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Gamé X, Phé V. [First-line treatment for non-neurogenic overactive bladder]. Prog Urol 2020; 30:904-919. [PMID: 33220819 DOI: 10.1016/j.purol.2020.08.055] [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: 07/20/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim was to synthesize current knowledge on overactive bladder (OAB) first-line treatments. METHOD A systematic literature review based on PubMed, Embase and Google Scholar was conducted in June 2020. RESULTS Behavioral treatments are based on bladder training and timed voiding using a bladder diary. Lifestyle modifications should be suggested. They include reduction of fluid intake, consumption of caffeine, sodas, weight loss, avoidance of acidic fruit juices and of spicy and acidic salty diet, alkalization of urine by diet and possibly, vitamin D supplementation. Pelvic floor muscle training is mainly based on manual techniques, electrostimulation and/or biofeedback. It has been shown to be effective in treating OAB. In menopausal women, local hormone therapy improves all OAB symptoms. Oral drugs include anticholinergics and beta-3-agonists. Their efficacy is quite similar and superior to placebo. In case of failure of monotherapy, they may be combined. CONCLUSION Apart from some lifestyle modifications, the efficacy of first-line treatments for OAB has been demonstrated by prospective controlled studies. They may be prescribed individually or in combination.
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Affiliation(s)
- X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, université Paul-Sabatier, TSA50032, 31059 Toulouse, France.
| | - V Phé
- Service d'urologie, AP-HP, hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
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2
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Gamé X, Phé V. [Treatment for refractory non-neurogenic overactive bladder]. Prog Urol 2020; 30:920-930. [PMID: 33220820 DOI: 10.1016/j.purol.2020.09.004] [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: 08/01/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim was to synthesize current knowledge on refractory overactive bladder treatments. METHOD A systematic literature review based on PubMed, Embase and Google Scholar was conducted in July 2020. RESULTS Today, refractory overactive bladder treatment includes tibial nerve stimulation, whether percutaneously or transcutaneously, sacral neuromodulation, and botulinum toxin A detrusor injections. These conservative treatments have marginalized surgical treatments, which mainly involve supratrigonal cystectomy with augmentation cystoplasty. Several potential new treatments are being evaluated but can only be currently offered as part of clinical research protocols. CONCLUSION "Conservative" treatments for refractory overactive bladder have been shown to be effective. Other treatments could enrich the treatment options.
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Affiliation(s)
- X Gamé
- Département d'urologie, transplantation rénale et andrologie, université Paul Sabatier, CHU Rangueil, TSA50032, 31059 Toulouse, France.
| | - V Phé
- Service d'urologie, hôpital Pitié-Salpêtrière, Sorbonne université, AP-HP, Paris, France
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Vurture G, Peyronnet B, Feigin A, Biagioni MC, Gilbert R, Rosenblum N, Frucht S, Di Rocco A, Nitti VW, Brucker BM. Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson's disease. Neurourol Urodyn 2018; 37:2669-2677. [PMID: 29767449 DOI: 10.1002/nau.23717] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/23/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of intradetrusor onabotulinum toxin A injections for the treatment of overactive bladder (OAB) in patients with Parkinson's disease (PD). METHODS All PD patients who underwent intradetrusor injections of onabotulinum toxin A (BoNT-A) for storage symptoms between 2010 and 2017 were included in a retrospective study. A 100 U dose of BoNT-A (Botox®, Allergan Irvine, CA) was used for the first injection in all patients. The primary endpoint was clinical success defined as any subjective improvement in OAB symptoms self-assessed by the patients 4 weeks after the injections. RESULTS Out of 24 patients analyzed, 19 reported improvement of their OAB symptoms 4 weeks after the first injection (79.2%) with complete resolution of urgency urinary incontinence in seven patients (29.1%; P < 0.001). The average post-void residual (PVR) increased significantly after the first injection from 17.6 to 125.3 mL (P < 0.001). Three of the patients had to start clean intermittent catheterization (CIC) after the first injection (12.5%). Out of 49 injections in total, only five caused incomplete bladder emptying requiring the use of CIC (10.2%). Higher pre-injection PVR was significantly associated with both a lower chance of symptomatic improvement (P = 0.04) and a higher risk of incomplete bladder emptying with institution of CIC (P = 0.047). CONCLUSION Intradetrusor injections of BoNT-A 100 U appeared as a safe and effective option in PD patients with OAB symptoms and a low PVR before the injection. Higher preoperative PVR was the strongest predictor of both treatment failure and postoperative urinary retention requiring CIC.
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Affiliation(s)
- Gregory Vurture
- Department of Urology, New York University School of Medicine, New York, New York
| | - Benoit Peyronnet
- Department of Urology, New York University School of Medicine, New York, New York
- Department of Urology, University of Rennes, Rennes, France
| | - Andrew Feigin
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Milton C Biagioni
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Rebecca Gilbert
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Nirit Rosenblum
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Steven Frucht
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Alessandro Di Rocco
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Victor W Nitti
- Department of Urology, New York University School of Medicine, New York, New York
| | - Benjamin M Brucker
- Department of Urology, New York University School of Medicine, New York, New York
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Valentini FA, Marti BG, Robain G. Do urodynamics provide a better understanding of voiding disorders in women over 80? Prog Urol 2018; 28:230-235. [PMID: 29307483 DOI: 10.1016/j.purol.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/14/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022]
Abstract
AIMS Population ageing has as consequence an increasing number of women older than 80 years with lower urinary tract symptoms (LUTS). Despite old age, urodynamic study is often performed to diagnose the cause of LUTS. Our purpose is to discuss the contribution of urodynamics to manage that population. METHODS Urodynamic studies of 169 consecutive women older than 80 years, respectively 124 non-neurological (non-N) and 45 neurological (N), were retrospectively analysed. RESULTS Number of co-morbidities was lower in non-N (2.5 vs. 3.1) with predominance of cardiovascular and endocrinology while musculo-skeletal, cognitive and previous pelvic surgery predominated in N. Among main complaint, incomplete retention or dysuria was more frequent in N while incontinence and frequency were predominant in non-N. More frequent urodynamic diagnosis (UD) was "normal" i.e. non contributive (25.0%) and intrinsic sphincter deficiency (ISD=21.7%) in non-N, detrusor overactivity (DO=42.2%) and detrusor underactivity (DU=38.8%) in N. In non-N, there were 94 treatment proposals based on the complaint when UD was "normal" and on UD for DO, DU and ISD. In N, treatment proposals were mainly prompted voiding or self-catheterization based on DU diagnosis. CONCLUSION Usefulness of urodynamics to manage LUT dysfunction in women older than 80 y is greatly dependent on their neurological status. In non-neurological women this is non debatable but proposed treatment needs to take into account existing co-morbidities. In neurological women the main usefulness is to unmask DU and to propose the best management in order to avoid complete retention. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F A Valentini
- Service de médecine physique et de la réadaptation, université Pierre-et-Marie-Curie, hôpital Rothschild, 5, rue Santerre, 75012 Paris, France.
| | - B G Marti
- Hôpital Saint-Antoine, 75012 Paris, France
| | - G Robain
- Service de médecine physique et de la réadaptation, université Pierre-et-Marie-Curie, hôpital Rothschild, 5, rue Santerre, 75012 Paris, France
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Turmel N, Hentzen C, Chesnel C, Charlannes A, Le Breton F, Amarenco G. [Food, diet and dietetic in treatment of urinary tract dysfunctions. A review]. Prog Urol 2017; 27:395-401. [PMID: 28576427 DOI: 10.1016/j.purol.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/20/2017] [Accepted: 05/02/2017] [Indexed: 11/29/2022]
Abstract
Overactive bladder symptoms (OAB) are frequent and can impact quality of life for these patients. Numerous and various treatments could be proposed in order to improve well-being and quality of life, but all these treatments have side effects and determine for many patients, important care constraints. We present here a review of food and diet in OAB. MATERIAL AND METHODS Literature review from PubMed Medline database and Google scholar to August 2016, without time restriction. Two hundred and ninety-six articles were screened, in English and in French, and finally, 10 were retained. HAS recommandation have been used for level of evidence. RESULTS On the 10 studies included, only two randomised controled trial were included. The first one showed decreases on urgency (by a half) (P=0.02) and on frequency (by a third) (P=0.035), secondary to reduction of caffeine consumption by a half after education [LE2]. The second randomized trial showed significant decreases on the first need to void in urodynamic study after caffeine consumption (170mL vs. 210mL) [LE2]. Feed like bread, chicken or nutrient like vitamin C or D were assessed in cohort or observational studies and appear as protective factors of OAB onset. Instead carbonated drinks may have a negative impact on symptoms, increasing urinary incontinence (OR 1.41 [95 % CI: 1.02-1.95]) [LE2], and there are contradictory results for alcohol consumption. CONCLUSION Diet seems to have an impact on overactive bladder syndrome and particularly caffeine consumption, which increases storage symptoms.
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Affiliation(s)
- N Turmel
- Service de neuro-urologie, hôpital Tenon, GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne universités, UPMC université Paris 06, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - C Hentzen
- Service de neuro-urologie, hôpital Tenon, GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne universités, UPMC université Paris 06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Chesnel
- Service de neuro-urologie, hôpital Tenon, GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne universités, UPMC université Paris 06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Charlannes
- Service de neuro-urologie, hôpital Tenon, GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne universités, UPMC université Paris 06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Le Breton
- Service de neuro-urologie, hôpital Tenon, GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne universités, UPMC université Paris 06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- Service de neuro-urologie, hôpital Tenon, GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne universités, UPMC université Paris 06, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Les nouveaux médicaments en cardiologie, gastro-entérologie, psychiatrie et urologie. ACTUALITES PHARMACEUTIQUES 2017. [DOI: 10.1016/j.actpha.2017.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hascoet J, Manunta A, Brochard C, Arnaud A, Damphousse M, Menard H, Kerdraon J, Journel H, Bonan I, Odent S, Fremond B, Siproudhis L, Gamé X, Peyronnet B. Outcomes of intra-detrusor injections of botulinum toxin in patients with spina bifida: A systematic review. Neurourol Urodyn 2016; 36:557-564. [PMID: 27187872 DOI: 10.1002/nau.23025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/30/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT Bladder management in spina bifida patients relies on clean intermittent catheterization and oral antimuscarinics with a significant failure rate. The efficacy of intradetrusor injections of botulinum toxin has been confirmed in patients with spinal cord injury or multiple sclerosis but not in patients with myelomeningocele. OBJECTIVE To conduct a systematic review of current evidence regarding the efficacy of intra-detrusor injections of Botulinum Toxin A (BTX-A) in spina bifida patients with neurogenic detrusor overactivity (NDO) refractory to antimuscarinics. METHODS A research has been conducted on Medline and Embase using the keywords: ("spina bifida" OR "myelomeningocele" OR "dysraphism") AND "toxin." The search strategy and studies selection were performed using the PICOS method according to the PRISMA statement. RESULT Twelve published series were included (n = 293 patients). All patients were <18 years old. There was no randomized study comparing BTX-A versus placebo and most studies had no control group. Most studies reported a clinical and urodynamic improvement with resolution of incontinence in 32-100% of patients, a decrease in maximum detrusor pressure from 32 to 54%, an increase of maximum cystometric capacity from 27 to 162%, and an improvement in bladder compliance of 28-176%. Two studies suggested lower efficacy in patients with low compliance bladder compared to those with isolated detrusor overactivity. CONCLUSION Intradetrusor injections of BTX-A could be effective in children with spina bifida but this assumption is not supported by high level of evidence studies. There is no data available in adult patients. Neurourol. Urodynam. 36:557-564, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Andrea Manunta
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Charlène Brochard
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de Gastro-Entérologie, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Alexis Arnaud
- Service de chirurgie pédiatrique, CHU Rennes, Rennes, France
| | - Mireille Damphousse
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de médecine physique et réadaptation, CHU Rennes, Rennes, France
| | - Hélène Menard
- Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Jacques Kerdraon
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Centre de rééducation de Kerpape, Ploemeur, France
| | - Hubert Journel
- Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Isabelle Bonan
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de médecine physique et réadaptation, CHU Rennes, Rennes, France
| | - Sylvie Odent
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de génétique, CHU Rennes, Rennes, France
| | - Benjamin Fremond
- Service de chirurgie pédiatrique, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Laurent Siproudhis
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de Gastro-Entérologie, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Xavier Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France
| | - Benoit Peyronnet
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
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8
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Peyronnet B, Sanson S, Amarenco G, Castel-Lacanal E, Chartier-Kastler E, Charvier K, Damphousse M, Denys P, de Seze M, Egon G, Even A, Forin V, Karsenty G, Kerdraon J, le Normand L, Loche CM, Manunta A, Mouracade P, Phe V, Previnaire JG, Ruffion A, Saussine C, Schurch B, Game X. Définition et prise en charge de l’échec d’une première injection de toxine botulique Botox® 200 U pour hyperactivité détrusorienne neurogène : résultats de l’enquête DETOX. Prog Urol 2015; 25:1219-24. [DOI: 10.1016/j.purol.2015.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 11/16/2022]
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Siepmann T, Penzlin AI, Frenz E, Barlinn K, Weidner K, Ziemssen T, Reichmann H, Illigens BMW. [Sensory and autonomic small fiber neuropathy]. MMW Fortschr Med 2015; 157 Spec No 2:60-4; quiz 65. [PMID: 26953479 DOI: 10.1007/s15006-015-3300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Peyronnet B, Castel-Lacanal E, Manunta A, Roumiguié M, Marque P, Rischmann P, Gamé X. Failure of botulinum toxin injection for neurogenic detrusor overactivity: Switch of toxin versus second injection of the same toxin. Int J Urol 2015; 22:1160-5. [DOI: 10.1111/iju.12950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/23/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Benoit Peyronnet
- Department of Urology; CHU Rangueil; Toulouse France
- Department of Urology; CHU Rennes; Rennes France
| | | | | | | | - Philippe Marque
- Department of Physical Medicine; CHU Rangueil; Toulouse France
| | | | - Xavier Gamé
- Department of Urology; CHU Rangueil; Toulouse France
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11
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Peyronnet B, Rigole H, Damphousse M, Manunta A. [Management of overactive bladder in women]. Prog Urol 2015; 25:877-83. [PMID: 26169251 DOI: 10.1016/j.purol.2015.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
Abstract
Overactive bladder (OAB) is defined as urgency, with or without urge incontinence, usually with frequency and nocturia. OAB has been reported in 9 to 43% of female patients. It is usually idiopathic. The diagnosis is clinical but an initial work-up may be needed to exclude an underlying cause (bladder tumor, stone, cystitis, neurological disorder…) using urinary tract ultrasound, urine culture or cystoscopy. The initial assessment may also include a frequency-volume chart and urodynamics. Behavioral therapy is the first line treatment. In case of failure, antimuscarinics are recommended. Nowadays, three treatment options are available for OAB refractory to antimuscarinics: sacral neuromodulation, peripheral tibial nerve stimulation and intra-detrusor injections of botulinum toxin. Surgical procedures such as augmentation cystoplasty are very rarely required.
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Affiliation(s)
- B Peyronnet
- Service d'urologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - H Rigole
- Service de médecine physique et rééducation, CHU de Rennes, 35000 Rennes, France
| | - M Damphousse
- Service de médecine physique et rééducation, CHU de Rennes, 35000 Rennes, France
| | - A Manunta
- Service d'urologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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