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He W, Huang G, Cui W, Tian Y, Sun Q, Zhao X, Zhao Y, Li D, Liu X. Comparative assessment of efficacy and safety of approved oral therapies for overactive bladder: a systematic review and network meta-analysis. Int Braz J Urol 2023; 49:535-563. [PMID: 37506033 PMCID: PMC10482468 DOI: 10.1590/s1677-5538.ibju.2023.0158] [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: 04/13/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
bladder based on a systematic review and network meta-analysis approach. METHODS Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022. Randomized controlled double-blind trials of oral medication for overactive bladder were screened against the protocol's entry criteria. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 software. RESULT A total of 60 randomized controlled double-blind clinical trials were included involving 50,333 subjects. Solifenacin 10mg was the most effective in mean daily micturitions and incontinence episodes, solifenacin 5/10mg in mean daily urinary urgency episodes and nocturia episodes, fesoterodine 8mg in urgency incontinence episodes/d and oxybutynin 5mg in voided volume/micturition. In terms of safety, solifenacin 5mg, ER-tolterodine 4mg, mirabegron, vibegron and ER-oxybutynin 10mg all showed a better incidence of dry mouth, fesoterodine 4mg, ER-oxybutynin 10mg, tolterodine 2mg, and vibegron in the incidence of constipation. Compared to placebo, imidafenacin 0.1mg showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and darifenacin 15mg in headache. CONCLUSION Solifenacin showed better efficacy. For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated. The choice of drugs should be tailored to the patient's specific situation to find the best balance between efficacy and safety.
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Affiliation(s)
- Wenjuan He
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Guangliang Huang
- HeBei Medical UniversityDepartment of Clinical PharmacyShijiazhuangHebeiChinaDepartment of Clinical Pharmacy, HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Wenyan Cui
- HeBei Medical UniversityDepartment of Clinical PharmacyShijiazhuangHebeiChinaDepartment of Clinical Pharmacy, HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Yunfei Tian
- University of Hong KongDepartment of psychologyHong KongChinaDepartment of psychology, the University of Hong Kong, Hong Kong, China
| | - Qian Sun
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Xiaojuan Zhao
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Yonghong Zhao
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Dan Li
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Xiuju Liu
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
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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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Bryophyllum pinnatum and Improvement of Nocturia and Sleep Quality in Women: A Multicentre, Nonrandomised Prospective Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:2115335. [PMID: 36798727 PMCID: PMC9928503 DOI: 10.1155/2023/2115335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 02/10/2023]
Abstract
Nocturia is a pathologic condition that significantly affects the quality of sleep. The aetiology of nocturia is multifactorial, and the evidence available on its management remains limited. Besides behavioural measures, validated pharmaceutical treatment options exist but are, however, associated with marked side effects. Prospective clinical studies with tablets prepared from the leaf press juice of the plant Bryophyllum pinnatum revealed a tendency towards reduction of micturition in patients with overactive bladder (OAB) and several improvements in sleep quality. These observations are in part supported by in vitro and in vivo data. In the present study, we investigated the effectiveness of Bryophyllum 50% chewable tablets in the treatment of nocturia and associated sleep disorders. Altogether, 49 women with idiopathic OAB and nocturia of ≥2 voids/night were treated with Bryophyllum 50% tablets for 3 weeks (350 mg chewable tablets, dosage 0-0-2-2 oral tablets; WELEDA AG, Arlesheim, Switzerland). Nocturia, voiding volumes at night (ml), quality of life, sleep quality, and daily sleepiness were assessed before and after treatment with a 3-day micturition diary, the International Consultation on Incontinence evaluating overactive bladder and related impact on quality of life (QoL) [ICIQ-OAB], the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS), respectively. The age of the study population was 68.5 ± 11.6 y. After treatment, nocturia diminished from 3.2 ± 1.4 to 2.3 ± 1.3 (P < 0.001) and the PSQI score decreased from 7.7 ± 3.7 to 6.6 ± 3.4 (P=0.004). Urgency, the ICIQ score, and the ESS lowered significantly, and the micturition volume showed a tendency to increase. No serious adverse drug reactions were reported, and compliance was good. The results show a beneficial effect on the nocturnal voids and sleep quality of women with OAB. Bryophyllum 50% tablets can be regarded as a well-tolerated alternative in the treatment of nocturia and broaden the repertoire of standard management.
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Harris WN, Everaert K. Overactive Bladder as a Key Driver of Nocturia: The Argument Against. Eur Urol Focus 2022; 8:6-7. [PMID: 35027328 DOI: 10.1016/j.euf.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
Studies have shown that therapies for overactive bladder reduce urgency symptoms. However, these studies fail to demonstrate clinically significant increases in bladder capacity or changes in mean voided volumes at night.
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Affiliation(s)
- William N Harris
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Kim J, Chung E. Pharmacotherapeutic options in the treatment of nocturia: update on current oral drug therapies. Expert Opin Pharmacother 2021; 23:405-411. [PMID: 34913416 DOI: 10.1080/14656566.2021.2016698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Nocturia is a common urinary complaint among patients presenting with lower urinary tract symptoms and in recent years, there is a greater emphasis to tailor the treatment for nocturia in a more holistic and multidisciplinary manner given the potential multifactorial causes for nocturia. AREAS COVERED Current oral drug therapies can be classified into three main groups, namely, decreasing polyuria, targeting bladder capacity, and improving sleep-wake and circadian rhythm. The authors focus this article on these oral therapies and provide their expert opinion. EXPERT OPINION Treatment strategies should always involve lifestyle changes and behavioral modifications, with the targeted treatment of underlying medical conditions that may cause nocturia. Desmopressin remains the only drug approved specifically for the treatment of nocturia. Medications targeting the bladder and prostate can have secondary benefits in minimizing nocturnal frequency and urgency especially if the drug is taken at nighttime. Treatment of an underlying sleep disorder or circadian disorder can often help to increase total sleep time and quality, and perhaps reducing the nocturnal diuresis and nocturia episodes. Future studies in nocturia should improve the identification and diagnosis of underlying mechanisms that lead to nocturia, so treatment can become more streamlined, while at the same time, explore the role of various pharmacotherapeutic agents and novel therapy to reduce or eliminate nocturia.
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Affiliation(s)
- Jason Kim
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - Eric Chung
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.,AndroUrology Centre, Brisbane, Australia.,AndroUrology Centre, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
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Wolff DT, Adler KA, Weinstein CS, Weiss JP. Managing Nocturia in Frail Older Adults. Drugs Aging 2020; 38:95-109. [PMID: 33230803 DOI: 10.1007/s40266-020-00815-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 12/17/2022]
Abstract
This review discusses the available evidence in the current evaluation and treatment of nocturia in frail older adults. No evidence specifically evaluates the use of behavioral interventions in the treatment of the frail older adult with nocturia, but their use is supported in other cohorts. Behavioral modifications and optimal management of comorbidities remain the first-line treatment for all age groups and should be emphasized in the frail due to their favorable safety profile. No studies specific to the frail older adult support the use of pharmacotherapy. Some evidence exists for the efficacy of several agents in the older adult; however, this is difficult to extrapolate to the frail, and safety concerns abound. Desmopressin may be effective in the older adult, but a high risk of hyponatremia raises concerns for its safety, and therefore it is not recommended in the frail. α-Antagonists may have limited efficacy in men with known benign prostatic hyperplasia (BPH); they are relatively well tolerated, although the risk of orthostatic hypotension in the frail should be considered. β3-agonist trials suggest limited clinical utility. Antimuscarinics are not found to be useful in this cohort and are contraindicated in the frail older adult given the ability of antimuscarinics to cause cognitive impairment, delirium, and falls. No data examine the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the frail older adult. Additionally, the American Geriatrics Society Beers Criteria recommends against the use of muscarinics in those over the age of 75 years and therefore their use is not supported.
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Affiliation(s)
- Dylan T Wolff
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
| | - Kerry A Adler
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Corey S Weinstein
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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Nocebo Response in the Pharmacological Management of Overactive Bladder: A Systematic Review and Meta-analysis. Eur Urol Focus 2020; 7:1143-1156. [PMID: 33153953 DOI: 10.1016/j.euf.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/20/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT The role of a nocebo response in managing urology patients is unclear. OBJECTIVE To assess the nocebo response in randomized placebo-controlled overactive bladder (OAB) trials of pharmacological treatment by investigating the adverse events in the placebo arms. EVIDENCE ACQUISITION PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials were searched to identify potential randomized controlled trials published from 1998 to November 2019. After evaluating the risk of bias in the selected studies, all selected full-text articles were included due to their overall acceptable quality. We extracted the event rate of the most commonly reported adverse events in the placebo arms of OAB trials, and finally, we performed a meta-analysis to calculate the cumulative rate of certain adverse events. The primary outcomes were the event rate of adverse events in the placebo arms of OAB trials of pharmacological treatment, and differences in adverse events in the placebo groups based on drug type and routes of administration. EVIDENCE SYNTHESIS After a systematic search and risk of bias assessment, 57 trials comprising 15 446 patients were included in this systematic review. We selected 13 commonly reported adverse events for the meta-analysis. Owing to the possible differences in study samples and design, we used a random model for the analysis. The average age of the patients was 59.5 yr and 79.8% were female. Dry mouth was the most commonly evaluated adverse event reported in 57 studies comprising 15 324 patients; the mean event rate was 4.9% (95% confidence interval [CI] 0.042-0.057, p < 0.001). Constipation was the second most commonly reported adverse event in 49 studies comprising 14 556 patients; the mean event rate of constipation was 2.6% (95% CI 0.022-0.031, p < 0.001). The event rate of headache was evaluated in 33 studies comprising 10 202 patients, with a mean event rate of 3.1% (95% CI 0.026-0.037, p < 0.001). CONCLUSIONS Dry mouth, constipation, headache, and nasopharyngitis were the most prevalent events in the included studies. The nocebo response plays a statistically significant role in causing and/or facilitating adverse events. Health care providers should have a better understanding of the positive and negative expectations associated with therapies to achieve the best possible outcomes for each individual patient. Finally, identification of the real effect of nocebo requires studies that also include a no-treatment arm. Research could help us better understand and potentially modify the nocebo response. PATIENT SUMMARY In this meta-analysis of 57 studies comprising 15 446 patients, we reviewed the adverse events extracted from the placebo arms of randomized controlled trials studying therapies for overactive bladder. Dry mouth, constipation, headache, and urinary tract infection were the most common adverse events. Adverse events varied based on the drug type and the route of administration. Negative expectations from the therapy and giving verbal information to the patient can cause/alleviate adverse events.
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Przydacz M, Chlosta M, Dudek P, Cudnoch-Jedrzejewska A, Zgliczynski W, Dobruch J, Antoniewicz A, Chlosta P. Desmopressin treatment for nocturia caused by nocturnal polyuria: practical guidelines. Cent European J Urol 2020; 73:498-505. [PMID: 33552576 PMCID: PMC7848835 DOI: 10.5173/ceju.2020.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Desmopressin is an effective and safe therapy for nocturia caused by nocturnal polyuria. However, many physicians are unsure about the proper diagnosis of nocturnal polyuria and the identification of patients who may benefit from desmopressin treatment. Therefore, to support urologists in their routine clinical practice, the aim of this study was to provide a comprehensive paradigm for diagnosing nocturnal polyuria with recommendations for the use of desmopressin. Material and methods A multidisciplinary group of experts reviewed the available literature. Findings were compiled into a practice-based approach for workup and treatment. Results We designed the nocturia diagnostic pathway to confirm nocturnal polyuria, identify possible causes of nocturnal polyuria, and classify patients with indications and contraindications for desmopressin therapy. A bladder diary remains a basic diagnostic tool. Underlying conditions that may lead to nocturnal polyuria include mainly cardiac insufficiency, arterial hypertension, chronic kidney failure, obstructive sleep apnea, peripheral edema, and excessive fluid intake at night. Treatment for nocturia caused by nocturnal polyuria is based on conservative management and pharmacotherapy, but pharmacological treatment should not precede a prior attempt at conservative treatment. Before administration of desmopressin, patients should be assessed for serum sodium concentration and carefully educated about the symptoms of hyponatremia. Older individuals or persons with risk factors for the development of hyponatremia should be checked regularly for hyponatremia during desmopressin therapy. Conclusions People with nocturia due to nocturnal polyuria should be evaluated carefully before initiating desmopressin treatment. Patients treated with desmopressin should be followed for both clinical efficacy and treatment-related adverse effects.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Chlosta
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Przemyslaw Dudek
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Agnieszka Cudnoch-Jedrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Zgliczynski
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Artur Antoniewicz
- Department of Urology, Multidisciplinary Hospital Warsaw-Międzylesie, Warsaw, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
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Emeruwa CJ, Gordon DJ, Weiss JP. Nocturia: Evaluation and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Nocturia is defined as awakening due to the desire to void during a period of intended sleep. The pathophysiology of nocturia is multifactorial and management remains a challenge. Herein, we provide an overview of the management strategies for nocturia and summarize the existing evidence for treatment of nocturia across the condition's broad etiologic categories: nocturnal polyuria, diminished bladder capacity, and global polyuria. RECENT FINDINGS Treatment should begin with behavioral modification. A high level of evidence supports the efficacy of desmopressin in the treatment of nocturnal polyuria. Data supporting the efficacy of α-blockers, antimuscarinics, and surgical bladder outlet procedures in the treatment of nocturia remains limited. Treatment options for nocturia are determined by underlying mechanism. Desmopressin is effective in treating nocturnal polyuria. Surgical intervention, α-blockers, and antimuscarinics may improve nocturia when associated with lower urinary tract symptoms or overactive bladder in the setting of diminished bladder capacity.
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Affiliation(s)
- Danielle J Gordon
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.
| | - Curran J Emeruwa
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA
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Li ESW, Flores VX, Weiss JP. Current guidelines and treatment paradigms for nocturnal polyuria: A "NEW" disease state for US physicians, patients and payers. Int J Clin Pract 2019; 73:e13337. [PMID: 30810265 DOI: 10.1111/ijcp.13337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/05/2019] [Accepted: 02/24/2019] [Indexed: 01/08/2023] Open
Abstract
Nocturia is one of the most bothersome symptoms encountered in urology, and its prevalence rises with age. Causes include both urological and non-urological aetiologies, often in combination. The effects of nocturia on a patient's quality of life can be detrimental. The initial approach to managing this condition includes appropriately classifying nocturia based on the results of a 24-hour bladder diary. Broadly, the categories under which nocturia can be classified include: low nocturnal or global bladder capacity, nocturnal polyuria, global polyuria and mixed.Based on the type of nocturia and possible underlying causes, clinicians can appropriately discuss with patients the treatment plans that may include a combination of behavioural, pharmacologic, and invasive therapy. The available literature on the management of nocturia was reviewed. Findings were incorporated into a practice-based approach for its workup and treatment.
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Affiliation(s)
- Eric S W Li
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Viktor X Flores
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
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Hotta H, Watanabe N. Gentle Perineal Skin Stimulation for Control of Nocturia. Anat Rec (Hoboken) 2019; 302:1824-1836. [PMID: 30980505 DOI: 10.1002/ar.24135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 10/30/2018] [Accepted: 11/18/2018] [Indexed: 11/06/2022]
Abstract
One of the major causes of nocturia is overactive bladder (OAB). Somatic afferent nerve stimuli are used for treating OAB. However, clinical evidence for the efficacy of this treatment is insufficient due to the lack of appropriate control stimuli. Studies on anesthetized animals, which eliminate emotional factors and placebo effects, have demonstrated an influence of somatic stimuli on urinary bladder functions and elucidated the underlying mechanisms. In general, the effects of somatic stimuli are dependent on the modality, location, and physical characteristics of the stimulus. Recently we showed that gentle stimuli applied to the perineal skin using a soft elastomer roller inhibited micturition contractions to a greater extent than a roller with a hard surface. Studies aiming to elucidate the neural mechanisms of gentle stimulation-induced inhibition reported that 1-10 Hz discharges of low-threshold cutaneous mechanoreceptive Aβ, Aδ, and C fibers evoked during stimulation with an elastomer roller inhibited the micturition reflex by activating the spinal cord opioid system, thereby reducing both ascending and descending transmission between bladder and pontine micturition center. The present review will provide a brief summary of (1) the effect of somatic electrical stimulation on the micturition reflex, (2) the effect of gentle mechanical skin stimulation on the micturition reflex, (3) the afferent, efferent, and central mechanisms underlying the effects of gentle stimulation, and (4) a translational clinical study demonstrating the efficacy of gentle skin stimuli for treating nocturia in the elderly with OAB by using the two roller types inducing distinct effects on rat micturition contractions. Anat Rec, 302:1824-1836, 2019. © 2019 American Association for Anatomy.
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Affiliation(s)
- Harumi Hotta
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Nobuhiro Watanabe
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Yoshida M, Takeda M, Gotoh M, Yokoyama O, Kakizaki H, Takahashi S, Masumori N, Nagai S, Hashimoto K, Minemura K. Efficacy of novel β 3 -adrenoreceptor agonist vibegron on nocturia in patients with overactive bladder: A post-hoc analysis of a randomized, double-blind, placebo-controlled phase 3 study. Int J Urol 2018; 26:369-375. [PMID: 30557916 PMCID: PMC6912249 DOI: 10.1111/iju.13877] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022]
Abstract
Objectives To investigate the efficacy of vibegron on nocturia in patients with overactive bladder. Methods Among the Japanese overactive bladder patients enrolled in the placebo‐controlled, multicenter, randomized, double‐blind phase 3 study of vibegron, a total of 669 patients with nocturia (≥1 nocturnal void) were included. Changes from baseline in micturition parameters were compared for vibegron treatment (50 and 100 mg/day) versus placebo. Correlations of hours of undisturbed sleep with the frequency of nocturnal voiding and the volume of the first nocturnal voiding were examined. Demographics and baseline characteristics contributing to reduction in the frequency of nocturnal voiding were also analyzed. Results At week 12, the frequency of nocturnal voiding was reduced from baseline by 0.74 and 0.78, respectively, for the vibegron 50 and 100 mg groups; the reductions were significant when compared with the placebo group (P < 0.05 and P < 0.001, respectively). The mean volume of nocturnal voids and the volume of the first nocturnal voiding were significantly greater in the vibegron groups than in the placebo group. The vibegron groups showed significant correlations of hours of undisturbed sleep with the changes in the frequency of nocturnal voiding and in the volume of the first nocturnal voiding. Vibegron treatment, no previous treatment with anticholinergics, ≥12 voids per day and hours of undisturbed sleep <180 min significantly contributed to a reduction in the frequency of nocturnal voiding. Conclusions Vibegron is a useful therapeutic option for improving nocturia in patients with overactive bladder.
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Affiliation(s)
- Masaki Yoshida
- Department of Urology, National Centre for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Masayuki Takeda
- Department of Urology, Graduate School of Medical Sciences, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Masumori
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
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Expert Opinion on Three Clinical Cases with a Common Urgent Problem: Urge Urinary Incontinence. Case Rep Urol 2018; 2018:8567436. [PMID: 30410813 PMCID: PMC6206570 DOI: 10.1155/2018/8567436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/06/2018] [Accepted: 10/04/2018] [Indexed: 01/03/2023] Open
Abstract
Urgency is the cornerstone symptom of overactive bladder (OAB) syndrome, which is associated with reduced health-related quality of life (HRQoL) and affects patients with different profiles. We report here three clinical pictures of OAB: a male patient with mixed lower urinary tract symptoms (LUTS), a young woman with comorbidities, and an elderly woman with mixed urinary incontinence. The aim is to analyze the specificities of these real cases, to discuss what would be the most appropriate management, and how treatment with fesoterodine, an antimuscarinic agent with key pharmacological properties, might meet the patients' expectations. Relevant and constructive messages are drawn: urgency, the cornerstone symptom, should be given special attention; fesoterodine is effective and well tolerated in the elderly; before switching to another medication consider increasing the dosage of fesoterodine; the major goal of initial therapy is to meet patient expectations; and involving the patient in the treatment plan increases her/his adherence.
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[Impact of medical and surgical treatments of LUTS on nocturia]. Prog Urol 2018; 28:848-855. [PMID: 30268350 DOI: 10.1016/j.purol.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Nocturia is the most frequently reported lower urinary tract symptom, but the impact of medical and surgical treatments on this symptom remains poorly evaluated. The objective of this work was to carry out a systematic review of the literature on the medical and surgical management of nocturia in men with bladder outlet obstruction due to benign prostatic hyperplasia. MATERIAL AND METHOD A systematic review of the literature was conducted including the effects of medical and surgical treatments on nocturia. Articles were selected by 3 independent reviewers before being analyzed and synthesized. RESULTS Among medical treatments, the most effective on nocturia seems to be desmopressin. Nevertheless, prescribing restrictions to men under 65 years of age hinder its use in routine practice. The effect of other medical treatments remains modest, although significant compared to placebo groups. The decrease in the number of nocturia would decrease from 0.25 to 0.7 in placebo group and from 0.29 to 1.1 in active treatment groups (alpha blocker, diuretic, anti-inflammatory, IPDE-5, 5 alpha reductase inhibitor). Surgical treatments seem to be more effective on nocturia. Although persistent in half of the patients undergoing surgery, the number of nocturia episodes decreased in 70% of them. CONCLUSION Nocturia is one of the most common urinary symptoms and the one that responds the least to the proposed medical and surgical treatments. The information given to patients by urologists must emphasize the modest effects to be expected in this area.
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Goldman HB, Oelke M, Kaplan SA, Kitta T, Russell D, Carlsson M, Arumi D, Mangan E, Ntanios F. Do patient characteristics predict which patients with overactive bladder benefit from a higher fesoterodine dose? Int Urogynecol J 2018; 30:239-244. [PMID: 29600400 DOI: 10.1007/s00192-018-3640-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/13/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We sought to determine whether baseline characteristics predict which overactive bladder (OAB) patients benefit from fesoterodine 8 mg versus 4 mg. METHODS In double-blind, placebo-controlled, flexible-dose trials, baseline characteristics of OAB patients with ≥ 1 urgency urinary incontinence (UUI) episodes/24 h who escalated from fesoterodine 4 mg to 8 mg were evaluated. Possible dose-escalation predictors (age; sex; previous antimuscarinic use; UUI, micturitions, and urgency episodes/24 h; race; body mass index; time to dose escalation; OAB duration) were compared in escalators versus non-escalators. Patients from fixed-dose trials with dose-escalator characteristics were identified (matched dose-escalator sample) to assess changes from baseline with fesoterodine 4 mg, 8 mg, and placebo. RESULTS In flexible-dose trials, significant predictors of fesoterodine dose escalation were younger age (≤ 65.8 years), greater number of baseline micturitions (≥ 13.1) and urgency episodes/24 h (≥ 10.9), greater OAB duration (≥ 9.1 years), and more frequent previous antimuscarinic use (58.3%), but not baseline UUI episodes/24 h. In the matched dose-escalator sample (fesoterodine 4 mg: n = 215; 8 mg: n = 198; placebo: n = 217), change from baseline in UUI episodes significantly improved with fesoterodine 8 mg versus 4 mg (P = 0.043) and with both doses versus placebo (P < 0.001). Dry mouth and constipation rates were higher with fesoterodine 8 mg. CONCLUSIONS Dose-escalator patients had a significantly greater UUI response with fesoterodine 8 mg versus 4 mg. Given the potential for adverse events, fesoterodine 4 mg is recommended to start; however, patients with UUI and identified predictors may benefit from initial treatment with fesoterodine 8 mg or rapid dose escalation.
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Affiliation(s)
- Howard B Goldman
- Cleveland Clinic Main Campus, Mail Code Q10-1; 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Abstract
Purpose of Review To assess current pharmacological principles used for treatment of nocturia/nocturnal polyuria. Recent Findings The pathophysiology of nocturia is often multifactorial, but two main mechanisms have been identified, occurring alone or in combination: low functional bladder capacity and nocturnal polyuria. The multifactorial pathophysiology not only implies several possible targets for therapeutic intervention but also means that it is unlikely that one treatment modality including drugs will be successful in all patients. Drugs approved for the treatment of male LUTS and male and female OAB are known to be far more effective for treatment of the daytime symptoms than for nocturia. Summary Several pharmacological principles have been tested with varying success. The treatment of choice should depend upon the main underlying cause, thus aiming primarily to increase bladder capacity by counteracting detrusor overactivity and/or reducing nocturnal polyuria. Using current available agents, effective, personalized treatment should be designed taking into account gender, co-morbidities, and identified etiological factors. However, there is a medical need for new, approved drugs for treatments for patients with nocturia.
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Affiliation(s)
- Karl-Erik Andersson
- Lund University, Lund, Sweden. .,Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA. .,Institute of Clinical Medicine, Department of Obstetrics and Gynecology, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, DK, Denmark.
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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Yokoyama O, Yamagami H, Hiro S, Hotta S, Yoshida M. Efficacy and safety of fesoterodine treatment for overactive bladder symptoms in elderly women with and without hypertension. Int J Urol 2017; 25:251-257. [PMID: 29224251 DOI: 10.1111/iju.13499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/10/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess fesoterodine treatment in elderly women with overactive bladder with and without hypertension. METHODS Data for 2527 elderly women with overactive bladder symptoms, including urgency urinary incontinence, were pooled from 10 double-blind, placebo-controlled fesoterodine studies. RESULTS A total of 1523 elderly women (60.3%) had a history of hypertension, and 1004 women (39.7%) had no hypertension history. Overactive bladder symptoms, mean bodyweight and mean body mass index at baseline were significantly higher in women with overactive bladder and hypertension versus those without hypertension (P < 0.05). Statistically significant improvements in overactive bladder symptoms at week 12 were observed for fesoterodine treatment versus placebo in women with hypertension and those without (P < 0.05). The diary-dry rate (no urgency urinary incontinence episodes), the proportion with less than eight micturitions/24 h, overactive bladder symptom bother and health-related quality of life were also statistically significantly improved by fesoterodine treatment in both populations. Incidence of treatment-related adverse events with fesoterodine was similar in women with hypertension (39.3%) and without hypertension (44.6%). Dry mouth and constipation were the most common treatment-related adverse events with fesoterodine in women with hypertension (26.2% and 5.2%, respectively) and without hypertension (30.5% and 8.0%). CONCLUSIONS A relationship among the severity of overactive bladder symptoms, hypertension and obesity in elderly women is suggested. Fesoterodine provides significantly greater improvements in overactive bladder symptoms and health-related quality of life versus placebo in women with or without hypertension. Hypertension does not appear to affect the efficacy and safety of fesoterodine in elderly women with overactive bladder symptoms, including urgency urinary incontinence.
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Affiliation(s)
- Osamu Yokoyama
- Faculty of Medical Science, University of Fukui, Fukui, Japan
| | | | | | | | - Masaki Yoshida
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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Geoffrion R. N o 353 – Traitements visant la vessie hyperactive : Accent sur la pharmacothérapie – Addenda. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1230-1239. [DOI: 10.1016/j.jogc.2017.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sakalis VI, Karavitakis M, Bedretdinova D, Bach T, Bosch JR, Gacci M, Gratzke C, Herrmann TR, Madersbacher S, Mamoulakis C, Tikkinen KA, Gravas S, Drake MJ. Medical Treatment of Nocturia in Men with Lower Urinary Tract Symptoms: Systematic Review by the European Association of Urology Guidelines Panel for Male Lower Urinary Tract Symptoms. Eur Urol 2017; 72:757-769. [DOI: 10.1016/j.eururo.2017.06.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/04/2017] [Indexed: 12/01/2022]
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No. 353-Treatments for Overactive Bladder: Focus on Pharmacotherapy - An Addendum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1221-1229. [PMID: 28986184 DOI: 10.1016/j.jogc.2017.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This technical update addendum reviews success rates and comparative evidence of the anticholinergic fesoterodine, as well as mechanism of action, safety profile, success rates, and comparative evidence of the β3 agonist mirabegron in the treatment of non-neurogenic overactive bladder syndrome (OAB). This adds to OAB pharmacotherapy recommendations initially published in 2012. INTENDED USERS Residents and other trainees, primary care practitioners, gynaecologists, urologists, urogynaecologists, and other health care providers who assess, counsel, and treat women with OAB. TARGET POPULATION Adult women with symptomatic OAB. OPTIONS This addition relates to fesoterodine, mirabegron, and anticholinergic-β3 agonist combination pharmacotherapy. OUTCOMES The outcomes of interest are clinical efficacy of fesoterodine compared with no treatment or other OAB therapies; mechanism of action and safety profile of mirabegron, clinical efficacy of mirabegron compared to no treatment or other OAB therapies; clinical efficacy of anticholinergic-β3 agonist combination pharmacotherapy for OAB. EVIDENCE PubMed, Medline, and the Cochrane Database were searched using the key words "fesoterodine" and "mirabegron." Results were restricted to English or French and human clinical and pharmacological research. Animal research and clinical studies including only male participants were excluded. Articles were included until the end of December 2016. Grey literature was not searched. Clinical practice guidelines, guidelines of specialty societies, and systematic reviews were included. RCTs and observational studies were included when evidence for the outcome of interest or in the target population was not available from systematic reviews. New studies not yet included in systematic reviews were also included. References of included articles were also searched to ensure comprehensive inclusion of relevant literature. VALUES The content and recommendations were drafted and agreed upon by the principal author, as well as members of the Urogynaecology Committee. The Board of the SOGC approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. The Summary of Findings is available upon request. BENEFITS, HARMS, AND/OR COSTS It is expected that this technical update will benefit patients with OAB by providing physicians and other interested health care providers with additional options for and knowledge of safe and effective OAB pharmacotherapy. The benefits clearly outweigh the potential harms or costs of implementation of this technical update, although there are no direct harms or costs identified. UPDATES: "Evidence will be reviewed 5 years after publication to decide whether all or part of the document should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations." SPONSORS Not applicable. RECOMMENDATIONS
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Abstract
Nocturia is an extremely common condition that has major sequelae for affected patients. Through disruption of sleep, nocturia impairs quality of life and worsens health outcomes, and is associated with a variety of morbidities including diabetes, coronary artery disease, obstructive sleep apnoea, obesity, metabolic syndrome, and depression. Unsurprisingly, several studies have also linked nocturia with reduced survival. Nocturia is not simply a consequence of lower urinary tract disease; rather, it is a multifactorial disorder that is often a manifestation of an underlying renal or systemic disease. Through the use of the frequency volume chart, clinicians can accurately quantify nocturia and determine its aetiology. Evaluation of quality of life and sleep using simple measures is essential in order to assess the impact of nocturia on a patient. Numerous treatment options for nocturia exist, but most are associated with minor benefit or lack sufficient evidence supporting their use. By systematically analysing an individual's causes of nocturia, clinicians can design appropriate treatment strategies to most effectively treat this condition.
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Affiliation(s)
- Hasan Dani
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
| | - Ashanda Esdaille
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
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Noguchi N, Chan L, Cumming RG, Blyth FM, Handelsman DJ, Seibel MJ, Waite LM, Le Couteur DG, Naganathan V. Lower Urinary Tract Symptoms and Incident Falls in Community Dwelling Older Men: The Concord Health and Ageing in Men Project. J Urol 2016; 196:1694-1699. [PMID: 27350076 DOI: 10.1016/j.juro.2016.06.085] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE We sought to determine which lower urinary tract symptoms are associated with incident falls in community dwelling older men. MATERIALS AND METHODS The Concord Health and Ageing in Men Project involves a representative sample of community dwelling men 70 years old or older in a defined geographic region in Sydney, New South Wales, Australia. Included in analysis were 1,090 men without neurological diseases, poor mobility or dementia at baseline. Lower urinary tract symptoms were assessed using I-PSS (International Prostate Symptom Score) and incontinence was assessed using ICIQ (International Consultation on Incontinence Questionnaire) at baseline. I-PSS subscores were calculated for storage and voiding symptoms. Incident falls in 1 year were determined by telephone followup every 4 months. RESULTS I-PSS storage and voiding subscores were associated with falls. Urgency incontinence was associated with falls (adjusted incidence rate ratio 2.57, 95% CI 1.54-4.30). In addition, intermediate to high I-PSS storage subscores without urgency incontinence were associated with falls (adjusted incidence rate ratio 1.72, 95% CI 1.24-2.38). Other types of incontinence and urgency alone without urgency incontinence were not associated with falls. CONCLUSIONS Lower urinary tract storage and voiding symptoms were associated with falls in community dwelling older men. Of the symptoms of overactive bladder urgency incontinence carried a high risk of falls. Storage symptoms also contributed to the fall risk independently of urgency incontinence. Circumstances of falls among men with lower urinary tract symptoms should be explored to understand how lower urinary tract symptoms increase the fall risk and generate hypotheses regarding potential interventions. Furthermore, trials to treat lower urinary tract symptoms in older men should include falls as an end point.
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Affiliation(s)
- Naomi Noguchi
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia.
| | - Lewis Chan
- Department of Urology, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia; School of Public Health, University of Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Markus J Seibel
- ANZAC Research Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia; ANZAC Research Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia
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Iimura K, Watanabe N, Masunaga K, Miyazaki S, Hotta H, Kim H, Hisajima T, Takahashi H, Kasuya Y. Effects of a Gentle, Self-Administered Stimulation of Perineal Skin for Nocturia in Elderly Women: A Randomized, Placebo-Controlled, Double-Blind Crossover Trial. PLoS One 2016; 11:e0151726. [PMID: 27003163 PMCID: PMC4803221 DOI: 10.1371/journal.pone.0151726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 03/03/2016] [Indexed: 12/03/2022] Open
Abstract
Background Somatic afferent nerve stimuli are used for treating an overactive bladder (OAB), a major cause of nocturia in the elderly. Clinical evidence for this treatment is insufficient because of the lack of appropriate control stimuli. Recent studies on anesthetized animals show that gentle stimuli applied to perineal skin with a roller could inhibit micturition contractions depending on the roller’s surface material. We examined the efficacy of gentle skin stimuli for treating nocturia. Methods The study was a cross-over, placebo-controlled, double-blind randomized clinical study using two rollers with different effects on micturition contractions. Participants were elderly women (79–89 years) with nocturia. Active (soft elastomer roller) or placebo (hard polystyrene roller) stimuli were applied to perineal skin by participants for 1 min at bedtime. A 3-day baseline assessment period was followed by 3-day stimulation and 4-day resting periods, after which the participants were subjected to other stimuli for another 3 days. The primary outcome was change in the frequency of nighttime urination, for which charts were maintained during each 3-day period. Results Twenty-four participants were randomized, of which 22 completed all study protocols. One participant discontinued treatment because of an adverse event (abdominal discomfort). In participants with OAB (n = 9), change from baseline in the mean frequency of urination per night during the active stimuli period (mean ± standard deviation, −0.74 ± 0.7 times) was significantly greater than that during placebo stimuli periods (−0.15 ± 0.8 times [p < 0.05]). In contrast, this difference was not observed in participants without OAB (n = 13). Conclusions These results suggest that gentle perineal stimulation with an elastomer roller is effective for treating OAB-associated nocturia in elderly women. Here the limitation was a study period too short to assess changes in the quality of sleep and life. Trial Registration UMIN Clinical Trial Registry (CTR) UMIN000015809
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Affiliation(s)
- Kaori Iimura
- Graduate School of Health Science, Teikyo Heisei University, Tokyo, Japan
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Nobuhiro Watanabe
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Koichi Masunaga
- Department of Urology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Shogo Miyazaki
- Graduate School of Health Science, Teikyo Heisei University, Tokyo, Japan
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Department of Acupuncture and Moxibustion, Faculty of Health Care, Teikyo Heisei University, Tokyo, Japan
| | - Harumi Hotta
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- * E-mail:
| | - Hunkyung Kim
- Department of Promotion of Prevention of Musculoskeletal Aging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tatsuya Hisajima
- Graduate School of Health Science, Teikyo Heisei University, Tokyo, Japan
- Department of Acupuncture and Moxibustion, Faculty of Health Care, Teikyo Heisei University, Tokyo, Japan
| | - Hidenori Takahashi
- Graduate School of Health Science, Teikyo Heisei University, Tokyo, Japan
- Department of Acupuncture and Moxibustion, Faculty of Health Care, Teikyo Heisei University, Tokyo, Japan
| | - Yutaka Kasuya
- Department of Urology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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Verdejo-Bravo C, Brenes-Bermúdez F, Valverde-Moyar MV, Alcántara-Montero A, Pérez-León N. [Consensus document on overactive bladder in older patients]. Rev Esp Geriatr Gerontol 2015; 50:247-56. [PMID: 26073220 DOI: 10.1016/j.regg.2015.04.001] [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: 04/07/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
Overactive nladder (OAB) is a clinical entity with a high prevalence in the population, having a high impact on quality of life, especially when it occurs with urge urinary incontinence. It is very important to highlight the low rate of consultation of this condition by the older population. This appears to depend on several factors (educational, cultural, professional), and thus leads to the low percentage of older patients who receive appropriate treatment and, on the other hand, a large percentage of older patients with a significant deterioration in their quality of life. Therefore, Scientific societies and Working Groups propose the early detection of OAB in their documents and clinical guidelines. Its etiology is not well known, but is influenced by cerebrovascular processes and other neurological problems, abnormalities of the detrusor muscle of bladder receptors, and obstructive and inflammatory processes of the lower urinary tract. Its diagnosis is clinical, and in the great majority of the cases it can be possible to establish its diagnosis and etiopathogenic orientation, without the need for complex diagnostic procedures. Currently, there are effective treatments for OAB, and we should decide the most appropriate for each elderly patient, based on their individual characteristics. Based on the main clinical practice guidelines, a progressive treatment is proposed, with the antimuscarinics being the most recommended drug treatment. Therefore, a group of very involved professionals in clinical practice for the elderly, and representing two scientific Societies (Spanish Society of Geriatrics and Gerontology [SEGG], and the Spanish Society of Primary Care Physicians [SEMERGEN]) developed this consensus document with the main objective of establishing practices and valid strategies, focused to simplify the management of this clinical entity in the elderly population, and especially to improve their quality of life. The recommendations presented in this consensus document are the result of a comprehensive review and critical discussion of articles, documents and clinical guidelines on OAB, both nationally and internationally. Are, where possible, levels of evidence and grades of recommendation are included.
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Affiliation(s)
| | | | | | | | - Noemí Pérez-León
- Sociedad Española de Médicos de Atención Primaria (Semergen), España
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Chapple C, Oelke M, Kaplan SA, Scholfield D, Arumi D, Wagg AS. Fesoterodine clinical efficacy and safety for the treatment of overactive bladder in relation to patient profiles: a systematic review. Curr Med Res Opin 2015; 31:1201-43. [PMID: 25798911 DOI: 10.1185/03007995.2015.1032917] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To summarize published evidence on the pharmacology, efficacy, and safety of fesoterodine for the treatment of overactive bladder (OAB) symptoms in relation to patient clinical and demographic profiles. METHODS A systematic review of published articles on fesoterodine was conducted via a PubMed search. Articles were identified using the search term fesoterodine, with limits of human species and abstract available. Review and meta-analysis articles, validation studies, articles focused on treatment compliance/adherence, meeting abstracts, and articles not focused on oral fesoterodine administration in human subjects were excluded. Data from retained articles were summarized descriptively. RESULTS Of 137 articles identified, 61 (15 articles on the pharmacology and 46 articles on the efficacy and/or safety of fesoterodine) met inclusion criteria. Superiority trials demonstrated the additional efficacy of fesoterodine 8 mg versus fesoterodine 4 mg and tolterodine extended release 4 mg in treating OAB. Prospective trials in specific patient populations indicated beneficial effects of fesoterodine in elderly patients, vulnerable elderly patients, patients dissatisfied with or with a suboptimal response to previous antimuscarinic therapy, patients with urge urinary incontinence (UUI) or nocturnal urgency, and men with persistent LUTS during alpha-blocker treatment. With two effective doses, the fesoterodine dose can be adjusted to achieve optimal efficacy and tolerability in individual patients. The most common adverse events during fesoterodine treatment are dry mouth and constipation. CONCLUSIONS Extensive evidence demonstrates the efficacy and safety of fesoterodine in relieving OAB symptoms, including urgency, urinary frequency, UUI, and nocturnal urgency, in patients with various clinical and demographic profiles. Trial results provide valuable information on fesoterodine treatment in specific patient populations, including both elderly and vulnerable elderly patients. Potential limitations of this review are that only English language articles in PubMed were searched and included.
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Trocio JN, Brubaker L, Schabert VF, Bavendam T, Chen CI, Zou KH, Petrilla AA, Burgio KL. Fesoterodine Prescription Fill Patterns and Evaluation of theYourWayPatient Support Plan for Patients With Overactive Bladder Symptoms and Physicians. Postgrad Med 2015; 126:246-56. [DOI: 10.3810/pgm.2014.05.2773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Nocturia is a common but overlooked lower urinary tract symptom that substantially reduces patient health and quality of life. Though traditionally viewed as occurring predominantly in males, nocturia has been found to be equally as prevalent in females. The recent emphasis on the importance of nocturia has resulted in a surge of research studies, providing a foundation for current and future management decisions. In this review, we describe the current recommendations for the female patient in light of the most recently published studies, including a unique interest in predicting treatment response.
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Affiliation(s)
- Andrew Chang
- Medical Scientist Training Program, Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA,
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Abstract
PURPOSE OF REVIEW Male patients with lower urinary tract symptoms have historically been managed in a prostate centric fashion. Population studies highlighting the prevalence and significance of storage symptoms, including nocturia, have meant a shift in the way men with lower urinary tract symptoms are assessed and managed. We review the recent guidelines and publications that have addressed this change in approach. RECENT FINDINGS A new β-3 adrenoreceptor agonist has demonstrated significant improvement in storage symptoms and appears to be well tolerated. SUMMARY We support a continued move towards a patient-focused and management using the current guidelines.
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Raskolnikov D, Friedman FM, Etwaru DJ, Weiss JP. The evaluation and management of persistent nocturia. Curr Urol Rep 2014; 15:439. [PMID: 25007892 DOI: 10.1007/s11934-014-0439-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nocturia, or waking at night to void, is a common symptom that leads to substantial morbidity. Men and women are both affected across a wide age range, such that the objective evaluation of nocturia remains a challenge, due largely to its multifactorial etiology. While for some patients, nocturia is caused by common structural conditions such as prostatic obstruction, for others it is due to a complex interplay between multiple underlying systemic diseases. For this reason, persistent nocturia merits particularly careful consideration. The purpose of this review is to describe the most recent salient research in the field of nocturia, with a particular emphasis on its evaluation and management.
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Affiliation(s)
- Dima Raskolnikov
- Department of Urology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA,
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Chapple C, Schneider T, Haab F, Sun F, Whelan L, Scholfield D, Dragon E, Mangan E. Superiority of fesoterodine 8 mg vs 4 mg in reducing urgency urinary incontinence episodes in patients with overactive bladder: results of the randomised, double-blind, placebo-controlled EIGHT trial. BJU Int 2014; 114:418-26. [PMID: 24552358 DOI: 10.1111/bju.12678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the superiority of fesoterodine 8 mg vs 4 mg for improvement in urgency urinary incontinence (UUI) episodes and other diary variables, diary-dry rate (proportion of patients with >0 UUI episodes on baseline diary and 0 UUI episodes on post-baseline diary), and improvements in measures of symptom bother, health-related quality of life (HRQL), and other patient-reported outcomes (PROs). PATIENTS AND METHODS This was a 12-week, randomised, double-blind, placebo-controlled, multinational trial of men and women aged ≥18 years with overactive bladder (OAB) symptoms including UUI (ClinicalTrials.gov ID NCT01302067). Patients were randomised (2:2:1) to receive fesoterodine 8 mg, fesoterodine 4 mg, or placebo once daily; those randomised to fesoterodine 8 mg started with fesoterodine 4 mg once daily for 1 week, then 8 mg once daily for the remaining 11 weeks. Patients completed bladder diaries at baseline and weeks 4 and 12 and the Patient Perception of Bladder Condition (PPBC), Urgency Perception Scale (UPS), and Overactive Bladder Questionnaire (OAB-q) at baseline and week 12. The primary endpoint was change from baseline to week 12 in UUI episodes per 24 h. RESULTS At week 12, patients receiving fesoterodine 8 mg (779 patients) had significantly greater reductions from baseline in UUI episodes, micturitions, and urgency episodes than patients receiving fesoterodine 4 mg (790) or placebo (386); diary-dry rate was significantly higher in the fesoterodine 8-mg group vs the fesoterodine 4-mg and placebo groups (all P < 0.05). At week 12, patients receiving fesoterodine 8 mg also had significantly greater improvements in scores on the PPBC, UPS, and all OAB-q scales and domains than patients receiving fesoterodine 4 mg or placebo (all P < 0.01). Patients receiving fesoterodine 4 mg had significantly greater improvements in UUI episodes, urgency episodes, and micturitions; significantly higher diary-dry rates; and significantly greater improvement in PPBC scores and OAB-q scores than patients receiving placebo (all P < 0.05). Dry mouth was the most commonly reported adverse event (AE) in the fesoterodine groups (placebo group, 3.4%; fesoterodine 4-mg group, 12.9%; fesoterodine 8-mg group, 26.1%); most cases were mild or moderate in all treatment groups. Rates of serious AEs and discontinuations due to AEs were low in all groups. CONCLUSIONS In a 12-week, prospectively designed, superiority trial, fesoterodine 8 mg showed statistically significantly superior efficacy vs fesoterodine 4 mg and placebo, as measured by reductions in UUI episodes and other diary variables, diary-dry dry rate, and improvements in measures of symptom bother, HRQL, and other PROs; clear evidence of dose-dependent efficacy is unique to fesoterodine among antimuscarinics and other oral agents for the treatment of OAB. Fesoterodine 4 mg was significantly more effective than placebo on all outcomes except for improvements in UPS scores. These data support the benefit of having two doses of fesoterodine in clinical practice, with the recommended starting dose of 4 mg for all patients and the fesoterodine 8-mg dose available for patients who require a higher dose to achieve optimal symptom relief.
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Wyndaele JJ, Schneider T, MacDiarmid S, Scholfield D, Arumi D. Flexible dosing with fesoterodine 4 and 8 mg: a systematic review of data from clinical trials. Int J Clin Pract 2014; 68:830-40. [PMID: 24754814 DOI: 10.1111/ijcp.12425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS To systematically review dose-escalation data from flexible-dose studies of fesoterodine and summarise factors associated with dose-escalation decisions. METHODS A PubMed search was conducted using the terms (fesoterodine AND flexible dose), with no limits. Articles were included if they contained fesoterodine dose-escalation data for efficacy or safety outcomes or factors associated with dose-escalation decisions. RESULTS Of 13 articles identified by the search, 10 articles (six clinical studies) met inclusion criteria. In flexible-dose trials of fesoterodine, 51-63% of subjects initially receiving fesoterodine 4 mg opted for dose escalation to fesoterodine 8 mg. Escalators generally reported significantly more severe overactive bladder (OAB) symptoms, greater OAB symptom bother and worse health-related quality of life at baseline than non-escalators. Escalators demonstrated less treatment benefit with fesoterodine 4 mg than non-escalators. Non-escalators generally had a higher rate of dry mouth and constipation with fesoterodine 4 mg than escalators. The decision to escalate appeared to be determined by the efficacy/tolerability responses; fesoterodine escalators demonstrated a lower sensitivity (less efficacy and fewer adverse events) before their decision to escalate. By study end (8-11 weeks after escalation decision), the efficacy and tolerability profiles were similar in escalators and non-escalators. CONCLUSIONS Data from flexible-dose studies provide strong evidence that fesoterodine provides treatment benefit to individual subjects with OAB because of its true dose-response effect. In clinical practice, it can be worthwhile to escalate to fesoterodine 8 mg in individual subjects who require additional efficacy benefit.
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Affiliation(s)
- J J Wyndaele
- Department of Urology, Universiteit en Universitair Ziekenhuis Antwerpen, Antwerp, Belgium
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Klausner AP. Overactive Bladder: Preparing for the Beast. J Urol 2013; 189:1194-5. [DOI: 10.1016/j.juro.2013.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Adam P. Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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