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Kozma B, Takacs P. Underdiagnosed but overtreated? Finding the role of modern therapies in the management of overactive bladder. Menopause 2025; 32:187-188. [PMID: 39903804 DOI: 10.1097/gme.0000000000002521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Affiliation(s)
- Bence Kozma
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Chen B, Yin P, Li J, Hou W, Fan Q, Huai Y, Liu L, Hu J, Chow ST, Li X, Ming S, Chen YL. Electroacupuncture versus solifenacin succinate for female overactive bladder: study protocol for a multicentre, randomised, controlled, double-dummy, non-inferiority trial. BMJ Open 2024; 14:e076374. [PMID: 39266323 PMCID: PMC11404179 DOI: 10.1136/bmjopen-2023-076374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/29/2024] [Indexed: 09/14/2024] Open
Abstract
INTRODUCTION Overactive bladder (OAB) affects approximately 500 million people worldwide, with a higher prevalence in women than in men, significantly impacting the quality of life of female patients. Treatment options for OAB are currently limited. Previous research has proposed that electroacupuncture could be a viable treatment for OAB in women, but there is a lack of high-quality clinical evidence. This study aims to evaluate the effectiveness of electroacupuncture as a safe and efficient non-pharmacological treatment for female OAB by comparing it with solifenacin succinate. METHODS AND ANALYSIS This study is a multicentre, single-blind, double-dummy randomised controlled non-inferiority clinical trial involving 204 eligible female participants with OAB. Participants will be randomly assigned in a 1:1 ratio to either the electroacupuncture group (receiving electroacupuncture and placebo) or the solifenacin succinate group (receiving sham electroacupuncture and solifenacin succinate). Each participant will undergo 12 sessions of electroacupuncture (or sham electroacupuncture) treatment and solifenacin succinate (or placebo) treatment over a 4-week period. The primary outcome measure will be the percentage change in the number of micturition episodes every 24 hours at week 4 compared with baseline. Secondary outcomes will include a percentage reduction in the number of micturition episodes every 24 hours at 2th, 8th and 16th weeks of the trial, Overactive Bladder Symptom Score, number of urinary incontinence and urgency episodes every 24 hours based on a 3-day voiding diary, OAB Questionnaire, Generalised Anxiety Disorder Scale-7, King's Health Questionnaire and Participant Self-evaluation of Therapeutic Effects. Adverse events will be monitored throughout the study. Efficacy analyses will be conducted on both the intention-to-treat population and the per-protocol set population. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Medical Ethics Committee of Longhua Hospital Shanghai University of Traditional Chinese Medicine (approval number: 2022LCSY097). Each participant will sign a written informed consent before randomisation. The results of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER : NCT05798403.
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Affiliation(s)
- Bingli Chen
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Acupuncture Department, Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
| | - Ping Yin
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juanjuan Li
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenguang Hou
- Acupuncture Department, Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
| | - Qian Fan
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yisheng Huai
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lumin Liu
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junwei Hu
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sandra Teresa Chow
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu Li
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuren Ming
- Acupuncture Department, Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
| | - Yue-Lai Chen
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Xu ZH, Zhang PF, Wang YF, Ma A, Bano Y, Ibrohimov A, Zhang C, Jiang HF, Zhang Y, Yu YL, Jiang HH. A Multi-Center, Randomized, Blind, Controlled Clinical Trial of the Safety and Efficacy of Micro Radio Frequency Therapy System for the Treatment of Overactive Bladder. Front Med (Lausanne) 2022; 9:746064. [PMID: 35646944 PMCID: PMC9133845 DOI: 10.3389/fmed.2022.746064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the efficacy and safety of low power micro radiofrequency (RF) therapy (μRFthera®) through urethra in the treatment of overactive bladders (OAB) through a prospective, single-blind, placebo-controlled, multi-center clinical protocol. Materials and Methods One hundred and fourteen patients with refractory OAB were randomized at 2:1 ratio, treatment to control undergoing same procedures except only the micro-RF treatment group at turned “on” setting in energy. Bladder diaries recorded during the screening period (3 days before enrollment) and during follow-up period on week 1, 3, and 7, respectively. The patients in control could choose receiving an energized treatment during extension stage. Results The treatment efficacy was 76.1%. There was 49.80% rate improvement compared to control (95%CL 32.48%, 67.13%). The crude rate ration (RR) was 2.89, 95% CI (1.67–5.01) with p < 0.001 in uni-variate analysis, while the RR became 2.94, 95% CI (1.67–5.16) with p < 0.001 after adjusted potential confounding factors in multi-variate analysis. Statistically significant improvements have been demonstrated in the frequency of urination, urgency, nocturia, and quality of life (QoL) scores. Conclusions Micro RF therapy is safe and effective for the treatment of OAB. The main treatment-related complications were catheterization related complications. Clinical Trial Registration Zhejiang Device Registration Certificate No. 202090909, www.chictr.org.cn, Clinical Trial Accession Number: ChiCTR2100050096.
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Affiliation(s)
- Zhi-Hui Xu
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Peng-Fei Zhang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu-Feng Wang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ao Ma
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yasmeen Bano
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Chen Zhang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao-Fei Jiang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yang Zhang
- Zhejiang-California International NanoSystems Institute, Hangzhou, China
| | - Yan-Lan Yu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yan-Lan Yu
| | - Hai-Hong Jiang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Hai-Hong Jiang
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Versi E, Rovner ES, Dmochowski RR, Tu LM, De Wachter S. Does urinary urgency drive urinary frequency in overactive bladder? Low Urin Tract Symptoms 2022; 14:242-247. [PMID: 35233968 DOI: 10.1111/luts.12427] [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: 12/15/2021] [Revised: 10/19/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine if reduction in urgency in patients with refractory overactive bladder syndrome (rOAB) is correlated with a reduction in voiding frequency and symptom bother. METHODS Data from a prospective series of women with rOAB undergoing radiofrequency ablation of the subtrigonal tissue, termed selective bladder denervation (SBD), was analyzed. Main outcome measures included urgency voids, nonurgency voids, and urgency urinary incontinence (UUI) epidsodes from a 3-day voiding diary and quality of life (QoL) measures (Overactive Bladder Questionnaire Short Form [OAB-q SF]). RESULTS The dataset comprised 62 completer subjects at 6 months. Compared to baseline, UUI and urgency voids were lower (P < .001), but nonurgency voids were increased (P < .001) and QoL measures were improved (P < .001), but functional bladder capacity did not increase. At baseline and 6 months post treatment, symptom bother was correlated with urgency voids (P < .05) but inversely correlated with nonurgency voids (P < .001). Urgency and nonurgency voids were inversely related at baseline and at 6 months (P < .0001). Following treatment, urgency voids decreased by 41% and nonurgency voids increased by 33%. CONCLUSIONS As with other interventions for OAB, SBD resulted in a reduction in OAB symptoms and an improvement in QoL measures. However, the decrease in urgency voids was offset by an increase in nonurgency voids, suggesting that habit or defensive voiding is a significant driver of urinary frequency. It is not certain if this is a unique finding of the SBD effect, but these data do suggest that analyses of outcomes of other OAB interventions are warranted to gain a better understanding of the genesis of OAB symptoms.
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Affiliation(s)
- Eboo Versi
- Department of Obstetrics, Gynecology, Reproductive Sciences, Rutgers, New Brunswick, New Jersey, USA
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - 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
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Araklitis G, Baines G, da Silva AS, Robinson D, Cardozo L. Recent advances in managing overactive bladder. F1000Res 2020; 9:F1000 Faculty Rev-1125. [PMID: 32968482 PMCID: PMC7489273 DOI: 10.12688/f1000research.26607.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. In this review, we focus on recent advances in the management of OAB. We examine the evidence on the effect of anticholinergic load on OAB patients. Advances in medical treatment include a new beta-3 agonist, vibegron, which is thought to have fewer drug interactions than mirabegron. Treatment of genitourinary syndrome of the menopause with oestrogens and ospemifene have also shown promise for OAB. Botulinum toxin has been shown to be an effective treatment option. We discuss the new implantable neuromodulators that are on the market as well as selective bladder denervation and laser technology.
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Affiliation(s)
- George Araklitis
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - Georgina Baines
- Department of Urogynaecology, King’s College Hospital, London, UK
| | | | - Dudley Robinson
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King’s College Hospital, London, UK
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Chen LC, Kuo HC. Current management of refractory overactive bladder. Low Urin Tract Symptoms 2020; 12:109-116. [PMID: 32073742 DOI: 10.1111/luts.12304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/21/2020] [Indexed: 12/19/2022]
Abstract
Overactive bladder (OAB) is a common condition affecting one-sixth to one-fifth of the global population. The treatment of refractory OAB remains a challenge for urologists. Current treatment options include the use of combination therapy with antimuscarinic agents and beta-3 adrenoceptor agonists, and treating underlying curable disorders. Intravesical botulinum toxin type A (BoNT-A) injection, percutaneous tibial nerve stimulation, and sacral nerve stimulation are third-line management therapies suggested by the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (AUA/SUFU) guidelines. In rare cases, more invasive surgical interventions can be considered after explaining the benefits and risks to the patients. Augmentation cystoplasty has a high success rate; however, it has also been associated with a high complication rate. In contrast, detrusor myomectomy is an easy procedure, but the treatment outcome remains controversial. Liposome-encapsulated BoNT-A is administered via bladder instillation, and promising results have been obtained in preliminary studies. More therapies are currently being investigated, and transient receptor potential vanilloid 1 antagonists may be new type of medication. Radiofrequency ablation and other targets for neuromodulation have also been studied; however, more evidence is needed to confirm their efficacy.
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Affiliation(s)
- Li-Chen Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Fundation and Tzu Chi University, Hualien, Taiwan
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Robinson D, Flint R, Veit-Rubin N, Araklitis G, Cardozo L. Is there enough evidence to justify the use of laser and other thermal therapies in female lower urinary tract dysfunction? Report from the ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S140-S147. [PMID: 32040871 DOI: 10.1002/nau.24298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
AIMS There is increasing evidence to suggest that thermomodulation may have a role in the management of women with lower urinary tract dysfunction (LUTD) and there has been widespread adoption of laser and radiofrequency (RF) therapies within clinical practice. However, in many areas of LUTD, the data are still limited and there remains a need for further evaluation of the safety and efficacy of thermal therapy. The aim of this study proposal is to report the findings of the International Consultation on Incontinence Research Society to clarify our current knowledge regarding the evidence for thermal therapy in LUTD and to set research priorities for the future. METHODS Literature review based on the search terms: "laser," "radiofrequency," "genitourinary syndrome of the menopause" or "urogenital atrophy," "stress urinary incontinence (SUI)," "pelvic organ prolapse," "OAB" or "overactive bladder," and "urinary tract infection." RESULTS The current available evidence, though of low or very low quality, appears promising for the use of laser therapy in the management of genitourinary syndrome of the menopause, there are some data to suggest a possible role in SUI although very little evidence for urogenital prolapse. At present, the evidence supporting the use of laser in OAB and recurrent urinary tract infection is limited or lacking, while the available evidence for RF in the management of all forms of LUTD is much less robust. CONCLUSIONS Laser and RF are being introduced clinically as a minimally invasive, low-risk interventions for women with LUTD although at present, the evidence supporting usage is limited. Consequently, there is an urgent need to demonstrate the safety and efficacy with prospective long-term studies including sham studies and comparative studies with current standard therapy.
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Affiliation(s)
- Dudley Robinson
- Department of Urogynaecology, Kings College Hospital, London, UK
| | - Richard Flint
- Department of Urogynaecology, Kings College Hospital, London, UK.,Kings College Hospital, London, UK
| | | | - George Araklitis
- Department of Urogynaecology, Kings College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, Kings College Hospital, London, UK.,Kings College Hospital, London, UK
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Brière R, Versi E, Richard PO, Gratton M, Tu LM. A Preliminary Study on the Impact of Detrusor Overactivity on the Efficacy of Selective Bladder Denervation for the Treatment of Female Refractory Overactive Bladder. Urology 2019; 136:88-94. [PMID: 31794815 DOI: 10.1016/j.urology.2019.08.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether the presence of detrusor overactivity (DO) is associated with the 12-week and 12-month clinical outcomes of selective bladder denervation (SBD) in women with refractory overactive bladder (OAB). METHODS Prospective single institutional study of refractory OAB females who underwent a urodynamic study and were categorized according to DO status (DO- vs DO+) prior to receiving SBD. RESULTS Among the 23 patients, 10 were DO- and 13 were DO+. Both groups reported improvement at 12 weeks on the 24-hour pad weight test, in urgency urinary incontinence (UUI) and urgency. At 12 months, both groups still reported improvement in urgency, but only the DO- group reported reduction on the pad weight test and only the DO+ group maintained improvement in the UUI rate. Clinical success (≥50% reduction in UUI) was achieved by all DO- and by 69% of DO+ patients at 12 weeks, and by 60% of DO- and 92% of DO+ patients at 12 months. Treatment benefit (Treatment Benefit Scale ≤2) was reported in 90% of DO- and 85% of DO+ patients at 12 weeks, and in 60% of DO- and 85% of DO+ patients at 12 months. When directly comparing both group outcomes, the only significant difference was the greater reduction of UUI in the DO- group at 12 weeks (-9.0 vs -6.5; P = .045). CONCLUSION Refractory OAB females appear to be effectively treated by SBD regardless of baseline DO status. DO status does not seem to be associated with the 12-week and 12-month outcomes of SBD.
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Affiliation(s)
| | - Eboo Versi
- Department of Obstetrics, Gynecology, Reproductive Sciences, Rutgers, New Brunswick, NJ
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Faculty of Medicine and Health Sciences, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Matthieu Gratton
- Division of Urology, Department of Surgery, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Le Mai Tu
- Division of Urology, Department of Surgery, Faculty of Medicine and Health Sciences, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, Québec, Canada.
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Initial Evaluation of a Novel Modulated Radiofrequency-based Bladder Denervation Device. Urology 2019; 134:237-242. [PMID: 31539508 DOI: 10.1016/j.urology.2019.08.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if targeted and modulated radiofrequency ablation (RFA) of the urinary bladder using our novel ablation device (Denerblate) reduces bladder nerve density, potentially leading to a novel strategy for the management of overactive bladder. METHODS Fifteen pigs were divided into 4 groups: control (n = 3), 1-week (n = 4), 4-week (n = 4) and 12-week (n = 4) survival times. Denerblate was deployed on the trigone area of the bladder. Three 240-second cycles of modulated RFA were applied with 30 seconds between cycles. At the end of each survival term, urinary bladders were harvested for histopathologic evaluation. Nerve count and density were manually calculated. RESULTS All procedures were successfully completed, and all animals survived to the desired time points. Mean nerve density (nerves/mm2) was highest in the control and 1-week survival group compared to the 4-week and 12-week groups, both of which demonstrated significant diminishment. Nerve density in the bladder neck at control, 1 week, 4 weeks, and 12 weeks were 1.8, 1.35, 0.87, and 0.12, respectively (P <.001). Nerve density in the bladder trigone area at control, 1 week, 4 weeks, and 12 weeks were 1.5, 0.98, 0.65, and 0.112, respectively (P <.001). Epithelial heat injury was observed in 14.3% at 1 week, 10.7% at 4 weeks, but completely resolved by 12 weeks. CONCLUSION In the porcine model, modulated RFA delivered by our novel device reduced nerve density in the bladder neck and trigone by 88.6% and 88.9% at 12 weeks without evidence of lasting epithelial injury.
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Rovner ES, Versi E, Le Mai T, Dmochowski RR, De Wachter S. One-year results with selective bladder denervation in women with refractory overactive bladder. Neurourol Urodyn 2019; 38:2178-2184. [PMID: 31359508 DOI: 10.1002/nau.24110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/30/2019] [Indexed: 01/23/2023]
Abstract
AIMS To report 1-year results with selective bladder denervation (SBD) of the trigone in women with refractory overactive bladder (OAB). METHODS In this prospective, international, multicenter case series, women with refractory OAB underwent a single SBD treatment of the bladder subtrigone region using temperature-controlled radiofrequency. Patients were followed for 1 year and evaluated for changes in OAB symptoms and adverse events. RESULTS Among 35 women, 29 (83%) returned for 1-year follow up. Median symptom reductions based on 3-day bladder diaries were 68% for urgency urinary incontinence ( P < .001), 67% for urinary incontinence ( P < .001), 43% for urgency episodes ( P < .001), 5% for urinary frequency ( P = .19), and 33% for the total urgency and frequency score ( P < .001), with the majority of treatment benefit realized in the first month. Treatment benefit was reported in 72% of patients, the clinical success rate (≥50% reduction in urgency urinary incontinence) was 69%, and the dry rate was 10%. Statistically significant improvements occurred on Symptom Bother and Health-related Quality of Life scales on the Overactive Bladder questionnaire, and on 6 of 9 King's Health Questionnaire domains. Patients with less severe baseline symptoms had similar quality of life improvements as those with more severe baseline symptoms. Device- or procedure-related adverse events were reported in 6 (17%) patients. CONCLUSIONS A single treatment with selective bladder denervation is durable for 1-year in a significant proportion of women with refractory overactive bladder.
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Affiliation(s)
- Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Eboo Versi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University, New Brunswick, New Jersey
| | - Tu Le Mai
- Division of Urology, Department of Surgery, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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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: 1.3] [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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