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Jha S, Jeppson PC, Dokmeci F, Marquini GV, Sartori MGF, Moalli P, Malik SA. Management of mixed urinary incontinence: IUGA committee opinion. Int Urogynecol J 2024; 35:291-301. [PMID: 38252279 PMCID: PMC10908639 DOI: 10.1007/s00192-023-05694-z] [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: 08/18/2023] [Accepted: 11/06/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI. METHODS A working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion. RESULTS The R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations. CONCLUSIONS Mixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.
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Affiliation(s)
- Swati Jha
- Department of Urogynecology, Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK.
| | - Peter C Jeppson
- The Woman's Center for Advanced Pelvic Surgery, The University of Arizona, Phoenix, AZ, USA
| | - Fulya Dokmeci
- Department of Obstetrics & Gynecology, Ankara School of Medicine, Ankara University, Ankara, Türkiye
| | - Gisele V Marquini
- Federal University of Uberlândia (UFU), Minas Gerais, Brazil and Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Marair G F Sartori
- Urogynecology Division, Gynecology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Pamela Moalli
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shazia A Malik
- Female Pelvic Medicine & Reconstructive Surgery, Department of Ob/Gyn, University of Arizona COMPhoenix, Tucson, AZ, USA
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How about the RCTs' quality of acupuncture treatment for female urinary incontinence in recent 20 years? A report quality assessment. World J Urol 2023; 41:197-204. [PMID: 36445372 DOI: 10.1007/s00345-022-04213-x] [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: 09/01/2022] [Accepted: 11/02/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To evaluate the quality of randomized controlled trials (RCTs) of acupuncture on female urinary incontinence (UI). METHODS We searched for related RCTs of acupuncture on female UI from seven databases (PubMed, Embase, Cochrane library, Web of Science, Medline, ClinicalKey, and Clinical trials). We applied CONSORT (2010 year) and STRICTA criteria to evaluate the relevant factors of included RCTs. Two trained researchers scored independently, and concordance was assessed by Cohen's к-statistic. The median and interquartile range summarized the CONSORT and STRICTA scores of the included studies. In addition, two independent sample t tests were used to assess the differences in the study quality between the 2000-2010 and the 2011-2022 years. RESULTS A total of 25 RCTs were finally included, and the scores were consistent between different assessors. The average CONSORT score was 10.50 (IQR 9.0-15.0) (total score was 25.0). Overall, the studies generally included scientific background (24/25, 96%), inclusion and exclusion criteria (24/25, 96%), outcome indicators (24/25, 96%), randomization methods (21/25, 84%), generalizability (19/25, 76%), and financial support (15/25, 60%). Most lacked sample size calculation (5/25, 20%), type of randomization (5/25, 20%), blinding (6/25, 24%), case screening period and follow-up (4/25, 16%), and study registration (6/25, 24%), etc. The average STRICTA score was 3.380 (IQR 3.02-3.95) (total score was 6.0). There had a lack of education on treatment methods for patients (3/25, 12%) and the qualification of acupuncturists (6/25, 24%). CONCLUSION The overall quality of RCTs on acupuncture treatment of female UI was suboptimal. It is still necessary to improve the research methods, especially the application of random methods, blinding, the interpretation of treatment, and the identification qualification of acupuncturists.
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European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. Eur Urol 2022; 82:49-59. [PMID: 35216856 DOI: 10.1016/j.eururo.2022.01.045] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guideline expands the remit to include these symptoms and conditions. OBJECTIVE To summarise the diagnostic section of the non-neurogenic female LUTS guideline and the management of female overactive bladder (OAB), stress urinary incontinence (SUI), and mixed urinary incontinence (MUI). EVIDENCE ACQUISITION New literature searches were carried out in September 2021 and evidence synthesis was conducted using the modified GRADE criteria as outlined for all EAU guidelines. A new systematic review (SR) on OAB was carried out by the panel for the purposes of this guideline. EVIDENCE SYNTHESIS The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. CONCLUSIONS Non-neurogenic female LUTS are an important cause of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion based on the best available evidence. This guideline serves to present this evidence to health care providers in an easily accessible and digestible format. PATIENT SUMMARY This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to diagnosis of these conditions, as well as the treatment of overactive bladder, stress urinary incontinence, and mixed urinary incontinence.
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Ariman A, Merder E, Çulha MG. The effect of Mirabegron and Duloxetine combination in mixed-type urinary incontinence treatment. Rev Assoc Med Bras (1992) 2021; 67:713-717. [PMID: 34550261 DOI: 10.1590/1806-9282.20201166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Stress-type and urgency-type urinary incontinence are seen together in mixed-type urinary incontinence. Treatment is usually chosen according to the predominant type of incontinence. The aim of this study is to evaluate the effect of mirabegron and duloxetine combination in the treatment of mixed-type urinary incontinence. METHODS The data of 88 mixed-type urinary incontinence patients who applied to the urology outpatient clinic between January 2018 and December 2019 were retrospectively analyzed. We applied mirabegron and duloxetine treatment to the patients. The International Consultation of Incontinence Questionnaire-Short Form, Overactive bladder symptom score questionnaire and daily pad count were statistically evaluated before and after the treatment. RESULTS Statistically significant improvements were observed using the questionnaire forms and decreased daily pad usage after the eight-week treatment (p<0.001). Based on the clinical global effect scale, 62.50% of patients had a partial or complete response to treatment and also the use of daily pads were decreased from 3.7-0.89 on an average. CONCLUSION Combination use of mirabegron and duloxetine in the treatment of mixed-type urinary incontinence improved symptom scores and decreased pad usage.
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Affiliation(s)
- Ahmet Ariman
- Prof. Dr. Cemil Taşcıoğlu City Hospital - Şişli, Istanbul. Turkey
| | - Erkan Merder
- Prof. Dr. Cemil Taşcıoğlu City Hospital - Şişli, Istanbul. Turkey
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Rodrigues-Amorim D, Olivares JM, Spuch C, Rivera-Baltanás T. A Systematic Review of Efficacy, Safety, and Tolerability of Duloxetine. Front Psychiatry 2020; 11:554899. [PMID: 33192668 PMCID: PMC7644852 DOI: 10.3389/fpsyt.2020.554899] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Abstract
Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved for the treatment of patients affected by major depressive disorder (MDD), generalized anxiety disorder (GAD), neuropathic pain (NP), fibromyalgia (FMS), and stress incontinence urinary (SUI). These conditions share parallel pathophysiological pathways, and duloxetine treatment might be an effective and safe alternative. Thus, a systematic review was conducted following the 2009 Preferred Reporting Items (PRISMA) recommendations and Joanna Briggs Institute Critical (JBI) Appraisals guidelines. Eighty-five studies focused on efficacy, safety, and tolerability of duloxetine were included in our systematic review. Studies were subdivided by clinical condition and evaluated individually. Thus, 32 studies of MDD, 11 studies of GAD, 19 studies of NP, 9 studies of FMS, and 14 studies of SUI demonstrated that the measured outcomes indicate the suitability of duloxetine in the treatment of these clinical conditions. This systematic review confirms that the dual mechanism of duloxetine benefits the treatment of comorbid clinical conditions, and supports the efficacy, safety, and tolerability of duloxetine in short- and long-term treatments.
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Affiliation(s)
- Daniela Rodrigues-Amorim
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - José Manuel Olivares
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain.,Head of Department of Psychiatry, Health Area of Vigo, Servizo Galego de Saúde (SERGAS), Vigo, Spain.,Director Neuroscience Area, Galicia Sur Health Research Institute (IISGS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - Carlos Spuch
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - Tania Rivera-Baltanás
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
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Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review. J Gen Intern Med 2019; 34:1615-1625. [PMID: 31062225 PMCID: PMC6667523 DOI: 10.1007/s11606-019-05028-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/06/2019] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs). METHODS We systematically reviewed nonsurgical interventions for urgency, stress, or mixed UI in women, focusing on AEs. We searched MEDLINE®, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and Embase® through December 4, 2017. We included comparative studies and single-group studies with at least 50 women. Abstracts were screened independently in duplicate. One researcher extracted study characteristics and results with verification by another independent researcher. When at least four studies of a given intervention reported the same AE, we conducted random effects model meta-analyses of proportions. We also assessed the strength of evidence. RESULTS There is low strength of evidence that AEs are rare with behavioral therapies and neuromodulation, and that periurethral bulking agents may result in erosion and increase the risk of voiding dysfunction. High strength of evidence finds that anticholinergics and alpha agonists are associated with high rates of dry mouth and constitutional effects such as fatigue and gastrointestinal complaints. Onabotulinum toxin A (BTX) is also associated with increased risk of urinary tract infections (UTIs) and voiding dysfunction (moderate strength of evidence). DISCUSSION Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.
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Minagawa T, Gotoh M, Yokoyama O, Sugaya K, Yamanishi T, Kawahara K, Kaga K, Kikuchi T, Nishizawa O. Therapeutic effect of propiverine hydrochloride on mixed-type urinary incontinence in women: The Female Urgency and Stress Urinary Incontinence Study of Propiverine Hydrochloride trial. Int J Urol 2018; 25:486-491. [DOI: 10.1111/iju.13553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Momokazu Gotoh
- Department of Urology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Osamu Yokoyama
- Department of Urology; University of Fukui School of Medical Sciences; Fukui Japan
| | - Kimio Sugaya
- Department of Urology; Kitakami Central Hospital; Chatanchou Japan
| | - Tomonori Yamanishi
- Department of Urology; Continence Center; Dokkyo Medical University; Mibuchou Japan
| | | | - Kanya Kaga
- Department of Urology; Continence Center; Dokkyo Medical University; Mibuchou Japan
| | | | - Osamu Nishizawa
- Department of Urology; North Alps Medical Center Azumi Hospital; Ikedamachi Japan
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Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A, Bedretdinova DA, Ambühl D, Farag F, Lombardo R, Schneider MP, Burkhard FC. EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence. Eur Urol 2018; 73:596-609. [PMID: 29398262 DOI: 10.1016/j.eururo.2017.12.031] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/27/2017] [Indexed: 11/28/2022]
Abstract
CONTEXT The European Association of Urology guidelines on urinary incontinence (UI) have been updated in cyclical fashion with successive major chapters being revised each year. The sections on assessment, diagnosis, and nonsurgical treatment have been updated as of mid-2016. OBJECTIVE We present a condensed version of the full guideline on assessment and nonsurgical management of UI, with the aim of improving accessibility and increasing their dissemination. EVIDENCE ACQUISITION Our literature search was updated from the previous cut-off of July 2010 up to April 2016. Evidence synthesis was carried out by a pragmatic review of current systematic reviews and any newer subsequent high-quality studies, based on Population, Interevention, Comparator, and Outcome questions. Appraisal was conducted by an international panel of experts, working on a strictly nonprofit and voluntary basis, to develop concise evidence statements and action-based recommendations using modified Oxford and GRADE criteria. EVIDENCE SYNTHESIS The guidelines include algorithms that summarise the suggested pathway for standard, uncomplicated patients with UI and are more useable in daily practice. The full version of the guideline is available at http://uroweb.org/guideline/urinary-incontinence/. CONCLUSIONS These updated guidelines provide an evidence-based summary of the assessment and nonsurgical management of UI, together with a clear clinical algorithm and action-based recommendations. Although these guidelines are applicable to a standard patient, it must be remembered that therapy should always be tailored to individual patients' needs and circumstances. PATIENT SUMMARY Urinary incontinence is a very common condition which negatively impacts patient's quality of life. Several types of incontinence exist and since the treatments will vary, it is important that the diagnostic evaluation establishes which type is present. The diagnosis should also identify patients who need rapid referral to an appropriate specialist. These guidelines aim to provide sensible and practical evidence-based guidance on the clinical problem of urinary incontinence.
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Affiliation(s)
- Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK.
| | - Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Francisco Cruz
- Department of Urology, Hospital São João/Faculty of Medicine of Porto, Porto, Portugal
| | - Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Centre, TX, USA
| | - Nikesh Thiruchelvam
- Urology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Andrea Tubaro
- Department of Urology, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | | | - David Ambühl
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Riccardo Lombardo
- Department of Urology, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Marc P Schneider
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Fiona C Burkhard
- Department of Urology, University Hospital Bern, Bern, Switzerland
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Sacco E, Pinto F, Tienforti D, Marangi F, Destito A, Racioppi M, Gardi M, Volpe A, Bassi P. Investigational Drug Therapies for Overactive Bladder Syndrome: The Potential Alternatives to Anticolinergics. Urologia 2018. [DOI: 10.1177/039156030907600301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Overactive bladder is a high prevalent and quality of life affecting disease. The mainstay of the medical therapy is represented by antimuscarinic drugs, but their side effects markedly affect patient compliance and prompt studies on novel investigational drugs. Methods A systematic literature search of peer-reviewed papers and meeting abstracts published by December 2008 was performed. PubMed databank was searched for original English articles, by using the following search terms: “overactive bladder” or “detrusor overactivity” or “urinary incontinence” and “treatment”, alone and linked to any potential molecular target or novel drug cited in the literature. Results Effective alternative pharmacological treatments are currently scarce, but many new promising compounds are emerging which target key molecular pathways involved in micturition control. The most promising potential therapeutic targets include central nervous system GABAergic inhibitory pathway, dopaminergic and serotoninergic systems, b-adrenoceptors and cAMP metabolism, nonadrenergic-noncholinergic mechanisms such as purinergic and neuropeptidergic systems, vanilloid receptor, bladder sensory nervous terminals, nonneuronal bladder signalling systems including urothelium and interstitial cells, prostanoids, Rho-kinase and different subtypes of potassium and calcium channels. Conclusions Despite the enormous amount of new biologic insight, very few novel pharmacological therapies seems to have passed the proof-of-concept clinical stage. The ultimate clinical utility of new drugs will depend on the ability to exploit tissue-specific differences and disease-related changes in molecular expression/function and to improve storage phase dysfunctions without interfering with the emptying phase. Further preclinical investigations and controlled clinical trials are urgently needed in this challenging field.
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Affiliation(s)
- E. Sacco
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
| | - F. Pinto
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
| | - D. Tienforti
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
| | - F. Marangi
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
| | - A. Destito
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
| | - M. Racioppi
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
| | - M. Gardi
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
| | - A. Volpe
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
| | - P.F. Bassi
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università’ Cattolica del Sacro Cuore, Roma
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Khoo CCK, Kujawa M, Reid S, Sahai A. Mixed urinary incontinence- what should we treat first? JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817693466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mixed urinary incontinence (MUI) is defined as ‘the involuntary loss of urine associated with urgency and also with effort or physical exertion, or on sneezing or coughing’. It is highly prevalent, increases with age and affects women more than men. It has a significant negative impact on health-related quality of life (HRQL). Additionally, treatment of mixed urinary incontinence places a large financial burden on both individuals and the NHS. Optimal management of this common condition is contested – should we treat the urge urinary incontinence (UUI), stress urinary incontinence (SUI) or predominant symptom first? At the 2015 BAUS Section of Female, Neurological and Urodynamic Urology this subject was debated. Based on a common scenario, the authors of the debate present the arguments for treating the urge urinary incontinence component, stress urinary incontinence component or the predominant symptom of mixed urinary incontinence first, before making recommendations for current practice.
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Affiliation(s)
- CCK Khoo
- Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK
| | - M Kujawa
- Department of Urology, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, Cheshire, UK
| | - S Reid
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, UK
| | - A Sahai
- Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, Guy’s Hospital, King’s Health Partners, London, UK
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Chughtai B, Laor L, Dunphy C, Lee R, Te A, Kaplan S. Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women. Rev Urol 2016; 17:78-83. [PMID: 27222643 DOI: 10.3909/riu0653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Leanna Laor
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Claire Dunphy
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Richard Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Steven Kaplan
- Department of Urology, Weill Cornell Medical College, New York, NY
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Sacco E, Bientinesi R. Innovative pharmacotherapies for women with overactive bladder: where are we now and what is in the pipeline? Int Urogynecol J 2014; 26:629-40. [PMID: 25377296 DOI: 10.1007/s00192-014-2557-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/18/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impressive prevalence of overactive bladder (OAB) and the relevant limitations of current treatments urge the need for novel therapeutic approaches. METHODS A systematic literature and web search was performed to identify investigational drugs that entered the early and late phases of clinical development for women with OAB symptoms. RESULTS Approved pharmacological therapies for OAB (antimuscarinics, beta-3 agonists, and botulinum toxin) are evolving with the development of alternative administration methods, combination strategies, and novel compounds, expected to improve effectiveness, bladder selectivity, and dose flexibility. A wealth of investigational compounds, developed with both public and companies' indoor nonclinical disease-oriented studies, entered the early and late stages of clinical development in the last decade. Most non-anticholinergic compounds in ongoing clinical trials target central and peripheral neurotransmitter receptors involved in neurological modulation of micturition, nonadrenergic-noncholinergic mechanisms, cyclic nucleotide metabolism, different subtypes of ion channels or peripheral receptors of prostaglandins, vanilloids, vitamin D3, and opioids. Fascinating advances are ongoing also in the field of genetic therapy. CONCLUSIONS New pharmaceutical formulations and drug combinations are expected to be available in the next decade in order to overcome the limitations of current drugs for OAB. Although proof-of-concept, patient-oriented studies yielded disappointing results for several tentative drugs, a lot of clinical research is ongoing that is expected to provide clinicians with novel therapeutic agents in the near future.
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Affiliation(s)
- Emilio Sacco
- Department of Urology, "Agostino Gemelli" Hospital, Catholic University Medical School, Rome, Italy,
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Song QX, Chermansky CJ, Birder LA, Li L, Damaser MS. Brain-derived neurotrophic factor in urinary continence and incontinence. Nat Rev Urol 2014; 11:579-88. [PMID: 25224451 DOI: 10.1038/nrurol.2014.244] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Urinary incontinence adversely affects quality of life and results in an increased financial burden for the elderly. Accumulating evidence suggests a connection between neurotrophins, such as brain-derived neurotrophic factor (BDNF), and lower urinary tract function, particularly with regard to normal physiological function and the pathophysiological mechanisms of stress urinary incontinence (SUI) and bladder pain syndrome/interstitial cystitis (BPS/IC). The interaction between BDNF and glutamate receptors affects both bladder and external urethral sphincter function during micturition. Clinical findings indicate reduced BDNF levels in antepartum and postpartum women, potentially correlating with postpartum SUI. Experiments with animal models demonstrate that BDNF is decreased after simulated childbirth injury, thereby impeding the recovery of injured nerves and the restoration of continence. Treatment with exogenous BDNF facilitates neural recovery and the restoration of continence. Serotonin and noradrenaline reuptake inhibitors, used to treat both depression and SUI, result in enhanced BDNF levels. Understanding the neurophysiological roles of BDNF in maintaining normal urinary function and in the pathogenesis of SUI and BPS/IC could lead to future therapies based on these mechanisms.
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Affiliation(s)
- Qi-Xiang Song
- Department of Urology, Changhai Hospital, Shanghai, PR China
| | - Christopher J Chermansky
- Department of Urology, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Longkun Li
- Department of Urology, Second Affiliated Hospital of TMMU, Chongqing, PR China
| | - Margot S Damaser
- Department of Biomedical Engineering, The Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH 44195, USA
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Kammerer-Doak D, Rizk DEE, Sorinola O, Agur W, Ismail S, Bazi T. Mixed urinary incontinence: international urogynecological association research and development committee opinion. Int Urogynecol J 2014; 25:1303-12. [PMID: 25091925 DOI: 10.1007/s00192-014-2485-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM The definition as well as the treatment of women with mixed urinary incontinence (MUI) is controversial. Since women with MUI are a heterogeneous group, the treatment of MUI requires an individual assessment of the symptom components: stress urinary incontinence, urinary urgency, urgency urinary incontinence, urinary frequency, and nocturia. The purpose of this paper is to summarize the current literature and give an evidence-based review of the assessment and treatment of MUI. METHODS A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the diagnosis and management of MUI was drafted based on a literature review. After evaluation by the entire IUGA R&D Committee, revisions were made, and the final document represents the IUGA R&D Committee Opinion on MUI. RESULTS This R&D Committee Opinion reviews the literature on MUI and summarizes the assessment and treatment with evidence-based recommendations. CONCLUSIONS The diagnosis of MUI encompasses a very heterogeneous group of women. The evaluation and treatment requires an individualized approach. The use of validated questionnaires is recommended to assess urinary incontinence symptoms and effect on quality of life. Conservative therapy is suggested as a first-line approach; if surgery is contemplated, urodynamic investigation is recommended. Women undergoing surgical treatment for MUI need to be counselled about the possibility of persistence of urinary urgency, frequency and urge incontinence even if stress urinary incontinence is cured.
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Affiliation(s)
- Dorothy Kammerer-Doak
- Women's Pelvic Specialty Care P.C, University of New Mexico Hospital, Albuquerque, NM, USA
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Do predictive parameters exist for therapy with duloxetine in women with stress urinary incontinence? Int Urogynecol J 2014; 25:1071-9. [DOI: 10.1007/s00192-014-2358-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
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Perahia DG, Bangs ME, Zhang Q, Cheng Y, Ahl J, Frakes EP, Adams MJ, Martinez JM. The risk of bleeding with duloxetine treatment in patients who use nonsteroidal anti-inflammatory drugs (NSAIDs): analysis of placebo-controlled trials and post-marketing adverse event reports. DRUG HEALTHCARE AND PATIENT SAFETY 2013; 5:211-9. [PMID: 24348072 PMCID: PMC3849082 DOI: 10.2147/dhps.s45445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To assess the safety of duloxetine with regards to bleeding-related events in patients who concomitantly did, versus did not, use nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin. Methods Safety data from all placebo-controlled trials of duloxetine conducted between December 1993 and December 2010, and post-marketing reports from duloxetine-treated patients in the US Food and Drug Administration Adverse Event Reporting System (FAERS), were searched for bleeding-related treatment-emergent adverse events (TEAEs). The percentage of patients with bleeding-related TEAEs was summarized and compared between treatment groups in all the placebo-controlled studies. Differences between NSAID user and non-user subgroups from clinical trial data were analyzed by a logistic regression model that included therapy, NSAID use, and therapy-by-NSAID subgroup interaction. In addition, to determine if higher duloxetine doses are associated with an increased incidence of bleeding-related TEAEs, and whether the use of concomitant NSAIDs might influence the dose effect if one exists, placebo-controlled clinical trials with duloxetine fixed doses of 60 mg, 120 mg, and placebo were analyzed. Also, the incidence of bleeding-related TEAEs reported for duloxetine alone was compared with the incidence in patients treated with duloxetine and concomitant NSAIDs. Finally, the number of bleeding-related cases reported for duloxetine in the FAERS database was compared with the numbers reported for all other drugs. Results Across duloxetine clinical trials, there was a significantly greater incidence of bleeding-related TEAEs in duloxetine- versus placebo-treated patients overall and also in those patients who did not take concomitant NSAIDS, but no significant difference was seen among those patients who did take concomitant NSAIDS. There was no significant difference in the incidence of bleeding-related TEAEs in the subset of patients treated with duloxetine 120 mg once daily versus those treated with 60 mg once daily regardless of concomitant NSAID use. The combination of duloxetine and NSAIDs was associated with a statistically significantly higher incidence of bleeding-related TEAEs compared with duloxetine alone. A similarly higher incidence of bleeding-related TEAEs was seen in patients treated with placebo and concomitant NSAIDs compared with placebo alone. Bleeding-related TEAEs reported in the FAERS database were disproportionally more frequent for duloxetine taken with NSAIDs compared with the full FAERS background, but there was no difference in the reporting of bleeding-related TEAEs when the cases reported for duloxetine taken with NSAIDs were compared against the cases reported for NSAIDs alone. Conclusion Concomitant use of NSAIDs was associated with a higher incidence of bleeding-related TEAEs in clinical trials regardless of whether patients were taking duloxetine or placebo; bleeding-related TEAEs did not appear to increase along with duloxetine dose regardless of NSAID use. In spontaneously reported post-marketing data, the combination of duloxetine and NSAID use was not associated with an increased reporting of bleeding-related events when compared to NSAID use alone.
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Affiliation(s)
- David G Perahia
- Neurosciences, Lilly Research Centre, Windlesham, Surrey, UK
| | - Mark E Bangs
- Neurosciences, Eli Lilly and Company, Indianapolis, IN, USA
| | - Qi Zhang
- Neurosciences, Eli Lilly and Company, Indianapolis, IN, USA
| | - Yingkai Cheng
- Neurosciences, Eli Lilly and Company, Indianapolis, IN, USA
| | - Jonna Ahl
- Neurosciences, Eli Lilly and Company, Indianapolis, IN, USA
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Abstract
Although common in women, mixed urinary incontinence (MUI) is under-reported and under-treated. It is linked to concomitant disturbances, which may be due to childbirth, ageing, or other medical conditions, in the complex bladder-urethra coordinated system of urine storage and emptying. Primary care physicians can evaluate MUI through history and simple clinical assessment or they can avail of more complex device and tools, such as urodynamic assessment. There is a wide range of therapeutic options. The recent proliferation of new drug treatments and surgical devices for urinary incontinence offers innovative strategies for therapy but products risk being introduced without long-term safety and efficacy assessment. Direct-to-consumer advertising has increased public awareness of MUI.
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Affiliation(s)
- Massimo Porena
- Department of Medical-Surgical Specialties and Public Health, Urology and Andrology Section, University of Perugia, Ospedale S. Maria della Misericordia. Loc. S. Andrea delle Fratte, Perugia, 06100 Italy
| | - Elisabetta Costantini
- Department of Medical-Surgical Specialties and Public Health, Urology and Andrology Section, University of Perugia, Ospedale S. Maria della Misericordia. Loc. S. Andrea delle Fratte, Perugia, 06100 Italy
| | - Massimo Lazzeri
- Department of Medical-Surgical Specialties and Public Health, Urology and Andrology Section, University of Perugia, Ospedale S. Maria della Misericordia. Loc. S. Andrea delle Fratte, Perugia, 06100 Italy
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Chang SR, Chen KH, Chang TC, Lin HH. A Taiwanese version of the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form for pregnant women: instrument validation. J Clin Nurs 2011; 20:714-22. [DOI: 10.1111/j.1365-2702.2010.03364.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Nitti VW, Kopp Z, Lin ATL, Moore KH, Oefelein M, Mills IW. Can we predict which patient will fail drug treatment for overactive bladder? A think tank discussion. Neurourol Urodyn 2010; 29:652-7. [PMID: 20432330 DOI: 10.1002/nau.20910] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The treatment of overactive bladder (OAB) has evolved over the past 20 years to include a number of behavioral, pharmacological, and minimally invasive treatments. After behavioral therapy, pharmacological therapy with antimuscarinics remains the mainstay of treatment. Despite this, a large number of patients will "fail" or be unsatisfied with drugs therapy. It would be extremely helpful to patients and clinicians to be able to predict who those patients are. However, there are a number of barriers. First and foremost are defining "success" and "failure" and this can vary dramatically from one patient to another. Endpoints other than the traditional variables used in clinical trials may be more effective in evaluating treatments and helping to predict outcomes. Along similar lines, there are various definitions for OAB that is "refractory" to conventional treatments and this term needs clarification. In many cases, response to therapy may be affected by factors such as comorbidities, metabolism of drugs, concurrent therapies, etc. These factors are sometimes obvious and sometimes not, and for a variety of reasons it can be quite difficult to predict or determine their effect on outcome. Finally, many patients with OAB include have mixed (stress and urgency) symptoms. It is important to sort out the OAB component of mixed symptoms and mixed urinary incontinence (MUI) when determining effects of therapy.
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Affiliation(s)
- Victor W Nitti
- Urogynaecology Department, Cambridge Wing, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed St, London, UK.
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Pérez-Martínez FC, Vela-Navarrete R, Virseda J, Ocaña AV, Lluel P, Rekik M, Bienaymé H, Ferté J, Attali P, Palea S. Halothane-anesthetized rabbit: a new experimental model to test the effects of besipirdine and duloxetine on lower urinary tract function. Urol Int 2010; 86:210-9. [PMID: 21071917 DOI: 10.1159/000321226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 09/10/2010] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The effects of besipirdine and its main metabolite, HP-748, as well as duloxetine and tomoxetine in the lower urinary tract (LUT) were studied using in vitro and in vivo techniques. MATERIALS AND METHODS For in vivo studies, besipirdine or duloxetine effects on cystometric parameters and striated sphincter electromyographic (SS-EMG) activity were investigated. On the isolated urethra, norepinephrine (NE) concentration-response curves (CRC) were performed in the presence of besipirdine, duloxetine or tomoxetine. Moreover, CRC to HP-748 were constructed in the absence or presence of prazosin. Potency (pEC(50)) and maximal responses (E(max)) were determined. RESULTS Besipirdine at 1, 3 and 5 mg/kg intravenously (i.v.) induced a significant increase in SS-EMG activity (250, 273 and 241%, respectively), bladder capacity (172, 197, and 235%, respectively), intercontraction interval (ICI; 208, 242, and 400%, respectively), and residual volume (181, 191, and 236%, respectively). Duloxetine at 2 mg/kg i.v. increased significantly SS-EMG activity (219%), micturition volume (222%), and ICI (205%). In the isolated urethra, besipirdine, tomoxetine and duloxetine significantly displaced to the left the NE CRC. In addition, HP-748 induced contraction of the isolated urethra with a pEC(50) of 5.89 and an E(max) of 37%. CONCLUSIONS These data support the potential of besipirdine as a new drug for LUT dysfunctions such as stress and mixed urinary incontinence.
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Brunton S, Wang F, Edwards SB, Crucitti AS, Ossanna MJ, Walker DJ, Robinson MJ. Profile of adverse events with duloxetine treatment: a pooled analysis of placebo-controlled studies. Drug Saf 2010; 33:393-407. [PMID: 20397739 DOI: 10.2165/11319200-000000000-00000] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The serotonin and noradrenaline (norepinephrine) reuptake inhibitor duloxetine has been approved in the US and elsewhere for a number of indications, including psychiatric illnesses and chronic pain conditions. Because the patient populations are diverse within these approved indications, and duloxetine is not yet approved for treatment of other conditions, we wanted to determine if adverse event profiles would differ among patients being treated for these various conditions. OBJECTIVE To provide detailed information on the adverse events associated with duloxetine and to identify differences in the adverse event profile between treatment indications and patient demographic subgroups. METHODS Data were analysed from all placebo-controlled trials of duloxetine completed as of December 2008. The 52 studies included 17,822 patients (duloxetine n = 10,326; placebo n = 7496) with major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia, osteoarthritis knee pain (OAKP), chronic lower back pain and lower urinary tract disorders. The main outcome measures were rates of treatment-emergent adverse events (TEAEs) and adverse events reported as the reason for discontinuation. RESULTS The overall TEAE rate was 57.2% for placebo-treated patients and 72.4% for duloxetine-treated patients (p < or = 0.001). Patients with OAKP had the lowest TEAE rate (placebo 36.7% vs duloxetine 50.2%, p < or = 0.01), while patients with fibromyalgia had the highest rate (placebo 80.0% vs duloxetine 89.0%, p < or = 0.001). The most common TEAE for all indications was nausea (placebo 7.2% vs duloxetine 23.4%, p < or = 0.001), which was predominantly mild to moderate in severity. No statistically significant treatment-by-subgroup interactions for age were found between placebo and duloxetine treatment for the most common TEAEs. The rates of duloxetine-associated dry mouth and fatigue were greater in women than in men (13.1% vs 10.4%, interaction p = 0.004; and 9.4% vs 7.6%, interaction p = 0.03, respectively). Duloxetine-associated dry mouth incidence was higher in Caucasians than non-Caucasians (13.2%, 11.0%, interaction p = 0.04). CONCLUSIONS Duloxetine treatment is associated with significantly higher rates of common TEAEs versus placebo, regardless of indication or demographic subgroup. Differences across indications are likely to be attributable to the underlying condition rather than duloxetine, as suggested by the similar trends observed in placebo- and duloxetine-treated patients.
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Affiliation(s)
- Stephen Brunton
- Faculty Development, Cabarrus Family Medicine Residency, Concord, North Carolina, USA
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23
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DeLancey JOL, Fenner DE, Guire K, Patel DA, Howard D, Miller JM. Differences in continence system between community-dwelling black and white women with and without urinary incontinence in the EPI study. Am J Obstet Gynecol 2010; 202:584.e1-584.e12. [PMID: 20510959 DOI: 10.1016/j.ajog.2010.04.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 02/02/2010] [Accepted: 04/14/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to compare continence system function of black and white women in a population-based sample. STUDY DESIGN As part of a cross-sectional population-based study, black and white women ages 35-64 years were invited to have pelvic floor testing to achieve prespecified groups of women with and without urinary incontinence. We analyzed data collected from 335 women classified as continent (n = 137) and stress (n = 102) and urge (n = 96) incontinent based on full bladder stress test and symptoms. Continence system functions were compared across racial and continence groups. RESULTS Comparing black to white women, maximal urethral closure pressure (MUCP) was 22% higher in blacks than whites (68.0 vs 55.8 cm H(2)O, P < .0001). White and black women with stress incontinence had MUCP 19% and 23% lower than continent women. MUCP in urge incontinent white women was as low as stress incontinent whites, but blacks with urge had normal urethral function. CONCLUSION Black women have higher urethral closure pressures than white women. White women with urge incontinence, but not black women, have reduced MUCP.
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Affiliation(s)
- John O L DeLancey
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA.
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Vella M, Duckett J, Basu M. The predictive value of pre-treatment cystometry in the outcome of women with mixed incontinence treated with duloxetine. Eur J Obstet Gynecol Reprod Biol 2010; 151:221-3. [PMID: 20434256 DOI: 10.1016/j.ejogrb.2010.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/19/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Whilst auditing the results of women treated with duloxetine, it was noted that some women with mixed urodynamic stress incontinence (USI) and detrusor overactivity (DO) reported worsening of their incontinence. Duloxetine works by increasing urethral resistance and may alter voiding function. Worsening voiding may result in worsening irritative symptoms. The aim of our study was to assess whether pre-treatment pressure flow studies predicted which women with mixed USI and DO became worse after treatment with duloxetine. STUDY DESIGN Women were recruited from our one-stop urogynaecology clinic. All women complained of troublesome mixed urinary symptoms with moderate or severe stress incontinence. Their initial assessment included a detailed history, a physical examination, a 3-day urinary diary, King's Quality of Life questionnaire and filling cystometry. RESULTS Fifty seven women were recruited. Thirty (52%) women recorded an improvement in their patient global impression of improvement (PGI-I) score; 18 (32%) recorded no change and nine (16%) women reported worsening bladder symptoms. Pressure flow studies of women who recorded a worsening of their incontinence were compared to those women who recorded no change or an improvement of their incontinence. The maximum flow rate (p=0.78), average flow rate (p=0.61), bladder capacity (p=0.14), detrusor pressure at maximum flow (p=0.68) and volume voided (0.66) showed no statistical difference when the two groups were compared. The pre-treatment voiding time (p=0.04) was statistically longer in women who got worse following treatment with duloxetine. CONCLUSION Pre-treatment pressure flow studies may be useful in predicting the outcome of treatment with duloxetine. Women who report worsening of their incontinence are more likely to have a longer voiding time compared to women who do not report worsening. Hence a prolonged voiding time may predict a poorer outcome for women treated with duloxetine.
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Affiliation(s)
- Maria Vella
- Department of Obstetrics and Gynaecology, Urogynaecology Unit, Medway Maritime Hospital, Windmill Road, Gillingham, Kent ME7 5NY, United Kingdom.
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Kerdraon J, Denys P. [Conservative treatment of female stress urinary incontinence]. J Gynecol Obstet Hum Reprod 2009; 38:S174-S181. [PMID: 20141916 DOI: 10.1016/s0368-2315(09)73577-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To synthethise evidence based results related to non surgical management for urinary incontinence in women. MATERIALS AND METHODS Electronic search in Pubmed, Cinahl, Cochrane Library, National Library for Health. RESULTS There were 72 randomized control studies and 8 reviews from the Cochrane Library. CONCLUSION Moderate to high levels of evidence suggest that pelvic muscle training and bladder training may resolve urinary incontinence in women. A weight loss program from obesity state improve urinary continence. The effects of electrical stimulation of pelvic floor, oestrogene therapy were inconstant or inhomogeneous. Duloxetine may improve continence and quality of life but it's range in therapeutic algorithm is still to be defined.
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Affiliation(s)
- J Kerdraon
- Centre mutualiste de Kerpape, BP 78, 56275 Ploemeur cedex, France.
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Klovning A, Avery K, Sandvik H, Hunskaar S. Comparison of two questionnaires for assessing the severity of urinary incontinence: The ICIQ-UI SF versus the incontinence severity index. Neurourol Urodyn 2009; 28:411-5. [PMID: 19214996 DOI: 10.1002/nau.20674] [Citation(s) in RCA: 227] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS To compare the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) with the Incontinence Severity Index (ISI), and to propose intervals for four severity levels of ICIQ-UI SF. METHODS Cross-sectional, Internet-based study of 1,812 women responding to a general health questionnaire. Four severity levels for the ICIQ-UI SF scores were constructed by iteratively adjusting the ranges for these levels until maximum Kappa scores were obtained when cross-tabulated with the ISI in a random sample of half of the women with urinary incontinence. Using these intervals, weighted Kappa was calculated for the remaining women as a validation process. RESULTS Three hundred forty-three women had urinary incontinence, and completed the ISI and the ICIQ-UI SF. A high correlation between the ISI and ICIQ-UI SF scores with versus without the QoL item was found (Spearman's rho = 0.62, P < 0.01 vs. rho = 0.71, P < 0.01, respectively). Maximum Kappa with quadratic weighting was obtained for the following scale for the ICIQ-UI SF: slight (1-5), moderate (6-12), severe (13-18) and very severe (19-21) (Kappa = 0.61), and without the QoL item: slight (1-3), moderate (4-5), severe (6-9) and very severe (10-11) (Kappa = 0.71) in the development sample. Correspondingly, for the validating sample, maximum Kappa with quadratic weighting was 0.61 and 0.74. CONCLUSIONS A high correlation between the ICIQ-UI SF and the ISI was found. The ICIQ-UI SF may be divided into the following four severity categories: slight (1-5), moderate (6-12), severe (13-18) and very severe (19-21). Neurourol. Urodynam. 28:411-415, 2009. (c) 2009 Wiley-Liss, Inc.
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Affiliation(s)
- Atle Klovning
- Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen, Kalfarveien, 31, N-5018, Bergen, Norway.
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Pharmacological treatment of overactive bladder: report from the International Consultation on Incontinence. Curr Opin Urol 2009; 19:380-94. [DOI: 10.1097/mou.0b013e32832ce8a4] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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28
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Brostrøm S. Which nonsurgical options are effective for the treatment of female urinary incontinence? NATURE CLINICAL PRACTICE. UROLOGY 2008; 5:532-533. [PMID: 18728631 DOI: 10.1038/ncpuro1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 07/17/2008] [Indexed: 05/26/2023]
Affiliation(s)
- Søren Brostrøm
- Department of Obstetrics and Gynecology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark.
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Schagen van Leeuwen JH, Lange RR, Jonasson AF, Chen WJ, Viktrup L. Efficacy and safety of duloxetine in elderly women with stress urinary incontinence or stress-predominant mixed urinary incontinence. Maturitas 2008; 60:138-47. [PMID: 18547757 DOI: 10.1016/j.maturitas.2008.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 04/22/2008] [Accepted: 04/29/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of duloxetine in community-dwelling women > or =65 years with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (S-MUI) versus placebo. METHODS Patients were randomly assigned for 12 weeks to placebo (N=134) or duloxetine (N=131) (20mg twice daily [BID] for 2 weeks and 40 mg BID for an additional 10 weeks), followed by a double-blind 4-week dose de-escalation/discontinuation phase. The primary efficacy variable was the percent change in incontinence episode frequency (IEF) from baseline to endpoint. Other variables included absolute IEF change, responder rate, changes in mean time between voids (MTBV), weekly continence pad usage, the impact of treatment on quality of life, patient's global impression of improvement (PGI-I), and changes in depression and cognition. RESULTS Duloxetine-treated patients had a significantly greater decrease from baseline to endpoint in mean IEF/week than placebo-treated patients (-52.47% vs. -36.70%, P<0.001). The IEF responder rate (> or =50% reduction in IEF/week) was 57.1% in the duloxetine group and 35.2% in the placebo group (P<0.001). Significant benefits of duloxetine were also demonstrated for weekly continence pad usage (P=0.011), MTBV (P<0.001), incontinence quality of life questionnaire (I-QOL) scores (P<0.001), and PGI-I ratings (P<0.001). Patients with depressive symptoms and cognitive impairments were few and changes were insignificant. The proportion of patients with > or =1 treatment-emergent adverse event (TEAE) was similar with both treatments, but dry mouth, fatigue, constipation, and hyperhidrosis were significantly more common in women taking duloxetine. CONCLUSIONS Duloxetine is a safe and effective treatment for elderly women with symptoms of SUI or S-MUI.
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Vella M, Duckett J, Basu M. Duloxetine 1 year on: the long-term outcome of a cohort of women prescribed duloxetine. Int Urogynecol J 2008; 19:961-4. [PMID: 18231697 DOI: 10.1007/s00192-008-0564-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 01/06/2008] [Indexed: 10/22/2022]
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Emerging pharmacological targets in overactive bladder therapy: experimental and clinical evidences. Int Urogynecol J 2008; 19:583-98. [PMID: 18196198 DOI: 10.1007/s00192-007-0529-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 11/25/2007] [Indexed: 02/06/2023]
Abstract
Antimuscarinics are the mainstay of the medical therapy for overactive bladder, but their side effects and often modest success have prompted studies on novel pharmacological approaches. In this paper, we give a systematic literature review of peer-reviewed papers on the subject. Effective nonantimuscarinic treatments are currently scarce, but many new promising compounds are emerging, which target key molecular pathways involved in micturition control. The most promising potential therapeutic targets include: nervous GABAergic, glycinergic, dopaminergic, and serotonergic systems; b-adrenoceptors and cAMP metabolism; nonadrenergic-noncholinergic mechanisms such as purinergic and neuropeptidergic systems; vanilloid receptors; bladder afferent nerves; nonneuronal bladder signaling systems including urothelium and interstitial cells; prostanoids; Rho-kinase; and different subtypes of potassium and calcium channels. Despite the enormous amount of new biologic insight, very few drugs with mechanism of action other than antimuscarinics have passed as yet the proof-of-concept stage. Further preclinical and clinical studies are urgently needed in this rapidly moving field.
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