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Kimura M, Ishii I, Baba A, Takara T. Beneficial effects of saw palmetto ( Serenoa repens) fruit extract on the urinary symptoms of healthy Japanese adults with possible lower urinary tract symptoms: A randomized, double-blind, placebo-controlled study. Nutr Health 2024:2601060241265389. [PMID: 39042923 DOI: 10.1177/02601060241265389] [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: 07/25/2024]
Abstract
Saw palmetto extract (SPE) is the most commonly used supplement for the treatment of lower urinary tract symptoms (LUTS), but most evidence is for those with LUTS, and little data is verifying its effectiveness for those who do not have the disease but are troubled by symptoms. The purpose of this study was to examine the effect of SPE on the improvement of urinary frequency problems that present stress due to urinary urgency in daily life, among healthy Japanese adults aged ≥50 years who are not diagnosed with benign prostatic hyperplasia or overactive bladder. They were randomly assigned to the SPE group or placebo group (34 participants per group) using a computerized random number generator. Each participant was instructed to take one capsule containing SPE (320 mg) or placebo every day for 12 weeks. Subjective symptoms were assessed using the overactive bladder questionnaire, and the score of symptom bother by frequent urination during the daytime hours was set as the primary outcome. The other outcomes were subjective urinary symptoms and urinary frequencies. The final efficacy analysis dataset was per protocol set, and 33 participants in each group were analyzed. After SPE intervention for 12 weeks, the score of symptom bother by frequent urination during the daytime hours was significantly improved and the daytime frequency of urination assessed using the urinary log was significantly decreased. The consumption of SPE improved urinary frequency-related quality of life such as bother of urinary symptoms in healthy Japanese adults (UMIN000045334).
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Affiliation(s)
- Mai Kimura
- YAWATA CORPORATION, Yonago, Tottori, Japan
| | | | - Asami Baba
- ORTHOMEDICO Inc., Bunkyo-ku, Tokyo, Japan
| | - Tsuyoshi Takara
- Medical Corporation Seishinkai, Takara Clinic, Shinagawa-ku, Tokyo, Japan
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Hagovska M, Svihra J, Macko L, Breza J, Svihra J, Luptak J, Lachvac L. The effect of pelvic floor muscle training in men with benign prostatic hyperplasia and overactive bladder. World J Urol 2024; 42:287. [PMID: 38698269 PMCID: PMC11065782 DOI: 10.1007/s00345-024-04974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/20/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Men with overactive bladder (OAB) and benign prostatic hyperplasia (BPH), will have deterioration in the quality of life. OBJECTIVE The aim of this study was to evaluate the effect of combining pelvic floor muscle training with the urgency suppression technique (PFMT-st) and silodosin in comparison with silodosin in men with benign prostatic hyperplasia (BPH) and overactive bladder (OAB) after 12 weeks of treatment. PATIENTS AND METHODS A total of 158 patients were randomized into two groups. The control group received oral silodosin at a daily dose of 8 mg. The experimental group was administered PFMT-st and silodosin. The evaluation methods included the number of voids and intensity of urgencies over 24 h using a micturition diary, the International Prostate Symptom Score (IPSS), the Overactive Bladder Questionnaire (OAB-q), and the patient global impression of improvement (PGI-I). RESULTS 142 of 172 (86.6%) men were assessed (70 in the control group, 72 in the experimental group). The significant changes were in favor of the experimental group (p < 0.001) in the number of voids per 24 h (- 1.95 ± 1.94 vs. - 0.90 ± 1.44), the OAB-q symptom score (- 14.25 ± 10.05 vs. - 9.28 ± 10.60), the intensity of urgencies (- 0.97 ± 0.53 vs. 0.24 ± 0.57), the IPSS (- 4.59 ± 3.00 vs. - 2.30 ± 3.63), and in the PGI-I (2.24 ± 0.79 vs. 3.60 ± 0.92). CONCLUSIONS The addition of PFMT-st to silodosin treatment significantly improved OAB in men with BPH. This is the first study to confirm that PFMT-st should be the first-choice treatment for OAB in BPH.
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Affiliation(s)
- Magdalena Hagovska
- Department of Physiatry, Balneology, and Medical Rehabilitation, Institution-Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
| | - Jan Svihra
- Department of Urology, Jessenius Faculty of Medicine, Comenius University Bratislava, Martin, Slovak Republic.
| | - Ladislav Macko
- Outpatient Clinic of Urology, Urocentrum, Levice, Slovak Republic
| | - Jan Breza
- Department of Pediatric Urology, Faculty of Medicine, Comenius University Bratislava, National Institute of Pediatric Diseases, Bratislava, Slovak Republic
| | - Jan Svihra
- Department of Urology, Jessenius Faculty of Medicine, Comenius University Bratislava, Martin, Slovak Republic
| | - Jan Luptak
- Department of Urology, Jessenius Faculty of Medicine, Comenius University Bratislava, Martin, Slovak Republic
| | - Lubomir Lachvac
- Department of Urology, Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
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Harvie HS, Richter HE, Sung VW, Chermansky CJ, Menefee SA, Rahn DD, Amundsen CL, Arya LA, Huitema C, Mazloomdoost D, Thomas S. Trial Design for Mixed Urinary Incontinence: Midurethral Sling Versus Botulinum Toxin A. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:478-488. [PMID: 38212101 PMCID: PMC11058039 DOI: 10.1097/spv.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
IMPORTANCE Mixed urinary incontinence (MUI) is common and can be challenging to manage. OBJECTIVES We present the protocol design and rationale of a trial comparing the efficacy of 2 procedures for the treatment of women with MUI refractory to oral treatment. The Midurethral sling versus Botulinum toxin A ( MUSA) trial compares the efficacy of intradetrusor injection of 100 U of onabotulinimtoxinA (an office-based procedure directed at the urgency component) versus midurethral sling (MUS) placement (a surgical procedure directed at the stress component). STUDY DESIGN The MUSA is a multicenter, randomized trial of women with MUI electing to undergo procedural treatment for MUI at 7 clinical centers in the NICHD Pelvic Floor Disorders Network. Participants are randomized to either onabotulinumtoxinA 100 U or MUS. OnabotulinimtoxinA recipients may receive an additional injection between 3 and 6 months. Participants may receive additional treatment (including crossover to the alternative study intervention) between 6 and 12 months. The primary outcome is change from baseline in Urogenital Distress Inventory (UDI) at 6 months. Secondary outcomes include change in UDI at 3 and 12 months, irritative and stress subscores of the UDI, urinary incontinence episodes, predictors of poor treatment response, quality of life and global impression outcomes, adverse events, use of additional treatments, and cost effectiveness. RESULTS Recruitment and randomization of 150 participants is complete and participants are currently in the follow-up phase. CONCLUSIONS This trial will provide information to guide care for women with MUI refractory to oral treatment who seek surgical treatment with either onabotulinumtoxinA or MUS.
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Affiliation(s)
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Vivian W Sung
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University/Women and Infants Hospital, Providence, RI
| | | | - Shawn A Menefee
- Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA
| | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern, TX
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham
| | - Lily A Arya
- From the Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania
| | | | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Ali MU, Winser SJ, Kannan P, Kranz GS, Fong KNK. Clinical tools for evaluating the severity of overactive bladder: A systematic review of psychometric properties. Clin Rehabil 2024; 38:636-646. [PMID: 38192076 DOI: 10.1177/02692155231225662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES To systematically evaluate the evidence describing the psychometric properties of clinical measures for assessing overactive bladder symptoms (urinary urgency with or without urge urinary incontinence, urinary frequency and nocturia). To evaluate the quality of this evidence-base using the COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tools. DATA SOURCES Five electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from dataset inception to August 2023. REVIEW METHODS Study screening, data extraction and quality appraisal were performed by two independent authors. Inclusion criteria were studies testing one or more psychometric properties of clinical tools for the assessment of overactive bladder symptoms among adults aged 18 years and older for both sexes. The methodological quality and quality of the evidence were evaluated using the COSMIN checklist and GRADE tools, respectively. RESULTS The search identified 40 studies totalling 10,634 participants evaluating the psychometric properties of 15 clinical tools. The COSMIN methodological quality was rated good for most measures, and the GRADE quality of evidence ranged from low (13%) to high (33%). The Overactive Bladder Symptom Score, Overactive Bladder Questionnaire and Neurogenic Bladder Symptom Score were of good methodological and high-GRADE evidence qualities. CONCLUSION Overactive Bladder Symptom Score, the Overactive Bladder Questionnaire and the Neurogenic Bladder Symptoms Score are promising psychometrically sound measures. The Overactive Bladder Symptom Score has been applied to the most culturally diverse populations supported by studies of good methodological and high-GRADE evidence quality.
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Affiliation(s)
- Mohammed Usman Ali
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Stanley John Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Kenneth Nai-Kuen Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Usman Ali M, Fong KNK, Kannan P, John Winser S, Muhammad Bello U, Salihu D, Kranz GS. Measures of quality of life of people with neurogenic overactive bladder: A systematic review of psychometric properties. Eur J Obstet Gynecol Reprod Biol 2024; 292:40-57. [PMID: 37976765 DOI: 10.1016/j.ejogrb.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To identify psychometrically robust quality-of-life (QOL) outcome measures for evaluating QOL among people with neurogenic overactive bladder (OAB). STUDY DESIGN Electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from inception to January 2023. Two independent reviewers participated in study screening, data extraction and quality appraisal. Studies were included if they validated at least one psychometric property of a QOL outcome measure among adults (age ≥ 18 years) with neurogenic OAB. The COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool were used to evaluate the methodological quality and quality of evidence, respectively, for each included study. RESULTS Database searches identified 47 studies that tested the psychometric properties of 15 QOL measures in a total of 19,994 participants with stroke, spinal cord injury, Parkinson's disease or multiple sclerosis. The Incontinence Quality of Life Questionnaire (I-QOL), King's Health Questionnaire, Overactive Bladder Questionnaire and Qualiveen were the best validated measures, with strong reliability, validity and responsiveness. I-QOL was the most robust, cross-culturally administered and psychometrically strong measure. The COSMIN checklist indicated sufficient methodological quality for 70% of measures, and the modified GRADE tool indicated quality of evidence ranging from moderate (67%) to high (33%). CONCLUSIONS This review identified the I-QOL as a culturally diverse measure with robust reliability, validity and responsiveness for assessing QOL among people with neurogenic OAB. These findings are supported by studies with good methodological quality (COSMIN) and high-quality evidence (GRADE).
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Affiliation(s)
- Mohammed Usman Ali
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Stanley John Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Umar Muhammad Bello
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dauda Salihu
- College of Nursing, Jouf University, Sakaka, Saudi Arabia
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; Department of Psychiatry and Psychotherapy, Comprehensive Centre for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria
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Filippini G, Minozzi S, Borrelli F, Cinquini M, Dwan K. Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis. Cochrane Database Syst Rev 2022; 5:CD013444. [PMID: 35510826 PMCID: PMC9069991 DOI: 10.1002/14651858.cd013444.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Spasticity and chronic neuropathic pain are common and serious symptoms in people with multiple sclerosis (MS). These symptoms increase with disease progression and lead to worsening disability, impaired activities of daily living and quality of life. Anti-spasticity medications and analgesics are of limited benefit or poorly tolerated. Cannabinoids may reduce spasticity and pain in people with MS. Demand for symptomatic treatment with cannabinoids is high. A thorough understanding of the current body of evidence regarding benefits and harms of these drugs is required. OBJECTIVES To assess benefit and harms of cannabinoids, including synthetic, or herbal and plant-derived cannabinoids, for reducing symptoms for adults with MS. SEARCH METHODS We searched the following databases from inception to December 2021: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), CINAHL (EBSCO host), LILACS, the Physiotherapy Evidence Database (PEDro), the World Health Organisation International Clinical Trials Registry Platform, the US National Institutes of Health clinical trial register, the European Union Clinical Trials Register, the International Association for Cannabinoid Medicines databank. We hand searched citation lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised parallel or cross-over trials (RCTs) evaluating any cannabinoid (including herbal Cannabis, Cannabis flowers, plant-based cannabinoids, or synthetic cannabinoids) irrespective of dose, route, frequency, or duration of use for adults with MS. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. To assess bias in included studies, we used the Cochrane Risk of bias 2 tool for parallel RCTs and crossover trials. We rated the certainty of evidence using the GRADE approach for the following outcomes: reduction of 30% in the spasticity Numeric Rating Scale, pain relief of 50% or greater in the Numeric Rating Scale-Pain Intensity, much or very much improvement in the Patient Global Impression of Change (PGIC), Health-Related Quality of Life (HRQoL), withdrawals due to adverse events (AEs) (tolerability), serious adverse events (SAEs), nervous system disorders, psychiatric disorders, physical dependence. MAIN RESULTS We included 25 RCTs with 3763 participants of whom 2290 received cannabinoids. Age ranged from 18 to 60 years, and between 50% and 88% participants across the studies were female. The included studies were 3 to 48 weeks long and compared nabiximols, an oromucosal spray with a plant derived equal (1:1) combination of tetrahydrocannabinol (THC) and cannabidiol (CBD) (13 studies), synthetic cannabinoids mimicking THC (7 studies), an oral THC extract of Cannabis sativa (2 studies), inhaled herbal Cannabis (1 study) against placebo. One study compared dronabinol, THC extract of Cannabis sativa and placebo, one compared inhaled herbal Cannabis, dronabinol and placebo. We identified eight ongoing studies. Critical outcomes • Spasticity: nabiximols probably increases the number of people who report an important reduction of perceived severity of spasticity compared with placebo (odds ratio (OR) 2.51, 95% confidence interval (CI) 1.56 to 4.04; 5 RCTs, 1143 participants; I2 = 67%; moderate-certainty evidence). The absolute effect was 216 more people (95% CI 99 more to 332 more) per 1000 reporting benefit with cannabinoids than with placebo. • Chronic neuropathic pain: we found only one small trial that measured the number of participants reporting substantial pain relief with a synthetic cannabinoid compared with placebo (OR 4.23, 95% CI 1.11 to 16.17; 1 study, 48 participants; very low-certainty evidence). We are uncertain whether cannabinoids reduce chronic neuropathic pain intensity. • Treatment discontinuation due to AEs: cannabinoids may increase slightly the number of participants who discontinue treatment compared with placebo (OR 2.41, 95% CI 1.51 to 3.84; 21 studies, 3110 participants; I² = 17%; low-certainty evidence); the absolute effect is 39 more people (95% CI 15 more to 76 more) per 1000 people. Important outcomes • PGIC: cannabinoids probably increase the number of people who report 'very much' or 'much' improvement in health status compared with placebo (OR 1.80, 95% CI 1.37 to 2.36; 8 studies, 1215 participants; I² = 0%; moderate-certainty evidence). The absolute effect is 113 more people (95% CI 57 more to 175 more) per 1000 people reporting improvement. • HRQoL: cannabinoids may have little to no effect on HRQoL (SMD -0.08, 95% CI -0.17 to 0.02; 8 studies, 1942 participants; I2 = 0%; low-certainty evidence); • SAEs: cannabinoids may result in little to no difference in the number of participants who have SAEs compared with placebo (OR 1.38, 95% CI 0.96 to 1.99; 20 studies, 3124 participants; I² = 0%; low-certainty evidence); • AEs of the nervous system: cannabinoids may increase nervous system disorders compared with placebo (OR 2.61, 95% CI 1.53 to 4.44; 7 studies, 1154 participants; I² = 63%; low-certainty evidence); • Psychiatric disorders: cannabinoids may increase psychiatric disorders compared with placebo (OR 1.94, 95% CI 1.31 to 2.88; 6 studies, 1122 participants; I² = 0%; low-certainty evidence); • Drug tolerance: the evidence is very uncertain about the effect of cannabinoids on drug tolerance (OR 3.07, 95% CI 0.12 to 75.95; 2 studies, 458 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Compared with placebo, nabiximols probably reduces the severity of spasticity in the short-term in people with MS. We are uncertain about the effect on chronic neurological pain and health-related quality of life. Cannabinoids may increase slightly treatment discontinuation due to AEs, nervous system and psychiatric disorders compared with placebo. We are uncertain about the effect on drug tolerance. The overall certainty of evidence is limited by short-term duration of the included studies.
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Affiliation(s)
- Graziella Filippini
- Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesca Borrelli
- Department of Pharmacy, School of Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - Michela Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Kerry Dwan
- Review Production and Quality Unit, Editorial & Methods Department, Cochrane Central Executive, London, UK
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Harvie HS, Sung VW, Neuwahl SJ, Honeycutt AA, Meyer I, Chermansky CJ, Menefee S, Hendrickson WK, Dunivan GC, Mazloomdoost D, Bass SJ, Gantz MG. Cost-effectiveness of behavioral and pelvic floor muscle therapy combined with midurethral sling surgery vs surgery alone among women with mixed urinary incontinence: results of the Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence randomized trial. Am J Obstet Gynecol 2021; 225:651.e1-651.e26. [PMID: 34242627 DOI: 10.1016/j.ajog.2021.06.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urinary incontinence is prevalent among women, and it has a substantial economic impact. Mixed urinary incontinence, with both stress and urgency urinary incontinence symptoms, has a greater adverse impact on quality of life and is more complex to treat than either stress or urgency urinary incontinence alone. Studies evaluating the cost-effectiveness of treating both the stress and urgency urinary incontinence components simultaneously are lacking. OBJECTIVE Cost-effectiveness was assessed between perioperative behavioral and pelvic floor muscle therapies combined with midurethral sling surgery and midurethral sling surgery alone for the treatment of women with mixed urinary incontinence. The impact of baseline severe urgency urinary incontinence symptoms on cost-effectiveness was assessed. STUDY DESIGN This prospective economic evaluation was performed concurrently with the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence randomized trial that was conducted from October 2013 to April 2016. Participants included 480 women with moderate-to-severe stress and urgency urinary incontinence symptoms and at least 1 stress urinary incontinence episode and 1 urgency urinary incontinence episode on a 3-day bladder diary. The primary within-trial analysis was from the healthcare sector and societal perspectives, with a 1-year time horizon. Costs were in 2019 US dollars. Effectiveness was measured in quality-adjusted life-years and reductions in urinary incontinence episodes per day. Incremental cost-effectiveness ratios of combined treatment vs midurethral sling surgery alone were calculated, and cost-effectiveness acceptability curves were generated. Analysis was performed for the overall study population and subgroup of women with Urogenital Distress Inventory irritative scores of ≥50th percentile. RESULTS The costs for combined treatment were higher than the cost for midurethral sling surgery alone from both the healthcare sector perspective ($5100 [95% confidence interval, $5000-$5190] vs $4470 [95% confidence interval, $4330-$4620]; P<.01) and the societal perspective ($9260 [95% confidence interval, $8590-$9940] vs $8090 [95% confidence interval, $7630-$8560]; P<.01). There was no difference between combined treatment and midurethral sling surgery alone in quality-adjusted life-years (0.87 [95% confidence interval, 0.86-0.89] vs 0.87 [95% confidence interval, 0.86-0.89]; P=.90) or mean reduction in urinary incontinence episodes per day (-4.76 [95% confidence interval, -4.51 to 5.00] vs -4.50 [95% confidence interval, -4.25 to 4.75]; P=.13). When evaluating the overall study population, from both the healthcare sector and societal perspectives, midurethral sling surgery alone was superior to combined treatment. The probability that combined treatment is cost-effective compared with midurethral sling surgery alone is ≤28% from the healthcare sector and ≤19% from the societal perspectives for a willingness-to-pay value of ≤$150,000 per quality-adjusted life-years. For women with baseline Urogenital Distress Inventory irritative scores of ≥50th percentile, combined treatment was cost-effective compared with midurethral sling surgery alone from both the healthcare sector and societal perspectives. The probability that combined treatment is cost-effective compared with midurethral sling surgery alone for this subgroup is ≥90% from both the healthcare sector and societal perspectives, at a willingness-to-pay value of ≥$150,000 per quality-adjusted life-years. CONCLUSION Overall, perioperative behavioral and pelvic floor muscle therapies combined with midurethral sling surgery was not cost-effective compared with midurethral sling surgery alone for the treatment of women with mixed urinary incontinence. However, combined treatment was of good value compared with midurethral sling surgery alone for women with baseline severe urgency urinary incontinence symptoms.
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Affiliation(s)
- Heidi S Harvie
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Vivian W Sung
- Department of Obstetrics and Gynecology, Women and Infants Hospital, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Simon J Neuwahl
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Amanda A Honeycutt
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Isuzu Meyer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Shawn Menefee
- Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA
| | | | - Gena C Dunivan
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Sarah J Bass
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Marie G Gantz
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
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Hagovska M, Svihra J. Evaluation of Silodosin and Pelvic Floor Muscle Training in Men with Benign Prostatic Hyperplasia and Overactive Bladder (Silodosing) Study Protocol (Spirit Compliant). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111426. [PMID: 34769943 PMCID: PMC8582742 DOI: 10.3390/ijerph182111426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022]
Abstract
The aim of our study will be to evaluate the effect of combining pelvic floor muscle training (PFMT) with the urgency-suppression technique and silodosin in comparison with silodosin alone in men with Benign Prostatic Hyperplasia (BPH) and Overactive Bladder (OAB) after 12 weeks of treatment. The primary outcome will be a change in the number of voidings and intensity of urgencies over 24 h using a micturition diary, and the secondary outcomes will be a change in lower urinary tract symptoms, a change in incontinence quality of life, a change in patients’ global impression of improvement, and a lower incidence of adverse events. A randomized intervention parallel multicenter study will be conducted in collaboration with 45 urological clinics at the national level. Patients will be assigned at a 1:1 ratio to the experimental and control groups using simple randomization according to odd and even patient sequence numbers in each ambulatory clinic. The experimental group will receive oral silodosin at a daily dose of 8 mg once daily and pelvic floor muscle training (PFMT) 5 times a week for 20–30 min a day, for 12 weeks. The control group will receive oral treatment with silodosin at a daily dose of 8 mg once daily for 12 weeks. The study protocol presents the starting points and design of a randomized, interventional, parallel, multicenter study looking at the effect of a combination of silodosin and PFMT versus silodosin treatment in men with BPH and OAB.
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Affiliation(s)
- Magdalena Hagovska
- Department of Physiatry, Balneology, and Medical Rehabilitation, Faculty of Medicine, PJ Safarik University, 040 01 Kosice, Slovakia;
| | - Jan Svihra
- Department of Urology, Jessenius Faculty of Medicine, Martin, Comenius University, 814 99 Bratislava, Slovakia
- Correspondence:
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Gray TG, Vickers H, Krishnaswamy P, Jha S. A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine. Int Urogynecol J 2021; 32:2033-2092. [PMID: 34037815 DOI: 10.1007/s00192-021-04810-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/17/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) are widely used in clinical practice and research in urogynaecology. There is no consensus on which PROMs should be used. No unifying document identifies all available PROMs and compares the psychometric properties of these. METHODS Systematic review of the literature following PRISMA guidelines. Studies where women had been administered an English-language PROM which assessed pelvic-floor symptomatology and psychometric properties had been reported were included. RESULTS 85 PROMs assessing pelvic-floor symptoms in a urogynaecology population were identified. 43 PROMs assessed lower urinary tract symptoms in 95 studies, four PROMS assessed vaginal symptoms in seven studies, 20 PROMs assessed bowel symptoms in 27 studies and three PROMs assessed sexual symptoms in seven studies. 15 PROMs assessed two or more of these symptom areas in 60 studies. PROMs with the with the best available psychometric evidence within these five areas were (urinary symptoms) the Incontinence Quality-of-Life questionnaire (I-QOL aka ICIQ-UIqol) and International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), (bowel symptoms) the Accidental Bowel Leakage Evaluation (ABLE) questionnaire and the International Consultation on Incontinence Bowel questionnaire (ICIQ-B), (vaginal symptoms) the Pelvic Organ Prolapse Symptom Score (POPSS), (sexual symptoms) the Pelvic organ prolapse- urinary Incontinence Sexual function Questionnaire- IUGA revised (PISQ-IR) and (comprehensive PROMs) the Australian Pelvic Floor Questionnaire and the Electronic Personal Assessment Questionnaire-Pelvic-Floor (ePAQ-PF). CONCLUSIONS Multiple PROMs with robust psychometric properties are available. Some widely used PROMs have weak evidence. Formal recommendations on which English-language PROMs to use within clinical practice and research in urogynaecology are required.
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Affiliation(s)
- Thomas G Gray
- Department of Urogynaecology and Pelvic Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, c/o Secretary, Room 27.3.024, Level Three, West Block, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
| | - Holly Vickers
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Priyanka Krishnaswamy
- Department of Urogynaecology, Queen Elizabeth University Hospital, G51 4TF, Glasgow, UK
| | - Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Frankel J, Varano S, Staskin D, Shortino D, Jankowich R, Mudd PN. Vibegron improves quality-of-life measures in patients with overactive bladder: Patient-reported outcomes from the EMPOWUR study. Int J Clin Pract 2021; 75:e13937. [PMID: 33332699 PMCID: PMC8244055 DOI: 10.1111/ijcp.13937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Quality of life (QOL) can be significantly impacted by symptoms of overactive bladder (OAB). Vibegron is a highly selective β3 -adrenergic receptor agonist that showed efficacy in treatment of symptoms of OAB in the randomised, double-blind, placebo- and active-controlled phase 3 EMPOWUR trial. Here we report patient-reported QOL outcomes from the EMPOWUR trial. METHODS Patients were randomly assigned 5:5:4 to receive vibegron 75 mg, placebo or tolterodine 4 mg extended release, respectively, for 12 weeks. Patients completed the OAB questionnaire (OAB-q) at baseline and at week 12 and the patient global impression (PGI) scales for severity, control, frequency and leakage at baseline and at weeks 4, 8 and 12. Change from baseline at week 12 and responder rates (OAB-q: patients achieving a ≥10-point improvement; PGI: patients reporting best possible response) were assessed. Vibegron was compared with placebo, and no comparisons were made between vibegron and tolterodine. RESULTS Of the 1518 patients randomised, 1463 (placebo, n = 520; vibegron, n = 526; tolterodine, n = 417) had evaluable data for efficacy measures and were included in the analysis. Mean baseline OAB-q and PGI scores were comparable among treatment groups. At week 12, patients receiving vibegron had greater improvements from baseline in OAB-q subscores of coping, concern, sleep, health-related QOL total and symptom bother (P < .01 each) compared with patients receiving placebo; a greater proportion of patients receiving vibegron vs placebo were responders in the OAB-q coping (P < .05) and symptom bother scores (P < .0001). Compared with placebo, a greater proportion of patients who received vibegron achieved the best response on all PGI end-points at week 12 (P < .05 each) and were classified as responders (P < .05 each). CONCLUSIONS In the 12-week EMPOWUR trial, treatment with vibegron was associated with significantly greater and clinically meaningful improvement in OAB-q and PGI scores compared with placebo, consistent with improvements in OAB symptoms. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier number NCT03492281.
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11
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Pozzi E, Boeri L, Capogrosso P, Cazzaniga W, Candela L, Fallara G, Schifano N, Costa A, Cignoli D, Tutolo M, Matloob R, Abbate C, Montorsi F, Salonia A. Can We Rely Solely on the International Prostate Symptoms Score to Investigate Storage Symptoms in Men with Lower Urinary Tract Symptoms Associated with Benign Prostatic Enlargement? Findings from a Cross-sectional Study. Eur Urol Focus 2021; 8:555-562. [PMID: 33757736 DOI: 10.1016/j.euf.2021.03.004] [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: 12/27/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Discrepancies exist between patient-reported storage phase symptoms severity and International Prostate Symptom Score (IPSS) scores. OBJECTIVE To investigate whether the Overactive Bladder questionnaire (OABq) can detect further storage phase lower urinary tract symptoms (LUTS) among patients complaining solely of voiding LUTS based on the IPSS questionnaire, and to address the real-life impact of voiding LUTS towards patients' quality of life (QoL). DESIGN, SETTING, AND PARTICIPANTS Data from 233 consecutive men seeking medical help for LUTS/benign prostate enlargement for the first time were analysed. All patients completed both the OABq and the IPSS questionnaire. In order to investigate patients with predominantly voiding phase symptoms, men with storage phase symptoms at IPSS were eventually excluded from the analysis. Patients with an OABq score of ≥40 were considered as those having moderate-to-severe storage LUTS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics and linear regression models tested the associations between OABq scores, IPSS, and IPSS-QoL. RESULTS AND LIMITATIONS OABq scores were higher in men with severe voiding symptoms than in men with mild voiding symptoms (p < 0.001). More than half of patients with predominant voiding symptoms, according to the IPSS questionnaire, depicted a pathologic OABq score. A higher rate of pathologic OABq scores was found in men with moderate/severe voiding symptoms than in those with mild scores (67.4% vs 49.6%, p < 0.001). At multivariable analysis, younger age (beta -0.1, p < 0.01), IPSS voiding subscore (beta 0.3, p < 0.001), and OABq score ≥40 (beta 1.1, p < 0.001) emerged as independent predictors of IPSS-QoL after accounting for prostate volume and flow max. CONCLUSIONS The OABq can detect the presence of further storage phase LUTS in patients presenting solely with voiding LUTS and IPSS suggestive of voiding phase symptoms. In addition, the OABq was associated with worse patient QoL regardless of the severity of voiding symptoms. PATIENT SUMMARY The Overactive Bladder questionnaire (OABq) is able to detect the presence of additional storage lower urinary tract symptoms (LUTS) in patients presenting solely with voiding LUTS according to the IPSS questionnaire. Moreover, the OABq is associated with worse quality of life in these patients regardless of the severity of voiding symptoms.
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Affiliation(s)
- Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Costa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Daniele Cignoli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Manuela Tutolo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rayan Matloob
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Costantino Abbate
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
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Ton J, Downing P, Versi E, van Uem S, Ephraim S, Murphy M, Lucente V. Outcomes of a single trigone-only vs. 20 trigone-sparing injections of OnabotulinumtoxinA for refractory overactive bladder (OAB). Int Urol Nephrol 2021; 53:1067-1072. [PMID: 33742316 DOI: 10.1007/s11255-021-02802-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare the safety and durability of a single intravesical trigonal-only versus 20 trigone-sparing injections of OnabotulinumtoxinA (BTA) for refractory OAB. METHODS A chart review of all idiopathic OAB patients treated with BTA from January 2016 to December 2018 was performed. Outcomes measures included: inter-injection interval, post-void residual (PVR), urinary tract infections (UTI), urinary retention requiring catheterization, and procedure time (min). Statistical analyses were performed using independent sample t-tests. RESULTS Baseline characteristics were comparable for the two groups, data on 69 treatments (19 patients trigone-only) were compared to 105 treatments (26 patients trigone-sparing). There were no differences in the inter-injection intervals or rates of UTI. The trigone-only group exhibited a lower mean PVR (113 ml vs 160 ml, p < 0.02), lower proportion with PVR > 150 ml (23% vs. 39%, p < 0.03), lower rate of urinary retention (5.3% vs. 17.4%, p < 0.02), and shorter procedure time (4.3 min vs. 5.7 min, p < 0.01). There were no cases of vesico-ureteral reflux. CONCLUSION While interpretation remains speculative, the results of this observational study suggest that a single trigone-only injection appears to be as safe and durable as multiple trigone-sparing injections but maybe quicker to perform and appears to have a lower impact on voiding function. Larger series and adequately powered prospective randomized clinical trials are warranted to validate the findings of this pilot study.
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Affiliation(s)
- Jessica Ton
- Anne Arundel Medical Center, Annapolis, MD, USA
| | | | - Eboo Versi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Stefanie van Uem
- Department of Urology, Stanford University School of Medicine, San Francisco, USA
| | | | - Miles Murphy
- Institute for Female Pelvic Medicine, Allentown, PA, USA
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Edelman M, Jellema P, Hak E, Denig P, Blanker MH. Patients' Attitudes Towards Deprescribing Alpha-Blockers and Their Willingness to Participate in a Discontinuation Trial. Drugs Aging 2020; 36:1133-1139. [PMID: 31515710 PMCID: PMC6884428 DOI: 10.1007/s40266-019-00712-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective The objective of this study was to gain insights into the attitudes of men with lower urinary tract symptoms towards deprescribing alpha-blockers and to assess their willingness to participate in a planned discontinuation trial. Methods This was a cross-sectional questionnaire study. Men aged 30 years and older with lower urinary tract symptoms, who were first prescribed an alpha-blocker in 2015 or 2016, were selected from a population-based prescription database. We recorded lower urinary tract symptom severity (e.g., International Prostate Symptom Score and Overactive Bladder questionnaire) and patient characteristics (e.g., comorbidity and polypharmacy). The linguistically validated Dutch version of the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire was also used, to which we added ten specific questions on attitudes towards the deprescribing of alpha-blockers. Information about a future discontinuation trial on alpha-blockers was then provided and participants were asked to indicate if they would participate. We explored the explanatory factors for the willingness to participate by logistic regression analyses. Results Of the 1380 patients in the database, 421 were using an alpha-blocker, and 195 completed the questionnaire. Of these, 16 men were excluded because of indwelling catheter use or unknown indication. The mean age of the 179 participants was 69.4 (standard deviation 9.2) years. Most men were satisfied with their current therapy, but almost all (93%) were willing to stop the medicine at the request of a doctor. Therefore, most men (61%) were willing to participate in the proposed alpha-blocker discontinuation trial. Willingness to stop therapy was affected by patients’ perceptions of the appropriateness of alpha-blocker therapy and concerns about stopping that therapy. Conclusions Although men who use alpha-blockers are generally satisfied with their current therapy, most will participate in a discontinuation trial. Electronic supplementary material The online version of this article (10.1007/s40266-019-00712-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malou Edelman
- Department of General Practice and Elderly Medicine, University Medical Centre Groningen, University of Groningen, Huispostcode FA21, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - Petra Jellema
- Department of General Practice and Elderly Medicine, University Medical Centre Groningen, University of Groningen, Huispostcode FA21, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - Eelko Hak
- Unit of Pharmaco-Therapy Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Medicine, University Medical Centre Groningen, University of Groningen, Huispostcode FA21, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
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Hagovska M, Švihra J, Buková A, Horbacz A, Dračková D, Lupták J, Švihra J. The Relationship between Overweight and Overactive Bladder Symptoms. Obes Facts 2020; 13:297-306. [PMID: 32396899 PMCID: PMC7445551 DOI: 10.1159/000506486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several authors have investigated the relationship between obesity - assessed only by body mass index (BMI) - and overactive bladder (OAB) symptoms. OBJECTIVES The objective of this study was to determine the relationship between body fat percentage (BFP) and the severity of OAB symptoms with an impact on quality of life. DESIGN Cross-sectional study. The sample consisted of 206 overweight women; they were university students (BMI = 25.8 ± 3.0) with an average age of 30.6 ± 2.4 years. Body composition analysis was used, including assessment of BFP, visceral fat area (cm2/level), and other parameters. OAB symptoms were evaluated with an OAB questionnaire (OAB-q), voiding diary, and quality of life scale (I-QoL). RESULTS Ninety women had a BFP >32% and 116 had a BFP <32%. The voiding diary and OAB-q confirmed significant differences in 24-h daytime and nighttime frequency of voiding and average urine volume during the day. The OAB-q symptom score was lower in the group with BFP <32%. I-QoL recorded significantly worse parameters in the group with BFP >32% (p < 0.01). The Patient Perception of Intensity of Urgency Scale significantly correlated with BFP (r = 0.466, p < 0.001). Women with a BFP above 32% had a 1.95 times greater chance of developing OAB (odds ratio = 1.95, 95% CI = 1.09-3.52, p < 0.02). CONCLUSION Young women with a BFP >32% were 95% more likely to have OAB than other young women with a BPF <32%.
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Affiliation(s)
- Magdaléna Hagovska
- Department of Physiatry, Balneology, and Medical Rehabilitation, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
| | - Ján Švihra
- Department of Urology, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, University Hospital Martin, Martin, Slovakia ,
| | - Alena Buková
- Institute of Physical Education and Sport, PJ Safarik University, Kosice, Slovakia
| | - Agata Horbacz
- Institute of Physical Education and Sport, PJ Safarik University, Kosice, Slovakia
| | - Dana Dračková
- Institute of Physical Education and Sport, PJ Safarik University, Kosice, Slovakia
| | - Ján Lupták
- Department of Urology, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, University Hospital Martin, Martin, Slovakia
| | - Ján Švihra
- Department of Urology, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, University Hospital Martin, Martin, Slovakia
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Blanker MH, Alma HJ, Devji TS, Roelofs M, Steffens MG, van der Worp H. Determining the minimal important differences in the International Prostate Symptom Score and Overactive Bladder Questionnaire: results from an observational cohort study in Dutch primary care. BMJ Open 2019; 9:e032795. [PMID: 31874883 PMCID: PMC7008409 DOI: 10.1136/bmjopen-2019-032795] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the minimal important difference (MID) of the International Prostate Symptom Score (IPSS) and the Overactive Bladder Questionnaire short form (OAB-q SF) assessed in primary care among patients treated for lower urinary tract symptoms (LUTS). DESIGN Single-arm, open-label observational cohort study with a 6-week follow-up. SETTING Twenty-two pharmacies in the Netherlands. PARTICIPANTS We enrolled Dutch men with uncomplicated LUTS who received a new alpha-blocker prescription from their general practitioner or urologist. PRIMARY AND SECONDARY OUTCOMES The IPSS and OAB-q SF were completed before and after 6 weeks of therapy. At 6 weeks, men also completed the Patient Global Impression of Improvement (PGI-I). The mean change scores of the IPSS and OAB-q SF were calculated for each PGI-I outcome category, with the category 'a little better' used to determine the MID. The SE of measurement (SEM) was calculated for each questionnaire. RESULTS In total, 165 men completed follow-up. The MID was 5.2 points (95% CI 3.9 to 6.4; SEM 3.6) for the IPSS and 11.0 points (95% CI 7.1 to 14.9; SEM 9.7) for the OAB-q SF. For both questionnaires, CIs showed an overlap with the no-change categories. However, the MID for the IPSS was higher in men with severe baseline symptoms (7.1; 95% CI 5.3 to 9.0) than in men with moderate baseline symptoms (3.2; 95% CI 1.7 to 4.8). CONCLUSION In this study, the MID for the IPSS was considerably higher than the MID of 3.1 reported in the only other study on this topic, but may be due to methodological differences. Interpretation of the MID for the OAB-q SF is hampered by the overlap with the SEM. Future studies are needed to confirm our results because correlations between the PGI-I and symptom questionnaires were suboptimal.
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Affiliation(s)
- Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harma Johanna Alma
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tahira Sakina Devji
- Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marjan Roelofs
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Henk van der Worp
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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A single-blind, randomized controlled trial to evaluate the effectiveness of transcutaneous tibial nerve stimulation (TTNS) in Overactive Bladder symptoms in women responders to percutaneous tibial nerve stimulation (PTNS). Physiotherapy 2019; 105:469-475. [DOI: 10.1016/j.physio.2018.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 12/02/2018] [Indexed: 11/18/2022]
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Effect of an exercise programme for reducing abdominal fat on overactive bladder symptoms in young overweight women. Int Urogynecol J 2019; 31:895-902. [PMID: 31773200 DOI: 10.1007/s00192-019-04157-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The effect of exercise in relation to overweight and overactive bladder (OAB) in young women has not been sufficiently supported by studies. The objective of our study was to reduce symptoms of OAB through a 3-month exercise programme in young overweight women with OAB. The sample consisted of 70 women (mean age 26.7 ± 4.8 years), 36 being treated and 34 in the control group. METHODS We used a body composition analyser with the assessment of skeletal muscle mass (SMM) (kg), body fat mass (BFM) (kg), body fat percentage (BFP) (%), visceral fat area (VFA) (cm²/level) and the waist/hip circumference index (WHR). OAB symptoms were evaluated using a voiding diary, the overactive bladder questionnaire (OAB-q) and the Patient Perception of Intensity of Urgency Scale (PPIUS). The intervention was a programme for the reduction of abdominal fat (PRAF), with elements of aerobic training, strengthening of the abdominal muscles and stretching. RESULTS In the OAB symptoms assessed through the voiding diary (number of voidings per 24 h, nocturia, mean voided volume) as well as in the OAB-q and PPIUS scales after training, significant differences were reported in favour of the treatment group [number of voidings per 24 h: treatment vs. control group, baseline 9.1 ± 0.3 vs. 8.6 ± 0.3, final 6.9 ± 0.2 vs. 8.1 ± 0.2, p < 0.0001; mean voided volume per 24 h (ml): treatment vs. control group, baseline 154.2 ± 9.1 vs. 162.2 ± 9.3, final 201.3 ± 9.3 vs. 164.1 ± 9.6, p < 0.0001] with a large effect size (ES). In the body composition analysis after training, significant differences were also reported in favour of the treatment group in the reduction of body mass index (BMI), BFP and VFA (p < 0.0001), with a large ES. CONCLUSIONS Body composition analysis confirmed a reduction of BMI, body weight, body fat percentage, visceral abdominal fat, the WHR index and waist circumference in favour of the treatment group after the 12-week PRAF exercise programme. A reduction in OAB symptoms was also objectively confirmed following the PRAF exercise programme.
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The impact of different intensities of exercise on body weight reduction and overactive bladder symptoms- randomised trial. Eur J Obstet Gynecol Reprod Biol 2019; 242:144-149. [PMID: 31590034 DOI: 10.1016/j.ejogrb.2019.09.027] [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] [Received: 05/29/2019] [Revised: 08/23/2019] [Accepted: 09/26/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES to investigate the effect of a 3-month exercise programme with two different intensities on the reduction of body weight and body fat percentage in overweight women with overactive bladder symptoms (OAB). STUDY DESIGN randomised controlled study. The sample consisted of 77 overweight women with OAB symptoms, with an average age of 26.2 years. Body mass index (BMI) measurements confirmed if women were overweight. Participants were split into two groups, as follows: Group 1 (programme with high intensity) (n = 39) and group 2 (programme with low intensity) (n = 38). For evaluation of body composition, we used Bioelectric impedance analysis with assessment of body fat percentage (BFP) and visceral fat area (VFA). OAB symptoms were evaluated using a voiding diary, an overactive bladder questionnaire (OAB-q) and the Patient Perception of Intensity of Urgency Scale (PPIUS). The intervention was a Programme for Reduction of Abdominal Fat, aimed at reducing abdominal fat with elements of aerobic training, strengthening of the surface and deep abdominal muscles and stretching. RESULTS Group 1 lost body weight and showed a reduction in Body Fat Percentage (BFP) of more than 5%, whereas group 2 did not. Significant differences in OAB symptoms (p < 0.01) were recorded after training in favour of group 1 (number of voiding per 24 h changed from 8.92 ± 1.7 to 6.87 ± 0.40, OAB-q SS from 11.36 ± 8.57 to 1.46 ± 3.4). In the body composition assessment, significant differences (p < 0.001) were recorded after training in favour of group 1, in terms of BMI, BFP, WFA and body weight reduction. CONCLUSION The high intensity exercise programme for reducing abdominal fat (PRAF) significantly reduces overweight and mild symptoms of OAB after 12 weeks.
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Sung VW, Borello-France D, Newman DK, Richter HE, Lukacz ES, Moalli P, Weidner AC, Smith AL, Dunivan G, Ridgeway B, Nguyen JN, Mazloomdoost D, Carper B, Gantz MG. Effect of Behavioral and Pelvic Floor Muscle Therapy Combined With Surgery vs Surgery Alone on Incontinence Symptoms Among Women With Mixed Urinary Incontinence: The ESTEEM Randomized Clinical Trial. JAMA 2019; 322:1066-1076. [PMID: 31529007 PMCID: PMC6749544 DOI: 10.1001/jama.2019.12467] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
Importance Mixed urinary incontinence, including both stress and urgency incontinence, has adverse effects on a woman's quality of life. Studies evaluating treatments to simultaneously improve both components are lacking. Objective To determine whether combining behavioral and pelvic floor muscle therapy with midurethral sling is more effective than sling alone for improving mixed urinary incontinence symptoms. Design, Setting, and Participants Randomized clinical trial involving women 21 years or older with moderate or severe stress and urgency urinary incontinence symptoms for at least 3 months, and at least 1 stress and 1 urgency incontinence episode on a 3-day bladder diary. The trial was conducted across 9 sites in the United States, enrollment between October 2013 and April 2016; final follow-up October 2017. Interventions Behavioral and pelvic floor muscle therapy (included 1 preoperative and 5 postoperative sessions through 6 months) combined with midurethral sling (n = 209) vs sling alone (n = 207). Main Outcomes and Measures The primary outcome was change between baseline and 12 months in mixed incontinence symptoms measured by the Urogenital Distress Inventory (UDI) long form; range, 0 to 300 points; minimal clinically important difference, 35 points, with higher scores indicating worse symptoms. Results Among 480 women randomized (mean [SD] age, 54.0 years [10.7]), 464 were eligible and 416 (86.7%) had postbaseline outcome data and were included in primary analyses. The UDI score in the combined group significantly decreased from 178.0 points at baseline to 30.7 points at 12 months, adjusted mean change -128.1 points (95% CI, -146.5 to -109.8). The UDI score in the sling-only group significantly decreased from 176.8 to 34.5 points, adjusted mean change -114.7 points (95% CI, -133.3 to -96.2). The model-estimated between-group difference (-13.4 points; 95% CI, -25.9 to -1.0; P = .04) did not meet the minimal clinically important difference threshold. Related and unrelated serious adverse events occurred in 10.2% of the participants (8.7% combined and 11.8% sling only). Conclusions and Relevance Among women with mixed urinary incontinence, behavioral and pelvic floor muscle therapy combined with midurethral sling surgery compared with surgery alone resulted in a small statistically significant difference in urinary incontinence symptoms at 12 months that did not meet the prespecified threshold for clinical importance. Trial Registration ClinicalTrials.gov Identifier: NCT01959347.
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Affiliation(s)
- Vivian W. Sung
- The Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Diane Borello-France
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania
| | - Diane K. Newman
- The Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Holly E. Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Emily S. Lukacz
- The Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla
| | - Pamela Moalli
- Women’s Center for Bladder and Pelvic Health, Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alison C. Weidner
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Ariana L. Smith
- The Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia
| | - Gena Dunivan
- The Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque
| | - Beri Ridgeway
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - John N. Nguyen
- The Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Kaiser Permanente, Downey, California
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Benjamin Carper
- Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Marie G. Gantz
- Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, North Carolina
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A Randomized Controlled Trial of Device Guided, Slow-Paced Respiration in Women with Overactive Bladder Syndrome. J Urol 2019; 202:787-794. [PMID: 31075059 DOI: 10.1097/ju.0000000000000328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the effects of device guided, slow-paced respiration on urgency associated urinary symptoms, perceived stress and anxiety, and autonomic function in women with overactive bladder syndrome. MATERIALS AND METHODS We performed a randomized, parallel group trial of slow-paced respiration to improve perceived stress and autonomic dysfunction as potential contributors to overactive bladder. Ambulatory women who reported at least 3 voiding or incontinence episodes per day associated with moderate to severe urgency were randomized to use a portable biofeedback device to practice daily, slow, guided breathing exercises or a control device which appeared identical and was reprogrammed to play music without guiding breathing. During 12 weeks we evaluated changes in urinary symptoms by voiding diaries, perceived stress and anxiety by validated questionnaires, and autonomic function by heart rate variability and impedance cardiography. RESULTS In the 161 randomized participants, including 79 randomized to paced respiration and 82 randomized to the control group, the average ± SD baseline frequency of voiding or incontinence associated with moderate to severe urgency was 6.9 ± 3.4 episodes per day. Compared to controls the participants randomized to paced respiration demonstrated greater improvement in perceived stress (average Perceived Stress Scale score decrease 2.8 vs 1.1, p=0.03) but not in autonomic function markers. During 12 weeks the average frequency of voiding or incontinence associated with moderate to severe urgency, which was the study primary outcome, decreased by a mean of 0.9 ± 3.2 episodes per day but no significant between group difference was detected. CONCLUSIONS Among women with overactive bladder slow-paced respiration was associated with a modest improvement in perceived stress during 12 weeks. However, it was not superior to a music listening control for reducing urinary symptoms or changing autonomic function.
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Blanker MH, Admiraal A, Brandenbarg P, Steffens MG, van Balken MR, Mulder HJ, van der Worp H. Effectiveness of a newly developed online self-management program for male patients with uncomplicated lower urinary tract symptoms. Neurourol Urodyn 2019; 38:2273-2279. [PMID: 31385388 PMCID: PMC6851635 DOI: 10.1002/nau.24131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/23/2019] [Indexed: 12/31/2022]
Abstract
Aims To explore the effect of an online self‐management program in secondary care for men with lower urinary tract symptoms (LUTS). Methods We performed a prospective nonrandomized double‐cohort pilot study of consecutive adult men referred with uncomplicated LUTS to three urology outpatient departments. Men in both cohorts received care as usual from a urologist, but men in the intervention cohort also had access to an online self‐management program. Outcomes were assessed after 6 and 12 weeks: LUTS severity was assessed with the International Prostate Symptom Score (IPSS), the Overactive Bladder Questionnaire (OABq), and the Perceived Global Impression of Improvement (PGI‐I). The main outcome of interest was a clear improvement in the PGI‐I scores (“much better” or “very much better”). Results Age, symptom severity, and quality of life scores were comparable between the intervention (n = 113) and standard care (n = 54) cohorts. Clear improvement in the PGI‐I scores was reported after 12 weeks in 19.4% and 26.1% of men in the intervention and standard care cohorts, respectively. However, logistic regression analysis indicated that the difference between cohorts was not significant. Multivariable linear regression analysis also indicated no significant differences between cohorts for the IPSS or the OABq score at either assessment point. Notably, the uptake of the intervention was low (53%). Conclusions We found no significant benefit from adding an online self‐management program to standard care for men with LUTS, probably due to the low uptake of the intervention that may have resulted from the timing in the care pathway.
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Affiliation(s)
- Marco H Blanker
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Anja Admiraal
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Pim Brandenbarg
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Henk-Jan Mulder
- Department of Urology, Martini Hospital, Groningen, The Netherlands
| | - Henk van der Worp
- Department of General Practice & Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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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: 1.0] [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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Foley S, Choudhury N, Huang M, Stari A, Nazir J, Freeman R. Quality of life in patients aged 65 years and older with overactive bladder treated with mirabegron across eight European countries: Secondary analysis ofBELIEVE. Int J Urol 2019; 26:890-896. [DOI: 10.1111/iju.14050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen Foley
- Department of Urology Royal Berkshire Hospital Reading, BerkshireUK
| | | | - Moses Huang
- Astellas Pharma Europe Ltd Chertsey, SurreyUK
| | - Anny Stari
- Astellas Pharma Europe Ltd Chertsey, SurreyUK
| | | | - Robert Freeman
- Department of Obstetrics and Gynaecology University Hospitals Plymouth, Devon UK
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Hagovska M, Švihra J, Buková A, Horbacz A, Dračková D, Švihrová V. Comparison of body composition and overactive bladder symptoms in overweight female university students. Eur J Obstet Gynecol Reprod Biol 2019; 237:18-22. [PMID: 31003045 DOI: 10.1016/j.ejogrb.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/20/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare body composition in young overweight women with OAB compared to women without OAB, and to determine the severity of the symptoms of OAB, as well as to investigate the impact of OAB on quality of life. STUDY DESIGN Cross-sectional study. The sample consisted of 1932 enrolled women classed as overweight (BMI:25-29.9).From this sample, 276 women were recruited. Of these, 206 women with an average age of 30.6 ± 20.4 years and an average BMI of 25.8 ± 3.0 were confirmed to be overweight. We used the Voiding Diary, the Overactive Bladder Questionnaire(OAB-q),and the Incontinence Quality of Life (I-QoL) scale. Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis, with assessment of: skeletal muscle mass(kg)(SMM), body fat mass (kg)(BFM), body fat percentage (%)(BFP), visceral fat area (cm2/level)(VFA), and waist to hip ratio(WHR). RESULTS The voiding diary and OAB-q results confirmed OAB in 102 women. There was no significant difference in BMI between groups. The body composition analysis showed significant differences in BFP, VFA, and WHR, with higher values in the OAB group(p < 0.01). SMM, however, was higher in the group without OAB(p < 0.01). Recorded I-QoL scores showed worse parameters in the OAB group(p < 0.001). Women with a body fat percentage above 32% have a 1.95 times greater chance of developing OAB. Odds ratio [OR] = 1.95,(95%CI:1.09-3.52,p < 0.02). CONCLUSION Body fat percentage, visceral fat area, and waist to hip ratio were significantly higher in overweight women with OAB, compared with women without OAB and a comparable BMI.
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Affiliation(s)
- Magdaléna Hagovska
- Department of Physiatry, Balneology, and Medical Rehabilitation, Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic.
| | - Ján Švihra
- Department of Urology, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Slovak Republic
| | - Alena Buková
- Institute of Physical Education and Sport, PJ Safarik University, Kosice, Slovak Republic
| | - Agáta Horbacz
- Institute of Physical Education and Sport, PJ Safarik University, Kosice, Slovak Republic
| | - Dana Dračková
- Institute of Physical Education and Sport, PJ Safarik University, Kosice, Slovak Republic
| | - Viera Švihrová
- Department of Public Health, Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Slovak Republic
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Markland AD, Tangpricha V, Beasley TM, Vaughan CP, Richter HE, Burgio KL, Goode PS. Comparing Vitamin D Supplementation Versus Placebo for Urgency Urinary Incontinence: A Pilot Study. J Am Geriatr Soc 2019; 67:570-575. [PMID: 30578542 PMCID: PMC6403014 DOI: 10.1111/jgs.15711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To estimate the efficacy of vitamin D supplementation to reduce urgency urinary incontinence (UUI) episodes. DESIGN Pilot, two-arm, randomized trial conducted from 2013 to 2017. Interventions were 12 weeks of weekly oral 50,000 IU vitamin D3 or placebo. SETTING Academic, university-based outpatient clinic. PARTICIPANTS Community-dwelling postmenopausal women, 50 years or older, with at least three UUI episodes on 7-day bladder diary and serum vitamin 25-hydroxyvitamin D (25[OH]D) of 30 ng/mL or less. MEASUREMENTS The primary efficacy estimate was the percentage change in UUI episodes. Secondary estimates included changes in other lower urinary tract symptoms, along with exploratory subgroup analysis by race/ethnicity and obesity. RESULTS We randomized 56 women (aged 50-84 years; mean = 60.5 ± 8.2 years), 28 to vitamin D and 28 to placebo; 51 completed treatments. Mean serum 25(OH)D at baseline (21.2 ± 5.2 and 18.2 ± 5.6, P = .30) improved to 57.9 ± 16.3 ng/mL with vitamin D3 and 21.9 ± 8.2 ng/mL with placebo (P < .001). UUI episodes per 24-hour day decreased by 43.0% with vitamin D3 compared to 27.6% with placebo (P = .22). Among black women (n = 33), UUI episodes decreased by 63.2% with vitamin D3 compared to 22.9% with placebo (P = .03). Among obese women, UUI episodes decreased by 54.1% with vitamin D compared to 32.7% with placebo (P = .29). For all women, changes in voiding frequency (P = .40), nocturia (P = .40), urgency (P = .90), incontinence severity (P = .81), and overactive bladder symptom severity (P = .47) were not different between arms. CONCLUSIONS Postmenopausal women with UUI and vitamin D insufficiency demonstrated a greater than 40% decrease in UUI episodes, which did not reach statistical significance compared to placebo, except in the subset of black women. The results of this pilot study support further investigation of vitamin D3 alone or in combination with other treatments for UUI, particularly for women in higher-risk subgroups. J Am Geriatr Soc 67:570-575, 2019.
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Affiliation(s)
- Alayne D. Markland
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | | | - T. Mark Beasley
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- Department of Medicine, Emory University, Atlanta, GA
| | - Holly E. Richter
- University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, AL
| | - Kathryn L. Burgio
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Patricia S. Goode
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
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Discriminant Ability, Concurrent Validity, and Responsiveness of PROMIS Health Domains Among Patients With Lumbar Degenerative Disease Undergoing Decompression With or Without Arthrodesis. Spine (Phila Pa 1976) 2018; 43:1512-1520. [PMID: 29621093 DOI: 10.1097/brs.0000000000002661] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The aim of this study was to investigate the ability of Patient-Reported Outcomes Measurement Information System (PROMIS) health domains to discriminate between levels of disease severity and to determine the concurrent validity and responsiveness of PROMIS relative to "legacy" measures. SUMMARY OF BACKGROUND DATA PROMIS may measure recovery after lumbar spine surgery. Concurrent validity and responsiveness have not been compared with legacy measures in this population. METHODS We included 231 adults undergoing surgery for lumbar degenerative disease. Discriminant ability of PROMIS was estimated for adjacent categories of disease severity using the Oswestry Disability Index (ODI). Concurrent validity was determined through correlation between preoperative legacy measures and PROMIS. Responsiveness was estimated using distribution-based and anchor-based criteria (change from preoperatively to within 3 months postoperatively) anchored to treatment expectations (North American Spine Society Patient Satisfaction Index) to determine minimal important differences (MIDs). Significance was accepted at P < 0.05. RESULTS PROMIS discriminated between disease severity levels, with mean differences between adjacent categories of 3 to 8 points. There were strong to very strong correlations between Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, and PROMIS anxiety, depression, fatigue, and sleep disturbance; between ODI and PROMIS fatigue, pain, and physical function; between the 12-Item Short-Form Health Survey physical component and PROMIS pain and physical function; and between the Brief Pain Inventory (BPI) pain interference and PROMIS depression and pain. BPI back pain and leg pain intensity showed weak or no correlation with PROMIS. Distribution-based MIDs ranged from 3.0 to 3.5 points. After incorporating longitudinal anchor-based estimates, final PROMIS MID estimates were anxiety, -4.4; depression, -6.0; fatigue, -5.3; pain, -5.4; physical function, 5.2; satisfaction with participation in social roles, 6.0; and sleep disturbance, -6.5. CONCLUSION PROMIS discriminated between disease severity levels, demonstrated good concurrent validity, and was responsive to changes after lumbar spine surgery. LEVEL OF EVIDENCE 2.
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Kurtis MM, Balestrino R, Rodriguez-Blazquez C, Forjaz MJ, Martinez-Martin P. A Review of Scales to Evaluate Sleep Disturbances in Movement Disorders. Front Neurol 2018; 9:369. [PMID: 29896152 PMCID: PMC5986889 DOI: 10.3389/fneur.2018.00369] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/07/2018] [Indexed: 01/09/2023] Open
Abstract
Patients with movement disorders have a high prevalence of sleep disturbances that can be classified as (1) nocturnal sleep symptoms, such as insomnia, nocturia, restless legs syndrome (RLS), periodic limb movements (PLM), obstructive sleep apnea (OSA), and REM sleep behavior disorder; and (2) diurnal problems that include excessive daytime sleepiness (EDS) and sleep attacks. The objective of this review is to provide a practical overview of the most relevant scales that assess these disturbances to guide the choice of the most useful instrument/s depending on the line of research or clinical focus. For each scale, the reader will find a brief description of practicalities and psychometric properties, use in movement disorder cohorts and analyzed strengths and limitations. To assess insomnia, the Pittsburgh Sleep Quality Index, a generic scale, and three disease-specific scales: the Parkinson Disease Sleep Scale (PDSS), the PDSS-2, and Scales for outcomes in Parkinson's disease (PD)-Sleep-Nocturnal Sleep subscale are discussed. To evaluate nocturia, there are no specific tools, but some extensively validated generic urinary symptom scales (the Overall Bladder Questionnaire and the Overactive Bladder Symptom Score) and some PD-specific scales that include a nocturia item are available. To measure RLS severity, there are currently four domain-specific generic scales: The International Restless Legs Scale, the Johns Hopkins Restless Legs Severity Scale, the Restless Legs Syndrome-6 measure, a Pediatric RLS Severity Scale, and the Augmentation Severity Rating Scale (a scale to evaluate augmentation under treatment) and several instruments that assess impact on quality of sleep and health-related quality of life. To evaluate the presence of PLM, no clinical scales have been developed to date. As far as OSA, commonly used instruments such as the Sleep Apnea Scale of the Sleep Disorders Questionnaire, the STOP-Bang questionnaire, and the Berlin Questionnaire are reviewed. Three scales have been extensively used to assess EDS: the generic Epworth Sleepiness Scale, the Stanford Sleepiness Scale, and the PD-specific Scales for outcomes in PD-Sleep-Daytime sleepiness subscale. To date, only the Inappropriate Sleep Composite Score specifically evaluates propensity to sleep attacks.
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Affiliation(s)
- Mónica M. Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Roberta Balestrino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, Madrid, Spain
| | - Maria João Forjaz
- National School of Public Health and Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, Madrid, Spain
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Freeman R, Foley S, Rosa Arias J, Vicente E, Grill R, Kachlirova Z, Stari A, Huang M, Choudhury N. Mirabegron improves quality-of-life, treatment satisfaction, and persistence in patients with overactive bladder: a multi-center, non-interventional, real-world, 12-month study. Curr Med Res Opin 2018; 34:785-793. [PMID: 29254376 DOI: 10.1080/03007995.2017.1419170] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Observational studies can provide evidence about patient outcomes in routine clinical practice. This prospective, non-interventional study (BELIEVE) is the largest real-world European study to date to assess quality-of-life, treatment satisfaction, resource utilization, and persistence in patients with overactive bladder (OAB) who were prescribed mirabegron as part of routine clinical practice. METHODS The primary objective was to evaluate change from baseline in quality-of-life based on overactive bladder questionnaire (OAB-q) sub-scales. Secondary objectives included evaluation of treatment persistence, patient satisfaction, healthcare resource utilization and adverse events (AEs). Follow-up was for 12 months with visit windows at 2-4 and 10-12 months. Median change from baseline in total OAB-q and its sub-scales (Health-related quality-of-life [HRQoL] and symptom bother scale) were assessed. RESULTS Overall, 862 patients were enrolled from eight European countries. In the Full Analysis Set (FAS), 73.7% were female, mean age was 61.2 years; 47.7% ≥65 years. At baseline, 41.3% had switched from other OAB treatments, 42.2% were treatment naïve, 10.1% were lapsed, and 6.4% were on combination treatment. Symptom bother and HRQoL total scores improved from baseline to 2-4 and 10-12 months. There was a notable improvement in dry rate, increasing from 34.9% at baseline to 43.7% at 10-12 months in the FAS, and a reduction in pad use. Persistence was high, with 53.8% of FAS patients remaining on mirabegron at 10-12 months. Overall, no unexpected safety issues were observed and AEs were consistent with the known safety profile of mirabegron. CONCLUSION Patients receiving mirabegron in a real-world setting reported meaningful improvements in QoL and health status, with a persistence rate of 53.8% at 12 months for the FAS. No unexpected safety issues were observed, and AEs were consistent with the known safety profile of mirabegron.
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Affiliation(s)
| | - Steve Foley
- b Royal Berkshire Hospital , Reading , Berkshire UK
| | - José Rosa Arias
- c Department of Urology , Hospital Comarcal Santiago Apóstol , Miranda de Ebro-Burgos , Spain
| | - Eduardo Vicente
- d Urology Department , Parc Taulí University Hospital , Sabadell, Barcelona , Spain
| | | | | | - Anny Stari
- f Astellas Pharma Europe Ltd , Chertsey , Surrey UK
| | - Moses Huang
- f Astellas Pharma Europe Ltd , Chertsey , Surrey UK
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Herschorn S, Staskin D, Tu LM, Fialkov J, Walsh T, Gooch K, Schermer CR. Patient-reported outcomes in patients with overactive bladder treated with mirabegron and tolterodine in a prospective, double-blind, randomized, two-period crossover, multicenter study (PREFER). Health Qual Life Outcomes 2018; 16:69. [PMID: 29673355 PMCID: PMC5909214 DOI: 10.1186/s12955-018-0892-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/05/2018] [Indexed: 12/29/2022] Open
Abstract
Background The PREFER study was an assessment of medication tolerability, treatment preference and symptom improvement during treatment with mirabegron (M) and tolterodine (T) extended release (ER) in patients with overactive bladder (OAB). In this analysis of PREFER, patient-reported outcomes (PROs) were assessed during treatment. Methods PREFER was a two-period, 8-week crossover, double-blind, phase IV study (NCT02138747) of treatment-naïve adults with OAB ≥3 months randomized to 1 of 4 treatment sequences (M/T; T/M; M/M; T/T), separated by a 2-week washout. Tolterodine ER was dosed at 4 mg for 8 weeks and mirabegron was dosed at 25 mg for 4 weeks then increased to 50 mg for the next 4 weeks. At each visit, PROs related to treatment satisfaction, quality of life and symptom bother were assessed using the OAB Satisfaction (OAB-S; 3 independent scales/5 single-item overall assessments), OAB-q (total health-related QoL [HRQoL] and subscales [Sleep, Social, Coping, Concern] and Symptom Bother scale) and Patient Perception of Bladder Condition (PPBC) questionnaires. Responder rates were reported for OAB-q subscales based on a minimal important difference (MID; ≥ 10-point improvement) and OAB-S Medication Tolerability score ≥ 90. Results In total, 358 randomized patients received ≥1 dose of double-blind study medication and completed ≥1 post-baseline value (OAB-S scale, OAB-q, PPBC): M/T (n = 154), T/M (n = 144), M/M (n = 30) or T/T (n = 30). At end of treatment (EoT), mirabegron and tolterodine ER were associated with similar mean improvements in 7 of the 8 OAB-S scores investigated, OAB-q scales and PPBC. A higher percentage of patients achieved clinically relevant improvements (MID) in OAB-q scales and OAB-S Medication Tolerability score during treatment with mirabegron than tolterodine ER. Conclusions On average, patients with OAB experienced improvements in treatment satisfaction, HRQoL and symptom bother that were of a similar magnitude during treatment with mirabegron or tolterodine ER. However, during mirabegron treatment, patients were more likely to achieve clinically relevant improvements in tolerability and HRQoL (as measured by the MID for the OAB-q or an OAB-S Medication Tolerability score ≥ 90) than during tolterodine ER treatment. Trial registration NCT02138747; registered May 13, 2014.
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Affiliation(s)
- Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, MG408, Toronto, Ontario, M4N 3M5, Canada.
| | - David Staskin
- Tufts University School of Medicine, Boston, MA, USA
| | - Le Mai Tu
- University of Sherbrooke, Quebec, Canada
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Concurrent Validity and Responsiveness of PROMIS Health Domains Among Patients Presenting for Anterior Cervical Spine Surgery. Spine (Phila Pa 1976) 2017; 42:E1357-E1365. [PMID: 28742757 DOI: 10.1097/brs.0000000000002347] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE The aim of this study was to determine the validity and responsiveness of Patient-Reported Outcomes Measurement Information System (PROMIS) health domains. SUMMARY OF BACKGROUND DATA PROMIS health domains (anxiety, depression, fatigue, pain, physical function, satisfaction with participation in social roles, sleep disturbance) may measure quality of care and determine minimal important differences (MIDs) after spine surgery. We examined concurrent validity of PROMIS domains before and PROMIS domain MIDs after anterior cervical spine surgery. METHODS We included 148 adults undergoing cervical spine surgery from February 2015 through June 2016. We determined concurrent validity by correlations of preoperative PROMIS domains with legacy measures and responsiveness of PROMIS domains using distribution-based and anchor-based criteria (preoperative to postoperative change, within 6 months) anchored to treatment expectations (assessed using North American Spine Society Patient Satisfaction Index criteria). Statistical significance was accepted as P < 0.05. RESULTS All PROMIS domains showed moderate to strong correlations with Neck Disability Index, Short-Form Health Survey, version 2 (SF-12v2), and Brief Pain Inventory pain interference and weak correlations with intensity of arm/neck pain (except between PROMIS pain and neck pain [r = 0.45, P < 0.001] and PROMIS physical function and SF-12v2 physical [r = -0.14, P = 0.138] and mental [r = 0.39, P < 0.001] components). PROMIS domains were well correlated with Generalized Anxiety Disorder-7 and Patient Health Questionnaire-8 except PROMIS physical function (r = -0.29, P = 0.002). Distribution-based PROMIS MID estimates ranged from 2.3 to 3.9 points. Incorporating cross-sectional and longitudinal anchor-based criteria, final PROMIS MID estimates were as follows: anxiety, -5.7; depression, -4.6, fatigue, -5.8; pain, -5.2; physical function, 4.5; satisfaction with participation in social roles, 4.4; and sleep disturbance, -7.4. CONCLUSION PROMIS domains are a valid assessment of health in this population and were responsive to postoperative improvements in symptoms and quality of life. LEVEL OF EVIDENCE 2.
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Combined Tolterodine and Vaginal Estradiol Cream for Overactive Bladder Symptoms After Randomized Single-Therapy Treatment. Female Pelvic Med Reconstr Surg 2017; 22:254-60. [PMID: 26945271 DOI: 10.1097/spv.0000000000000256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to compare 12-week outcomes of single-therapy tolterodine (Detrol LA) extended release to intravaginal estrogen (Estrace) for overactive bladder (OAB) symptoms and characterize 24- and 52-week outcomes in women undergoing combined therapy. METHODS A single-site randomized, open-label trial in women with urinary frequency, urgency, nocturia, and/or urgency urinary incontinence symptoms was performed. Fifty-eight participants were randomized to oral tolterodine extended release daily or intravaginal estradiol cream nightly for 6 weeks then twice per week. The primary outcome was change in Overactive Bladder Questionnaire (OAB-q) symptom bother score at 12 weeks. Secondary outcomes included the Health-Related Quality of Life Questionnaire (HRQL) of the OAB-q and a 3-day bladder diary. At 12 weeks, subjects were offered addition of the alternative therapy with follow-up at 24 and 52 weeks. RESULTS There was no difference in symptom bother score improvement between the tolterodine and intravaginal estradiol groups baseline to 12 weeks (20.6 ± 21.7, -15.8 ± 23.3, respectively, P = 0.45). There was a significant within-group decrease in symptom bother score from baseline to 12 weeks (tolterodine, P < 0.0001, and intravaginal estradiol, P = 0.002). Secondary outcome improvement within groups was noted in the HRQL total, urinary incontinence episodes, and median voiding frequency (all P ≤ 0.03) in the tolterodine group and in the HRQL total score (P = 0.03) in the intravaginal estradiol group, with no differences between groups. Combined therapy outcomes at 24 and 52 weeks compared with single therapy at 12 weeks revealed significant improvement in symptom bother score in the intravaginal estradiol + tolterodine group at 24 and 52 weeks (20.0 ± 23.9, P = 0.008; -16.7 ± 23.3, P = 0.02, respectively). CONCLUSIONS Significant within-group improvement in OAB-q symptom bother was noted in both the intravaginal estradiol and tolterodine groups for OAB symptoms, with no difference between groups. Greater improvement from 12-week single therapy to 24 and 52 weeks of combined therapy was noted in the group originally assigned to intravaginal estradiol. The role of combined medical therapy for OAB symptoms needs further investigation.
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Robinson D, Kelleher C, Staskin D, Mueller ER, Falconer C, Wang J, Ridder A, Stoelzel M, Paireddy A, van Maanen R, Hakimi Z, Herschorn S. Patient-reported outcomes from SYNERGY, a randomized, double-blind, multicenter study evaluating combinations of mirabegron and solifenacin compared with monotherapy and placebo in OAB patients. Neurourol Urodyn 2017; 37:394-406. [PMID: 28704584 DOI: 10.1002/nau.23315] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/25/2017] [Indexed: 11/12/2022]
Abstract
AIMS To evaluate patient-reported outcomes (PROs) of combinations of solifenacin and mirabegron compared with solifenacin and mirabegron monotherapy and with placebo in patients with overactive bladder (OAB) from the SYNERGY trial. METHODS Following a 4-week placebo run-in, period patients (≥18 years) with OAB were randomized 2:2:1:1:1:1 to receive solifenacin 5 mg + mirabegron 25 mg (combination 5 + 25 mg), solifenacin 5 mg + mirabegron 50 mg, (combination 5 + 50 mg), solifenacin 5 mg, mirabegron 25 mg, mirabegron 50 mg or placebo for 12 weeks, followed by a 2-week washout period. At each visit, PROs related to quality of life, symptom bother, and treatment satisfaction were assessed, including OAB-q Symptom Bother score, health-related quality of life (HRQOL) Total score, treatment satisfaction-visual analogue scale (TS-VAS), and patient perception of bladder condition (PPBC) questionnaires. RESULTS Overall, 3527 patients were randomized into the study, with 3494 receiving double-blind treatment. At end of treatment (EoT), both combination groups showed greater improvements in OAB-q Symptom Bother score compared with the monotherapy groups (nominal P < 0.001). Statistically significant improvements in HRQOL Total scores were observed in the combination groups versus monotherapy groups (P ≤ 0.002). For both combination groups, the OAB-q Symptom Bother score responder rates at EoT were statistically significantly higher versus mirabegron monotherapy (P < 0.05). The mean adjusted changes from baseline to EoT for PPBC were greater in the combination groups compared with monotherapy groups. CONCLUSIONS PROs showed that combination therapy provided clear improvements and an additive effect for many HRQOL parameters, including OAB-q Symptom Bother score, HRQOL Total score, and PPBC.
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Affiliation(s)
| | | | - David Staskin
- Tufts University School of Medicine, Boston, Massachusetts
| | | | | | | | - Arwin Ridder
- Astellas Pharma Global Development, Leiden, Netherlands
| | | | - Asha Paireddy
- Astellas Pharma Global Development, Leiden, Netherlands
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Sakayori M, Ohashi T, Momma T, Kaneda T, Nishimura S, Sutani S, Yamashita S, Shigematsu N. Quantitative analysis of genitourinary toxicity after iodine-125 brachytherapy for localized prostate cancer: Followup of the International Prostate Symptom Score and Overactive Bladder Symptom Score. Brachytherapy 2017; 16:806-814. [PMID: 28552494 DOI: 10.1016/j.brachy.2017.04.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To analyze genitourinary toxicity by followup of the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) after prostate brachytherapy. METHODS AND MATERIALS Six hundred eighty patients were treated with iodine-125 brachytherapy for localized prostate cancer. IPSS, OABSS, and two categories of IPSS questions (storage symptom score [IPSS-S] and voiding symptom score [IPSS-V]) were evaluated. RESULTS The median followup was 54 months (range, 24-108). All scales showed rapid increases followed by gradual decreases. The median times to IPSS peak and resolution were 1 and 6 months, respectively. The resolution rates of IPSS, IPSS-S, IPSS-V, and OABSS at the last followup were 84.2%, 86.3%, 89.5%, and 83.0%, respectively. The difference between IPSS baseline and peak was greater for larger preimplant prostate volumes (≥25 mL, p = 0.004). The time to resolution was longer for higher biologic effective dose (BED) (≥210 Gy, p = 0.019 [IPSS]), in those with larger prostate volumes (≥25 mL, p = 0.025 [OABSS]), in younger patients (younger than 70 years, p = 0.043 [IPSS-S]), and in those with androgen deprivation therapy (ADT) use (p = 0.049 [IPSS-V]). Urge incontinence, included in the OABSS, was observed more commonly in older patients (75 years and older, p = 0.018), with ADT use (p < 0.001), and for higher BED (≥210 Gy, p = 0.006). CONCLUSIONS The IPSS and OABSS showed similar patterns of change. Urinary symptoms improved more rapidly in those with high baseline IPSS levels. The OABSS was useful for following urinary symptoms after prostate brachytherapy. Age, ADT use, preimplant prostate volume, and BED were significantly associated with urinary outcomes.
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Affiliation(s)
- Masanori Sakayori
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshio Ohashi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan; Department of Radiology, National Hospital Organization Saitama Hospital, Saitama, Japan.
| | - Tetsuo Momma
- Department of Urology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Tomoya Kaneda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shuichi Nishimura
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinya Sutani
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shoji Yamashita
- Department of Radiology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Naoyuki Shigematsu
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Validation of overactive bladder questionnaire (1-week recall version) in medically complex elderly patients with overactive bladder. Int Urogynecol J 2017; 28:1857-1863. [DOI: 10.1007/s00192-017-3305-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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Wielage RC, Perk S, Campbell NL, Klein TM, Posta LM, Yuran T, Klein RW, Ng DB. Mirabegron for the treatment of overactive bladder: cost-effectiveness from US commercial health-plan and Medicare Advantage perspectives. J Med Econ 2016; 19:1135-1143. [PMID: 27326725 DOI: 10.1080/13696998.2016.1204307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The first class of oral pharmacologic treatments for overactive bladder (OAB) are antimuscarinics that are associated with poor persistence, anticholinergic adverse events, and increased anticholinergic burden (ACB) with risk of cognitive impairment. Mirabegron, a β3-adrenoceptor agonist, is an oral treatment that does not contribute to ACB and has early evidence of improved persistence. The objective of the analysis was to assess the cost-effectiveness of mirabegron for OAB vs six antimuscarinics in the US. METHODS A Markov state-transition model assessed US commercial health-plan and Medicare Advantage perspectives over a 3-year time horizon in an OAB patient population. Transition probabilities between five micturition and five incontinence severity states were derived from a network meta-analysis of 44 trials of oral OAB treatments. Therapy beginning with an oral OAB agent could discontinue or switch to another oral agent and could be followed by tibial nerve stimulation, sacral neuromodulation, or onabotulinumtoxinA. The primary outcome was cost per quality-adjusted life year (QALY). Utilities were mapped from incontinence and micturition frequencies as well as demographics. Based on analysis of data from a large healthcare system, elevated ACB was associated with increased healthcare utilization and probability of cognitive impairment. RESULTS From both commercial and Medicare Advantage perspectives, mirabegron was the most clinically effective treatment, while oxybutynin was the least expensive. Tolterodine immediate release (IR) was also on the cost-effectiveness frontier. The analysis estimated costs per QALY of $59,690 and $66,347 for mirabegron from commercial health plan and Medicare Advantage perspectives, respectively, compared to tolterodine IR. Other antimuscarinics were dominated. CONCLUSIONS This analysis estimated that mirabegron is a cost-effective treatment for OAB from US commercial health plan and Medicare Advantage perspectives, due to fewer projected adverse events and comorbidities, and data suggesting better persistence.
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Affiliation(s)
| | - Sinem Perk
- a Medical Decision Modeling Inc. , Indianapolis IN , USA
| | - Noll L Campbell
- b Center for Aging Research, Regenstrief Institute Inc. , Indianapolis IN , USA
- c Purdue University College of Pharmacy , West Lafayette IN , USA
| | | | - Linda M Posta
- d Medical Affairs, Americas, Astellas Pharma Global Development , Northbrook IL , USA
| | - Thomas Yuran
- d Medical Affairs, Americas, Astellas Pharma Global Development , Northbrook IL , USA
| | - Robert W Klein
- a Medical Decision Modeling Inc. , Indianapolis IN , USA
| | - Daniel B Ng
- d Medical Affairs, Americas, Astellas Pharma Global Development , Northbrook IL , USA
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Hakimi Z, Herdman M, Pavesi M, Devlin N, Nazir J, Hoyle C, Odeyemi IAO. Using EQ-5D-3L and OAB-5D to assess changes in the health-related quality of life of men with lower urinary tract symptoms associated with benign prostatic hyperplasia. Qual Life Res 2016; 26:1187-1195. [PMID: 27896711 DOI: 10.1007/s11136-016-1460-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess changes in the health status of men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) using the EQ-5D-3L and OAB-5D instruments and to evaluate the sensitivity of the instruments. METHODS Data were available from a large randomised phase III trial of men with moderate-to-severe storage and voiding LUTS/BPH (NEPTUNE). Men received a fixed-dose combination of solifenacin 6 mg plus oral controlled absorption system (OCAS™) formulation of tamsulosin (TOCAS, 0.4 mg), TOCAS monotherapy or placebo and completed the EQ-5D-3L and OAB-5D at baseline and weeks 4, 8 and 12. Analysis of covariance was used to estimate changes in EQ-5D-3L Index, EQ-VAS and OAB-5D. Changes in dimension level were summarised using the Paretian Classification of Health Change (PCHC). RESULTS Improved health-related quality of life from baseline was seen in all treatment arms on EQ-5D-3L and OAB-5D at week 12, although only OAB-5D showed statistically significant differences between active treatment and placebo, both on the index score and using the PCHC approach. Effect sizes in the active treatment groups were large (>0.8) on OAB-5D but small (≈0.2) on EQ-5D-3L. EQ-5D-3L showed a very high ceiling effect (45% of men reported full health at baseline) and a substantial proportion of these men reported improvements at week 12 in several dimensions of OAB-5D. CONCLUSIONS A large ceiling effect on EQ-5D-3L substantially limited its sensitivity in this population. OAB-5D proved more sensitive to changes in health status and could be considered a complement to ED-5D-3L as a source of utilities for health economic modelling.
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Affiliation(s)
- Zalmai Hakimi
- Astellas Pharma Europe B.V., Astellas Medical Affairs, Global, HEOR, Sylviusweg 62, 2300 AH, Leiden, The Netherlands.
| | | | - Marco Pavesi
- Data Management Centre, European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
| | | | - Jameel Nazir
- Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, Chertsey, UK
| | | | - Isaac A O Odeyemi
- Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, Chertsey, UK
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Otsuka A, Kageyama S, Suzuki T, Matsumoto R, Nagae H, Kitagawa M, Furuse H, Ozono S. Comparison of mirabegron and imidafenacin for efficacy and safety in Japanese female patients with overactive bladder: A randomized controlled trial (COMFORT study). Int J Urol 2016; 23:1016-1023. [PMID: 27686226 DOI: 10.1111/iju.13231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of mirabegron compared with imidafenacin for the treatment of female patients with overactive bladder. METHODS Patients (n = 89) were randomized to receive 0.1 mg imidafenacin twice daily (n = 47) or 50 mg mirabegron once daily (n = 42) for 12 weeks. The primary efficacy end-point was change in total Overactive Bladder Symptom Score. Secondary efficacy end-points included change in Overactive Bladder Symptom Score, 3-day micturition diary, International Prostate Symptom Score and Overactive Bladder Questionnaire. Safety assessments included adverse events, vital signs, post-void residual volume and patient-reported incidence, and severity of distinctive symptoms related to adverse events. RESULTS The mirabegron group showed a significantly reduced mean total Overactive Bladder Symptom Score from baseline, but no significant differences were noted in change of total Overactive Bladder Symptom Score compared with the imidafenacin group. Significant improvements in secondary efficacy end-points were observed regarding the mean number of micturitions/24 h, mean number of urgency episodes/24 h, mean number of incontinence episodes/24 h, mean volume voided/micturition, total International Prostate Symptom Score and quality of life in both groups, with no significant differences between the groups. The overall incidence of adverse events and the incidence of dry mouth were significantly higher in the imidafenacin group than in the mirabegron group. Patient-reported incidence and the severity of dry mouth were significantly exacerbated in the imidafenacin group. CONCLUSIONS Treatment with 50 mg mirabegron once daily effectively relieves overactive bladder symptoms in women with fewer adverse events than treatment with antimuscarinics.
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Affiliation(s)
- Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Takahisa Suzuki
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Rikiya Matsumoto
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | | | - Hiroshi Furuse
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Seiichiro Ozono
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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MacDiarmid S, Al-Shukri S, Barkin J, Fianu-Jonasson A, Grise P, Herschorn S, Saleem T, Huang M, Siddiqui E, Stölzel M, Hemsted C, Nazir J, Hakimi Z, Drake MJ. Mirabegron as Add-On Treatment to Solifenacin in Patients with Incontinent Overactive Bladder and an Inadequate Response to Solifenacin Monotherapy. J Urol 2016; 196:809-18. [DOI: 10.1016/j.juro.2016.03.174] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
Affiliation(s)
| | - Salman Al-Shukri
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Jack Barkin
- Humber River Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Moses Huang
- Astellas Pharma Europe Ltd., Chertsey, Surrey
| | | | | | | | | | | | - Marcus J. Drake
- University of Bristol and Bristol Urological Institute, Bristol, United Kingdom
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Abrams P, Kelleher C, Staskin D, Kay R, Martan A, Mincik I, Newgreen D, Ridder A, Paireddy A, van Maanen R. Combination treatment with mirabegron and solifenacin in patients with overactive bladder: exploratory responder analyses of efficacy and evaluation of patient-reported outcomes from a randomized, double-blind, factorial, dose-ranging, Phase II study (SYMPHONY). World J Urol 2016; 35:827-838. [DOI: 10.1007/s00345-016-1908-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/23/2016] [Indexed: 11/25/2022] Open
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Kaufman MR, Chang-Kit L, Raj SR, Black BK, Milam DF, Reynolds WS, Biaggioni I, Robertson D, Dmochowski RR. Overactive bladder and autonomic dysfunction: Lower urinary tract symptoms in females with postural tachycardia syndrome. Neurourol Urodyn 2016; 36:610-613. [PMID: 26859225 DOI: 10.1002/nau.22971] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/21/2016] [Indexed: 11/07/2022]
Abstract
AIMS Postural Tachycardia Syndrome (POTS) represents an autonomic disorder predominantly affecting females between 15 and 50 years of age. POTS is a chronic disorder (>6 months) characterized by an excessive heart rate increment on standing (>30 beats/min) in the presence of characteristic symptoms of cerebral hypoperfusion or sympathetic activation. Patients have clinically been noted to describe lower urinary tract symptoms (LUTS), although urologic symptoms have not been methodically assessed in the POTS population. Herein, we present data from a pilot study designed to identify and quantitate overactive bladder (OAB) in patients diagnosed with POTS. METHODS Patients admitted to the Vanderbilt Autonomic Dysfunction Center between June 2009 and October 2010 for evaluation for the potential diagnosis of POTS completed a validated, standardized questionnaire for OAB (OAB-q) at presentation. Symptom score and subscale analyses were conducted. Subscale health related quality of life (HRQL) scores were transformed into a 0-100 scale, with higher scores reflecting superior HRQL. Data are presented as mean ± SD. RESULTS Thirty-two females presented for evaluation of symptoms consistent with POTS. Twenty-nine women were subsequently diagnosed with POTS with 19 of these patients completing the OAB-q questionnaire (65.5% response rate). Average age was 33.5 ± 8.3 years. Symptom severity transformed score was 26.0 ± 16.4, with 13 of 19 patients (68.4%) meeting clinical criteria for diagnosis of probable clinically significant OAB. Nocturia was the most bothersome symptom, followed by increased daytime frequency and urgency. CONCLUSIONS This pilot study describes bothersome lower urinary tract dysfunction in patients presenting with POTS as assessed by patient-reported questionnaire data. Nocturia demonstrated the greatest negative impact on health-related quality of life (HRQL), while social interaction was the least affected HRQL domain. In patients with dysautonomia, this data provides a critical baseline for mechanistic insight into both disease-specific and global pathophysiology of nocturia and OAB. Neurourol. Urodynam. 36:610-613, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melissa R Kaufman
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Laura Chang-Kit
- Division of Urology, Albany Medical College, Albany, New York
| | - Satish R Raj
- Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt Medical Center, Nashville, Tennessee
| | - Bonnie K Black
- Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee
| | - Douglas F Milam
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - W Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Italo Biaggioni
- Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt Medical Center, Nashville, Tennessee
| | - David Robertson
- Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt Medical Center, Nashville, Tennessee.,Department of Neurology, Vanderbilt Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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Drake MJ, Sokol R, Coyne K, Hakimi Z, Nazir J, Dorey J, Klaver M, Traudtner K, Odeyemi IA, Oelke M, van Kerrebroeck P. Responder and health-related quality of life analyses in men with lower urinary tract symptoms treated with a fixed-dose combination of solifenacin and tamsulosin oral-controlled absorption system: results from the NEPTUNE study. BJU Int 2015; 117:165-72. [PMID: 25907003 DOI: 10.1111/bju.13162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effect of a fixed-dose combination (FDC) of solifenacin and an oral-controlled absorption system (OCAS™) formulation of tamsulosin (TOCAS) on health-related quality of life (HRQoL) in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). PATIENTS AND METHODS Men with moderate-to-severe storage symptoms and voiding symptoms were treated for 12 weeks with a FDC of solifenacin 6 or 9 mg plus TOCAS (0.4 mg), TOCAS monotherapy (0.4 mg) or placebo in a randomised, double-blind study (NEPTUNE). The co-primary endpoints were Total Urgency Frequency Score (TUFS) and total International Prostate Symptom Score (IPSS). HRQoL was assessed by several secondary endpoints: IPSS QoL index, overactive bladder questionnaire (OAB-q), and Patient Global Impression (PGI) scale. The correlation between symptom improvement (TUFS) and HRQoL was assessed by Spearman rank correlation coefficients. Single and double responder analyses, using subjective and objective measures, were also performed. RESULTS In the responder analyses, men treated with a FDC of solifenacin 6 mg plus TOCAS consistently had significantly improved outcomes compared with placebo (8/8 responder analyses performed) and TOCAS (6/8 responder analyses performed). There was a significant correlation (P < 0.001) between the reduction in TUFS and the improvement in HRQoL defined by IPSS QoL score, OAB-q symptom bother score, PGI overall bladder symptoms and PGI general health. CONCLUSIONS In men with LUTS/BPH who have moderate-to-severe storage symptoms and voiding symptoms, the reduction in symptoms with a once-daily FDC of solifenacin and TOCAS was associated with consistent patient-relevant improvements in HRQoL compared with placebo and TOCAS monotherapy.
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Affiliation(s)
- Marcus J Drake
- University of Bristol and Bristol Urological Institute, Bristol, UK
| | - Roman Sokol
- Private Urological Care Centre, Piaristicka, Trencin, Slovakia
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Lee HN, Lee KS, Kim JC, Chung BH, Kim CS, Lee JG, Kim DK, Park CH, Park JK, Hong SJ. Rate and associated factors of solifenacin add-on after tamsulosin monotherapy in men with voiding and storage lower urinary tract symptoms. Int J Clin Pract 2015; 69:444-53. [PMID: 25363606 DOI: 10.1111/ijcp.12581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/29/2014] [Indexed: 11/27/2022] Open
Abstract
AIM To explore the rate of add-on therapy with solifenacin in men with voiding and storage lower urinary tract symptoms (LUTS) after tamsulosin monotherapy and to explore predictive factors for starting solifenacin add-on therapy. METHODS Men aged ≥ 45 years with IPSS ≥ 12 and symptoms of OAB (OAB-V8 ≥ 8, micturition ≥ 8/24 h, urgency ≥ 2/24 h) were enrolled to receive tamsulosin 0.2 mg once daily. After 4 weeks, men with residual symptoms of OAB and reported 'dissatisfied' or 'a little satisfied' were received solifenacin 5 mg in combination with tamsulosin monotherapy. Subjects completed an IPSS, a Quality of life (QoL) index, OAB V8, and an International Consultation of Incontinence Questionnaire (ICIQ)-Male LUTS, and patient perception of bladder condition (PPBC) at baseline and week 4. RESULTS Of a total of 305 patients, 254 patients completed 4 weeks of tamsulosin treatment. For 176 patients, solifenacin was added (69.3%). Significant predictive factors of solifenacin add-on therapy included long LUTS duration, high IPSS, number of micturitions per 24 h, more urgency episodes, high urgency severity score in a voiding diary and high OAB V8 score. Based on multivariable analysis, potential predictive factors of solifenacin add-on therapy included long LUTS duration (OR = 1.008, 95% CI: 1.001-1.014), high serum PSA (OR = 1.543, 95% CI: 1.136-2.095) and small prostate size (OR = 0.970, 95% CI: 0.947-0.994) (p < 0.05). IPSS, daytime micturitions and urgency episodes, OAB V8 scores, ICIQ and PPBC were improved after tamsulosin monotherapy. CONCLUSIONS Two thirds of men with voiding and storage LUTS needed to add anticholinergics after 4 weeks of tamsulosin monotherapy. Patients with longer lasting symptoms and storage symptoms with small prostate volume may require the anticholinergic add-on.
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Affiliation(s)
- H N Lee
- Department of Urology, Seoul Seonam Hospital, Ewha Womans University, Seoul, Korea
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How does site of pelvic organ prolapse repair affect overactive bladder symptoms? Female Pelvic Med Reconstr Surg 2015; 20:203-7. [PMID: 24978085 DOI: 10.1097/spv.0000000000000087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess how site of pelvic organ prolapse repair affects overactive bladder (OAB) symptoms, we compared change in OAB symptoms in women undergoing isolated anterior/apical (AA) repair versus isolated posterior (P) repair. METHODS This is a retrospective cohort study of women with bothersome OAB undergoing either AA or P prolapse repair. The subjects completed the Pelvic Floor Distress Inventory short form and the Overactive Bladder Questionnaire (OAB-q) validated questionnaires preoperatively and 6 weeks postoperatively. Our primary outcome was OAB-q symptom severity (SS) change score (preoperative minus postoperative score) compared between the 2 groups. RESULTS Of 175 subjects, 133 (76%) underwent AA repair and 42 (24%) underwent P repair. Baseline OAB-q SS scores and baseline characteristics were similar except that the AA group had more severe baseline prolapse (median pelvic organ prolapse quantification stage 3 for AA [interquartile range, 2-3] vs stage 2 for P [interquartile range, 1-3]; P<0.01] and a higher rate of concomitant midurethral sling (57% in AA vs 31% in P; P<0.01). Overall OAB symptoms significantly improved within 6 weeks of surgery (P<0.01). The mean ± SD OAB-q SS change score was higher in the AA repair group (26 ± 24 in AA vs 13 ± 28 in P; P=0.01), indicating greater improvement in OAB symptom severity after AA repair. In linear regression adjusting for age, body mass index, diabetes, stress urinary incontinence, pelvic organ prolapse quantification stage, anticholinergic use, and midurethral sling, this difference did not remain significant. CONCLUSIONS Patients have significant improvement in OAB symptoms after POP repair. In adjusted analyses, there was no difference in improvement in OAB-q SS scores in the patients who had AA versus P repair.
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The effect of mirabegron on patient-related outcomes in patients with overactive bladder: the results of post hoc correlation and responder analyses using pooled data from three randomized Phase III trials. Qual Life Res 2015; 24:1719-27. [PMID: 25688038 PMCID: PMC4483243 DOI: 10.1007/s11136-014-0904-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/03/2022]
Abstract
PURPOSE To understand how improvements in the symptoms of overactive bladder (OAB) seen with the β3-adrenoceptor agonist mirabegron 50 mg, correlate with patient experience as measured by validated and standard patient-reported outcomes (PROs), and to identify whether there is overall directional consistency in the responsiveness of PROs to treatment effect. METHODS In a post hoc analysis of pooled data from three randomized, double-blind, placebo-controlled, 12-week Phase III trials of mirabegron 50 mg once daily, responder rates for incontinence frequency (≥50 % reduction in incontinence episodes/24 h from baseline to final visit), micturition frequency (≤8 micturitions/24 h at final visit), and PROs [minimally important differences in patient perception of bladder condition (PPBC) and subsets of the overactive bladder questionnaire (OAB-q) measuring total health-related quality of life (HRQoL), and symptom bother] were evaluated individually and in combination. RESULTS Mirabegron 50 mg demonstrated greater improvement from baseline to final visit than placebo for each of the responder analyses, whether for individual objective and subjective outcomes or combinations thereof. These improvements versus placebo were statistically significant for all double and triple responder analyses and for all single responder analyses except PPBC. PRO measurements showed directional consistency and significant correlations, and there were also significant correlations between objective and subjective measures of efficacy. CONCLUSIONS The improvements in objective measures seen with mirabegron 50 mg translate into a meaningful clinical benefit as evident by the directional consistency seen in HRQoL measures of benefit.
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Pretorius S, Kinsey D, Alexander T, Glover L, Kraus S, Duggan P. The mediating role of illness perceptions in psychological outcomes in overactive bladder. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2014. [DOI: 10.1111/ijun.12054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sara Pretorius
- Department of Psychological Health and Wellbeing; University of Hull; Hull UK
| | - Debbie Kinsey
- Department of Psychological Health and Wellbeing; University of Hull; Hull UK
| | - Tim Alexander
- Department of Psychological Health and Wellbeing; University of Hull; Hull UK
| | - Lesley Glover
- Department of Psychological Health and Wellbeing; University of Hull; Hull UK
| | - Sigurd Kraus
- Department of Urology; East Yorkshire Hospitals NHS Trust; Hull UK
| | - Paul Duggan
- Department of Psychological Health and Wellbeing; University of Hull; Hull UK
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Gotoh M, Kobayashi T, Sogabe K. Characterization of symptom bother and health-related quality of life in Japanese female patients with overactive bladder. Neurourol Urodyn 2014; 34:730-5. [PMID: 25212503 DOI: 10.1002/nau.22663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 06/30/2014] [Indexed: 11/06/2022]
Abstract
AIMS To analyze the impact of overactive bladder (OAB) symptoms and patient characteristics on symptom bother and quality of life (QOL). METHODS An analysis of the data of 967 patients from SET-Q, a prospective, multicenter, open, observational study in the post-marketing setting, was performed. The eligible subjects were treatment-naive female patients with OAB who complained of an urgency episode at least once a week. Symptom bother and QOL were assessed by the OAB-questionnaire (OAB-q), and severity of OAB symptoms was estimated by the OAB symptom score (OABSS). Multiple regression analysis was utilized for clarifying how OAB symptom severity affects QOL. RESULTS The symptoms with the highest bother score were daytime frequency and urgency in the under-50s age group, urgency in the 50s, 60s, and 70s age groups, night-time frequency and urgency incontinence in the over-80s age group, respectively. With an increase in severity of OAB as well as severity of urgency assessed by the OABSS, an increase in symptom bother and impairment in health-related quality of life (HRQL) in the OAB-q were observed. Multiple regression analysis demonstrated the significant relationship with urgency and nighttime frequency to symptom bother, and also significant interaction between age and urgency incontinence, associated with further negative effect on HRQLs in elderly patients. CONCLUSIONS This large sample study, by utilizing the scored questionnaire for symptom severity, bother and HRQL, showed that the symptoms with the highest bother were age-dependent. It was also confirmed that symptom bother will be inferred by the OABSS.
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Affiliation(s)
- Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Keizo Sogabe
- Medical Affairs, Astellas Pharma Inc., Tokyo, Japan
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Palma T, Raimondi M, Souto S, Fozzatti C, Palma P, Riccetto C. Correlation between body mass index and overactive bladder symptoms in pre-menopausal women. Rev Assoc Med Bras (1992) 2014; 60:111-7. [PMID: 24918997 DOI: 10.1590/1806-9282.60.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 08/30/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of the study was to establish a correlation between Overactive Bladder (OAB) symptoms and Body Mass Index (BMI) in women aged 20-45. METHODS We interviewed 1.050 women aged 20-45 in the area of Campinas, Brazil, to investigate the prevalence of overactive bladder symptoms. In this study, we used the ICIQ-OAB questionnaire (ICS standard), in its validated portuguese version and a specific questionnaire for the demographics, which includes information about BMI. RESULTS Overall, women with BMI ≥30 presented a significantly higher score than women with a lower BMI (18.5 - 24.9) (p=0.0066). In the analysis of individual symptoms, no significant differences were found regarding urinary frequency (p=0.5469). Women with BMI ≥30 presented more nocturia than women with BMI ranging between 18.5 and 24.9 (p=0.0154). Women in the group of BMI 25 - 29.9 presented more urgency than women with BMI 18.5 - 24.9 (p=0.0278). Significant difference was also found regarding urge-incontinence; women with BMI 25 - 29.9 presented a higher score than women in the group 18.5 - 24.9 (p= 0.0017). Analysis was also performed on the visual analogue scale regarding how much each symptom bothers the women (quality of life). There were no significant differences regarding frequency, nocturia or urgency but urgency incontinence bother was significant. Women with BMI 25 - 29.9 were more bothered by incontinence than women with BMI 18.5 - 24.9 (p=0.002). CONCLUSION In conclusion, this study reinforces the correlation between BMI and OAB symptoms. Obese women present more OAB symptoms than non-obese women.
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Does concomitant anterior/apical repair during midurethral sling improve the overactive bladder component of mixed incontinence? Int Urogynecol J 2014; 25:1269-75. [DOI: 10.1007/s00192-014-2400-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
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Coyne KS, Thompson CL, Lai JS, Sexton CC. An overactive bladder symptom and health-related quality of life short-form: Validation of the OAB-q SF. Neurourol Urodyn 2014; 34:255-63. [DOI: 10.1002/nau.22559] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/16/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Jin-Shei Lai
- Department of Medical Social Sciences and Pediatrics; Feinberg School of Medicine, Northwestern University; Chicago Illinois
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