similar questionnaire.

RESULTS AND LIMITATIONS

In 2003, 4072 of the 7763 men who responded in 1992 were still available in the Population Register and 3257 men (80%) aged 56-103 yr, responded. Prevalence of UI and OAB had increased (p<0.01) in the same men assessed in 1992 (4.5% and 15.6%, respectively) and 2003 (10.5% and 44.4%, respectively). The prevalence of nocturia, urgency, slow stream, hesitancy, incomplete emptying, postmicturition dribble, and the number of daytime micturitions had also increased (p<0.01). Only a minority reported regression of symptoms. Men with UI or OAB reported a poorer (p<0.001) HRQoL compared with men without UI or OAB.

CONCLUSIONS

There was a marked increase in the prevalence of UI, OAB, and other LUTS in the same men assessed longitudinally over this 11-yr period. UI and OAB had a negative influence on HRQoL, and men who developed UI or OAB had a greater deterioration in HRQoL than men who had no change in their UI/OAB status over time.

Behavioral intervention versus pharmacotherapy or their combinations in the management of overactive bladder dysfunction

Overactive bladder syndrome (OAB) refers to individuals with the following symptoms: urinary urgency, increased urinary frequency, and urge incontinence. These symptoms are not life threatening but can cause embarrassment and significantly impact quality of life. There are numerous treatment options for OAB, including behavioral therapy, traditional pharmacological therapy or a combination of the two. These options are considered the mainstay of treatment for OAB. We carried out a comprehensive systematic review of the available literature on the effectiveness of behavioral intervention, anticholinergic drugs, and their combination in the management of adults with overactive bladder, with emphasis on results from clinical trials and primary literature. Each treatment intervention is efficacious, and the choice should be based on the patient's severity of symptoms, tolerability, compliance and satisfaction with the treatment. Based on available literature, management of OAB using a combination of behavioral therapy and drug intervention is the most efficacious in terms of patient satisfaction, perceived improvement, and reduction of bladder symptoms. It is also the most practical and cost effective for optimal management of patients with OAB. Pharmacological treatment, in addition to behavioral therapy, remains important in the management of adults with OAB syndrome.

Emerging drugs for treatment of overactive bladder and detrusor overactivity

BACKGROUND

Overactive bladder (OAB) signifies the presence of urinary urgency and can have major effects on quality of life and social functioning. Standard antimuscarinic drugs have good initial response rates but substantial adverse effects and long-term compliance problems.

OBJECTIVES

To review the complexities of the mechanisms underlying OAB and the current drugs available for treating its symptoms.

METHODS

The literature was reviewed to define current therapies and drugs in clinical trials. Articles were identified by means of a computerised PubMed and Cochrane Library search (using the following keywords: overactive bladder, detrusor overactivity, urgency and bladder), supported by a search of the PharmaProjects database.

CONCLUSIONS

New drug classes, such as beta-3 adrenergic agonists, may work by reducing contractility or excitability of bladder muscle. Moderation of afferent activity may allow improved OAB symptoms, with lower risk of affecting voiding function. Agents acting on the CNS could influence OAB favourably, but target selection and adverse effects are an issue. The recognition of the functional contribution of the urothelium and the diversity of nerve transmitters has sparked interest in both peripheral and central modulation of OAB pathophysiology.

Overactive bladder: epidemiology and social impact

PURPOSE OF REVIEW

Overactive bladder epidemiology is a rapidly evolving field. The new terminology of lower urinary tract function, introduced in 2002, modified the definitions of all four components of overactive bladder. In the same year, the lack of specific information on overactive bladder prevalence was identified and consequently new studies were launched and recently published.

RECENT FINDINGS

Following the new terminology, overactive bladder now includes both a purely sensory disorder and a condition related to an altered bladder behaviour. Studies conducted in selected countries and populations suggested comparable prevalence data worldwide, although the syndrome is considered to be underreported. 'Urge' is now considered the cornerstone symptom of overactive bladder. Recent epidemiological data confirm the increase in overactive bladder prevalence with age and suggest that most diet and lifestyle factors are not associated with the condition, with the exception of body mass index. Among the symptoms, urge and urinary incontinence were considered to be more significantly related to patients' quality of life compared with frequency and nocturia. The socioeconomic consequences of the overactive bladder syndrome were recently estimated in a large US study and a total cost of 12.6 billion US dollars was calculated.

SUMMARY

Specific data on overactive bladder epidemiology are now available, providing new evidence about its relevance as a clinical issue. Both wet and dry overactive bladder cause a significant reduction in quality of life. In our daily practice we have to consider that overactive bladder is frequently underreported as patients believe that no treatment is available and urinary incontinence is considered a natural consequence of aging.