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Park J, Chang Y, Choi HR, Kim JH, Seo SW, Ryu HJ, Cho Y, Kim C, Kwon R, Lim GY, Ahn J, Kim KH, Kim H, Hong YS, Zhao D, Cho J, Guallar E, Park HY, Ryu S. Overactive bladder and cognitive impairment in middle-aged women: A cross-sectional study. Maturitas 2024; 187:108042. [PMID: 38878628 DOI: 10.1016/j.maturitas.2024.108042] [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: 01/18/2024] [Revised: 04/22/2024] [Accepted: 06/02/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Overactive bladder (OAB) is a common condition in middle-aged and older women. It has been reported to be potentially linked to cognitive decline, particularly in older adults. This study investigated the association between OAB symptoms and cognitive impairment in middle-aged women. MATERIALS AND METHODS This cross-sectional study had a sample of 1652 women (mean age 49.3 ± 2.8 years) who were not taking medication for either urinary tract infection or OAB. OAB symptoms and cognitive function were evaluated by self-administered questionnaires: the Overactive Bladder Symptom Score and the Alzheimer's disease 8. Logistic regression models estimated prevalence ratios (PRs) with 95 % confidence intervals (CI) for cognitive impairment according to the presence/absence of OAB. Mediation analyses assessed the impact of poor sleep quality on this association. RESULTS Cognitive impairment was more prevalent in women with OAB than in those without OAB (multivariable-adjusted PR: 1.88 [95 % CI: 1.52-2.24]). Women experiencing nocturia (≥twice a night), urinary urgency at least once a week, and urgency urinary incontinence at least once a week had multivariable-adjusted PRs (95 % CI) for cognitive impairment of 2.08 (1.50-2.65), 2.12 (1.66-2.58), and 1.75 (1.17-2.34), respectively. Poor sleep quality mediated 10.81 % [95 % CI: 4.55-19.44 %] of the relationship between OAB and cognitive impairment. CONCLUSIONS Among middle-aged women not taking OAB medications, OAB symptoms were associated with cognitive impairment, partly because of poor sleep quality. Further research is needed to determine whether early screening of patients with OAB can help identify those susceptible to cognitive impairment associated with OAB medication and if preventive measures should be targeted at this group.
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Affiliation(s)
- Jungeun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hye Rin Choi
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea; Healthcare Data Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea; Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hui Jin Ryu
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Yoosun Cho
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chanmin Kim
- Department of Statistics, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ria Kwon
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Ga-Young Lim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Jiin Ahn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kye-Hyun Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Soo Hong
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Di Zhao
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juhee Cho
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Gomes EDT, Passos GR, Antunes NDJ, de Oliveira MG, de Souza VB, Schenka AA, da Costa JL, Antunes E, Mónica FZ. The multidrug resistance protein 4 is expressed and functionally active in isolated bladder from pig. Am J Physiol Regul Integr Comp Physiol 2024; 327:R291-R303. [PMID: 38881411 DOI: 10.1152/ajpregu.00238.2023] [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: 10/23/2023] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
Multidrug resistance proteins type 4 (MRP4) and 5 (MRP5) play pivotal roles in the transport of cyclic nucleotides in various tissues. However, their specific functions within the lower urinary tract remain relatively unexplored. This study aimed to investigate the effect of pharmacological inhibition of MRPs on cyclic nucleotide signaling in isolated pig bladder. The relaxation responses of the bladder were assessed in the presence of the MRP inhibitor, MK571. The temporal changes in intra- and extracellular levels of cAMP and cGMP in stimulated tissues were determined by mass spectrometry. The gene (ABCC4) and protein (MRP4) expression were also determined. MK571 administration resulted in a modest relaxation effect of approximately 26% in carbachol-precontracted bladders. The relaxation induced by phosphodiesterase inhibitors such as cilostazol, tadalafil, and sildenafil was significantly potentiated in the presence of MK571. In contrast, no significant potentiation was observed in the relaxation induced by substances elevating cAMP levels or stimulators of soluble guanylate cyclase. Following forskolin stimulation, both intracellular and extracellular cAMP concentrations increased by approximately 15.8-fold and 12-fold, respectively. Similarly, stimulation with tadalafil + BAY 41-2272 resulted in roughly 8.2-fold and 3.4-fold increases in intracellular and extracellular cGMP concentrations, respectively. The presence of MK571 reduced only the extracellular levels of cGMP. This study reveals the presence and function of MRP4 transporters within the porcine bladder and paves the way for future research exploring the role of this transporter in both underactive and overactive bladder disorders.NEW & NOTEWORTHY This study investigates the impact of pharmacological inhibition of MRP4 and MRP5 transporters on cyclic nucleotide signaling in isolated pig bladders. MK571 administration led to modest relaxation, with enhanced effects observed in the presence of phosphodiesterase inhibitors. However, substances elevating cAMP levels remained unaffected. MK571 selectively reduced extracellular cGMP levels. These findings shed light on the role of MRP4 transporters in the porcine bladder, opening avenues for further research into bladder disorders.
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Affiliation(s)
- Erick de Toledo Gomes
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Gabriela Reolon Passos
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Mariana Gonçalves de Oliveira
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Valeria Barbosa de Souza
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - André Almeida Schenka
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - José Luiz da Costa
- Campinas Poison Control Center, University of Campinas, Campinas, Brazil
| | - Edson Antunes
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fabiola Zakia Mónica
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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Soria-Chacartegui P, Cendoya-Ramiro P, González-Iglesias E, Martín-Vílchez S, Rodríguez-Lopez A, Mejía-Abril G, Román M, Luquero-Bueno S, Ochoa D, Abad-Santos F. Genetic Variation in CYP2D6, UGT1A4, SLC6A2 and SLCO1B1 Alters the Pharmacokinetics and Safety of Mirabegron. Pharmaceutics 2024; 16:1077. [PMID: 39204422 PMCID: PMC11359404 DOI: 10.3390/pharmaceutics16081077] [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: 07/23/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
Mirabegron is a drug used in overactive bladder (OAB) treatment. Genetic variation in pharmacogenes might alter its pharmacokinetics, affecting its efficacy and safety. This research aimed to analyze the impact of genetic variation on mirabegron pharmacokinetics and safety. Volunteers from three bioequivalence trials (n = 79), treated with a single or a multiple dose of mirabegron 50 mg under fed or fasting conditions, were genotyped for 115 variants in pharmacogenes and their phenotypes were inferred. A statistical analysis was performed, searching for associations between genetics, pharmacokinetics and safety. CYP2D6 intermediate metabolizers showed a higher elimination half-life (t1/2) (univariate p-value (puv) = 0.018) and incidence of adverse reactions (ADRs) (puv = 0.008, multivariate p (pmv) = 0.010) than normal plus ultrarapid metabolizers. The UGT1A4 rs2011425 T/G genotype showed a higher t1/2 than the T/T genotype (puv = 0.002, pmv = 0.003). A lower dose/weight corrected area under the curve (AUC/DW) and higher clearance (CL/F) were observed in the SLC6A2 rs12708954 C/C genotype compared to the C/A genotype (puv = 0.015 and 0.016) and ADR incidence was higher when the SLCO1B1 function was decreased (puv = 0.007, pmv = 0.010). The lower elimination and higher ADR incidence when CYP2D6 activity is reduced suggest it might be a useful biomarker in mirabegron treatment. UGT1A4, SLC6A2 and SLCO1B1 might also be involved in mirabegron pharmacokinetics.
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Affiliation(s)
- Paula Soria-Chacartegui
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Patricia Cendoya-Ramiro
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Eva González-Iglesias
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Samuel Martín-Vílchez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Andrea Rodríguez-Lopez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Gina Mejía-Abril
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Manuel Román
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Sergio Luquero-Bueno
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Dolores Ochoa
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Wang X, Wang G, Cen P, Lan H, Guo L, Yisha Z, Gu A, Liu G, Wang Z, Liu T, Yu Q. Lactobacillus-Polydopamine System for Targeted Drug Delivery in Overactive Bladder: Evidence from Bladder Cell Spheroids, Rat Models, and Urinary Microbiome Profiling. Int J Nanomedicine 2024; 19:8353-8371. [PMID: 39161357 PMCID: PMC11332418 DOI: 10.2147/ijn.s465745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/17/2024] [Indexed: 08/21/2024] Open
Abstract
Introduction Overactive bladder (OAB) is a highly prevalent condition with limited treatment options due to poor efficacy, side effects, and patient compliance. Novel drug delivery systems that can target the bladder wall may improve OAB therapy. Methods We explored a polydopamine (PDA)-coated lactobacillus platform as a potential carrier for localized OAB treatment. Urinary microbiome profiling was performed to identify the presence of lactobacillus in healthy and OAB groups. Lactobacillus-PDA nanoparticles were synthesized and characterized by electron microscopy and spectrophotometry. A rat bladder perfusion model and human bladder smooth muscle cell spheroids were used to assess the distribution and penetration of the nanoparticles. The efficacy of the Lactobacillus-PDA system (LPS) for delivering the antimuscarinic drug solifenacin was evaluated in an OAB rat model. Results Urinary microbiome profiling revealed lactobacillus as a dominant genus in both healthy and OAB groups. The synthesized Lactobacillus-PDA nanoparticles exhibited uniform size and optical properties. In the rat bladder perfusion model, the nanoparticles distributed throughout the bladder wall and smooth muscle without toxicity. The nanoparticles also penetrated human bladder smooth muscle cell spheroids. In the OAB rat model, LPS facilitated the delivery of solifenacin and improved treatment efficacy. Discussion The results highlight LPS as a promising drug carrier for targeted OAB therapy via penetration into bladder tissues. This bacteriotherapy approach may overcome limitations of current systemic OAB medications. Lactobacillus, a probiotic bacterium present in the urinary tract microbiome, was hypothesized to adhere to and penetrate the bladder wall when coated with PDA nanoparticles, making it a suitable candidate for localized drug delivery.
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Affiliation(s)
- Xiaolong Wang
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Guanyi Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Peibin Cen
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Hongyu Lan
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Linfa Guo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Zuhaer Yisha
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Aodun Gu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Guiyong Liu
- Department of Urology, Qianjiang Central Hospital of Hubei Province, Qianjiang, People’s Republic of China
| | - Zijian Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Tongzu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
- Hubei Key Laboratory of Urological Diseases, Wuhan University, Wuhan, People’s Republic of China
- Hubei Clinical Research Center for Laparoscopic/Endoscopic Urologic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Urology, Wuhan University, Wuhan, People’s Republic of China
- Hubei Medical Quality Control Center for Laparoscopic/Endoscopic Urologic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
- Wuhan Clinical Research Center for Urogenital Tumors, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Qingfeng Yu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Urological Diseases, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Guangdong Engineering Research Center of Urinary Minimally Invasive Surgery Robot and Intelligent Equipment, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Guangzhou Institute of Urology, Guangzhou Medical University, Guangzhou, People’s Republic of China
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Tarcan T, Hashim H, Malde S, Sinha S, Sahai A, Acar O, Selai C, Agro EF, Abrams P, Wein A. Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI-RS 2023. Neurourol Urodyn 2024; 43:1447-1457. [PMID: 38477358 DOI: 10.1002/nau.25435] [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: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
AIMS Lower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome. METHODS A think tank of ICI-RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS. RESULTS Our think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity. CONCLUSION Future research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust & King's College London, London, UK
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - Arun Sahai
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Omer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- College of Medicine, Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Caroline Selai
- University College London - Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery/UCLH NHS Foundation Trust, London, UK
| | - Enrico Finazzi Agro
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Finazzi Agrò E, Rosato E, Wagg A, Sinha S, Fede Spicchiale C, Serati M, Mancini V, de Rijk M, Tarcan T, Wein A, Abrams P, Bou Kheir G. How do we make progress in phenotyping patients with lower urinary tract such as overactive bladder and underactive detrusor, including using urine markers and microbiome data, to personalize therapy? ICI-RS 2023-Part 2. Neurourol Urodyn 2024; 43:1272-1282. [PMID: 38178629 DOI: 10.1002/nau.25379] [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: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) and underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. OBJECTIVES The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. METHODS A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU using urodynamic tests, functional neuro-imaging, urinary markers, and microbiome. RESULTS AND CONCLUSIONS The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract (LUT) symptoms, such as OAB and UAB. The intricate interplay between the LUT and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Rosato
- School of Specialization in Urology, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | - Maurizio Serati
- Department Obstetrics and Gynecology. Urogynecology Unit, University of Insubria, Varese, Italy
| | - Vito Mancini
- Urinary Incontinence Center, Urology and Renal Transplantation Unit, Policlinico di Foggia Hospital and University of Foggia, Foggia, Italy
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Tufan Tarcan
- Marmara University School of Medicine, Istanbul, Turkey
- Koç University, Istanbul, Turkey
| | - Alan Wein
- Desai Sethi Institute of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Li W, Huang J, Chen J, Zhang C, Luo R, Liu B, Zhou X. Associations between serum testosterone levels and overactive bladder in women: a cross-sectional research of NHANES 2011 to 2016. Int Urol Nephrol 2024; 56:2521-2529. [PMID: 38472623 DOI: 10.1007/s11255-024-03996-9] [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: 12/18/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Androgen receptors are expressed in the pelvic floor and lower urinary tract. However, the association between serum testosterone and overactive bladder (OAB) in women remains unclear. This study aimed to investigate their association in a nationally representative population. METHODS In this cross-sectional study, we collected data on female participants older than 20 years with serum total testosterone measurements and OAB questionnaires from the 2011-2016 National Health and Nutrition Examination Survey (NHANES). Survey-weighted logistic regression models were used to analyze the relationship between testosterone and OAB in women. RESULTS Data on 4991 women was analyzed in this study, of whom 25.9% had OAB symptoms. Women with lower serum testosterone had an increased frequency of urge urinary incontinence and nocturia compared to participants with enough testosterone. The multivariate logistic models showed that those women with a testosterone level less than 18.5 ng/dL had significantly higher odds of OAB compared to those with a testosterone level greater than 18.5 ng/dL [OR 95% CI = 1.271 (1.073-1.505), P = 0.0076]. Separate interaction analyses revealed no significant effect of age, BMI, diabetes, education, alcohol use and menopause on the association between serum testosterone and OAB. Sensitivity analyses demonstrated that additional variables (depression, stroke and stress urinary incontinence) had no significant effect on this relationship. CONCLUSIONS Low serum testosterone is associated with an increased likelihood of OAB in women. This supports the potential therapeutic role of testosterone supplementation in women with OAB. Given the direct and indirect effects of testosterone on the pelvic floor and lower urinary tract, a potential mechanism for this relationship can be further explored in translational studies.
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Affiliation(s)
- Wenshuang Li
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Junlong Huang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jialiang Chen
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Chi Zhang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Ruixiang Luo
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Bolong Liu
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.
| | - Xiangfu Zhou
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.
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Finazzi Agrò E, Rosato E, Wagg A, Sinha S, Fede Spicchiale C, Serati M, Mancini V, de Rijk M, Tarcan T, Wein A, Abrams P, Bou Kheir G. How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1. Neurourol Urodyn 2024; 43:1261-1271. [PMID: 38178627 DOI: 10.1002/nau.25377] [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: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. OBJECTIVES The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. METHODS A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment. RESULTS AND CONCLUSIONS The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Rosato
- School of specialization in Urology, Policlinico Tor Vergata University Hospital, University of Rome Tor Vergata and Urology Unit, Rome, Italy
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | - Maurizio Serati
- Department Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Varese, Italy
| | - Vito Mancini
- Urology and renal transplantation Unit, Urinary incontinence center, Policlinico di Foggia Hospital and University of Foggia, Foggia, Italy
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Tufan Tarcan
- Marmara University School of Medicine, Istanbul, Turkey and Koç University School of Medicine, Istanbul, Turkey
| | - Alan Wein
- University of Miami Miller School of Medicine, Desai Sethi Institute of Urology, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Sahai A, Robinson D, Abrams P, Wein A, Malde S. What is the best first choice oral drug therapy for OAB? Neurourol Urodyn 2024; 43:1328-1336. [PMID: 38270332 DOI: 10.1002/nau.25397] [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: 12/17/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
AIMS The management of overactive bladder (OAB) involves lifestyle changes and conservative measures in the first instance with the use of liquid/dietary advice, weight loss, and bladder training. Thereafter oral pharmacotherapy is instigated in symptomatic patients. Antimuscarinics and beta 3 agonists form the main classes of drug therapy in this field. Views on what is the best first line OAB treatment is changing based on recent evidence and adverse event profiles of these medications. METHODS At the ICI-RS meeting 2023, Bristol, UK this topic was discussed and debated as a proposal. The following article summarizes the concepts presented that day as well as the interactive discussion that took place thereafter. RESULTS OAB guidelines are moving in many circumstances to an either antimuscarinic or beta 3 agonist approach based on patient factors. Several studies have raised concerns on the long-term impact of antimuscarinics, in relation to cognition, dementia, cardiovascular events, and mortality all related to antimuscarinic load. Neither antimuscarinics nor beta 3 agonists have good persistence and adherence rates in the medium to long term. Several barriers also exist to prescribing including guidelines recommending utilizing drugs with the lowest acquisition cost and "step therapy." A newer approach to managing OAB is personalized therapy in view of the many possible etiological factors and phenotypes. These concepts are highlighted in this article. CONCLUSIONS Current oral pharmacotherapy in managing OAB is limited by adverse events, adherence and persistence problems. Both antimuscarinics and beta 3 agonists are efficacious but most clinical trials demonstrate significant placebo effects in this field. Personalizing treatment to the individual seems a logical approach to OAB. There is a need for better treatments and further studies are required of existing treatments with high quality longer term outcomes.
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Affiliation(s)
- Arun Sahai
- Department of Urology, Guy's Hospital & King's College, London, UK
| | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital & King's College, London, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
- University of Bristol, Bristol, UK
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami Miller School of medicine, Miami, Florida, USA
- University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sachin Malde
- Department of Urology, Guy's Hospital & King's College, London, UK
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Rotem R, Weintruab AY, Padoa A. Bridging present and future: A narrative review and visionary outlook on innovative solutions for the diagnosis and treatment of urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2024; 301:55-59. [PMID: 39094536 DOI: 10.1016/j.ejogrb.2024.07.064] [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: 06/19/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024]
Abstract
Urinary incontinence, characterized by the involuntary leakage of urine, significantly impacts millions globally, affecting their quality of life, social interactions, and psychological well-being. Traditional diagnostic methods and treatments often fall short, especially for refractory urinary incontinence, due to their invasive nature and limited scope for continuous, real-time assessment. This narrative review critically examines current approaches to diagnosing and managing urinary incontinence, highlights significant gaps in practice, and underscores the urgent need for innovative solutions. We explore the evolution of diagnostic and treatment modalities and introduce a preliminary method involving a conceptual catheter device that promises to shift toward non-invasive, real-time monitoring and management. This review synthesizes prevailing research and provides a visionary outlook on how emerging technologies could revolutionize urinary incontinence care, offering a future of personalized, patient-centered strategies. Our discussion extends to the limitations of conventional urodynamic studies, which are often uncomfortable and fail to capture the dynamic nature of urinary incontinence in everyday settings. The proposed preliminary method features an advanced, smart-device solution integrating sensors and artificial intelligence to offer precise, real-time insights into bladder activity. This device, still in the conceptual stages, has the potential to transform the landscape of urinary incontinence management by enhancing diagnostic accuracy and therapeutic efficacy. By bridging the gap between current limitations and future possibilities, this paper aims to inspire ongoing innovation and research in the field of urogynecology.
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Affiliation(s)
- Reut Rotem
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Adi Y Weintruab
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anna Padoa
- Department of Obstetrics and Gynecology, Yitzhak Shamir (Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Li M, Xu M, Zhou H, Pan Y, Liu X. The association between different levels of depression and overactive bladder: A cross-sectional study of the 2005-2018 National Health and Nutrition Examination Survey. Neurourol Urodyn 2024. [PMID: 39032101 DOI: 10.1002/nau.25563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND There is growing evidence of a possible correlation between depression and overactive bladder (OAB). However, few studies have classified depression according to its severity. Whether there is an association between different levels of depression and OAB symptoms remains unclear. METHODS Participants with complete information about depression, OAB, and covariates in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. Depression symptoms were assessed by the Patient Health Questionnaire-9. OAB symptoms were evaluated by the Overactive Bladder Symptom Score. Weighted multivariate logistic regression models were applied to analyze the relationship between depression and OAB. RESULTS A total of 30 359 participants were included in this study, consisting of 6245 OAB patients and 24 114 non-OAB participants. The multivariate logistic regression suggested depression independently correlated with OAB (odds ratio [OR] = 2.764, 95% confidence interval [CI] = 2.429-3.146, p < 0.001). Further, mild (OR = 2.355, 95% CI = 2.111-2.627, p < 0.001), moderate (OR = 3.262, 95% CI = 2.770-3.841, p < 0.001), and moderately severe to severe depression (OR = 3.927, 95% CI = 3.246-4.752, p < 0.001) were all associated with OAB. Additionally, depression was also correlated with urgency urinary incontinence (OR = 2.249, 95% CI = 1.986-2.548, p < 0.001) and nocturia (OR = 2.166, 95% CI = 1.919-2.446, p < 0.001). CONCLUSION This study indicated different levels of depression, even mild depression, were independent risk factors for OAB. Given the frequent coexistence and potential interactions between depression and OAB, clinicians should be aware of the importance of assessing both physical and psychological symptoms in these patients. Early diagnosis and holistic treatment may improve the treatment outcomes, particularly for those suffering from both conditions.
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Affiliation(s)
- Muwei Li
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingming Xu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hang Zhou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Pan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Wang X, Guo L, Yisha Z, Gu A, Liu T. Polo-like kinase 1 inhibition modulates urinary tract smooth muscle contraction and bladder cell transcriptional programs. Cytoskeleton (Hoboken) 2024. [PMID: 38994819 DOI: 10.1002/cm.21888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/11/2024] [Accepted: 06/08/2024] [Indexed: 07/13/2024]
Abstract
The serine/threonine kinase polo-like kinase 1 (PLK1) is a master regulator of cell proliferation and contraction, but its physiological role in the lower urinary tract is unknown. We utilized transcriptomic programs of human bladder smooth muscle cells (hBSMCs), 3D bladder spheroid viability assays, and human ureterovesical junction contractility measurements to elucidate the impacts of PLK1 inhibition. This work reveals PLK1 reduction with the selective inhibitor TAK-960 (500 nM) suppresses high K+-evoked contractions of human urinary smooth muscle ex vivo while decreasing urothelial cell viability. Transcriptomic analysis of hBSMCs treated with TAK-960 shows modulation of cell cycle and contraction pathways, specifically through altered expression of Cys2/His2-type zinc finger transcription factors. In bladder spheroids, PLK1 inhibition also suppresses smooth muscle contraction protein filamin. Taken together, these findings establish PLK1 is a critical governor of urinary smooth muscle contraction and urothelial proliferation with implications for lower urinary tract disorders. Targeting PLK1 pharmacologically may therefore offer therapeutic potential to ameliorate hypercontractility and aberrant growth. Further elucidation of PLK1 signaling networks promises new insights into pathogenesis and much needed treatment advances for debilitating urinary symptoms.
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Affiliation(s)
- Xiaolong Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Linfa Guo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zuhaer Yisha
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Aodun Gu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tongzu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Urological Diseases, Wuhan, China
- Hubei Clinical Research Center for Laparoscopic/Endoscopic Urologic Surgery, Wuhan, China
- Institute of Urology, Wuhan University, Wuhan, China
- Hubei Medical Quality Control Center for Laparoscopic/Endoscopic Urologic Surgery, Wuhan, China
- Wuhan Clinical Research Center for Urogenital Tumors, Wuhan, China
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Park J, Chang Y, Kim JH, Choi HR, Kwon R, Lim GY, Ahn J, Kim KH, Kim H, Hong YS, Zhao D, Cho J, Guallar E, Park HY, Ryu S. Menopausal stages and overactive bladder symptoms in middle-aged women: A cross-sectional study. BJOG 2024. [PMID: 38992913 DOI: 10.1111/1471-0528.17912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To examine the prevalence of overactive bladder (OAB) according to menopausal stages in middle-aged women. DESIGN Cross-sectional study. SETTING Total Healthcare Center in South Korea. POPULATION Middle-aged Korean women (n=3469, mean age, 49.5 ± 2.9 years). METHODS Menopausal stages were defined according to the Stages of Reproductive Aging Workshop +10 criteria, and menopausal symptoms were assessed using the Korean version of Menopause-Specific Quality of Life (MENQOL). Logistic regression models were used to estimate prevalence ratios with 95% confidence intervals for OAB according to menopausal stage and to assess the associations with menopausal symptoms. MAIN OUTCOME MEASURES OAB symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS). RESULTS The prevalence of OAB increased with menopausal stage; however, the multivariable-adjusted prevalence ratios for women in menopausal transition and postmenopausal stage were insignificant (ptrend = 0.160) compared to those for premenopausal women. Among individual OAB symptoms, the multivariable-adjusted prevalence ratios for nocturia increased with menopausal stage in a dose-response manner (ptrend = 0.005 for 1 time/day; ptrend < 0.001 for ≥2 times/day). The association between menopausal stages and nocturia occurring ≥2 times/day was evident in women without OAB and with relatively high MENQOL scores, vasomotor symptoms and difficulty sleeping. CONCLUSIONS The prevalence of OAB, particularly nocturia, increased with menopausal stage, and the association was obvious in women with other menopausal symptoms. This finding underscores the importance of addressing nocturia as a potential menopausal symptom in middle-aged women. Further studies are required to understand the mechanisms linking OAB with menopausal symptoms in middle-aged women.
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Affiliation(s)
- Jungeun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Rin Choi
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Korea
- Healthcare Data Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ria Kwon
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Ga-Young Lim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Jiin Ahn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kye-Hyun Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Soo Hong
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di Zhao
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
| | - Eliseo Guallar
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | | | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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Lu SH, Yun TF, Kou YR, Chang YP. Preliminary evidence for therapeutic impact of intravesical glucosamine on protamine sulfate and potassium chloride-induced bladder overactivity in rat model. World J Urol 2024; 42:405. [PMID: 38990380 DOI: 10.1007/s00345-024-05100-3] [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: 02/21/2024] [Accepted: 05/31/2024] [Indexed: 07/12/2024] Open
Abstract
PURPOSE To investigate the protective effect of intravesical glucosamine in treating overactive bladder (OAB). METHODS Ninety-two female Sprague-Dawley (SD) rats were divided into 4 groups i.e. protamine sulfate (PS), N-acetylcysteine (NAC), and glucosamine-treated PS (GPS), and normal saline control (NC) were used. We induced hyperactivity in rats via intravesical infusion of PS and potassium chloride (KCl), whereas the NC group underwent a sustained intravesical saline infusion for 1 h. N-acetylcysteine (NAC), a potential antioxidant as well as anti-inflammatory agent was employed as positive control. Cystometrography (CMG) was then conducted to determine urodynamic parameters, i.e., leak point pressure (LPP, n = 48) and inter-contractile interval, the duration between two voids (ICI, n = 32). RESULTS LPP was significantly elevated in the GPS group (mean ± SD: 110.9 ± 6.2 mmHg) compared to the NC (81.0 ± 32.5 mmHg), PS (40.3 ± 10.9 mmHg), and NAC group (70.3 ± 19.4 mmHg). The cystometrogram data also reveals a prolonged ICI in the GPS group (241.3 ± 40.2 s) compared to the NC group (216.0 ± 41.7 s), PS group (128.8 ± 23.6 s), and NAC group (193.8 ± 28.3 s). CONCLUSION This preliminary study implies the ameliorative impact of GPS treatment on OAB in terms of improved urodynamic parameters, including LPP and ICI.
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Affiliation(s)
- Shing-Hwa Lu
- Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 11031, Taiwan.
- School of Medicine, Department of Urology, Taipei Medical University, Taipei, Taiwan.
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Tien-Fu Yun
- Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 11031, Taiwan
- School of Medicine, Department of Urology, Taipei Medical University, Taipei, Taiwan
| | - Yu Ru Kou
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yi-Ping Chang
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan.
- Division of Nephrology, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, Taiwan.
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Rocha AK, Monteiro S, Campos I, Volpato M, Verleun D, Valim L, Riccetto C, Botelho S. Isolated bladder training or in combination with other therapies to improve overactive bladder symptoms: a systematic review and meta-analysis of randomized controlled trials. Braz J Phys Ther 2024; 28:101102. [PMID: 39106788 PMCID: PMC11347853 DOI: 10.1016/j.bjpt.2024.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 11/23/2023] [Accepted: 07/11/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Bladder training (BT), the maintenance of a scheduled voiding regime at gradually adjusted intervals, is a common treatment for overactive bladder (OAB). OBJECTIVES To assess the effects of isolated BT and/or in combination with other therapies on OAB symptoms. METHODS A systematic review of eight databases was conducted. After screening titles and abstracts, full texts were retrieved. Cochrane RoB 2 and the GRADE approach were used. RESULTS Fourteen RCTs were included: they studied isolated BT (n = 11), BT plus drug treatment (DT; n = 5), BT plus intravaginal electrical stimulation (IVES; n = 2), BT plus biofeedback and IVES (n = 1), BT plus pelvic floor muscle training and behavioral therapy (n = 2), BT plus percutaneous tibial nerve stimulation, and BT plus transcutaneous tibial nerve stimulation (n = 1). In a meta-analysis of short-term follow-up data, BT plus IVES resulted in greater improvement in nocturia (mean difference [MD]: 0.89, 95% CI: 0.5, 1.20), urinary incontinence (UI; MD: 1.93, 95% CI: 1.32, 2.55), and quality of life (QoL; MD: 4.87, 95% CI: 2.24, 7.50) than isolated BT, while DT and BT improved UI (MD: 0.58, 95% CI: 0.23, 0.92) more than isolated BT. CONCLUSION In the short term, BT plus IVES improves the OAB symptoms of nocturia and UI while improving QoL. The limited number of RCTs and heterogeneity among them provide a low level of evidence, making the effect of BT on OAB inconclusive, which suggests that new RCTs should be performed.
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Affiliation(s)
- A K Rocha
- Postgraduate Program in Rehabilitation Sciences, Institute of Motricity Sciences, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | - S Monteiro
- Department of Physiotherapy at Pontifícia Universidade Católica de Minas Gerais (PUC-MINAS), Belo Horizonte, Minas Gerais, Brazil; Postgraduate Program in Surgical Sciences, School of Medicine of the Universidade Estadual de Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - I Campos
- Postgraduate Program in Rehabilitation Sciences, Institute of Motricity Sciences, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | - M Volpato
- Postgraduate Program in Surgical Sciences, School of Medicine of the Universidade Estadual de Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - D Verleun
- Latu Sensu Postgraduate Program in Physiotherapy in Women's Health and Pelvic Dysfunctions - Faculdade de Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, Minas Gerais, Brazil
| | - L Valim
- Department of Physiotherapy at Pontifícia Universidade Católica de Minas Gerais (PUC-MINAS), Belo Horizonte, Minas Gerais, Brazil
| | - C Riccetto
- Postgraduate Program in Surgical Sciences, School of Medicine of the Universidade Estadual de Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - S Botelho
- Postgraduate Program in Rehabilitation Sciences, Institute of Motricity Sciences, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil; Postgraduate Program in Surgical Sciences, School of Medicine of the Universidade Estadual de Campinas, (UNICAMP), Campinas, São Paulo, Brazil.
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Zhang D, Yan Z, He J, Yao Y, Liu K. The exposure to volatile organic compounds associate positively with overactive bladder risk in U.S. adults: a cross-sectional study of 2007-2020 NHANES. Front Public Health 2024; 12:1374959. [PMID: 38912261 PMCID: PMC11190323 DOI: 10.3389/fpubh.2024.1374959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The aim of this study was to comprehensively investigate the potential relationship between blood volatile organic compounds (VOCs) and overactive bladder (OAB) risk. Methods A total of 11,183 participants from the 2007-2020 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study. We used multivariate logistic regression models to investigate the relationship between nine blood VOCs and OAB risk. Restricted cubic spline (RCS) analysis was used to investigate the dose-response relationship between blood VOCs and OAB. In addition, the overall association of blood VOCs with OAB risk was assessed by weighted quantile sum (WQS) regression model. Finally, we conducted subgroup analyses to explore the findings in different high-risk populations. Results After adjusting for potential confounders, logistic regression analysis revealed that blood 2,5-dimethylfuran (aOR = 2.940, 95% CI: 1.096-7.890, P = 0.032), benzene (aOR = 1.460, 95% CI: 1.044-2.043, P = 0.027) and furan (aOR = 9.426, 95% CI: 1.421-62.500, P = 0.020) were positively independent associated with the risk of OAB. And dose-response risk curves indicated that 2,5-dimethylfuran, benzene and furan in the blood were linearly positive associated with OAB risk. WQS regression analysis showed that exposure to mixed blood VOCs increased the risk of OAB (OR = 1.29, 95% CI: 1.11-1.49), with furans having the greatest weight. In subgroup analyses, we found that OAB was more susceptible to blood VOCs in young and middle-aged, male, non-hypertensive, and alcohol-drinking populations. Conclusions The results of this study indicate that high exposure to VOCs is independently and positively associated with OAB risk in U.S. adults, particularly 2,5-dimethylfuran, benzene, and furan. In addition, age, gender, hypertension and alcohol consumption may influence the association. Our study provided novel epidemiologic evidence to explore the potential role of environmental pollutants in OAB.
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Affiliation(s)
| | | | | | - Yunmin Yao
- Department of Urology, The Fifth People's Hospital of Wujiang District, Suzhou, China
| | - Kai Liu
- Department of Urology, The Fifth People's Hospital of Wujiang District, Suzhou, China
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Anis O, Cohen AD, Aharony S, Kitrey ND, Dotan I, Shenhar C, Comaneshter D, Beckenstein T, Yaron S. Increased prevalence of metabolic syndrome in female patients with overactive bladder: A population-based study. Neurourol Urodyn 2024. [PMID: 38837822 DOI: 10.1002/nau.25521] [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: 10/17/2023] [Revised: 04/28/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES To assess the association between overactive bladder syndrome (OAB) and the metabolic syndrome (MetS). PATIENTS AND METHODS A population-based study was conducted to compare OAB patients with age-, sex- and ethnicity-matched control subjects regarding the prevalence of the parameters of the MetS, with respect to obesity, hyperlipidemia, hypertension and diabetes mellitus. The characteristics of the OAB population were assessed. Adjusted odds ratios (OR) were calculated by logistic regression. RESULTS 110 024 OAB patients and 220 455 controls. were identified. OAB was associated with a higher prevalence of MetS (35.4% vs. 27.5%, p < 0.001). The fully adjusted OR for MetS in patients with OAB compared to controls was 1.44; 95% confidence interval (CI) 1.42-1.46; p < 0.001. Among metabolic parameters, obesity was found to be the strongest factor associated with OAB (OR 1.55, 95% CI 1.53-1.58, p < 0.001), and higher high-density lipoprotein cholesterole levels (>50) had a protective effect on the risk of OAB (OR 0.75, 95% CI 0.73-0.76, p < 0.001). CONCLUSIONS Data from this cohort suggest that OAB is positively associated with MetS. Clinicians approaching patients with OAB should be aware of this association. A multimodal treatment focusing on the MetS may be considered in these patients.
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Affiliation(s)
- Omer Anis
- Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
- Section of Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arnon Dov Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Quality Measures and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Shachar Aharony
- Department of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | - Noam D Kitrey
- Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Idit Dotan
- Institute of Endocrinology, Rabin Medical Center, Beilinson campus, Petah-Tikva, Israel
| | - Chen Shenhar
- Section of Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | | | | | - Shlomit Yaron
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
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Li Marzi V, Musco S, Lombardo R, Cicione A, Gemma L, Morselli S, Gallo ML, Serni S, Campi R, De Nunzio C. Prevalence of lower urinary tract symptoms in taxi drivers: a cross-sectional web-based survey. Prostate Cancer Prostatic Dis 2024; 27:283-287. [PMID: 38160226 DOI: 10.1038/s41391-023-00777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Aim of the study was to evaluate the prevalence of LUTS in taxi drivers. METHODS Between February 24th 2021 and March 26th 2021 a web based survey was administered to Taxi drivers in the city of Florence. Taxi drivers were evaluated with baseline characteristics such as: age, BMI, smoking, career length, comorbidities, and treatment. LUTS were evaluated using the international prostate symptom score (IPSS) and the overactive bladder (OAB) score. As well sexual function was evaluated using the international index erectile function (IIEF) and female sexual function index (FSFI) questionnaires. Risk factors for LUTS were evaluated using regression analysis. RESULTS The overall response rate was 64.6% (537/830 taxi drivers filled the questionnaires). Among them, 449 (83.6%) were men and 88 (16.4%) females. Overall, median IPSS was 5 (2/9) and median OAB score was 10 (7/14). On multivariate binary regression analysis age > 50 (OR:1.60; p < 0,05), Smoking (OR:1.57; p < 0,05), chronic treatment (OR:1.57; p < 0,05), recurrent cystitis (OR: 2.66; p < 0,05) and chronic pelvic pain (OR:4.94; p < 0,05) were independent risk factors for moderate/severe LUTS. On multivariate binary logistic regression analysis, risk factors for erectile dysfunction were age older than 50 years (OR = 3.64; p < 0.05) and urinary incontinence (OR = 5.53; p = 0.005). CONCLUSIONS According to our web-based survey, Taxi drivers in the metropolitan city of Florence had non-negligible symptomatic LUTS and even sexual dysfunction. Our data suggest as LUTS are particular influenced by several life-style and behavioural factors as type and duration of work.
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Affiliation(s)
- Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Stefania Musco
- Unit of Neuro-Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Lombardo
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Antonio Cicione
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simone Morselli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Lucia Gallo
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
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Gibson S, Ellsworth P. Emerging therapies for overactive bladder: preclinical, phase I and phase II studies. Expert Opin Investig Drugs 2024; 33:601-612. [PMID: 38695250 DOI: 10.1080/13543784.2024.2349285] [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: 02/07/2024] [Accepted: 04/25/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Overactive bladder syndrome is a common chronic condition with a significant impact on quality of life and economic burden. Persistence with pharmacologic therapy has been limited by efficacy and side effects. A greater understanding of the pathophysiology of overactive bladder has led to the initial evaluation of several drugs affecting ion channels, the autonomic nervous system, and enzymes which may provide useful alternatives for the management of overactive bladder. AREAS COVERED A comprehensive review was performed using PubMed and Cochrane databases as well as reviewing clinical trials in the United States. The current standard of care for overactive bladder will be discussed, but this paper focuses on investigational drugs currently in preclinical studies and phase I and II clinical trials. EXPERT OPINION Current therapies for overactive bladder have limitations in efficacy and side effects. A greater understanding of the pathophysiology of overactive bladder has identified the role(s) of other pathways in the overactive bladder syndrome. Targeting alternative pathways including ion channels and enzymes may provide alternative therapies of overactive bladder and a more tailored approach to the management of overactive bladder.
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Affiliation(s)
- Samantha Gibson
- Division of urology, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Pamela Ellsworth
- Division of urology, University of Central Florida College of Medicine, Orlando, FL, USA
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Bou Kheir G, Verbakel I, Vande Walle J, Wyndaele M, Sinha S, Arlandis S, Raes A, Abrams P, Wein A, Hervé F, Everaert K. Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process. Neurourol Urodyn 2024; 43:1040-1057. [PMID: 38289322 DOI: 10.1002/nau.25307] [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: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) is a prevalent urological condition characterized by urinary urgency, with or without urgency urinary incontinence, accompanied by increased daytime frequency and nocturia. However, the current definition of OAB lacks a specified time frame, hindering our understanding of the temporal aspects and transitions that occur within the OAB spectrum. METHODS A modified Delphi study was conducted in three rounds, involving a panel of international experts in functional urology, urogynaecology, geriatrics, transitional medicine, and pediatric urology. The study took place between February 2023 and June 2023 and employed two sequential rounds of online surveys, followed by a final hybrid group discussion session in June 2023. RESULTS The Delphi process resulted in a consensus definition of lifelong OAB as a persistent and continuous condition that may manifest differently from birth and evolve over time, with varying levels of clinical perception. The course of its progression is influenced by transition periods and modifying factors, mainly anatomical, hormonal, and psychosocial/stressors. Three main transition periods were identified: achievement of daytime continence, adulthood to elderly, and transition to frail elderly. The panel also considered the therapeutic and diagnostic implications of lifelong OAB, as well as future research prospects in terms of importance and feasibility. CONCLUSIONS Future longitudinal research is needed to develop this concept and further identify transitions and temporal dynamics.
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Affiliation(s)
- George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Paediatric Nephrology and Rheumatology, ERknet Center, Ghent University Hospital, Ghent, Belgium
| | - Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ann Raes
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alan Wein
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
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21
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Wei B, Zhao Y, Lin P, Qiu W, Wang S, Gu C, Deng L, Deng T, Li S. The association between overactive bladder and systemic immunity-inflammation index: a cross-sectional study of NHANES 2005 to 2018. Sci Rep 2024; 14:12579. [PMID: 38822015 PMCID: PMC11143340 DOI: 10.1038/s41598-024-63448-3] [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: 02/16/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
Current research indicate that inflammation is linked to the development of overactive bladder (OAB). The aim of this study was to examine the correlation between OAB and the systemic immunity-inflammation index (SII) in the USA. We analyzed data from 31,881 participants in the National Health and Nutrition Examination Survey 2005-2018. SII, calculated as platelet count × neutrophil count/lymphocyte count, was categorized into quartiles. OAB was defined by the presence of urge urinary incontinence and nocturia. Weighted logistic regression models were used to examine the independent relationship between SII and OAB, adjusting for demographic factors, kidney function, and diabetes status. The results showed that each tenfold increase in log-transformed SII was associated with an 18% higher odds of OAB (OR 1.18, 95% CI 1.08-1.28) in the fully adjusted model. Compared to the lowest SII quartile, the highest quartile had a 28% increased OAB risk (OR 1.28, 95% CI 1.12-1.47). The positive association between SII and OAB risk was consistently observed across subgroups stratified by age, sex, race, marital status, education, and poverty level. Our study reveals a positive correlation between SII levels and OAB, indicating that higher SII levels are associated with an increased likelihood of developing OAB.
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Affiliation(s)
- Baian Wei
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Ying Zhao
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Pinli Lin
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Wenqiang Qiu
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Shusheng Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Chiming Gu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Lili Deng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Tewei Deng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China.
| | - Siyi Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China.
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22
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Cornu JN, Donon L, Thullier C, Meyer F, Klap J, Campagne-Loiseau S, Mariadassou A, Peyronnet B. New TENSI+ Device for Transcutaneous Posterior Tibial Nerve Stimulation: A Prospective, Multicentre, Post-market Clinical Study. Eur Urol Focus 2024:S2405-4569(24)00076-2. [PMID: 38816338 DOI: 10.1016/j.euf.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/05/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Our aim was to report the first clinical trial of TENSI+, a new device for transcutaneous posterior tibial nerve stimulation (TNS) for treatment of overactive bladder (OAB). METHODS A prospective, multicentre clinical trial was conducted in adults with OAB in seven French centres. The main exclusion criteria were prior percutaneous or transcutaneous TNS or invasive OAB treatment, current antimuscarinic use, 24-h polyuria, known bladder disease, postvoid residual volume >150 ml, and pelvic organ prolapse stage >2. Patients self-administered daily TTNS sessions of 20 min with TENSI+ at home after education by a specialized nurse. A bladder diary, Urinary Symptom Profile and OAB-q questionnaires, and Patient Global Impression of Improvement (PGI-I) scores were evaluated at baseline and 3 and 6 mo. The primary endpoint was efficacy, based on PGI-I and variations in bladder diary parameters. Success was defined as a PGI-I score ≤3 and any improvement ≥30% in bladder diary parameters. KEY FINDINGS AND LIMITATIONS The study included 78 patients (13 males). Nine patients had neurological disease, 21 had previously tried antimuscarinics, and 41 had wet OAB at baseline. At 3 mo, 65/78 patients had a full analysis set. Treatment was successful in 44/65 patients (67%), with 25/65 (38%) reporting both an objective improvement and high satisfaction. All OAB-related endpoints were significantly improved, except bladder capacity and total voided volume per 24 h. At 6 mo, only five of 44 patients had interrupted their treatment. No factor predictive of success was identified. Two adverse events (pain at stimulation site and/or pelvic pain) were reported and spontaneously resolved without treatment interruption. CONCLUSIONS AND CLINICAL IMPLICATIONS TENSI+ is a safe and effective TTNS treatment option for OAB management. PATIENT SUMMARY TENSI+ is a new device for nerve stimulation in patients with overactive bladder. Patients use the device at home every day. In our short-term trial, TENSI+ use improved symptoms in 67% of patients. Further evaluation over a longer period of time is needed.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, University of Rouen, Rouen, France.
| | - Laurence Donon
- Department of Urology, Polyclinique de la Côte Basque, Saint-Jean-de-Luz, France
| | - Caroline Thullier
- Department of Urology, University Hospital of Grenoble, Grenoble, France
| | - François Meyer
- Department of Urology, Hôpital Privé des Peupliers, Paris, France
| | - Julia Klap
- Department of Urology, Claude Galien Hospital, Quincy-sous-Sénart, France
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23
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He Q, Wu L, Deng C, He J, Wen J, Wei C, You Z. Diabetes mellitus, systemic inflammation and overactive bladder. Front Endocrinol (Lausanne) 2024; 15:1386639. [PMID: 38745959 PMCID: PMC11091467 DOI: 10.3389/fendo.2024.1386639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
Background Increasing evidence emphasizes the potential relationship between diabetes and OAB (overactive bladder). However, large population epidemiology is still lacking. Methods This cross-sectional study included six cycle NHANES surveys, with a total of 23863 participants. Logistic regression models were constructed to analyze the association between diabetes mellitus, diabetes-related markers, and inflammatory biomarkers with OAB. Restricted cubic splines were used to analyze the non-linear associations. Mediating analysis was performed to test the effect of inflammatory biomarkers on the relationship between diabetes-related markers and OAB. Finally, machine learning models were applied to predict the relative importance and construct the best-fit model. Results Diabetes mellitus participants' OAB prevalence increased by 77% compared with non-diabetes. As the quartiles of diabetes-related markers increased, the odds of OAB monotonically increased in three models (all p for trend < 0.001). Glycohemoglobin exhibited a linear association with OAB (p for nonlinearity > 0.05). White blood cells significantly mediated the associations between diabetes-related markers (glycohemoglobin, fasting glucose, and insulin) with OAB, and the proportions were 7.23%, 8.08%, and 17.74%, respectively (all p < 0.0001). Neutrophils partly mediated the correlation between (glycohemoglobin, fasting glucose, and insulin) and OAB at 6.58%, 9.64%, and 17.93%, respectively (all p < 0.0001). Machine learning of the XGBoost model constructs the best fit model, and XGBoost predicts glycohemoglobin is the most important indicator on OAB. Conclusion Our research revealed diabetes mellitus and diabetes-related markers were remarkably associated with OAB, and systemic inflammation was an important mediator of this association.
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Affiliation(s)
- Qingliu He
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lizhen Wu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Changqi Deng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiatai He
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Wen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Chengcheng Wei
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhijiao You
- Department of Urology, Jinjiang Municipal Hospital, Quanzhou, Fujian, China
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Shimizu S. Insights into the associative role of hypertension and angiotensin II receptor in lower urinary tract dysfunction. Hypertens Res 2024; 47:987-997. [PMID: 38351189 DOI: 10.1038/s41440-024-01597-8] [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: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
In men, the lower urinary tract comprises the urinary bladder, urethra, and prostate, and its primary functions include urine storage and voiding. Hypertension is a condition that causes multi-organ damage and an age-dependent condition. Hypertension and the renin-angiotensin system activation are associated with the development of lower urinary tract dysfunction. Hypertensive animal models show bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. In the renin-angiotensin system, angiotensin II and the angiotensin II type 1 receptor, which are expressed in the lower urinary tract, have been implicated in the pathogenesis of lower urinary tract dysfunction. Moreover, among the several antihypertensives, renin-angiotensin system inhibitors have proven effective in human and animal models of lower urinary tract dysfunction. This review aimed to elucidate the hitherto known mechanisms underlying the development of lower urinary tract dysfunction in relation to hypertension and the angiotensin II/angiotensin II type 1 receptor axis and the effect of renin-angiotensin system inhibitors on lower urinary tract dysfunction. Possible mechanisms through which hypertension or activation of Ang II/AT1 receptor axis causes LUTD such as bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. LUT: lower urinary tract, LUTD: lower urinary tract dysfunction, AT1: angiotensin II type 1, ACE: angiotensin-converting enzyme.
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Affiliation(s)
- Shogo Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, 783-8505, Japan.
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25
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El-Sayed RF, Moqbel NM, Hussein AF, Abdelatty MA, Hanna SA, Azim MSA. Lax Uterosacral Ligament and Urge Urinary Incontinence: MRI Findings in Symptomatic Patients Versus Healthy Volunteers. Int Urogynecol J 2024; 35:793-801. [PMID: 38240800 PMCID: PMC11052867 DOI: 10.1007/s00192-023-05722-y] [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: 10/26/2023] [Accepted: 12/15/2023] [Indexed: 04/29/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to explore the association between urge urinary incontinence (UUI) and lax uterosacral ligaments (USL) using MRI. METHODS Sixty-seven female participants were recruited prospectively: 41 continent volunteers (control group) and 26 patients with UUI. Static proton density- and T2-weighted turbo spin echo sequences of MR images were used. A radiologist employed a standardized grid system to record structural observations of the USLs on sequentially numbered axial MR images and then applied a four-point grading scale to assess ligament visibility. MR images were interpreted by a radiologist and a urologist, and then validated by an expert radiologist. RESULTS The comparison between the mean length of uterosacral ligaments in the control and UUI groups was highly statistically significant (p < 0.001). The mean length of the right USL was 38 ± 11 mm, and the left USL was 35 ± 12 mm in the UUI group. In the control group, the mean length of the USL was 22 ± 9 mm on the right side and 18 ± 9 mm on the left side, along their craniocaudal extent. The highest inter-observer agreement was on the level of origin and insertion (image numbers), whereas the lowest agreement was on the anatomical site of origin and insertion of the USL in both the control and UUI groups. CONCLUSIONS The average length of USLs in patients with UUI is significantly longer than that in healthy continent women, indicating laxity. Our findings support the relationship between the laxity of the USL and UUI symptoms and have therapeutic implications.
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Affiliation(s)
- Rania F El-Sayed
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Noha M Moqbel
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Ahmed F Hussein
- Department of Urology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Mohamed A Abdelatty
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt.
| | - Sameh A Hanna
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Mohamed S Abdel Azim
- Department of Urology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
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Andersson KE. Promising therapeutic targets for the treatment of urine storage dysfunction: what's the status? Expert Opin Ther Targets 2024; 28:251-258. [PMID: 38629152 DOI: 10.1080/14728222.2024.2344698] [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: 11/19/2023] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Opinions differ on what drugs have both a rationale and a development potential for the treatment of bladder storage dysfunction. AREAS COVERED In the present review, the focus is given to small molecule blockers of TRP channels (TRPV1, TRPV4, TRPA1, and TRPM8), P2 × 3receptor antagonists, drugs against oxidative stress, antifibrosis agents, cyclic nucleotide - dependent pathways, and MaxiK±channel - gene therapy. EXPERT OPINION TRPV1 channel blockers produce hypothermia which seems to be a problem even with the most efficacious second-generation TRPV1 antagonists. This has so far precluded their application to urine storage disorders. Other TRP channel blockers with promising rationale have yet to be tested on the human lower urinary tract. The P2 × 3receptor antagonist, eliapixant, was tested in a randomized controlled clinical trial, was well tolerated but did not meet clinical efficacy endpoints. Antifibrosis agent still await application to the human lower urinary tract. New drug principles for oxidative stress, purine nucleoside phosphorylase inhibition, and NOX inhibition are still at an experimental stage, and so are soluble guanylate cyclase stimulators. Gene therapy with MaxiK±channels is still an interesting approach but no new trials seem to be in pipeline.
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Affiliation(s)
- Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Laboratory Medicine, Lund University, Lund, Sweden
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Cho KJ, Kim JC. Novel pharmacotherapeutic avenues for bladder storage dysfunction in men. Expert Opin Pharmacother 2024; 25:585-594. [PMID: 38651268 DOI: 10.1080/14656566.2024.2346278] [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: 02/21/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Bladder storage dysfunction is associated with low quality of life in men and remains a challenging field in pharmacotherapy because of low persistence followed by patient-perceived lack of efficacy and adverse effects. The persistent desire for the development of novel pharmacotherapy is evident, leading to numerous research efforts based on its pathophysiology. AREAS COVERED This review describes the pathophysiology, current pharmacotherapeutic strategies, and emerging novel drugs for male bladder storage dysfunction. The section on emerging pharmacotherapy provides an overview of current research, focusing on high-potential target molecules, particularly those being evaluated in ongoing clinical trials. EXPERT OPINION As pharmacotherapies targeting alpha-adrenergic, beta-adrenergic, and muscarinic receptors - the current primary targets for treating male bladder storage dysfunction - have demonstrated insufficient efficacy and side effects, researchers are exploring various alternative molecular targets. Numerous targets have been identified as central to regulating bladder afferent nerve activity, and their pharmacological effects and potential have been evaluated in animal-based experiments. However, there is a limited number of clinical trials for these new pharmacotherapies, and they have not demonstrated clear superiority over current treatments. Further research is needed to develop new effective pharmacotherapies for bladder storage dysfunction in men.
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Affiliation(s)
- Kang Jun Cho
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Chul Kim
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lin W, Li T, Xu Z, Chen P, Zheng Q, Hong YK, Liu WJ. Association of socioeconomic status and overactive bladder in US adults: a cross-sectional analysis of nationally representative data. Front Public Health 2024; 12:1345866. [PMID: 38596511 PMCID: PMC11003547 DOI: 10.3389/fpubh.2024.1345866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/29/2024] [Indexed: 04/11/2024] Open
Abstract
Background Socioeconomic status inequality is an important variable in the emergence of urological diseases in humans. This study set out to investigate the association between the prevalence of overactive bladder (OAB) and the poverty income ratio (PIR) that served as a more influential indicator of socioeconomic status compared to education and occupation. Method Data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2020 were used in this cross-sectional study. The association between the PIR and OAB was examined using weighted multivariate logistic regression and weighted restricted cubic splines (RCS). Additionally, interaction analysis was used for investigation to the connections between PIR and OAB in various covariate groups in order to confirm the stability of the results. Results We observed a noteworthy inverse association between PIR and OAB after adjusting for potential confounding variables (OR = 0.87, 95% CI, 0.84-0.90, p < 0.0001). PIR was transformed into categorical variables, and the association held steady after that (1.0 < PIR <4.0 vs. PIR ≤ 1.0, OR = 0.70, 95% CI =0.63-0.77, p < 0.0001; PIR ≥ 4.0 vs. PIR ≤ 1.0, OR = 0.56, 95% CI =0.48-0.65, p < 0.0001). Additionally, RCS analysis showed that PIR and OAB had a negative nonlinear response relationship. Subgroup analyses showed that the inverse association between PIR and prevalence of OAB was stronger in obese than in nonobese individuals (P for interaction < 0.05). Conclusion In our study, we observed a significant negative association between the PIR and the prevalence of OAB. In the future, PIR could be used as a reference standard to develop strategies to prevent and treat OAB.
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Affiliation(s)
- Weilong Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Taibiao Li
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Zhengyuan Xu
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Peixin Chen
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Qianqi Zheng
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Ying-kai Hong
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Wei-juan Liu
- Department of Medical Cosmetic Center, the First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
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Fourel M, Hafez S, Ramdane N, Perrouin-Verbe MA, De Wachter S, Vermersch P, Biardeau X. Response to tibial and sacral nerve modulation in overactive bladder: Is there any correlation? Neurourol Urodyn 2024; 43:415-423. [PMID: 38078739 DOI: 10.1002/nau.25352] [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: 07/11/2023] [Revised: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To assess the correlation between the response to transcutaneous tibial nerve stimulation (TTNS) and subsequent response to sacral nerve modulation (SNM) to treat overactive bladder (OAB). MATERIALS AND METHODS All patients who consecutively received TTNS followed by a two-stage SNM between January 2016 and June 2022 to treat OAB in two university hospital centers were included. The response to each therapy was evaluated with success defined by a 50% or greater improvement in one or more bothersome urinary symptoms from baseline. The primary endpoint was the statistical relationship between the response to TTNS and the response to SNM, assessed by logistic regression. Secondary endpoints were the statistical relationship between the response to TTNS and the response to SNM when controlling for gender, age (<57 years vs. >57 years), presence of an underlying neurological disease, and presence of DO, adding the factor and interaction to the previous regression model. RESULTS Among the 92 patients enrolled in the study, 68 of them were women (73.9%), and the median age was 57.0 [41.0-69.0] years. The success was reported in 22 patients (23.9%) under TTNS and 66 patients (71.7%) during the SNM test phase. There was no statistical correlation between response to TTNS and response to SNM in the overall population (confidence interval: 95% [0.48-4.47], p = 0.51). Similarly, there was no statistical correlation when controlling for age <57 years or ≥57 years, with p = 1.0 and p = 0.69, respectively. No statistical study could be conducted for the other subpopulations due to small sample sizes. CONCLUSION The response to TTNS does not predict the response to SNM in the treatment of OAB. TTNS and SNM should be considered as separate therapies, and the decision-making process for OAB treatment should take this into account.
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Affiliation(s)
- Mathieu Fourel
- Department of Urology, Lille Academic Hospital, University of Lille, Lille, France
| | - Samy Hafez
- Centre Hospitalo-Universitaire de Nantes, Urology Department, Nantes Université, Nantes, France
| | | | | | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wlrijk, Belgium
| | - Patrick Vermersch
- Inserm U1172 LilNCog, CHU Lille, FHU Precise, University of Lille, Lille, France
| | - Xavier Biardeau
- Department of Urology, Lille Academic Hospital, University of Lille, Lille, France
- Inserm U1172 LilNCog, CHU Lille, FHU Precise, University of Lille, Lille, France
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Lee WC, Chow PM, Hsu CN, Chuang YC. The impact of diabetes on overactive bladder presentations and associations with health-seeking behavior in China, South Korea, and Taiwan: Results from a cross-sectional, population-based study. J Chin Med Assoc 2024; 87:196-201. [PMID: 38132568 DOI: 10.1097/jcma.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study aimed to explore the impact of diabetes on overactive bladder (OAB) presentations and related predictors of healthcare-seeking behavior among adults aged ≥ 40 years in China, Taiwan, and South Korea. METHODS An internet-based survey was conducted to assess the prevalence of diabetes, OAB presentations, and self-perceived urinary symptoms by a multi-national sample of 8284 individuals who completed the survey between June 2, 2015 and July 31, 2015. Independent associations with health-seeking behavior for urinary symptoms were estimated with odds ratio (OR) with 95% confidence interval (95% CI) using multivariate logistic regression. RESULTS Diabetes was reported in 13.6% of participants and OAB was 20.8%. Diabetic participants were older than non-diabetic participants in both sexes. Participants with diabetes reported a higher rate of OAB (43.1%) and increased bothersome symptoms associated with OAB than those without diabetes. Participants with diabetes (OR, 3.07 [2.39-3.96]], urgent incontinence (OR, 2.38 [1.86-3.03]), frequency (OR, 1.86 [1.45-2.38]), and nocturia (OR, 1.14 [1.05-1.24]) were associated with healthcare-seeking behavior. CONCLUSION The proportion of diabetic participants with OAB was 2.5-fold higher than those without diabetes. Diabetes, urinary frequency, nocturia, and urgent incontinence are predictors of medical treatment-seeking behavior, but the key symptom of OAB-urgency is not a predictor of treatment-seeking behavior. It is important for clinicians to recognize the interplay between diabetes and OAB and to early identify various bothersome urinary symptoms for better health outcomes in daily practice.
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Affiliation(s)
- Wei-Chia Lee
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Yao-Chi Chuang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
- Center for Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
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Ewerton F, Cruz F, Kapp M, Klein S, Roehm P, Chapple C. Efficacy and Safety of Eliapixant in Overactive Bladder: The 12-Week, Randomised, Placebo-controlled Phase 2a OVADER Study. Eur Urol Focus 2024; 10:90-97. [PMID: 37563004 DOI: 10.1016/j.euf.2023.07.008] [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: 04/21/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Effective, well-tolerated novel treatments for overactive bladder (OAB) are lacking. The P2X3 receptor antagonist eliapixant demonstrated potential to reduce OAB symptoms in preclinical studies. OBJECTIVE To evaluate the safety, tolerability, and efficacy of eliapixant in patients with OAB with urgency urinary incontinence (UUI). DESIGN, SETTING AND PARTICIPANTS OVADER was a 12-wk, randomised, placebo-controlled, double-blind, parallel-group, multicentre, phase 2a study (NCT04545580) conducted between 2020 and 2022 in private and institutional clinical practices. Eligible patients were aged ≥18 yr with wet OAB symptoms (urgency, urinary frequency, and urinary incontinence) for ≥3 mo before screening. INTERVENTION Randomisation (1:1 ratio) to oral eliapixant 125 mg or placebo twice daily. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the mean change from baseline in the mean number of UUI episodes/24 h over weeks 4, 8, and 12 according to an electronic bladder diary, evaluated using a repeated-measurement model in a Bayesian framework. RESULTS AND LIMITATIONS Of 202 patients enrolled, 85 were valid for per-protocol analysis. The primary efficacy endpoint was not met. The posterior probability for eliapixant superiority over placebo was 40% (point estimate 0.05, 95% credible interval -∞ to 0.38), which did not meet the predefined criterion of ≥90% probability. Secondary and exploratory endpoints were not met. The incidence of adverse events was similar in the eliapixant (n = 32, 63%) and placebo (n = 27, 56%) groups; most were mild and five led to discontinuation of eliapixant. CONCLUSIONS OVADER did not meet its clinical efficacy endpoints. Potential reasons include the nonspecific OAB symptom complex, the poorly understood pathophysiology, and the coinciding COVID-19 pandemic. PATIENT SUMMARY We tested whether a new drug called eliapixant would reduce symptoms of overactive bladder in comparison to placebo. We found that the drug did not work. More knowledge on how overactive bladder occurs is needed to find new drugs to treat this condition.
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Affiliation(s)
| | - Francisco Cruz
- Department of Urology, São João University Hospital Centre, Porto, Portugal; Faculty of Medicine and I3S Institute for Investigation and Innovation in Health, University of Porto, Porto, Portugal
| | | | | | | | - Christopher Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Huang S, Guo C, Tai S, Ding H, Mao D, Huang J, Qian B. Prevalence of overactive bladder in Chinese women: A systematic review and meta-analysis. PLoS One 2023; 18:e0290396. [PMID: 38127870 PMCID: PMC10735185 DOI: 10.1371/journal.pone.0290396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Overactive bladder (OAB) is a significant public health issue that adversely affects the quality of life of patients and imposes a significant socioeconomic burden, with varying prevalence rates across study populations in Chinese women. A systematic review and meta-analysis were conducted to estimate the prevalence of OAB in Chinese women. METHODS Relevant published articles on the prevalence of OAB in Chinese women were searched through July 21, 2022, using PubMed, EMbase, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data, and VIP databases. After the independent screening of articles, data extraction, and quality assessment of included studies by two investigators, a meta-analysis was performed using Stata 16.0 software, and the prevalence was determined using a random-effects model. To identify potential sources of heterogeneity, subgroup analyses were conducted with subgroup categories including age, Body Mass Index (BMI), region, and survey year. Publication bias was assessed by visually examining the funnel plot and Egger's test. RESULTS Twenty studies were included in this meta-analysis. The results of the random-effects model indicated that the prevalence of OAB in Chinese women was 14% (95% Confidence Interval: 9%-18%). The prevalence increased significantly in the past decade (from 8% in pre-2006 to 18% in 2016-2021). A prevalence (18%) was observed among women aged 31-40 compared with other age groups. The BMI range of 24-27.9 (18%) was higher than the other groups. Additionally, the prevalence of this BMI range was comparatively higher in North China and Southwest China (21%) than in Central China and East China. In addition, publication bias was observed. CONCLUSIONS OAB incidence has increased in Chinese women over the last two decades, affecting more than 20% of women aged 31-40 years and above. With the increasing prevalence of OAB, greater emphasis has been placed on implementing preventative and control measures.
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Affiliation(s)
- Shaoming Huang
- Department of Urology, Ganzhou Municipal Hospital, Ganzhou, China
| | - Chuan Guo
- Department of Urology, Chengfei Hospital, Chengdu, China
| | - Shengcheng Tai
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Hongxiang Ding
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Dikai Mao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Biao Qian
- Department of Urology, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
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Celenay ST, Korkut Z, Bulbul SB, Altay H, Oskay K. Effects of spinal stabilization exercises focusing on the pelvic floor in women with overactive bladder. Int Urogynecol J 2023; 34:2959-2967. [PMID: 37638983 DOI: 10.1007/s00192-023-05638-7] [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: 06/05/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the effects of spinal stabilization exercises (SSEs) focusing on the pelvic floor with regard to urinary symptoms, pelvic floor muscle strength (PFMS), core stability, quality of life (QoL), and perception of subjective improvement (PSI) in women with overactive bladder (OAB). METHODS Patients were randomly divided into SSE (n=23) and control (n=24) groups. The SSE group received SSEs focusing on the pelvic floor for 3 days a week for 8 weeks and recommendation. The control group received only recommendation. Before (BT) and after treatment (AT), urinary symptoms were evaluated with Overactive Bladder Questionnaire-Version 8 (OAB-V8) and bladder diary. PFMS, core stability, and QoL were assessed using the Modified Oxford Scale (MOS), Sharman test, and King's Health Questionnaire (KHQ) respectively. AT, PSI with a Likert-type scale, and compliance with recommendations using a visual analog scale were assessed. RESULTS The OAB-V8 and the KHQ scores, the number of voids per day and voids per night decreased and the MOS and the Sharman scores increased in the SSE group (p<0.05). In the control group, the OAB-V8 and incontinence effect, social limitations, emotional state, and sleep sub-dimension scores related to KHQ decreased (p<0.05). The OAB-V8, role and physical limitations, emotional state, and sleep sub-dimension scores decreased more, and the MOS, the Sharman, the PSI, and the compliance with recommendations scores increased more in the SSE group than in the control group (p<0.05). CONCLUSIONS The SSEs focusing on the pelvic floor improved urinary symptoms, PFMS, core stability, QoL, and PSI. This exercise approach may be beneficial in the management of OAB.
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Affiliation(s)
- Seyda Toprak Celenay
- Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | | | - Saliha Beste Bulbul
- Health Sciences Institute, Physiotherapy and Rehabilitation Graduate Program, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Hafize Altay
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Mardin Artuklu University, Mardin, Turkey
| | - Kemal Oskay
- Ankara Gazi Mustafa Kemal Occupational and Environmental Diseases Hospital, Department of Urology, Ankara, Turkey
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Kulawik J, Cornu JN. Re: Real-time Changes in Brain Activity During Tibial Nerve Stimulation for Overactive Bladder: Evidence from Functional Near-infrared Spectroscopy Hype Scanning. Eur Urol 2023; 84:598. [PMID: 37455175 DOI: 10.1016/j.eururo.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Justine Kulawik
- Department of Urology, Hôpital Charles Nicolle, Rouen, France
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Barba M, Cola A, Rezzan G, Costa C, Re I, Volontè S, Terzoni S, Frigerio M, Maruccia S. Flat Magnetic Stimulation for Urge Urinary Incontinence. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1999. [PMID: 38004048 PMCID: PMC10673601 DOI: 10.3390/medicina59111999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods: This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results: Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 (p < 0.001) and ICIQ-UI SF scores (p < 0.001) and an improvement in sexual function (p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusions: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Giorgia Rezzan
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Ilaria Re
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Silvia Volontè
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Stefano Terzoni
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy; (S.T.); (S.M.)
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Serena Maruccia
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy; (S.T.); (S.M.)
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Lin W, Wang H, Wu Z, Zhang W, Lin ME. Associations between exposure to organophosphate esters and overactive bladder in U.S. adults: a cross-sectional study. Front Public Health 2023; 11:1186848. [PMID: 38026372 PMCID: PMC10666646 DOI: 10.3389/fpubh.2023.1186848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background The relationship between exposure to organophosphate esters (OPEs) and the risk of developing overactive bladder (OAB) is uncertain. The purpose of this study is to examine the potential link between urinary metabolites of organophosphate esters and OAB. Method Data from the National Health and Nutrition Examination Survey (NHANES) database of the 2011-2016 cycles were utilized. Four urinary metabolites of organophosphate esters: diphenyl phosphate (DPHP), bis (1,3-dichloro-2-propyl) phosphate (BDCPP), bis (2-chloroethyl) phosphate (BCEP), and dibutyl phosphate (DBUP) were included in the study. Multivariate logistic regression and restricted cubic spline (RCS) were used to evaluate the relationship between urinary OPEs metabolites and OAB. Interaction analysis was conducted on subgroups to confirm the findings. Results A total of 3,443 United States (US) adults aged 20 years or older were included in the study, of whom 597 participants were considered to have OAB. After adjusting for potential confounding factors, we found a positive association between DPHP and the risk of overactive bladder. The risk of overactive bladder increased with increasing DPHP concentrations compared with quartile 1 (quartile 2, OR = 1.19, 95% CI, 0.82-1.73, P = 0.34; quartile 3, OR = 1.67, 95% CI, 1.10-2.53, P = 0.02; Q4, OR = 1.75, 95% CI, 1.26-2.43, P = 0.002). However, after dividing the participants by gender, only the female group retained consistent results. Additionally, restricted cubic spline analysis revealed a nonlinear dose-response correlation between DPHP and OAB in female participants. In the subgroup analysis based on age, race, body mass index (BMI), recreational activity, smoking status, drinking status, hypertension, diabetes, and stroke, the interaction analysis revealed that the findings were uniform. Conclusion Our findings indicate that exposure to DPHP could elevate the risk of OAB in US adult females. Further experimental studies are needed to explore the underlying mechanism in the future.
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Affiliation(s)
- Weilong Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, Guangdong, China
| | - Haoxu Wang
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, Guangdong, China
| | - Zesong Wu
- Clinical Medicine Science, Shantou University Medical College, Shantou, Guangdong, China
| | - Wei Zhang
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, Guangdong, China
- The First Affiliated Hospital of Shantou University Medical College Hao Jiang Hospital, Shantou, Guangdong, China
| | - Ming-En Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, Guangdong, China
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Balla H, Borsodi K, Őrsy P, Horváth B, Molnár PJ, Lénárt Á, Kosztelnik M, Ruisanchez É, Wess J, Offermanns S, Nyirády P, Benyó Z. Intracellular signaling pathways of muscarinic acetylcholine receptor-mediated detrusor muscle contractions. Am J Physiol Renal Physiol 2023; 325:F618-F628. [PMID: 37675459 DOI: 10.1152/ajprenal.00261.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/10/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
Acetylcholine plays an essential role in the regulation of detrusor muscle contractions, and antimuscarinics are widely used in the management of overactive bladder syndrome. However, several adverse effects limit their application and patients' compliance. Thus, this study aimed to further analyze the signal transduction of M2 and M3 receptors in the murine urinary bladder to eventually find more specific therapeutic targets. Experiments were performed on adult male wild-type, M2, M3, M2/M3, or Gαq/11 knockout (KO), and pertussis toxin (PTX)-treated mice. Contraction force and RhoA activity were measured in the urinary bladder smooth muscle (UBSM). Our results indicate that carbamoylcholine (CCh)-induced contractions were associated with increased activity of RhoA and were reduced in the presence of the Rho-associated kinase (ROCK) inhibitor Y-27632 in UBSM. CCh-evoked contractile responses and RhoA activation were markedly reduced in detrusor strips lacking either M2 or M3 receptors and abolished in M2/M3 KO mice. Inhibition of Gαi-coupled signaling by PTX treatment shifted the concentration-response curve of CCh to the right and diminished RhoA activation. CCh-induced contractile responses were markedly decreased in Gαq/11 KO mice; however, RhoA activation was unaffected. In conclusion, cholinergic detrusor contraction and RhoA activation are mediated by both M2 and M3 receptors. Furthermore, whereas both Gαi and Gαq/11 proteins mediate UBSM contraction, the activation at the RhoA-ROCK pathway appears to be linked specifically to Gαi. These findings may aid the identification of more specific therapeutic targets for bladder dysfunctions.NEW & NOTEWORTHY Muscarinic acetylcholine receptors are of utmost importance in physiological regulation of micturition and also in the development of voiding disorders. We demonstrate that the RhoA-Rho-associated kinase (ROCK) pathway plays a crucial role in contractions induced by cholinergic stimulation in detrusor muscle. Activation of RhoA is mediated by both M2 and M3 receptors as well as by Gi but not Gq/11 proteins. The Gi-RhoA-ROCK pathway may provide a novel therapeutic target for overactive voiding disorders.
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Affiliation(s)
- Helga Balla
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Kinga Borsodi
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Őrsy
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Horváth
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter József Molnár
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Ádám Lénárt
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Mónika Kosztelnik
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
- HUN-REN-SE Cerebrosvascular and Neurodegenerative Disease Research Group, Budapest, Hungary
| | - Éva Ruisanchez
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
- HUN-REN-SE Cerebrosvascular and Neurodegenerative Disease Research Group, Budapest, Hungary
| | - Jürgen Wess
- Molecular Signaling Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
| | - Stefan Offermanns
- Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Péter Nyirády
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Zoltán Benyó
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
- HUN-REN-SE Cerebrosvascular and Neurodegenerative Disease Research Group, Budapest, Hungary
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Monteiro S, Rocha AK, Valim L, Silva SLAD, Riccetto C, Botelho S. Bladder training compared to bladder training associated with pelvic floor muscle training for overactive bladder symptoms in women: A randomized clinical trial. Neurourol Urodyn 2023; 42:1802-1811. [PMID: 37723948 DOI: 10.1002/nau.25285] [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: 04/28/2022] [Revised: 08/10/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
AIMS To compare the effects of bladder training (BT) versus BT with pelvic floor muscle training (PFMT) in women with overactive bladder (OAB) symptoms. METHODS Randomized controlled clinical trial including women with OAB symptoms, randomized into two groups: BT versus BT + PFMT. For 12 consecutive weeks, the women received home BT. The BT + PFMT performed supervised PFMT, once/week, associated at home PFMT protocol. Primary outcomes were urinary urgency, daytime voiding frequency, nocturia and urgency urinary incontinence assisted by both 3-day bladder diary and International Consultation on Incontinence OAB (ICIQ-OAB) questionnaire. Secondary outcomes were 24-h pad test and Patient Global Impression of Improvement. T-test, analysis of variance, Mann-Whitney (SPSS 20.0) and power/effect size (G-power) were applied in data analyses. RESULTS Sixty-three women were included (B = 31; BT + PFMT = 32). There was no significant statistical difference between groups in terms of urinary symptoms: daytime frequency (BT: pre: 11.59 [±5.80], post: 9.10 [±4.05]; BT + PFMT: pre: 10.67 [±3.73], post: 8.08 [±3.38]) p = 0.75; nocturia: (BT: pre: 1.46 [±0.91], post: 0.82 [±0.82]; BT + PFMT: pre: 1.80 [±2.26], post: 0.82 [±1.15]) p = 0.70; urinary urgency (BT: pre: 3.22 [±4.70], post: 4.49 [±4.32]; BT + PFMT: pre: 6.87 [±5.60], post: 6.15 [±4.52]) p = 0.10; ICIQ-OAB total score: (BT: pre: 9.16 [±2.55], post: 6.32 [±3.77]; (BT + PFMT: pre: 9.75 [±2.06], post: 5.06 [±3.44] p = 0.30. CONCLUSIONS Supervised PFMT added to BT did not provide further improvements than isolated BT in women with OAB symptoms.
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Affiliation(s)
- Sílvia Monteiro
- Postgraduate Program in Surgical Science, School of Medical Sciences of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Physiotherapy Department Pontifical Catholic University of Minas Gerais (PUC-MINAS), Belo Horizonte, Minas Gerais, Brazil
| | - Anna Karoline Rocha
- Postgraduate Program in Rehabilitation Sciences, Motor Science Institute of the Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | - Lilian Valim
- Physiotherapy Department Pontifical Catholic University of Minas Gerais (PUC-MINAS), Belo Horizonte, Minas Gerais, Brazil
| | | | - Cássio Riccetto
- Postgraduate Program in Surgical Science, School of Medical Sciences of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Simone Botelho
- Postgraduate Program in Surgical Science, School of Medical Sciences of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Motor Science Institute of the Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
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Chen YC, Chen HW, Kuo HC. Bladder neck incompetence could be an etiology of overactive bladder syndrome in women with stress urinary incontinence after anti-incontinence surgery: insights from transrectal sonography. World J Urol 2023; 41:3083-3089. [PMID: 37775546 DOI: 10.1007/s00345-023-04639-x] [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: 07/10/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To investigate the prevalence of bladder neck incompetence (BNI) and the anatomic differences between different types of urinary incontinence (UI) and overactive bladder (OAB) by transrectal sonography, and to investigate these differences among those with stress UI (SUI) or mixed UI (MUI) who exhibited de novo or persistent OAB symptoms following anti-incontinence surgery. METHODS A retrospective analysis was conducted on a total of 184 patients with SUI, MUI, urge UI (UUI), or OAB dry who underwent transrectal ultrasound between 2017 and 2022. The presence of BNI and urethral incompetence assessed by transrectal ultrasound were recorded in all included patients, and recorded preoperatively and postoperatively among patients with SUI and MUI who underwent anti-incontinence surgery. RESULTS Among the patients, 91%, 84%, 76%, and 71% exhibited BNI in MUI, SUI, UUI, OAB dry group, respectively. Significantly higher rate of patients with BNI were found in MUI than in OAB dry group. Patients with OAB symptoms after anti-incontinence surgery exhibited significantly higher rates of BNI and urethral incompetence than those who did not have postoperative OAB symptoms. Among MUI patients with preoperative BNI, significantly lower rate of postoperative BNI and urethral incompetence was observed in individuals who had improved OAB symptoms after surgery, compared to those without improvement. CONCLUSION A higher BNI rate was observed in the MUI group. A significantly higher BNI rate was observed in women with OAB symptoms after anti-incontinence surgery. Patients with MUI had improved OAB symptoms if BNI was successfully corrected after anti-incontinence surgery.
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Affiliation(s)
- Yu-Chen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hao-Wei Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, No.707 Sec.3, Zhongyang Rd., Hualien City, 970473, Taiwan, ROC.
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Matta R, Saskin R, Neu S, Locke JA, Kowalczyk A, Steup A, Herschorn S. Predicting Mirabegron Treatment Response in Patients with Overactive Bladder: A Post Hoc Analysis of Data from Clinical Trials. Eur Urol Focus 2023; 9:957-965. [PMID: 37120417 DOI: 10.1016/j.euf.2023.04.001] [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: 12/20/2022] [Revised: 03/02/2023] [Accepted: 04/02/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Many patients discontinue overactive bladder (OAB) treatment because of unmet treatment expectations and/or tolerability issues. OBJECTIVE To develop a model for predicting the individual treatment response to mirabegron using patient baseline characteristics. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc analysis of data from eight global phase 2/3, double-blind, randomized, placebo- or active-controlled trials of mirabegron in adult patients with OAB. INTERVENTION Mirabegron 50 mg once-daily monotherapy for ≥12 wk. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary efficacy outcomes were the change in the mean number of micturitions and the number of incontinence episodes/24 h after 12 wk of treatment. Secondary efficacy outcomes were the change in the mean number of urgency episodes/24 h and the change in Symptom Bother score after 12 wk of treatment. Baseline demographic characteristics, OAB-related characteristics, and intrinsic and extrinsic factor variables were used to create multivariable linear regression models to predict the primary and secondary outcomes. RESULTS AND LIMITATIONS Data for 3627 patients were included. The predicted effect of mirabegron 50 mg was an average of 2.5 fewer micturition episodes/24 h (95% confidence interval -2.85 to -2.14) and 0.81 fewer incontinence episodes/24 h (95% confidence interval -1.15 to -0.46) from baseline to week 12. A higher number of urgency episodes was predictive of a larger reduction in micturition episodes; body mass index (BMI) ≥30 kg/m2, OAB symptoms for ≥12 mo, and incontinence at baseline were predictive of a smaller reduction. Mixed stress/urgency incontinence and more than five urgency episodes per day were predictive of greater reductions in incontinence episodes. Reductions in urgency episodes and Symptom Bother score were also predicted with mirabegron. Limitations include the exclusion of placebo groups from the analysis and the use of clinical trial rather than real-world data. CONCLUSIONS Data from the predictive models provide new insights into the effects of modifiable factors (such as BMI) and nonmodifiable factors on treatment outcomes with mirabegron 50 mg. PATIENT SUMMARY This study aimed to identify factors that could predict how patients with overactive bladder respond to mirabegron treatment to help doctors effectively treat this condition. Mirabegron treatment was associated with a lower number of urinations and occurrences of urinary incontinence per day. Factors associated with worse responses to the medication included being obese.
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Affiliation(s)
- Rano Matta
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Refik Saskin
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Sarah Neu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jennifer A Locke
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | - Achim Steup
- Astellas Pharma US, Inc., Northbrook, IL, USA
| | - Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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Huang J, Li H, Zhang Y, Liu J, Cao H, Long Y. Excitatory purinergic and cholinergic expression changed in a partial bladder outlet obstruction-induced overactive bladder rat model. Sci Rep 2023; 13:18395. [PMID: 37884550 PMCID: PMC10603080 DOI: 10.1038/s41598-023-45014-5] [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: 05/14/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
Overactive bladder (OAB) is a common, long-term symptom complex with a high prevalence in women worldwide. OAB has caused a social burden, and effective treatments are urgently needed. However, the pathogenesis of OAB has yet to be elucidated. Model rats underwent bladder outlet obstruction surgery. In the 2nd, 3rd, and 4th weeks after surgery, metabolic cages were used to detect the 12 h urine volume of rats in the sham and model groups. The urodynamic parameters bladder leak point pressure (BPLL), maximum voiding pressure (MVP), residual volume (RV), maximum bladder capacity (MBC), bladder compliance (BC), voided efficiency (VE), and non-voiding contractions (NVCs) were also detected. Moreover, the contractile responses of isolated detrusor muscles to electrical and carbachol stimulation were examined at the abovementioned time points. At the 4th week after surgery, the bladders of both groups were obtained for hematoxylin-eosin (H&E) and Masson's trichrome staining. Real-time qPCR and Western blot were performed to quantify the expression of choline acetyltransferase (ChAT) and solute carrier family 17 member 9 (SLC17A9). At week 4, compared with the sham group, the 12 h urine volume of PBOO group increased significantly. The BLPP, MVP, VE, MBC, and NVCs increased significantly, and the VE was significantly reduced in 4-week PBOO group. The contractile responses of isolated detrusor muscles to electrical and carbachol stimulation significantly increased in 4-week PBOO group. In the 4-week PBOO group, the bladder wall and the ratio of bladder muscle to collagen within the bladder smooth muscle layer wall were significantly higher than those in the sham group. ChAT and SLC17A9 mRNA and protein expression in the OAB model rats significantly increased. At 4 weeks after PBOO, the OAB model was successfully established. The gene and protein expression levels of ChAT and SLC17A9 increased in the bladder of the OAB model, suggesting that OAB may be related to increased excitatory purinergic and cholinergic expression.
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Affiliation(s)
- Jingyi Huang
- Guangzhou University of Chinese Medicine, No.232 Outer Ring East Road, Higher Education Mega Center, Guangzhou, Guangdong, China
| | - Hongliang Li
- Guangzhou University of Chinese Medicine, No.232 Outer Ring East Road, Higher Education Mega Center, Guangzhou, Guangdong, China
| | - Yao Zhang
- Guangzhou University of Chinese Medicine, No.232 Outer Ring East Road, Higher Education Mega Center, Guangzhou, Guangdong, China
| | - Jiaye Liu
- Guangzhou University of Chinese Medicine, No.232 Outer Ring East Road, Higher Education Mega Center, Guangzhou, Guangdong, China
| | - Hongying Cao
- Guangzhou University of Chinese Medicine, No.232 Outer Ring East Road, Higher Education Mega Center, Guangzhou, Guangdong, China.
| | - Yongling Long
- Guangzhou University of Chinese Medicine, No.232 Outer Ring East Road, Higher Education Mega Center, Guangzhou, Guangdong, China.
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Hara T. Heterogeneity of placebo effects on urinary incontinence in overactive bladder syndrome: A meta-analysis of Japanese placebo-controlled clinical trials. Int J Urol 2023; 30:896-905. [PMID: 37317904 DOI: 10.1111/iju.15226] [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: 03/06/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The effect sizes, changes over time, and heterogeneity of placebo effects on frequency of urination for voiding disorders in Japanese clinical trials have been published. This study evaluated the characteristics of placebo effects on overall and urge incontinence in overactive bladder patients. METHODS A meta-analysis of Japanese placebo-controlled clinical trials was conducted to determine placebo effects on the daily frequency of overall (n = 16) and urge (n = 11) incontinence and identify factors that should be considered in clinical trials. RESULTS The between-study heterogeneity variance of placebo effects for overall and urge incontinence at 8 weeks was estimated as I2 = 70.3% and 64.2%, and the prediction interval for the ratio of means ranged from g = 0.31-0.91 and 0.32-0.81, respectively. Subgroup analysis using the random-effects model showed placebo effects in overall incontinence (p = 0.08) and urge incontinence (p < 0.0001). The ratio of means (95% confidence interval) of urge incontinence frequency from baseline to 4 (n = 10), 8 (n = 10), and 12 (n = 7) weeks were 0.65 (0.57, 0.74), 0.51 (0.42, 0.62), and 0.48 (0.36, 0.64), respectively, for the random-effects model. Regression analysis did not reveal any significant factors that influenced placebo effects. CONCLUSIONS This meta-analysis confirmed the characterization of placebo effects on overall and urge incontinence, which demonstrates heterogeneity between trials. The impact of population, follow-up period, and endpoints on placebo effects should be considered when designing clinical trials for overactive bladder syndrome.
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Affiliation(s)
- Tomohiko Hara
- Office of New Drug II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
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Cornu JN, Klap J, Thuillier C, Donon L, Meyer F, Even L, Bourguin A, Richard C, Wagner L, Peyronnet B. Efficacy and safety of the TENSI+ device for posterior tibial nerve stimulation: A multicenter, retrospective study. Prog Urol 2023; 33:541-546. [PMID: 37516600 DOI: 10.1016/j.purol.2023.07.001] [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: 05/14/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES Transcutaneous posterior tibial nerve stimulation (TC-PTNS) is a validated option for lower urinary tract symptoms (LUTS) management, with a short-term success rate of around 60% and few adverse events. Our goal was to report the efficacy and safety results of TC-PTNS using the newly issued device TENSI+ for LUTS management. PATIENTS AND METHODS A multicenter, retrospective study was conducted in 7 urology departments in France. All patients treated with TC-PTNS for LUTS using the TENSI+ device between September 2021 and February 2022 were included. All patients received supervised at-home training by a specialized nurse. All patients were asked to do daily, 20minutes sessions of TC-PTNS. Patient demographics, history, initial symptoms and previous treatment were collected at inclusion. A follow-up visit was scheduled at 3 months. Efficacy was evaluated through treatment persistence at 3 months and PGI-I (Patient Global Impression of Improvement) score. Adverse events were recorded. RESULTS One hundred and three patients (86 women and 17 men) were included. All patients had overactive bladder symptoms, 64 suffered from urgency incontinence, and 24 had associated voiding symptoms. Eighteen patients had neurogenic background, and 30 previously received anticholinergics. After a median follow-up of 12 [10-21]weeks, 70 patients were still using the device (68%). PGI-I score reflected an improvement in 70.9% and was 1, 2 and 3 in 28, 26 and 19 patients respectively, while 24 were unchanged and 6 were worse. No clinical baseline parameter was predictive of success. Adverse events included pain at stimulation site (two cases) and pelvic pain (two patients), which rapidly resolved after treatment interruption. CONCLUSIONS TC-PTNS with TENSI+ device is an effective option for LUTS management, with results that seem similar to other TC-PTNS approaches. Adverse events were mild and reversible after treatment interruption. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, University of Rouen, 1, rue de Germont, 76031 Rouen Cedex, France.
| | - Julia Klap
- Department of Urology, Claude Galien Hospital, France
| | - Caroline Thuillier
- Department of Urology, University Hospital of Grenoble, Grenoble, France
| | - Laurence Donon
- Department of Urology, Polyclinique de la côte Basque, France
| | - François Meyer
- Department of Urology Saint-Louis Hospital, Paris, France
| | - Lucie Even
- Department of Urology, La Seyne sur Mer, France
| | - Anael Bourguin
- Department of Urology, University of Nimes, Nimes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | - Laurent Wagner
- Department of Urology, University of Nimes, Nimes, France
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Cho YJ, Shin B, Lee SH, Park S, Kim YK, Kim JJ, Kim E. Altered Urine Microbiome in Male Children and Adolescents with Attention-Deficit Hyperactivity Disorder. Microorganisms 2023; 11:2063. [PMID: 37630623 PMCID: PMC10458914 DOI: 10.3390/microorganisms11082063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
While interest in developing the human microbiome as a biomarker for attention-deficit hyperactivity disorder (ADHD) is increasing, there has been limited exploration in utilizing urine samples. In this study, we analysed urine microbiome profiles by extracting 16S ribosomal DNA from purified bacteria-derived extracellular membrane vesicles obtained from urine samples. Sequencing libraries were constructed by amplifying V3-V4 hypervariable regions sequenced using Illumina MiSeq. Profiles of male Korean children and adolescents with ADHD (n = 33) were compared with healthy sex-matched controls (n = 39). Statistically controlling for age, we found decreased alpha diversity in the urine bacteria of the ADHD group, as evidenced by reduced Shannon and Simpson indices (p < 0.05), and significant differences in beta diversity between the two groups (p < 0.001). The phyla Firmicutes and Actinobacteriota, as well as the genera Ralstonia and Afipia, were relatively more abundant in the ADHD group. The phylum Proteobacteria and the genera Corynebacterium and Peptoniphilus were more abundant in the control group. Notably, the genus Afipia exhibited significant correlations with the Child Behavior Checklist Attention Problems score and DSM-oriented ADHD subscale. This study is the first to propose the urine microbiome as a potential biomarker for pediatric ADHD.
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Affiliation(s)
- Yoon Jae Cho
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea
| | - Bokyoung Shin
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea
| | - Sung-Ha Lee
- Center for Happiness Studies, Seoul National University, Seoul 08826, Republic of Korea
| | - Sangmin Park
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul 08826, Republic of Korea
| | | | - Jae-Jin Kim
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Eunjoo Kim
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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45
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Yuk JS, Lee JH. Risk of overactive bladder after hysterectomy for uterine fibroids. Int Urogynecol J 2023; 34:1823-1829. [PMID: 36752850 DOI: 10.1007/s00192-023-05474-9] [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: 09/19/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluated the association between previous hysterectomy for uterine fibroids and the risk of developing overactive bladder (OAB). METHODS We used national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine leiomyoma or adenomyosis between 1 January 2011 and 31 December 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time period. Propensity score matching (PSM, 1:1) was performed to balance confounders. OAB events were defined by drug prescriptions (beta 3 agonist or anticholinergics) for more than 1 month based on previous studies. RESULTS After matching, 58,195 cases (hysterectomy group) and 58,195 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.9 years in the nonhysterectomy group and 8.0 years in the hysterectomy group. There was no significant difference in the rate of OAB development between the groups (0.3% vs 0.3%; p=0.061). Additionally, compared with the nonhysterectomy group (hazard ratio: 1 (reference)), hysterectomy without adnexal surgery (hazard ratio: 1.169 [0.915-1.493]) and hysterectomy with adnexal surgery (hazard ratio: 1.342 [0.83-2.171]) did not significantly increase the risk of OAB after adjusting for confounders; this relationship remained nonsignificant after stratifying patients according to age group. CONCLUSIONS Previous hysterectomy with or without adnexal surgery for the treatment of uterine fibroids did not increase the risk of developing OAB, defined as drug therapy lasting more than 1 month.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 327, Gongneung-ro, Nowon-gu, Seoul, 01830, South Korea.
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Mehnert U, Walter M, Leitner L, Kessler TM, Freund P, Liechti MD, Michels L. Abnormal Resting-State Network Presence in Females with Overactive Bladder. Biomedicines 2023; 11:1640. [PMID: 37371735 DOI: 10.3390/biomedicines11061640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Overactive bladder (OAB) is a global problem reducing the quality of life of patients and increasing the costs of any healthcare system. The etiology of OAB is understudied but likely involves supraspinal network alterations. Here, we characterized supraspinal resting-state functional connectivity in 12 OAB patients and 12 healthy controls (HC) who were younger than 60 years. Independent component analysis showed that OAB patients had a weaker presence of the salience (Cohen's d = 0.9) and default mode network (Cohen's d = 1.1) and weaker directed connectivity between the fronto-parietal network and salience network with a longer lag time compared to HC. A region of interest analysis demonstrated weaker connectivity in OAB compared to HC (Cohen's d > 1.6 or < -1.6), particularly within the frontal and prefrontal cortices. In addition, weaker seed (insula, ventrolateral prefrontal cortex) to voxel (anterior cingulate cortex, frontal gyrus, superior parietal lobe, cerebellum) connectivity was found in OAB compared to HC (Cohen's d > 1.9). The degree of deviation in supraspinal connectivity in OAB patients (relative to HC) appears to be an indicator of the severity of the lower urinary tract symptoms and an indication that such symptoms are directly related to functional supraspinal alterations. Thus, future OAB therapy options should also consider supraspinal targets, while neuroimaging techniques should be given more consideration in the quest for better phenotyping of OAB.
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Affiliation(s)
- Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Matthias Walter
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London WC1N 3AR, UK
- Neuroscience Center Zürich, University of Zürich and Swiss Federal Institute of Technology Zürich, 8057 Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Lars Michels
- Neuroscience Center Zürich, University of Zürich and Swiss Federal Institute of Technology Zürich, 8057 Zürich, Switzerland
- Department of Neuroradiology, University Hospital Zürich, University of Zürich, 8091 Zürich, Switzerland
- Clinical Neuroscience Center, University Hospital Zürich, 8091 Zürich, Switzerland
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Covarrubias C, Cammisotto PG, Shamout S, Campeau L. Decrease in the Ratio proBDNF/BDNF in the Urine of Aging Female Patients with OAB. Metabolites 2023; 13:723. [PMID: 37367881 DOI: 10.3390/metabo13060723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Imbalance in the levels of neurotrophins, growth factors crucial in the development, function, and survival of neurons is commonly observed in many pathological states. Concentrations of brain-derived neurotrophic factor (BDNF) and its precursor (proBDNF) were measured in the urine of a cohort of aging female patients with overactive bladder disease (OAB). When reported to creatinine, levels were similar between OAB patients and healthy controls. However, the ratio proBDNF/BDNF was significantly decreased in the OAB group. Receiver operating characteristic (ROC) curve analysis of the ratio proBDNF/BDNF displayed a good diagnostic value for OAB (AUC = 0.729). Clinical questionnaires of symptom severity (OABSS and IIQ-7) were negatively correlated with this ratio. On the other hand, microRNAs (miRNA) involved in proBDNF gene translation were expressed at comparable levels between groups. However, urinary enzymatic activity of matrix metalloproteinase-9 (MMP-9), the enzyme that cleaves proBDNF into BDNF, was increased in OAB compared to controls. Levels of miR-491-5p, the main miRNA that downregulates MMP-9 synthesis, were greatly decreased in urine from OAB patients. These results suggest that the ratio proBDNF/BDNF could be useful in the phenotyping of OAB in an aging population, and the difference could originate from enhanced MMP-9 enzymatic activity rather than translational control.
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Affiliation(s)
| | | | - Samer Shamout
- Lady Davis Institute, McGill University, Montreal, QC H3A 0G4, Canada
| | - Lysanne Campeau
- Lady Davis Institute, McGill University, Montreal, QC H3A 0G4, Canada
- Urology Department, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
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Javan Balegh Marand A, Baars C, Heesakkers J, van den Munckhof E, Ghojazadeh M, Rahnama'i MS, Janssen D. Differences in the Urinary Microbiome of Patients with Overactive Bladder Syndrome with and without Detrusor Overactivity on Urodynamic Measurements. Life (Basel) 2023; 13:life13051199. [PMID: 37240844 DOI: 10.3390/life13051199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION It has been hypothesized that the urinary microbiome might play an important role in OAB. Studies have been conducted on the association between OAB symptoms and the microbiome, although a possible causality still has to be determined. MATERIAL AND METHODS In this study, 12 female patients, ≥18 years of age, with 'OAB DO+' and 9 female patients with 'OAB DO-' were included. Patients were excluded if they met one of the following exclusion criteria: bladder tumors and previous bladder operations; sacral neuromodulation; injection of Botox in the bladder; and TOT or TVT operations. Urine samples were collected and stored with patient informed consent and with the approval of the Hospital Ethical Review Board (Arnhem-Nijmegen). All OAB patients underwent urodynamics before collecting urine samples, and the diagnosis of detrusor overactivity was confirmed by two individual urologists. In addition, samples from 12 healthy controls who did not undergo urodynamic evaluation were analyzed. The 16S rRNA V1-V2 region amplification and gel electrophoresis were used to determine the microbiota. RESULTS 12 of the OAB patients had DO shown on their urodynamic studies; the remaining 9 patients had a normoactive detrusor on their urodynamic measurements. Overall, there were no substantial differences among the demographic characteristics of the subjects. The samples were classified as the following: 180 phyla, 180 classes, 179 orders, 178 families, 175 genera, and 138 species. The least commonly observed phyla were Proteobacteria, with an average presence of 10%, followed by Bacteroidetes with 15%, Actinobacteria with 16%, and Firmicutes with 41%. Most of the sequences could be classified according to the genus level for each sample. DISCUSSION Significant differences were observed in the urinary microbiome of patients with overactive bladder syndrome who have detrusor overactivity on urodynamics compared to OAB patients without detrusor overactivity and matched controls. OAB patients with detrusor overactivity have a significantly less diverse microbiome and show a higher proportion of Lactobacillus, particularly Lactobacillus iners. The results imply that the urinary microbiome could be involved in the pathogenesis of a specific phenotype of OAB. The urinary microbiome could be a new starting point to study the causes and treatments of OAB.
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Affiliation(s)
- Aida Javan Balegh Marand
- Department of Urology, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Cléo Baars
- Department of Urology, Radboud University, 6525 GA Nijmegen, The Netherlands
| | - John Heesakkers
- Department of Urology, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Ellen van den Munckhof
- Research Center for Evidence-Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran
| | - Morteza Ghojazadeh
- Viroclinics-DDL Diagnostic Laboratory, 2288 ER Rijswijk, The Netherlands
| | | | - Dick Janssen
- Department of Urology, Radboud University, 6525 GA Nijmegen, The Netherlands
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Ko KJ, Lee KS. Retrospective Observational Study of Treatment Patterns and Efficacy of onabotulinumtoxinA Therapy in Patients with Refractory Overactive Bladder in Clinical Practice. Toxins (Basel) 2023; 15:toxins15050338. [PMID: 37235372 DOI: 10.3390/toxins15050338] [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: 04/17/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to evaluate the treatment patterns and long-term efficacy of onabotulinumtoxinA injections in a clinical setting. This single-center retrospective study was conducted on patients with refractory overactive bladder (OAB) aged 18 years or older who received onabotulinumtoxinA 100 IU administered between April 2012 and May 2022. The primary endpoint was the treatment pattern, including the retreatment rate and OAB medication prescription pattern. The duration and effectiveness of onabotulinumtoxinA treatment were analyzed using the overactive bladder symptom score and voiding diaries. A total of 216 patients were enrolled in this study, and the overall patient satisfaction rate was 55.1%. After the first injection, 19.9% received a second treatment, and 6.1% received three or more injections. The median duration until the second injection was 10.7 months. Among the patients, 51.4% resumed OAB medications after 2.96 months. The presence of urodynamic detrusor overactivity was observed only in female patients (odds ratio, 23.65; 95% CI, 1.84 to 304.40), which was associated with a good response. In contrast to clinical trials, the degree of improvement and retreatment rate did not meet expectations. Our findings provide valuable insights into the effectiveness of onabotulinumtoxinA injections in patients with refractory OAB symptoms in real-world practice.
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Affiliation(s)
- Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
- Research Institute for Future Medicine Samsung Medical Center, Seoul 06351, Republic of Korea
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Stoniute A, Madhuvrata P, Still M, Barron-Millar E, Nabi G, Omar MI. Oral anticholinergic drugs versus placebo or no treatment for managing overactive bladder syndrome in adults. Cochrane Database Syst Rev 2023; 5:CD003781. [PMID: 37160401 PMCID: PMC10167789 DOI: 10.1002/14651858.cd003781.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Around 16% of adults have symptoms of overactive bladder (OAB; urgency with frequency and/or urge incontinence), with prevalence increasing with age. Anticholinergic drugs are commonly used to treat this condition. This is an update of a Cochrane Review first published in 2002 and last updated in 2006. OBJECTIVES To assess the effects of anticholinergic drugs compared with placebo or no treatment for treating overactive bladder syndrome in adults. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 14 January 2020), and the reference lists of relevant articles. We updated this search on 3 May 2022, but these results have not yet been fully incorporated. SELECTION CRITERIA We included randomised or quasi-randomised trials in adults with overactive bladder syndrome that compared an anticholinergic drug alone with placebo treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility and extracted data from the included studies, including an assessment of the risk of bias. We assessed the certainty of the body of evidence using the GRADE approach. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 104 studies, 71 of which were new or updated for this version of the review. Although 12 studies did not report the number of participants, there were 47,106 people in the remainder of the included studies. The majority of the studies had insufficient information to allow judgement of risk of bias and we judged them to be unclear for all domains. Nine anticholinergic drugs were included in these studies: darifenacin; fesoterodine; imidafenacin; oxybutynin; propantheline; propiverine; solifenacin; tolterodine and trospium. No studies were found that compared anticholinergic drugs to no treatment. At the end of the treatment period, anticholinergics may slightly increase condition-specific quality of life (mean difference (MD) 4.41 lower, 95% confidence interval (CI) 5.28 lower to 3.54 lower (scale range -100 to 0); 12 studies, 6804 participants; low-certainty evidence). Anticholinergics are probably better than placebo in terms of patient perception of cure or improvement (risk ratio (RR) 1.38, 95% CI 1.15 to 1.66; 9 studies, 8457 participants; moderate-certainty evidence), and the mean number of urgency episodes per 24-hour period (MD 0.85 lower, 95% CI 1.03 lower to 0.67 lower; 23 studies, 16,875 participants; moderate-certainty evidence). Compared to placebo, anticholinergics may result in an increase in dry mouth adverse events (RR 3.50, 95% CI 3.26 to 3.75; 66 studies, 38,368 participants; low-certainty evidence), and may result in an increased risk of urinary retention (RR 3.52, 95% CI 2.04 to 6.08; 17 studies, 7862 participants; low-certainty evidence). Taking anticholinergics may be more likely to lead to participants withdrawing from the studies due to adverse events (RR 1.37, 95% CI 1.21 to 1.56; 61 studies, 36,943 participants; low-certainty evidence). However, taking anticholinergics probably reduces the mean number of micturitions per 24-hour period compared to placebo (MD 0.85 lower, 95% CI 0.98 lower to 0.73 lower; 30 studies, 19,395 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS The use of anticholinergic drugs by people with overactive bladder syndrome results in important but modest improvements in symptoms compared with placebo treatment. In addition, recent studies suggest that this is generally associated with only modest improvement in quality of life. Adverse effects were higher with all anticholinergics compared with placebo. Withdrawals due to adverse effects were also higher for all anticholinergics except tolterodine. It is not known whether any benefits of anticholinergics are sustained during long-term treatment or after treatment stops.
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Affiliation(s)
- Akvile Stoniute
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Priya Madhuvrata
- Obstetrics & Gynaecology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Madeleine Still
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Evelyn Barron-Millar
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ghulam Nabi
- Section of Academic Urology, Division of Cancer Research, University of Dundee, Dundee, UK
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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