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Bele U, Serdinšek T, Homšak E, But I. The Impact of Extracorporeal Magnetic Stimulation as Addition to Mirabegron in Overactive Bladder Treatment in Women: A Single-Centre Randomized Sham-Controlled Study. J Clin Med 2024; 13:916. [PMID: 38337609 PMCID: PMC10856599 DOI: 10.3390/jcm13030916] [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: 01/14/2024] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: The purpose of our prospective, single-blinded, randomized, sham-controlled study was to investigate the effect of the additional extracorporeal magnetic stimulation (ExMI) to pharmacological treatment in overactive bladder syndrome (OAB) in women. (2) Methods: We recruited 56 women with OAB, who were allocated into two study groups: the active group received mirabegron 50 mg daily and a total of 16 sessions of ExMI in 8 weeks, whereas the sham group received mirabegron 50 mg daily and sham stimulation following the same treatment protocol. Treatment success was evaluated after 4 and 8 weeks. (3) Results: Both groups experienced significant reduction in daytime urinary frequency, nocturia, and number of weekly incontinence episodes after 8 weeks. There were no statistically significant differences in end-point daytime urinary frequency and nocturia between groups. However, the overall average reduction rate in weekly number of incontinence episodes was 43.7% in treatment group and 24.2% in the control group. The number of urinary incontinence episodes in the treatment and control group was reduced for 3.8 ± 11.8 vs. 2.5 ± 4.3 episodes at week 4 and additional 3.3 ± 6 vs. 0.4 ± 3.2 episodes at week 8, respectively (p = 0.013). Moreover, IIQ-7 score showed a significantly greater score reduction and patients' evaluated improvement of symptoms was higher in the active group. (4) Conclusions: The addition of ExMI to mirabegron in OAB treatment further improves the weekly incontinence episode reduction rate and also leads to grater improvement in symptoms.
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Affiliation(s)
- Uros Bele
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia; (U.B.); (I.B.)
- Department for Urology, University Hospital Graz, 8036 Graz, Austria
| | - Tamara Serdinšek
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia; (U.B.); (I.B.)
- Department of General Gynaecology and Gynaecologic Urology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Evgenija Homšak
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia; (U.B.); (I.B.)
- Department of Laboratory Diagnostics, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Igor But
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia; (U.B.); (I.B.)
- Department of General Gynaecology and Gynaecologic Urology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, 2000 Maribor, Slovenia
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Zhang X, Li M, Dong W, Lv X, Li L, Yang X, Cao Y. Prevalence and influencing factors of lower urinary tract symptoms in female nurses: a cross-sectional study based on TARGET. Front Public Health 2023; 11:1201184. [PMID: 37404267 PMCID: PMC10315681 DOI: 10.3389/fpubh.2023.1201184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Background Even though occupational women have a high incidence of lower urinary tract symptoms (LUTS), which seriously affect their daily work life, few large scale sample studies have provided empirical evidence to support this phenomenon among female nurses in China. Consequently, this article investigated female nurses who was presupposed to have a high prevalence of LUTS, which adversely exposes their health and patient safety to these risks. Additionally, it is considered important to explore the factors associated with LUTS in female nurses for patient care safety and nurse bladder health practice. Objectives The purpose of this study was to assess the incidence of LUTS and symptoms-related risk factors among female nurses, to provide evidence for the prevention and control of LUTS. Methods An online survey recruiting 23,066 participants was carried out in a multicenter cross-sectional study in 42 hospitals from December 2020 to November 2022. Stepwise multivariate logistic regression analysis and nomogram were used to identify the factors associated with lower urinary tract symptoms. Besides, SPSS version 26.0, R version 4.2.2, and GraphPad Prism Version 8.3 software packages were used for statistical analysis. Results Based on the completion rate of the questionnaire which was 84.1% (n = 19,393), it was found that among 19,393 female nurses, the prevalence of LUTS was 67.71% and this rate was influenced by age, Body Mass Index (BMI), marital status, years of working, menstrual status, mode of delivery, history of breastfeeding, history of miscarriage, history of alcohol and coffee or tea consumption (p < 0.05). Interestingly, we also find that in addition to the above mentioned factors, anxiety, depression, and perceived stress were also related to LUTS in female nurses (p < 0.05). Conclusion Given the high prevalence of LUTS among female nurses and their potential influencing factors, female nurses should focus on their reproductive health and develop good lifestyle habits. Thus, nursing managers should provide a warm and harmonious work environment and sensitize female nurses to increase their awareness about the importance of drinking clean water and urinating during work in a hygienic environment.
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Affiliation(s)
- Xinyue Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Mengli Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Wenshuo Dong
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Xiaoyan Lv
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
| | - Li Li
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
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Sartori LGF, Nunes BM, Farah D, Oliveira LMD, Novoa CCT, Sartori MGF, Fonseca MCM. Mirabegron and Anticholinergics in the Treatment of Overactive Bladder Syndrome: A Meta-analysis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:337-346. [PMID: 37494577 PMCID: PMC10371066 DOI: 10.1055/s-0043-1770093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE To compare the use of mirabegron with anticholinergics drugs for the treatment of overactive bladder (OB). DATA SOURCE Systematic searches were conducted in EMBASE, PUBMED, Cochrane, and LILACS databases from inception to September 2021. We included RCTs, women with clinically proven OB symptoms, studies that compared mirabegron to antimuscarinic drugs, and that evaluated the efficacy, safety or adherence. DATA COLLECTION RevMan 5.4 was used to combine results across studies. We derived risk ratios (RRs) and mean differences with 95% CIs using a random-effects meta-analytic model. Cochrane Collaboration Tool and GRADE was applied for risk of bias and quality of the evidence. DATA SYNTHESIS We included 14 studies with a total of 10,774 patients. Fewer total adverse events was reported in mirabegron group than in antimuscarinics group [RR 0.93 (0.89-0.98)]. The risk of gastrointestinal tract disorders and dry mouth were lower with mirabegron [RR 0,58 (0.48-0.68); 9375 patients; RR 0.44 (0.35-0.56), 9375 patients, respectively]. No difference was reported between mirabegron and antimuscarinics drugs for efficacy. The adherence to treatment was 87.7% in both groups [RR 0.99 (0.98-1.00)]. CONCLUSION Mirabegron and antimuscarinics have comparable efficacy and adherence rates; however, mirabegron showed fewer total and isolated adverse events.
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Affiliation(s)
| | | | - Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Leticia Maria de Oliveira
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Marcelo Cunio Machado Fonseca
- Department of Gynecology, Health Technologies Assessment Center, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Enuresis and overactive bladder in sickle cell patients: a narrative review of the literature. World J Urol 2023; 41:953-962. [PMID: 36662241 DOI: 10.1007/s00345-023-04288-0] [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: 11/05/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The aim of this review is to clarify the prevalence, pathophysiology and clinical presentation of enuresis and overactive bladder in sickle cell patients. MATERIALS AND METHODS This narrative review of the literature was conducted in March 2022 by running a search in PubMed, Embase, Scopus and Cochrane databases without publication date limitation, using the following keywords: enuresis or nocturia or overactive bladder or urinary incontinence or bedwetting and sickle cell. RESULTS Eight cross-sectional studies were included, six of which had a non-sickle cell control population. The prevalence of enuresis in children and adolescents with sickle cell disease ranged from 20.3 to 49.4%. It decreased with age to 2.9% in adult sickle cell patients. Enuresis in sickle cell patients has been attributed to several causes, including lack of urine concentration with nocturnal polyuria, reduced bladder capacity, nocturnal bladder hyperactivity, sleep and/or respiratory disorders are likely causes of enuresis in sickle cell patients. The prevalence of overactive bladder is three times higher in sickle cell patients than in control groups. The latter is also observed three times more frequently in men who have had prior episodes of priapism. CONCLUSION Enuresis and overactive bladder are common in sickle cell patients. Several mechanisms have been described to try to explain enuresis in sickle cell patients but overactive bladder seems to play a major role. Studies evaluating the efficacy of certain experimentally validated treatments must be carried out to improve the management of these complications which affect the quality of life of sickle cell patients.
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McKernan LC, Connors EL, Ryden AM, Finn MTM, Kim A, Vandekar SN, Dmochowski RR, Reynolds WS. Clinical hypnosis can reduce lower urinary tract symptoms in individuals with chronic pain. Neurourol Urodyn 2023; 42:330-339. [PMID: 36378832 PMCID: PMC10239668 DOI: 10.1002/nau.25090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/20/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
STUDY PURPOSE Lower urinary tract symptoms (LUTS) can occur in chronic pain populations at high rates and drastically affect quality of life. Hypnosis is a nonpharmacological treatment used in chronic pain known to have beneficial implications to health outside of pain reduction. This study evaluated the potential for hypnosis to reduce LUTS in a sample of individuals with chronic pain, if baseline LUTS severity affected outcomes, and specific LUTS that may respond to hypnosis. METHODS Sixty-four adults with chronic pain and LUTS at a level of detectable symptom change (American Urological Association Symptom Index, AUASI 3) participated in an 8-week group hypnosis protocol. Participants completed validated assessments of LUTS, pain, and overall functioning before, after, 3- and 6-months posttreatment. Linear mixed effects models assessed improvement in LUTS over time while accounting for known factors associated with outcome (e.g., age, gender). The interaction of baseline symptom severity and treatment assessed the potential effect of baseline symptoms on change scores. RESULTS Participants experienced significant and meaningful improvements in LUTS following group hypnosis (p = 0.006). There was a significant interaction between baseline symptom severity and treatment (p < 0.001), such that those with severe symptoms experienced the most pronounced gains over time (e.g., an 8.8 point reduction). Gains increased over time for those with moderate and severe symptoms. Changes in LUT symptoms occurred independently of pain relief. CONCLUSIONS This pilot study suggests hypnosis has the potential to drastically improve LUTS in individuals with chronic pain, even when pain reduction does not occur. Results provide initial evidence for the treatment potential of hypnosis in urologic pain (and possibly non-pain/benign) populations, with randomized trials needed for definitive outcomes.
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Affiliation(s)
- Lindsey C. McKernan
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Erin L. Connors
- Department of Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Anna M. Ryden
- Department of Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Michael T. M. Finn
- Helen DeVos Children’s Hospital, Grand Rapids, Michigan, USA
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, Michigan, USA
| | - Ahra Kim
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Simon N. Vandekar
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - W. Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Sacral neuromodulation for overactive bladder using the InterStim and BetterStim systems. Sci Rep 2022; 12:22299. [PMID: 36566332 PMCID: PMC9789967 DOI: 10.1038/s41598-022-26267-y] [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: 01/20/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
This study aimed to evaluate differences in the clinical outcomes of different sacral neuromodulation systems (InterStim and BetterStim) used in the treatment of overactive bladder. Data from a previously established database of sacral neuromodulation in China (the InterStim system) and a 2020 clinical trial of the BetterStim system were screened. Patients with overactive bladder undergoing stage II implanted pulse generator implantation were selected for analysis and divided into InterStim and BetterStim system groups. Voiding diaries and subjective scores obtained preoperatively, after stage I tined-lead implantation (experience period), and after stage II implanted pulse generator implantation were compared between the two groups. This study included 113 patients with overactive bladder (43, InterStim system group; 70, BetterStim system group). Voiding diaries and subjective scores significantly improved in both the InterStim and BetterStim system groups over the treatment period. Specifically, the urination frequency (all P < 0.001), average voiding volume (all P < 0.001), and average urinary leakage (InterStim, P < 0.05; BetterStim, P < 0.01) in both groups significantly improved at different periods during treatment. At the same time, the urgency perception scale (P < 0.001) and OAB-related quality of life score (InterStim, P < 0.05; BetterStim, P < 0.01) also significantly improved. There was no significant difference in urination frequency at baseline between the two groups (P = 0.169). Urination frequency was significantly higher in the BetterStim system group than in the InterStim group during the experience period and at follow-up (P = 0.031, P = 0.006). There was no significant difference in the number of urinary leakages between the different systems at baseline (P = 0.662), although this was higher in the InterStim system group during the experience period (P = 0.016), and the difference disappeared at the last follow-up (P = 0.565). There were significant differences in baseline urgency perception scale (P = 0.001) and OAB-related quality of life score (P < 0.001) between the two groups; however, these differences were not maintained at follow-up (P = 0.81, P = 0.479). Both sacral neuromodulation systems are safe and effective in treating overactive bladder. The InterStim system may be more beneficial for patients with dry overactive bladder. Satisfactory outcomes may be achieved with the BetterStim system in patients with wet overactive bladder. However, further studies are required to confirm this finding.
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A Randomized Controlled Trial Comparing Telemedicine Versus In-Person Office Visits for the Follow-Up of Overactive Bladder. Female Pelvic Med Reconstr Surg 2022; 28:819-824. [PMID: 35830578 DOI: 10.1097/spv.0000000000001231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Overactive bladder is a condition that may be ideally suited for the use of telemedicine because initial treatment options are behavioral modification and pharmacotherapy. OBJECTIVE We sought to evaluate if there was an overall difference in patient follow-up rates between telemedicine and in-person visits. STUDY DESIGN New patients presenting with overactive bladder from July 2020 to March 2021 were randomized into telemedicine and in-person visits groups. A prospective database was maintained to compare follow-up rates, satisfaction rates, and time commitment. RESULTS Forty-eight patients were randomized, 23 to the telemedicine group and 25 to the in-person visits group. There was no significant difference in follow-up rates between the telemedicine and in-person follow-up groups at 30 days (39% vs 28%, P = 0.41), 60-days (65% vs 56% P = 0.51) or 90 days (78% vs 60%, P = 0.17). There was no significant difference in satisfaction rates between the 2 groups. There was a significant difference between the average telemedicine visit time and in-person visit time (12.1 ± 6.9 minutes vs 22.8 ± 17.1 minutes; P = 0.02). For in-person visits, the average travel time was 49 minutes (interquartile range, 10-90 minutes) and average miles traveled was 22.1 miles (interquartile range, 10-70 miles). CONCLUSIONS There was no significant difference in follow-up or satisfaction rates between telemedicine and in-person visits. Telemedicine visits took half the length of time compared with in-person visits. On average, patients in the telemedicine group saved approximately 1 hour per follow-up visit. Telemedicine visits save both the health care provider and patient significant amounts of time without sacrificing patient satisfaction and follow-up rates.
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Duperrouzel C, Martin C, Mendell A, Bourque M, Carrera A, Mack A, Nesheim J. Healthcare and economic burden of anticholinergic use in adults with overactive bladder: a systematic literature review. J Comp Eff Res 2022; 11:1375-1394. [PMID: 36354285 DOI: 10.2217/cer-2022-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: To determine the economic burden associated with anticholinergic medication use in adults with overactive bladder (OAB) in the USA. Methods: A systematic literature review was conducted to identify articles assessing healthcare resource utilization (HCRU) and costs associated with anticholinergic use in adults with OAB. Results: From the 34 articles identified, increased anticholinergic burden, switching anticholinergic treatments and potentially inappropriate anticholinergic use were associated with increased HCRU and/or costs. However, studies comparing patients with OAB receiving anticholinergics to individuals with untreated OAB or without OAB reported a mix of increases and decreases in HCRU and costs. Conclusion: Additional controlled studies assessing the economic impact of anticholinergics in OAB are needed and may enable optimization of economic and potentially patient outcomes.
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Chen JV, Gahn JC, Nesheim J, Mudd PN. Budget Impact Analysis of Vibegron for the Treatment of Overactive Bladder in the USA. PHARMACOECONOMICS 2022; 40:979-988. [PMID: 35881325 PMCID: PMC9522665 DOI: 10.1007/s40273-022-01163-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Overactive bladder (OAB) is associated with considerable clinical and economic burden. Treatment of patients with OAB using anticholinergics is limited by tolerability issues and increased anticholinergic burden, which is associated with increased risk of dementia and falls/fractures. This analysis assessed the budget impact of introducing the β3-adrenergic agonist vibegron for the treatment of patients with OAB from US commercial payor and Medicare perspectives. METHODS A budget impact model (BIM) with a 5-year time horizon was developed using a top-down, prevalence-based approach and projected market shares for 1-million-member US commercial and Medicare plans. The BIM included vibegron, mirabegron, and anticholinergics, incorporating changes in clinical outcomes (efficacy, drug-drug interactions, anticholinergic burden (ACB), OAB-related comorbidities, and adverse events (AEs)). Costs per member per month (PMPM) and per treated member per month (PTMPM) were determined. One-way sensitivity analyses quantified the impact of changes in key variables. RESULTS The introduction of vibegron was associated with a modest increase in PMPM cost over 5 years of $0.12 (range for years 1‒5, $0.01‒$0.26) for commercial payors and $0.24 ($0.01‒$0.52) for Medicare (PTMPM cost: $2.70 ($0.17‒$4.85) and $3.15 ($0.19‒$5.82), respectively). Costs were partially offset by savings related to decreased third-line treatment use, yearly decreases in AE and comorbidity incidence, reduced drug-drug interactions, and reduced ACB associated with vibegron introduction. PMPM costs were most sensitive to vibegron market share assumptions, OAB prevalence, and vibegron persistence at 1 month for private payors and Medicare and additionally vibegron persistence at 12 months for Medicare. CONCLUSIONS Vibegron may address unmet needs in treating OAB and is a useful addition to health plans while minimizing risks of anticholinergic AEs, ACB, and drug-drug interactions, which may partially offset increased pharmacy costs.
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Affiliation(s)
| | - James C Gahn
- Medical Decision Modeling, Indianapolis, IN, USA
| | - Jeffrey Nesheim
- Urovant Sciences, 5281 California Ave, Suite 100, Irvine, CA, 92617, USA.
| | - Paul N Mudd
- Urovant Sciences, 5281 California Ave, Suite 100, Irvine, CA, 92617, USA
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Mohammadnezhad G, Azadmehr B, Yousefi N. Cost-effectiveness evaluation of mirabegron versus anti-muscarinics and third-line therapies: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1187-1198. [PMID: 36172806 DOI: 10.1080/14737167.2022.2130761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Overactive bladder (OAB) is defined as urinary urgency, usually with urinary frequency and nocturia, with or without urgency urinary incontinence. OAB can interfere with health-related quality of life. The current treatment for OAB includes conservative management, surgery, and pharmacotherapy. Mirabegron is a new drug acting by the mechanism of ß3-adrenoceptor agonism. This study aimed to review the cost-effectiveness of mirabegron in the treatment of OAB. AREAS COVERED We searched published articles in electronic search databases. Ten studies were included in the qualitative analysis. Various antimuscarinics, including oxybutynin, fesoterodine, tolterodine, darifenacin, and trospium were compared with mirabegron. The results were evaluated and compared according to the quality-adjusted life-years (QALY), cost/year, and incremental cost-effectiveness ratio (ICER). Of the ten studies in only three, mirabegron was not a cost-effective strategy. In seven cases, mirabegron was cost-effective. EXPERT OPINION : Based on our findings, the cost-effectiveness of mirabegron was variable in different regions; however, most of the studies show the cost-effectiveness of mirabegron. Our study illustrates that mirabegron's incremental cost-effectiveness ratio in comparison with its comparators is below the willingness to pay threshold even in the countries with low GDP/Capita. The results also showed that despite the low price and no difference in the effectiveness of mirabegron compared to antimuscarinic drugs, the sensitivity of the study results to adverse effects and supportive therapeutic interventions for patients treated with antimuscarinic drugs. Our proposal for future economic studies for OAB pharmacotherapy is to compare different doses, formulations, and administration forms in a real-world context.
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Affiliation(s)
| | - Behniya Azadmehr
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hargreaves E, Baker K, Barry G, Harding C, Zhang Y, Kandala NB, Zhang X, Kernohan A, Clarkson CE. Acupuncture for treating overactive bladder in adults. Cochrane Database Syst Rev 2022; 9:CD013519. [PMID: 36148895 PMCID: PMC9502659 DOI: 10.1002/14651858.cd013519.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Overactive bladder is a common, long-term symptom complex, which includes frequency of micturition, urgency with or without associated incontinence and nocturia. Around 11% of the population have symptoms, with this figure increasing with age. Symptoms can be linked to social anxiety and adaptive behavioural change. The cost of treating overactive bladder is considerable, with current treatments varying in effectiveness and being associated with side effects. Acupuncture has been suggested as an alternative treatment. OBJECTIVES To assess the effects of acupuncture for treating overactive bladder in adults, and to summarise the principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (including In-Process, Epub Ahead of Print, Daily), ClinicalTrials.gov and WHO ICTRP (searched 14 May 2022). We also searched the Allied and Complementary Medicine database (AMED) and bibliographic databases where knowledge of the Chinese language was necessary: China National Knowledge Infrastructure (CNKI); Chinese Science and Technology Periodical Database (VIP) and WANFANG (China Online Journals), as well as the reference lists of relevant articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs and cross-over RCTs assessing the effects of acupuncture for treating overactive bladder in adults. DATA COLLECTION AND ANALYSIS Four review authors formed pairs to assess study eligibility and extract data. Both pairs used Covidence software to perform screening and data extraction. We assessed risk of bias using Cochrane's risk of bias tool and assessed heterogeneity using the Chi2 testand I2 statistic generated within the meta-analyses. We used a fixed-effect model within the meta-analyses unless there was a moderate or high level of heterogeneity, where we employed a random-effects model. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 15 studies involving 1395 participants in this review (14 RCTs and one quasi-RCT). All included studies raised some concerns regarding risk of bias. Blinding of participants to treatment group was only achieved in 20% of studies, we considered blinding of outcome assessors and allocation concealment to be low risk in only 25% of the studies, and random sequence generation to be either unclear or high risk in more than 50% of the studies. Acupuncture versus no treatment One study compared acupuncture to no treatment. The evidence is very uncertain regarding the effect of acupuncture compared to no treatment in curing or improving overactive bladder symptoms and on the number of minor adverse events (both very low-certainty evidence). The study report explicitly stated that no major adverse events occurred. The study did not report on the presence or absence of urinary urgency, episodes of urinary incontinence, daytime urinary frequency or episodes of nocturia. Acupuncture versus sham acupuncture Five studies compared acupuncture with sham acupuncture. The evidence is very uncertain about the effect of acupuncture on curing or improving overactive bladder symptoms compared to sham acupuncture (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -1.03 to 0.31; 3 studies; 151 participants; I2 = 65%; very low-certainty evidence). All five studies explicitly stated that there were no major adverse events observed during the study. Moderate-certainty evidence suggests that acupuncture probably makes no difference to the incidence of minor adverse events compared to sham acupuncture (risk ratio (RR) 1.28, 95% CI 0.30 to 5.36; 4 studies; 222 participants; I² = 0%). Only one small study reported data for the presence or absence of urgency and for episodes of nocturia. The evidence is of very low certainty for both of these outcomes and in both cases the lower confidence interval is implausible. Moderate-certainty evidence suggests there is probably little or no difference in episodes of urinary incontinence between acupuncture and sham acupuncture (mean difference (MD) 0.55, 95% CI -1.51 to 2.60; 2 studies; 121 participants; I2 = 57%). Two studies recorded data regarding daytime urinary frequency but we could not combine them in a meta-analysis due to differences in methodologies (very low-certainty evidence). Acupuncture versus medication Eleven studies compared acupuncture with medication. Low-certainty evidence suggests that acupuncture may slightly increase how many people's overactive bladder symptoms are cured or improved compared to medication (RR 1.25, 95% CI 1.10 to 1.43; 5 studies; 258 participants; I2 = 19%). Low-certainty evidence suggests that acupuncture may reduce the incidence of minor adverse events when compared to medication (RR 0.34, 95% CI 0.26 to 0.45; 8 studies; 1004 participants; I² = 51%). The evidence is uncertain regarding the effect of acupuncture on the presence or absence of urinary urgency (MD -0.40, 95% CI -0.56 to -0.24; 2 studies; 80 participants; I2 = 0%; very low-certainty evidence) and episodes of urinary incontinence (MD -0.33, 95% CI -2.75 to 2.09; 1 study; 20 participants; very low-certainty evidence) compared to medication. Low-certainty evidence suggests there may be little to no effect of acupuncture compared to medication in terms of daytime urinary frequency (MD 0.73, 95% CI -0.39 to 1.85; 4 studies; 360 participants; I2 = 28%). Acupuncture may slightly reduce the number of nocturia episodes compared to medication (MD -0.50, 95% CI -0.65 to -0.36; 2 studies; 80 participants; I2 = 0%, low-certainty evidence). There were no incidences of major adverse events in any of the included studies. However, major adverse events are rare in acupuncture trials and the numbers included in this review may be insufficient to detect these events. AUTHORS' CONCLUSIONS The evidence is very uncertain about the effect acupuncture has on cure or improvement of overactive bladder symptoms compared to no treatment. It is uncertain if there is any difference between acupuncture and sham acupuncture in cure or improvement of overactive bladder symptoms. This review provides low-certainty evidence that acupuncture may result in a slight increase in cure or improvement of overactive bladder symptoms when compared with medication and may reduce the incidence of minor adverse events. These conclusions must remain tentative until the completion of larger, higher-quality studies that use relevant, comparable outcomes. Timing and frequency of treatment, point selection, application and long-term follow-up are other areas relevant for research.
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Affiliation(s)
- Emma Hargreaves
- Department of Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Christopher Harding
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Yingying Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ngianga-Bakwin Kandala
- Warwick Medical School, University of Warwick, Coventry, UK
- Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Xiaowen Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Carl E Clarkson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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Stewart LE, Siddique M, Jacobs KM, Raker CA, Sung VW. Oral phenazopyridine vs intravesical lidocaine for bladder onabotulinumtoxinA analgesia: a randomized controlled trial. Am J Obstet Gynecol 2022; 227:308.e1-308.e8. [PMID: 35580634 DOI: 10.1016/j.ajog.2022.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The efficacy of intradetrusor onabotulinumtoxinA injections for the management of idiopathic overactive bladder has been well-established. The injections are typically performed in the office setting using local analgesia, most commonly a 20 to 30-minute intravesical instillation of lidocaine. There are limited data evaluating alternative bladder analgesics. OBJECTIVE To compare pain scores with preprocedure oral phenazopyridine vs intravesical lidocaine in women undergoing intradetrusor onabotulinumtoxinA injections for idiopathic overactive bladder. STUDY DESIGN Nonpregnant adult females with idiopathic overactive bladder, scheduled for office injection of 100 units of intradetrusor onabotulinumtoxinA were randomized to either 200 mg of oral phenazopyridine taken 1 to 2 hours preprocedure or a 20-minute preprocedure intravesical instillation of 50 mL of 2% lidocaine. We excluded participants with neurogenic bladders, and those who had received intradetrusor onabotulinumtoxinA injections in the previous 12 months. The primary outcome was pain measured by a 100-mm visual analog scale. Demographic characteristics and overall satisfaction with the procedure were also recorded. Providers answered questions about cystoscopic visualization, ease of procedure, and perception of participant comfort. Prespecified noninferiority margin was set to equal the anticipated minimum clinically important difference of 14 mm. A planned sample of 100 participants, 50 in each treatment arm, provided 80% power to detect noninferiority at a significance level of.05. We performed a modified intention-to-treat analysis and compared variables with the t test or the Fisher exact test. RESULTS A total of 111 participants were enrolled, and complete data were obtained for 100 participants; 47 participants were randomized to phenazopyridine and 53 to lidocaine. Baseline characteristics did not differ between groups. There were 19.6% and 20.8% of participants in the phenazopyridine and lidocaine groups, respectively, who previously underwent intradetrusor onabotulinumtoxinA injections. The mean postprocedure pain was 2.7 mm lower in the phenazopyridine group than in the lidocaine group (95% confidence interval, -11.3 to 10.7), demonstrating noninferiority. More than 90% of participants in both groups stated that the pain was tolerable. Slightly more participants reported being "very satisfied" in the lidocaine group, although this was not statistically significant (50.0% vs 40.4%; P=.34). Providers reported clear visualization in 89.4% of participants in the phenazopyridine group and in 100% of participants in the lidocaine group (P=.02). Provider perception of participant comfort and overall ease of procedure were not different between groups. Length of time in the exam room was significantly shorter in the phenazopyridine than in the lidocaine group (44.4 vs 57.5 minutes; P=.0003). CONCLUSION In women receiving intradetrusor onabotulinumtoxinA injections for idiopathic overactive bladder, oral phenazopyridine was noninferior to intravesical lidocaine for procedural pain control. Phenazopyridine is well-tolerated by participants, allows for the procedure to be performed with similar ease, and is associated with shorter appointment times.
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13
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Clearwater W, Kassam F, Aalami Harandi A, Tenggardjaja CF, Abraham N. Combination and Novel Pharmacologic Agents for OAB. Curr Urol Rep 2022; 23:129-141. [PMID: 35567657 DOI: 10.1007/s11934-022-01097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To evaluate recent literature on combination and novel pharmacologic therapies for overactive bladder (OAB). RECENT FINDINGS Combination therapies demonstrating greater efficacy than monotherapy include combination anticholinergics, anticholinergic plus β-3 agonist, and anticholinergic with behavioral modification, percutaneous tibial nerve stimulation, or sacral neuromodulation. Promising novel therapies include new bladder selective anticholinergics, new β-3 agonists, and gabapentin. OAB is a symptom complex caused by dysfunction in the interconnected neural, muscular, and urothelial systems that control micturition. Although several therapeutic targets and treatment options exist, complete resolution is not always achieved, discontinuation rate for medical therapy is high, and few patients subsequently progress to third-line treatment options. Recent literature suggests combination therapy diversifying therapeutic targets is more effective than targeting a single pathway and novel treatments targeting additional pathways have promising results.
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Affiliation(s)
- Whitney Clearwater
- Department of Obstetrics & Gynecology and Women's Health, Division of Female Pelvic Medicine and Reconstructive Surgery, Montefiore Medical Center / Albert Einstein College of Medicine, 1250 Waters Place, Tower Two, 9th floor, Bronx, NY, 10461, USA
| | - Farzaan Kassam
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Tower 1 PH, Bronx, NY, 10461, USA
| | | | - Christopher F Tenggardjaja
- Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Kaiser Permanente Los Angeles Medical Center, Sunset Blvd, Los Angeles, CA, USA
| | - Nitya Abraham
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Tower 1 PH, Bronx, NY, 10461, USA.
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Li X, Li X, Zhou Z, Zhao H, Liao L. Feasibility of a Transcutaneous Tibial Nerve Stimulation Device Use in Overactive Bladder Patients: A Pilot Study From a Single Tertiary Care Center. Front Neurol 2022; 13:872200. [PMID: 35528738 PMCID: PMC9074788 DOI: 10.3389/fneur.2022.872200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the preliminary efficacy, safety, and acceptability of a transcutaneous tibial nerve stimulation (TTNS) device in overactive bladder (OAB) patients.MethodsTwenty OAB patients who failed with conservative treatments were recruited consecutively. All patients received 60 min of daily unilateral stimulation for 4 weeks using a smart wearable transcutaneous tibial nerve stimulation device and the stimulations were at 20 Hz frequency, 200 μs pulse width. OAB symptoms were observed at baseline and week 4, using a 3-days voiding diary, the overactive bladder symptom score (OABSS), the perception of bladder condition (PPBC), and the American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL). Urodynamic characteristics were measured to determine the pilot efficacy of the device during the treatment comparing the baseline parameters to the post-treatment parameters.ResultsAmong the patients, 15 cases were OAB-dry and five cases were OAB-wet. All patients were evaluated at the end of the study and no significant side effects were found during the treatment. The daily micturition frequency and the number of incontinence episodes per day were reduced from 15.10 ± 1.61 to 12.00 ± 4.56, and 3.20 ± 0.80 to 0.47 ± 0.38, respectively. The mean voiding volume was increased from 130.10 ± 53.07 to 157.30 ± 66.95 mL. The OABSS, AUA-SI-QoL, and PPBC were reduced from 9.35 ± 1.39 to 5.9 ± 2.36, 5.70 ± 0.47 to 3.85 ± 1.04, and 5.70 ± 0.47 to 4.35 ± 0.86, respectively. The first sensation of bladder filling (1st SBF), maximal bladder capacity (MBC), and mean compliance were increased from 87.50 (60.00–167.50) to 150.00 (104.00–211.30) mL, 175.00 (120.30–354.00) to 255.00 (151.50–491.50) mL, and 36.67 (12.44–39.69) to 40.00 (20.00–52.50) mL/cmH2O, respectively. The maximum detrusor pressure (Pdet. max) was reduced from 14.50 (5.00–35.25) to 11.00 (6.00–20.00) cmH2O.ConclusionThe preliminary results demonstrated that the TTNS device was safe, effective, and acceptable to use in OAB patients, but the results need to be substantiated by conducting more randomized controlled studies further.
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Affiliation(s)
- Xunhua Li
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zhonghan Zhou
- University of Health and Rehabilitation Sciences, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui Zhao
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Limin Liao
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Ghavidel-Sardsahra A, Ghojazadeh M, Rahnama'I MS, Naseri A, Yazdandoost S, Khezerloo T, Seyedi-Sahebari S, Hosseinifard H, Vahed N, Mostafaei H, Salehi-Pourmehr H, Hajebrahimi S. Efficacy of percutaneous and transcutaneous posterior tibial nerve stimulation on idiopathic overactive bladder and interstitial cystitis/painful bladder syndrome: A systematic review and meta-analysis. Neurourol Urodyn 2022; 41:539-551. [PMID: 35032328 DOI: 10.1002/nau.24864] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Percutaneous and transcutaneous posterior tibial nerve stimulation (PTNS and TTNS) showed a promising effect on overactive bladder (OAB) and interstitial cystitis/painful bladder syndrome. We aimed to give a systematic review and meta-analysis on the efficacy and safety of these therapeutic methods as well. METHODS We searched studies available on PubMed, Embase, Cochrane, Scopus, Web of Science, and ProQuest on March 31, 2021, to find both published and unpublished studies. The retrieved articles were screened by two independent researchers and then the selected studies were critically appraised by Cochrane risk-of-bias tool for randomized trials, and Joanna Briggs Institute's checklist for quasi-experimental studies. Finally, the results of studies were synthesized using Review Manager (RevMan) 5.4 statistical software when the data were homogenous. The meta-analysis was performed by calculating the effect size (mean difference) and their 95% confidence intervals (CIs). RESULTS Of the total 3194 publications, 68 studies were included in our qualitative evaluation and 9 studies (11 trials) in the quantitative stage. When TTNS or PTNS were compared to sham, placebo, no treatment, or conservative management, a decrease in frequency of urination was observed in both TTNS (mean difference [MD]: -3.18, 95% CI: -4.42 to -1.94, and p < 0.00001), and PTNS (MD: -2.84, 95% CI: -4.22 to -1.45, and p < 0.00001), and overall TTNS or PTNS (MD: -2.95, 95% CI: -4.01 to -1.88, and p < 0.00001). Significant improvements in mean voiding volume (MVV) and decreasing nocturia were also observed. CONCLUSIONS Nerve stimulations either PTNS or TTNS appear to be effective interventions in treating refractory idiopathic OAB in terms of daily voiding frequency, MVV, urgency episodes, and nighttime voiding frequency. However, our result did not show any improvement in terms of urinary incontinence, postvoid residual volume or urge incontinence, and maximum cystometric capacity which emphasized the efficacy of these modalities on dry-OAB rather than wet-OAB.
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Affiliation(s)
| | - Morteza Ghojazadeh
- Research Center for Evidence Based-Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Taha Khezerloo
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hossein Hosseinifard
- Research Center for Evidence Based-Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nafiseh Vahed
- Research Center for Evidence Based-Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence Based-Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based-Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.,Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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16
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A Review of Aging and the Lower Urinary Tract: The Future of Urology. Int Neurourol J 2022; 25:273-284. [PMID: 34991304 PMCID: PMC8748297 DOI: 10.5213/inj.2142042.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are common among elderly people, with significant effects on individuals, caregivers, and the wider health care system. As the elderly population with multiple comorbidities is increasing, the burden of LUTS will increase. This review describes the demographic trends in the aging society, changes in lower urinary tract function with aging, and deterioration of physical and cognitive function in aging, as well as what has been done regarding geriatric urology and what urologists should do to meet the health care needs of the aging population. Frailty and dementia are unmissable factors in the evaluation of elderly patients. Numerous reports have described associations between LUTS and frailty and between LUTS and dementia. Urologists must be aware of the multiplex physical, cognitive, and social characteristics of elderly people. Maintaining a geriatric viewpoint in the diagnosis, treatment, and management of elderly individuals with LUTS will fulfill the unmet needs of elderly people. It is also essential to discuss the treatment and management goals of LUTS with patients and caregivers. Active case identification, appropriate evaluations of LUTS and comorbidities, and a multidisciplinary approach with other health-care professionals are recommended for better treatment and management.
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Shireman J, Gajarawala SN, Stanton A, McCrary M. Treating overactive bladder with percutaneous tibial nerve stimulation. JAAPA 2021; 34:27-30. [PMID: 34813532 DOI: 10.1097/01.jaa.0000769720.96528.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Overactive bladder can affect patients at any age; however, it is more common in women over age 40 years. Many treatments are available, including behavioral interventions, antimuscarinics, beta-3 agonists, and botulinum toxin injection. This article describes a patient who was successfully treated with percutaneous tibial nerve stimulation after traditional treatment failed.
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Affiliation(s)
- Jordan Shireman
- At the time this article was written, Jordan Shireman was a student in the PA program at South University in Tampa, Fla. She now practices in behaviorial medicine with TeamHealth in Tamarac, Fla. Shilpa N. Gajarawala practices in the Department of Medical and Surgical Gynecology at Mayo Clinic Florida, is an assistant professor in obstetrics and gynecology in the Mayo Clinic College of Medicine, and adjunct faculty in the DMSc program at Rocky Mountain University of Health Science in Provo, Utah. Melissa McCrary and Amanda Stanton practice in the Department of Medical and Surgical Gynecology at Mayo Clinic Florida and are instructors of obstetrics and gynecology at Mayo Clinic College of Medicine and Science. The authors have disclosed no potential conflicts of interest, financial or otherwise
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18
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Engin S, Kaya Yasar Y, Barut EN, Getboga D, Erac Y, Sezen SF. The inhibitory effect of trimetazidine on detrusor contractility - a potential repositioning of trimetazidine for the treatment of overactive bladder. J Pharm Pharmacol 2021; 74:94-102. [PMID: 34109981 DOI: 10.1093/jpp/rgab072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to identify the effect of trimetazidine (TMZ), an antianginal drug, on detrusor smooth muscle (DSM) contractility and its possible mechanisms of action. METHODS We performed in-vitro contractility studies on isolated mouse DSM strips and investigated the effect of TMZ on Ca2+ levels in fura-2-loaded A7r5 cells. KEY FINDINGS TMZ (300 or 1000 µM) inhibited carbachol (CCh)- and KCl-induced contractions and produced a concentration-dependent (10-1000 µM) relaxation in KCl-precontracted DSM strips. TMZ-induced relaxation was markedly decreased by BaCl2, an inward-rectifying K+ channel blocker, but was not altered by preincubation with tetraethylammonium, glibenclamide, 4-aminopyridine, propranolol, L-NAME or methylene blue. TMZ (300 or 1000 µM) reduced both the CaCl2-induced contraction of depolarized DSM strips under Ca2+-free conditions and the CCh-induced contraction of DSM strips preincubated with nifedipine in Ca2+-containing Krebs solution. Furthermore, TMZ (1000 µM) significantly decreased the Ca2+ levels in fura-2-loaded A7r5 cells. CONCLUSIONS TMZ decreased DSM contractility and caused a concentration-dependent relaxation of the tissue possibly through its actions on Ca2+ transients and K+ channels. Our results provide preclinical evidence that TMZ would be a potential candidate to treat disorders related to the overactivity of the bladder.
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Affiliation(s)
- Seckin Engin
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey
| | - Yesim Kaya Yasar
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey.,Drug and Pharmaceutical Technology Application and Research Center, Karadeniz Technical University, Trabzon, Turkey
| | - Elif Nur Barut
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey
| | - Damla Getboga
- Department of Pharmacology, Faculty of Pharmacy, Ege University, İzmir, Turkey
| | - Yasemin Erac
- Department of Pharmacology, Faculty of Pharmacy, Ege University, İzmir, Turkey
| | - Sena F Sezen
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey.,Drug and Pharmaceutical Technology Application and Research Center, Karadeniz Technical University, Trabzon, Turkey
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19
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Cost-Effectiveness Analysis Between Sacral Neuromodulation and OnabotulinumtoxinA for the Treatment of Refractory Overactive Bladder in Women: A Systematic Review. Female Pelvic Med Reconstr Surg 2021; 27:481-487. [PMID: 34074937 DOI: 10.1097/spv.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We summarized the evidence evaluating the cost-effectiveness of sacral neuromodulation (SNM) versus onabotulinumtoxinA (BONT/A) in the treatment of refractory overactive bladder (OAB) among women. METHODS We searched PubMed Medline (1946-2019), EMBASE (1947-2019), Web of Science (1900-2019), Clinical Trials.gov, reviewed references of included studies, and Cochrane subsets of CDSR, DARE, CENTRAL, and NHSEED. We included cost-utility and cost-effectiveness analyses or decision analysis comparing SNM versus BONT/A in women with nonneurogenic refractory OAB. Primary outcomes included incremental cost-effectiveness ratios (ICERs), reported as cost per quality-adjusted life year (QALY), which were abstracted or calculated. RESULTS Five studies met the inclusion criteria. Three studies were industry supported. Two studies of high quality found BONT/A to be dominant over SNM (ICER range of $415,571/QALY at 5 years and $236,370/QALY at 10 years). This trend was further supported by a third study of high quality that favored BONT/A because SNM was not cost-effective (ICER, $116,427/QALY at 2 years). In contrast, 2 other studies of lower quality found that SNM was cost-effective or dominant in comparison to BONT/A (ICER range, $3,717/QALY to €15,226/QALY at 10 years). In general, models were sensitive to treatment duration, intervention setting, and lacked robust data on long-term outcomes. CONCLUSIONS OnabotulinumtoxinA is more cost-effective for managing refractory OAB when compared with SNM. However, it remains unclear whether this finding holds true long term for what is considered a lifelong condition.
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20
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Carlson KV, Rovner ES, Nair KV, Deal AS, Kristy RM, Hairston JC. Persistence with mirabegron or antimuscarinic treatment for overactive bladder syndrome: Findings from the PERSPECTIVE registry study. Low Urin Tract Symptoms 2021; 13:425-434. [PMID: 33987973 PMCID: PMC8518921 DOI: 10.1111/luts.12382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/11/2021] [Indexed: 12/14/2022]
Abstract
Objectives This analysis from the PERSPECTIVE (a Prospective, Non‐interventional Registry Study of Patients Initiating a Course of Drug Therapy for Overactive Bladder) study evaluated treatment persistence with mirabegron or antimuscarinics over a 12‐month period. Methods Participants were adults diagnosed with overactive bladder (OAB) by their health care provider (HCP), who were initiating mirabegron or antimuscarinic treatment. The HCP made all treatment decisions, and patients were followed for 12 months with no mandatory scheduled visits. Information requests were sent to patients at baseline and months 1, 3, 6, and 12. Patients were nonpersistent if they switched, discontinued, or added OAB medications/therapies to their initial treatment. Reasons for discontinuation and switching patterns were investigated. Results Overall, 1514 patients were included (613 mirabegron and 901 antimuscarinic initiators). Persistence rates decreased steadily over time in both groups. A low proportion of patients added or switched medication at each time point. Unadjusted Kaplan‐Meier analysis showed similar persistence rates for both groups. When the data were adjusted for patient characteristics (age, sex, and OAB treatment status), mirabegron initiators had higher persistence rates. No significant differences were noted in unadjusted median time to end of persistence. However, end of treatment persistence by any cause was longer with mirabegron (median: 9.5 vs 6.7 months for antimuscarinics). HCPs stated that the most common reasons for nonpersistence were no symptomatic improvement and side effect aversion. Conclusions Treatment persistence was longer for mirabegron compared with antimuscarinic initiators after controlling for patient characteristics. End of treatment persistence by any cause was also longer with mirabegron.
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Affiliation(s)
- Kevin V Carlson
- Section of Urology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kavita V Nair
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Anna S Deal
- IPC/TeamHealth, Johnson City, Tennessee, USA
| | - Rita M Kristy
- Astellas Pharma Global Development, Inc., Northbrook, Illinois, USA
| | - John C Hairston
- Astellas Pharma Global Development, Inc., Northbrook, Illinois, USA
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21
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Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk. Int Urogynecol J 2021; 32:2819-2826. [PMID: 33683426 DOI: 10.1007/s00192-021-04736-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Recent publications show an association between exposure to anticholinergic medications and the risk of developing dementia. We hypothesized that urogynecology providers have changed their overactive bladder syndrome treatment as a result of this literature. METHODS This was an anonymous, cross-sectional, web-based survey of American Urogynecologic Society members. Survey questions queried awareness of the referenced literature, prescribing practices, the impact of insurance on treatment plans, and demographics. Our primary outcome measured the change in prescribing practice in response to literature linking anticholinergic medications with the risk of dementia. Descriptive statistics were used. RESULTS A total of 222 urogynecology providers completed the survey. Nearly all respondents (99.1%) were aware of the recent literature, and, as a result, 90.5% reported changing their practice. Prior to the publication of recent literature, a "non-CNS-sparing" anticholinergic (e.g., oxybutynin) was most commonly prescribed (64.4%), whereas after the literature was published, this shifted to ß3-adrenoceptor agonists (58.5%, p < 0.001). A majority of respondents (96.6%) reported that insurance restrictions led to a change in treatment for some patients, with 73.5% describing the prior-authorization process as difficult. Many providers (61.8%) reported that a trial of anticholinergics was required by insurance companies prior to authorizing mirabegron. CONCLUSIONS The recent literature associating anticholinergic medications with the development of dementia has changed practice patterns among survey respondents, with a shift away from anticholinergic medications and toward ß3-adrenoceptor agonists. The majority of respondents report insurance barriers to non-anticholinergic therapies, resulting in alteration of their preferred practices.
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Wang M, Jian Z, Ma Y, Jin X, Li H, Wang K. Percutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J 2020; 31:2457-2471. [DOI: 10.1007/s00192-020-04429-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/01/2020] [Indexed: 01/16/2023]
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Sex Differences in Prevalence and Patient Behavior Regarding Lower Urinary Tract Symptoms Among Japanese Medical Checkup Examinees. Urology 2020; 151:24-30. [PMID: 32540299 DOI: 10.1016/j.urology.2020.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the prevalence of lower urinary tract symptoms (LUTS) and patient behavior regarding LUTS and to reveal sex differences among medical checkup examinees. METHODS This cross-sectional, community-based study included participants age 40 years and above in Japan who presented for a medical checkup. The study parameters included the International Prostate Symptom Score, International Consultation on Incontinence Questionnaire-Short Form, overactive bladder symptom score, and an original questionnaire regarding patients' distress and behavior with respect to LUTS. RESULTS Of 1934 residents who presented for a medical checkup, 1582 (81.8%) individuals agreed to participants. Finally, the data of 1256 participants (808 men, 448 women) were analyzed in this study. The overall prevalence of LUTS was similar in both sexes (men 46.8%, women 44.5%; P = .156). Men had a significantly higher prevalence of LUTS than women for voiding and postmicturition symptoms, and a similar prevalence of storage symptoms and overactive bladder. Women had a significantly higher prevalence of urinary incontinence. The rate of distress regarding LUTS and the need to consult a physician were similar in both sexes. However, the consultation rate for LUTS was significantly lower in women than in men (men 38.5%, women 5.3%; P < .001), and women were more likely to restrict their activities owing to LUTS than men (men 13.0%, women 43.6%; P < .001). CONCLUSION Sufficient education regarding LUTS and providing appropriate medical facilities for consultation are warranted to encourage patients, particularly women, to treat their LUTS.
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Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial. J Urol 2020; 203:969-977. [PMID: 31738113 PMCID: PMC7204548 DOI: 10.1097/ju.0000000000000656] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Sacral neuromodulation and intradetrusor onabotulinumtoxinA injection are therapies for refractory urgency urinary incontinence. Sacral neuromodulation involves surgical implantation of a device that can last 4 to 6 years while onabotulinumtoxinA therapy involves serial office injections. We assessed the cost-effectiveness of 2-stage implantation sacral neuromodulation vs 200 units onabotulinumtoxinA for the treatment of urgency urinary incontinence. MATERIALS AND METHODS Prospective economic evaluation was performed concurrent with the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment) randomized trial of 386 women with 6 or more urgency urinary incontinence episodes on a 3-day diary. Analysis is from the health care system perspective with primary within-trial analysis for 2 years and secondary 5-year decision analysis. Costs are in 2018 U.S. dollars. Effectiveness was measured in quality adjusted life-years (QALYs) and reductions in urgency urinary incontinence episodes per day. We generated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. RESULTS Two-year costs were higher for sacral neuromodulation than for onabotulinumtoxinA ($35,680 [95% CI 33,920-37,440] vs $7,460 [95% CI 5,780-9,150], p <0.01), persisting through 5 years ($36,550 [95% CI 34,787-38,309] vs $12,020 [95% CI 10,330-13,700], p <0.01). At 2 years there were no differences in mean reduction in urgency urinary incontinence episodes per day (-3.00 [95% CI -3.38 - -2.62] vs -3.12 [95% CI -3.48 - -2.76], p=0.66) or QALYs (1.39 [95% CI 1.34-1.44] vs 1.41 [95% CI 1.36-1.45], p=0.60). The probability that sacral neuromodulation is cost-effective relative to onabotulinumtoxinA is less than 0.025 for all willingness to pay values below $580,000 per QALY at 2 years and $204,000 per QALY at 5 years. CONCLUSIONS Although both treatments were effective, the high cost of sacral neuromodulation is not good value for treating urgency urinary incontinence compared to 200 units onabotulinumtoxinA.
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Chang YW, Lo TS, Chang HN, Shiao YH, Yeh YC. Laser Acupuncture Alleviates Symptoms and Improves Quality of Life in Women with Overactive Bladder: A Double-Blind, Pilot Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:1705964. [PMID: 32419791 PMCID: PMC7201846 DOI: 10.1155/2020/1705964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical efficacy of laser acupuncture for the treatment of women with overactive bladder (OAB) in Taiwan. METHODS A double-blind randomized controlled trial was conducted on female patients with OAB symptoms referred from gynecologists, and subjects were divided into two groups using blocked randomization. LaserPan (RJ-Laser, Germany) was applied to seven selected acupuncture points. The subjects received laser acupuncture 3 times per week for 3 weeks, 9 sessions in total. Basic patient data, Overactive Bladder Symptom Score (OABSS), Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6) scores were recorded prior to first treatment and at the end of 3rd, 6th, and 9th treatments. RESULTS Thirty patients were enrolled, and twenty-seven patients completed all treatments in this study. The OABSS total score of the experimental group decreased significantly by 3.13 (p ≤ 0.001), 4.60 (p ≤ 0.001), and 3.79 (p ≤ 0.001) after 3rd, 6th, and 9th treatments, respectively, compared with that of the control group. The IIQ-7 score declined significantly from baseline by 4.57 (p=0.003) and 3.63 (p=0.023) after 3rd and 6th treatments, respectively, compared with that of the control group. Similarly, the UDI-6 score of the experimental group exhibited a significant decrease from baseline by 1.90 (p=0.042) and 2.25 (p=0.025) after 6th and 9th interventions, respectively, compared with that of the control group. CONCLUSIONS This study demonstrates that laser acupuncture can alleviate OAB symptoms and improve quality of life. This noninvasive device could be an effective therapy for women with OAB.
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Affiliation(s)
- Yu-Wei Chang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan
| | - Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Linkou, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan
- Chang Gung University, School of Medicine, Taoyuan, Taiwan
| | - Hsin-Ning Chang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan
- Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsien Shiao
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan
| | - Yuan-Chieh Yeh
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan
- Program in Molecular Medicine, School of Life Sciences, National Yang Ming University, Taipei, Taiwan
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Li B, Yu Q, Wang R, Gratzke C, Wang X, Spek A, Herlemann A, Tamalunas A, Strittmatter F, Waidelich R, Stief CG, Hennenberg M. Inhibition of Female and Male Human Detrusor Smooth Muscle Contraction by the Rac Inhibitors EHT1864 and NSC23766. Front Pharmacol 2020; 11:409. [PMID: 32317972 PMCID: PMC7154109 DOI: 10.3389/fphar.2020.00409] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Lower urinary tract symptoms (LUTS) due to overactive bladder (OAB) are caused by spontaneous detrusor contractions. Medical treatment with muscarinic receptor antagonists or β3-adrenoceptor agonists aims to inhibit detrusor contractions, but overall results are unsatisfactory. Consequently, improved understanding of bladder smooth muscle contraction and identification of novel compounds for its inhibition are needed to develop alternative options. A role of the GTPase Rac1 for smooth muscle contraction has been reported from the prostate, but is unknown in the human detrusor. Here, we examined effects of the Rac inhibitors NSC23766, which may also antagonize muscarinic receptors, and EHT1864 on contraction of human detrusor tissues. Methods Female and male human detrusor tissues were obtained from radical cystectomy. Effects of NSC23766 (100 µM) and EHT1864 (100 µM) on detrusor contractions were studied in an organ bath. Results Electric field stimulation induced frequency-dependent contractions of detrusor tissues, which were inhibited by NSC23766 and EHT1864. Carbachol induced concentration-dependent contractions. Concentration response curves for carbachol were shifted to the right by NSC23766, reflected by increased EC50 values, but unchanged Emax values. EHT1864 reduced carbachol-induced contractions, resulting in reduced Emax values for carbachol. The thromboxane analog U46619 induced concentration-dependent contractions, which remained unchanged by NSC23766, but were reduced by EHT1864. Conclusions NSC23766 and EHT1864 inhibit female and male human detrusor contractions. NSC23766, but not EHT1864 competitively antagonizes muscarinic receptors. In addition to neurogenic and cholinergic contractions, EHT1864 inhibits thromboxane A2-induced detrusor contractions. The latter may be promising, as the origin of spontaneous detrusor contractions in OAB is noncholinergic. In vivo, both compounds may improve OAB-related LUTS.
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Affiliation(s)
- Bingsheng Li
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Qingfeng Yu
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Ruixiao Wang
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Gratzke
- Department of Urology, University Hospital, LMU Munich, Munich, Germany.,Department of Urology, University of Freiburg, Freiburg, Germany
| | - Xiaolong Wang
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Annabel Spek
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Annika Herlemann
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | | | | | | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Hennenberg
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Abstract
OBJECTIVES A significant body of knowledge implicates menopausal estrogen levels in the pathogenesis of the common pelvic floor disorders (PFDs). These health conditions substantially decrease quality of life, increase depression, social isolation, caregiver burden, and economic costs to the individuals and society. METHODS This review summarizes the epidemiology of the individual PFDs with particular attention to the understanding of the relationship between each PFD and menopausal estrogen levels, and the gaps in science and clinical care that affect menopausal women. In addition, we review the epidemiology of recurrent urinary tract infection (rUTI)-a condition experienced frequently and disproportionately by menopausal women and hypothesized to be potentiated by menopausal estrogen levels. RESULTS The abundance of estrogen receptors in the urogenital tract explains why the natural reduction of endogenous estrogen, the hallmark of menopause, can cause or potentiate PFDs and rUTIs. A substantial body of epidemiological literature suggests an association between menopause, and PFDs and rUTIs; however, the ability to separate this association from age and other comorbid conditions makes it difficult to draw definitive conclusions on the role of menopause alone in the development and/or progression of PFDs. Similarly, the causative link between the decline in endogenous estrogen levels and the pathogenesis of PFDs and rUTIs has not been well-established. CONCLUSIONS Innovative human studies, focused on the independent effects of menopausal estrogen levels, uncoupled from tissue and cellular senescence, are needed.
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Karakus S, Musicki B, Navati MS, Friedman JM, Davies KP, Burnett AL. NO-Releasing Nanoparticles Ameliorate Detrusor Overactivity in Transgenic Sickle Cell Mice via Restored NO/ROCK Signaling. J Pharmacol Exp Ther 2020; 373:214-219. [PMID: 32144123 DOI: 10.1124/jpet.119.264697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/02/2020] [Indexed: 01/22/2023] Open
Abstract
Sickle cell disease (SCD) is associated with overactive bladder (OAB). Detrusor overactivity, a component of OAB, is present in an SCD mouse, but the molecular mechanisms for this condition are not well-defined. We hypothesize that nitric oxide (NO)/ ras homolog gene family (Rho) A/Rho-associated kinase (ROCK) dysregulation is a mechanism for detrusor overactivity and that NO-releasing nanoparticles (NO-nps), a novel NO delivery system, may serve to treat this condition. Male adult SCD transgenic, combined endothelial NO synthases (eNOSs) and neuronal NOS (nNOS) gene-deficient (dNOS-/-), and wild-type (WT) mice were used. Empty nanoparticle or NO-np was injected into the bladder, followed by cystometric studies. The expression levels of phosphorylated eNOS (Ser-1177), protein kinase B (Akt) (Ser-473), nNOS (Ser-1412), and myosin phosphatase target subunit 1 (MYPT1) (Thr-696) were assessed in the bladder. SCD and dNOS-/- mice had a greater (P < 0.05) number of voiding and nonvoiding contractions compared with WT mice, and they were normalized by NO-np treatment. eNOS (Ser-1177) and AKT (Ser-473) phosphorylation were decreased (P < 0.05) in the bladder of SCD compared with WT mice and reversed by NO-np. Phosphorylated MYPT1, a marker of the RhoA/ROCK pathway, was increased (P < 0.05) in the bladder of SCD mice compared with WT and reversed by NO-np. nNOS phosphorylation on positive (Ser-1412) regulatory site was decreased (P < 0.05) in the bladder of SCD mice compared with WT and was not affected by NO-np. NO-nps did not affect any of the measured parameters in WT mice. In conclusion, dysregulation of NO and RhoA/ROCK pathways is associated with detrusor overactivity in SCD mice; NO-np reverses these molecular derangements in the bladder and decreases detrusor overactivity. SIGNIFICANCE STATEMENT: Voiding abnormalities commonly affect patients with sickle cell disease (SCD) but are problematic to treat. Clarification of the science for this condition in an animal model of SCD may lead to improved interventions for it. Our findings suggest that novel topical delivery of a vasorelaxant agent nitric oxide into the bladder of these mice corrects overactive bladder by improving deranged bladder physiology regulatory signaling.
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Affiliation(s)
- Serkan Karakus
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins, University School of Medicine, Baltimore, Maryland (S.K., B.M., A.L.B.); and Departments of Physiology and Biophysics (M.S.N., J.M.F., K.P.D.) and Urology (K.P.D.), Albert Einstein College of Medicine, New York, New York
| | - Biljana Musicki
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins, University School of Medicine, Baltimore, Maryland (S.K., B.M., A.L.B.); and Departments of Physiology and Biophysics (M.S.N., J.M.F., K.P.D.) and Urology (K.P.D.), Albert Einstein College of Medicine, New York, New York
| | - Mahantesh S Navati
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins, University School of Medicine, Baltimore, Maryland (S.K., B.M., A.L.B.); and Departments of Physiology and Biophysics (M.S.N., J.M.F., K.P.D.) and Urology (K.P.D.), Albert Einstein College of Medicine, New York, New York
| | - Joel M Friedman
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins, University School of Medicine, Baltimore, Maryland (S.K., B.M., A.L.B.); and Departments of Physiology and Biophysics (M.S.N., J.M.F., K.P.D.) and Urology (K.P.D.), Albert Einstein College of Medicine, New York, New York
| | - Kelvin P Davies
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins, University School of Medicine, Baltimore, Maryland (S.K., B.M., A.L.B.); and Departments of Physiology and Biophysics (M.S.N., J.M.F., K.P.D.) and Urology (K.P.D.), Albert Einstein College of Medicine, New York, New York
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins, University School of Medicine, Baltimore, Maryland (S.K., B.M., A.L.B.); and Departments of Physiology and Biophysics (M.S.N., J.M.F., K.P.D.) and Urology (K.P.D.), Albert Einstein College of Medicine, New York, New York
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Comparing written and verbal delivery of a treatment regimen to women with overactive bladder: a randomized controlled trial. ACTA ACUST UNITED AC 2019; 27:76-81. [PMID: 31663980 DOI: 10.1097/gme.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Overactive bladder is a common condition among aging women requiring a multifaceted treatment approach, which is usually communicated by physician to the patient in the clinic setting. The objective of this two-center, randomized controlled trial was to determine if a transcribed list of six management strategies for overactive bladder improves immediate and delayed retention of these recommendations compared with a traditional verbal discussion. METHODS Between March, 2015 and February, 2019, women newly diagnosed with overactive bladder were randomized to either the intervention group, where they received a transcribed list of six treatment recommendations, or to the control group, where the same six recommendations were communicated verbally by their physician. Participants in both groups were asked to recall treatment recommendations immediately after their appointment and 2 weeks later. A score out of 6 was assigned at each time point based on the number of recommendations participants could list. Scores at each point of recall were compared between groups. RESULTS Seventy-two women were recruited and randomized to either the written instruction (n = 34) or verbal discussion group (n = 38). Immediate total retention score was significantly better for women who received the transcribed list compared with those receiving verbal communication (P = 0.002). There was no difference in 2-week total information retention scores between groups. CONCLUSIONS A written list of recommendations is a quality improvement initiative that can improve overactive bladder participants' immediate retention of a suggested treatment regimen, but lacks impact 2 weeks later.
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Karakus S, Anele UA, Silva FH, Musicki B, Burnett AL. Urinary dysfunction in transgenic sickle cell mice: model of idiopathic overactive bladder syndrome. Am J Physiol Renal Physiol 2019; 317:F540-F546. [PMID: 31215803 DOI: 10.1152/ajprenal.00140.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Voiding abnormalities are common among the sickle cell disease (SCD) population, among which overactive bladder (OAB) syndrome is observed at rates as high as 39%. Although detrusor overactivity is the most common cause of OAB, its molecular pathophysiology is not well elucidated. The nitric oxide (NO) signaling pathway has been implicated in the regulation of lower genitourinary tract function. In the present study, we evaluated the role of the NO signaling pathway in voiding function of transgenic SCD mice compared with combined endothelial and neuronal NO synthase gene-deficient mice, both serving as models of NO deficiency. Mice underwent void spot assay and cystometry, and bladder and urethral specimens were studied using in vitro tissue myography. Both mouse models exhibited increased void volumes; increased nonvoiding and voiding contraction frequencies; decreased bladder compliance; increased detrusor smooth muscle contraction responses to electrical field stimulation, KCl, and carbachol; and increased urethral smooth muscle relaxation responses to sodium nitroprusside compared with WT mice. In conclusion, our comprehensive behavioral and functional study of the SCD mouse lower genitourinary tract, in correlation with that of the NO-deficient mouse, reveals NO effector actions in voiding function and suggests that NO signaling derangements are associated with an OAB phenotype. These findings may allow further study of molecular targets for the characterization and evaluation of OAB.
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Affiliation(s)
- Serkan Karakus
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Uzoma A Anele
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Fábio H Silva
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil
| | - Biljana Musicki
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur L Burnett
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Factors Associated with Improvements in Patient-Reported Outcomes During Mirabegron or Antimuscarinic Treatment of Overactive Bladder Syndrome: A Registry Study (PERSPECTIVE). Adv Ther 2019; 36:1906-1921. [PMID: 31222714 PMCID: PMC6822866 DOI: 10.1007/s12325-019-00994-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Indexed: 01/18/2023]
Abstract
Introduction Patient-reported outcomes (PROs) provide valuable insights about the effectiveness of overactive bladder (OAB) treatments. The aim of PERSPECTIVE (a Prospective, non-intErventional Registry Study of PatiEnts initiating a Course of drug Therapy for overactIVE bladder) was to provide real-world evidence from the USA and Canada on patient-perceived effectiveness and safety of mirabegron and antimuscarinics for treating OAB symptoms. Methods This prospective, non-interventional registry followed adult patients with OAB who were starting treatment with mirabegron or antimuscarinics. All treatment decisions were made at the discretion of the treating healthcare provider with no mandatory visits after enrollment. The primary objective was to identify factors associated with improved treatment effectiveness from a patient perspective mainly using the OAB Questionnaire Short-Form (OAB-q SF). The form was sent to patients via email link at baseline and months 1, 3, 6, and 12. Treatment-emergent adverse event (TEAE) data were collated from investigator reports. Results Overall, 1514 patients were included (female 73.5%, mean age 62.2 years). Mirabegron was initiated by 613 patients and antimuscarinics by 901 patients. A PRO response rate of approximately 60% was achieved (575 patients did not complete baseline PROs). Similar improvements in OAB-q SF symptom bother score and health-related quality of life (HRQoL) total score were observed for mirabegron and antimuscarinic initiators. Covariate-adjusted models demonstrated that worse baseline PRO score, Hispanic ethnicity, being treatment naïve, and use of complementary/supportive OAB therapies at baseline were significantly associated with greater improvements in both scores. The most frequent TEAEs were gastrointestinal disorders (dry mouth, constipation, and nausea) and nervous system disorders (headache, somnolence, and dizziness). Conclusion There are no differences between mirabegron and antimuscarinics in terms of patient-reported OAB symptom bother and HRQoL. Trial Registration ClinicalTrials.gov identifier, NCT02386072. Funding Astellas Pharma Global Development, Inc. Plain Language Summary Plain language summary available for this article. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-00994-7) contains supplementary material, which is available to authorized users.
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Lee HY, Doo SW, Yang WJ, Song YS, Sun HY, Nho EJ, Lee B, Kim JH. Efficacy and Safety of Noninvasive Intravesical Instillation of Onabotulinum Toxin-A for Overactive Bladder and Interstitial Cystitis/Bladder Pain Syndrome: Systematic Review and Meta-analysis. Urology 2018; 125:50-57. [PMID: 30552935 DOI: 10.1016/j.urology.2018.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of noninvasive intravesical instillation of onabotulinum toxin-A (OBTX-A) through systematic review and meta-analysis. Recently, several studies of noninvasive intravesical instillation of OBTX-A have been published. However, its efficacy is not well validated yet compared to well-known efficacy of minimally invasive intravesical injection of OBTX-A. METHOD Systematic review and meta-analysis were performed to evaluate the efficacy of noninvasive intravesical instillation of OBTX-A in patients with overactive bladder and interstitial cystitis/bladder pain syndrome by measuring outcomes such as urgency episode per 72 hours, frequency per 72 hours, urgency urinary incontinence, voided volume (VV), postvoided residual volume, maximum flow rate, and patient perception of bladder condition. RESULT Six trials in 4 studies that compared instillation of OBTX-A and placebo involving 248 patients (121 experimental and 127 controls) were included for final data extraction. Instillation of OBTX-A significantly increased VV, with a mean difference of 38.48 (95% confidence interval: 76.05, 0.92) compared to the placebo group. However, other outcomes showed statistically insignificant changes. Major adverse events were not reported in the group receiving intravesical instillation of OBTX-A. CONCLUSION Intravesical instillation of OBTX-A showed limited efficacy with improvement of VV for treatment of overactive bladder or interstitial cystitis/bladder pain syndrome. More studies are needed to overcome the efficacy of current noninvasive bladder instillation of OBTX-A regarding effective drug transport.
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Affiliation(s)
- Hyun Young Lee
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | - Seung Whan Doo
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | - Yun Seob Song
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | - Hwa Yeon Sun
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | | | - Bora Lee
- Department of Statistics, Graduate School of Chung-Ang University, Seoul, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea.
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Tu LM, De Wachter S, Robert M, Dmochowski RR, Miller LE, Everaert K. Initial clinical experience with selective bladder denervation for refractory overactive bladder. Neurourol Urodyn 2018; 38:644-652. [PMID: 30499155 PMCID: PMC7379657 DOI: 10.1002/nau.23881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/01/2018] [Indexed: 11/12/2022]
Abstract
Aims To report the initial clinical experience with selective bladder denervation (SBD) of the trigone in women with refractory overactive bladder (OAB). Methods Females with refractory OAB underwent SBD of the bladder sub‐trigone region. Patients were treated using a 10‐s voltage‐controlled radiofrequency (RF) algorithm (RF10) at study onset. The protocol was modified during the study after which point remaining patients received 60‐s temperature‐controlled RF (RF60). Patients were followed for 12 weeks and evaluated for adverse events and changes in OAB symptoms. Exploratory analyses on the influence of RF duration were performed. Results Among 63 patients, SBD resulted in statistically significant and clinically important improvements for most outcomes. Comparing RF10 (n = 34) to RF60 (n = 29), treatment benefit was greater with RF60 including mean reduction in urgency urinary incontinence (−2.5 vs −0.9; P < 0.01), urinary incontinence (−2.6 vs −0.8; P < 0.001), and total urgency and frequency score (−13 vs −7; P = 0.02); and improvements in symptom bother (−33 vs −18; P < 0.01) and quality of life (28 vs 16; P = 0.02) on the OAB questionnaire. The proportion of urgency urinary incontinence treatment responders (≥50% reduction in episodes) was 79% with RF60 and 31% with RF10. The frequency of device‐ or procedure‐related adverse events was comparable in RF10 versus RF60 groups (14.7% vs 17.2%). Conclusions This study demonstrated the feasibility of SBD in alleviating symptoms of refractory OAB. A 60‐s RF algorithm using deeper ablations of the sub‐trigonal tissues was more effective and comparably safe to a 10‐s RF algorithm using more superficial ablations.
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Affiliation(s)
- Le Mai Tu
- Division of Urology, Department of Surgery, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Magali Robert
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Calgary, Alberta, Canada
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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