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Cost Effectiveness of Sacral Neuromodulation and OnabotulinumtoxinA in Managing Refractory Idiopathic Overactive Bladder. Urology 2020; 149:1-10. [PMID: 33227305 DOI: 10.1016/j.urology.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
Little information from clinical and modelled studies are available on cost effectiveness of OnabotulinumtoxinA and SNM for the treatment of idiopathic overactive bladder. We aimed to summarize the evidence in this regard from different healthcare systems. Seven studies from 5 countries were reviewed. Some modelled studies with a 10-year time frame showed that sacral neuromodulation became dominant long-term; others suggested OnabotulinumtoxinA was more cost effective at <5 years. There was considerable heterogeneity in the base case/sensitivity analysis and statistical modelling among the studies. Clinical studies with longer term follow-up will help determine cost effectiveness more accurately.
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Jiang J, Patil D, Traore EJ, Hammett J, Filson CP. Contemporary Patterns of Third-line Treatments for Privately Insured Individuals With Overactive Bladder in the United States. Urology 2020; 142:87-93. [DOI: 10.1016/j.urology.2020.04.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/16/2022]
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3
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Martin S, Han E, Gilleran J. Salvage Combination Therapies for Refractory Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0496-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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4
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Cost-Effectiveness of Third-Line Therapies for Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0477-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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5
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Wyndaele JJ, Birch B, Borau A, Burks F, Castro-Diaz D, Chartier-Kastler E, Drake M, Ishizuka O, Minigawa T, Opisso E, Peters K, Padilla-Fernández B, Reus C, Sekido N. Surgical management of the neurogenic bladder after spinal cord injury. World J Urol 2018; 36:1569-1576. [DOI: 10.1007/s00345-018-2294-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/05/2018] [Indexed: 10/17/2022] Open
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Kraus SR. Sacral Neuromodulation is Preferred over OnabotulinumtoxinA Injection for Overactive Bladder in Women. J Urol 2017; 198:501-502. [DOI: 10.1016/j.juro.2017.06.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Stephen R. Kraus
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Palma-Zamora ID, Atiemo HO. Understanding the Economic Impact of Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:333-343. [PMID: 28716315 DOI: 10.1016/j.ucl.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neurogenic bladder is a chronic and disabling condition associated with multiple comorbidities and a widespread economic impact. Literature on cost of care and resource utilization is sparse and heterogeneous. Nonstandardized approaches, impact perspectives, and types of costs are used to describe the economic implications of neurogenic bladder. The financial toll is difficult to ascertain due to indirect and intangible costs exacerbated by the underlying disability. Health resource utilization based on clinical manifestations of neurogenic bladder may serve as an alternative measure. Understanding the multifold economic implications and health resource utilization patterns of neurogenic bladder may guide improvement of treatment strategies.
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Affiliation(s)
- Isaac D Palma-Zamora
- Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Humphrey O Atiemo
- Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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8
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Apostolidis A, Averbeck MA, Sahai A, Rahnama'i MS, Anding R, Robinson D, Gravas S, Dmochowski R. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn 2017; 36:882-893. [DOI: 10.1002/nau.23170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Arun Sahai
- Department of Urology; Guy's and St.Thomas’ Hospitals; London UK
| | | | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | - Dudley Robinson
- Department of Urogynaecology; King's College Hospital; NHS Foundation Trust; London UK
| | - Stavros Gravas
- Department of Urology; University of Thessaly; Larissa Greece
| | - Roger Dmochowski
- Department of Urology; Vanderbilt University; Nashville Tennesse
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9
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Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian Healthcare System. World J Urol 2014; 33:1109-17. [DOI: 10.1007/s00345-014-1401-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/08/2014] [Indexed: 11/29/2022] Open
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10
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Colaco M, Sandberg J, Badlani G. Influencing Factors Leading to Malpractice Litigation in Radical Prostatectomy. J Urol 2014; 191:1770-5. [DOI: 10.1016/j.juro.2013.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Marc Colaco
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jason Sandberg
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gopal Badlani
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Peeters K, Sahai A, De Ridder D, Van Der Aa F. Long-term follow-up of sacral neuromodulation for lower urinary tract dysfunction. BJU Int 2014; 113:789-94. [PMID: 24238278 DOI: 10.1111/bju.12571] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To report our long-term experience of sacral neuromodulation (SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re-interventions and degree of success. PATIENTS AND METHODS This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator (IPG) (Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified. RESULTS The mean duration of follow-up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re-intervention. The re-intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow-up. CONCLUSIONS SNM appears effective in the long-term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re-intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re-intervention rates will improve.
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Affiliation(s)
- Karlien Peeters
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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12
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Post-radical hysterectomy detrusor dysfunctions: is sacral neurostimulation a valid treatment strategy? Support Care Cancer 2014; 22:1153-4. [PMID: 24458797 DOI: 10.1007/s00520-014-2135-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
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13
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Economics of Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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The Contemporary Indications for Augmentation Cystoplasty. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Overactive bladder (OAB) is commonly encountered in urologic practice. Treatment algorithms begin with conservative therapy and pharmacotherapy with antimuscarinics. Some patients do not receive adequate relief from these methods or they do not tolerate side effects from pharmacotherapy. A test stimulation for sacral neuromodulation and percutaneous tibial nerve stimulation are office-based techniques that are commonly used as the next step in the algorithm of care in patients with OAB. These techniques are efficacious and approved by the Food and Drug Administration for treatment of overactive bladder and its associated symptoms.
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Affiliation(s)
- Ravi Kacker
- Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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Sicras-Mainar A, Rejas J, Navarro-Artieda R, Aguado-Jodar A, Ruiz-Torrejón A, Ibáñez-Nolla J, Kvasz M. Health economics perspective of fesoterodine, tolterodine or solifenacin as first-time therapy for overactive bladder syndrome in the primary care setting in Spain. BMC Urol 2013; 13:51. [PMID: 24144225 PMCID: PMC4015546 DOI: 10.1186/1471-2490-13-51] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/11/2013] [Indexed: 11/25/2022] Open
Abstract
Background Overactive bladder (OAB) is associated with high healthcare costs, which may be partially driven by drug treatment. There is little comparative data on antimuscarinic drugs with respect to resource use and costs. This study was conducted to address this gap and the growing need for naturalistic studies comparing health economics outcomes in adult patients with OAB syndrome initiating treatment with different antimuscarinic drugs in a primary care setting in Spain. Methods Medical records from the databases of primary healthcare centres in three locations in Spain were assessed retrospectively. Men and women ≥18 years of age who initiated treatment with fesoterodine, tolterodine or solifenacin for OAB between 2008 and 2010 were followed for 52 weeks. Healthcare resource utilization and related costs in the Spanish National Health System were compared. Comparisons among drugs were made using multivariate general linear models adjusted for location, age, sex, time since diagnosis, Charlson comorbidity index, and medication possession ratio. Results A total of 1,971 medical records of patients (58.3% women; mean age, 70.1 [SD:10.6] years) initiating treatment with fesoterodine (n = 302), solifenacin (n = 952) or tolterodine (n = 717) were examined. Annual mean cost per patient was €1798 (95% CI: €1745; €1848). Adjusted mean (95% bootstrap CI) healthcare costs were significantly lower in patients receiving fesoterodine (€1639 [1542; 1725]) compared with solifenacin (€1780 [€1699; €1854], P = 0.022) or tolterodine (€1893 [€1815; €1969], P = 0.001). Cost differences occurred because of significantly fewer medical visits, and less use of absorbent products and OAB-related concomitant medication in the fesoterodine group. Conclusions Compared with solifenacin and tolterodine, fesoterodine was a cost-saving therapy for treatment of OAB in the primary care setting in Spain.
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Affiliation(s)
- Antoni Sicras-Mainar
- Directorate of Planning, Badalona Serveis Assistencials SA, Calle Gaietà Soler, 6-8 entlo, CP 08911 Badalona, Barcelona, Spain.
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Harris CJ, Dmochowski R, Reynolds WS. Botox for the Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0201-z] [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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18
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Barnett G, Ockrim J. Re: Cost of neuromodulation therapies for overactive bladder: percutaneous tibial nerve stimulation versus sacral nerve stimulation: M. Martinson, S. MacDiarmid and E. Black J Urol 2013; 189: 210-216. J Urol 2013; 190:1444-5. [PMID: 23886880 DOI: 10.1016/j.juro.2013.04.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Gillian Barnett
- Gillian Barnett and Associates Ltd., Letterkenny, County Donegal, Ireland
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Anger JT, Cameron AP, Madison R, Saigal CS, Clemens JQ. The effect of sacral neuromodulation on anticholinergic use and expenditures in a privately insured population. Neuromodulation 2013; 17:72-4; discussion 74. [PMID: 23647745 DOI: 10.1111/ner.12062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/15/2013] [Accepted: 02/21/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Sacral neuromodulation is Food and Drug Administration approved for many types of voiding dysfunction. Goals of treatment often include cessation of anticholinergic therapy. With the goal of understanding the impact of sacral neuromodulation on anticholinergic use, we analyzed patterns of care using a national claims-based dataset. MATERIALS AND METHODS The Ingenix (i3) data base contains insurance claims, including utilization and cost data, for 75 large employers. De-identified patients who underwent sacral neuromodulation between 2002 and 2007 were identified by the unique current procedural terminology-4 procedure code for pulse generator implantation, code 64590. The number and costs of anticholinergic prescriptions were compared before and after treatment. RESULTS There were 266 percutaneous and 794 two-staged procedures performed from 2002 to 2007 in the i3 dataset. A total of 484 pulse generator implantations were performed, representing 46% of the test procedures. During the year prior to pulse generator placement, each patient purchased an average of 2.1 prescriptions for an anticholinergic agent (SD 3.5). During the year after neuromodulation, each patient purchased an average of 1.0 prescription (SD 2.3, p < 0.0001 by t-test). Prescription charges were $241.31 per patient before and $103.52 after neuromodulation, a statistically significant cost difference (p < 0.0001 by t-test). During the year before the procedure, 50% of patients filled anticholinergic prescriptions. This decreased to 23% after the procedure (p < 0.0001 by chi-square test). CONCLUSIONS Sacral neuromodulation was associated with a significant decrease in the use of anticholinergic medication. Cost-effectiveness analyses that take into account patient quality-adjusted life years are needed to determine the true cost-benefit ratio of sacral neuromodulation.
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Affiliation(s)
- Jennifer T Anger
- Department of Urology, UCLA, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Carlson JJ, Hansen RN, Dmochowski RR, Globe DR, Colayco DC, Sullivan SD. Estimating the Cost-Effectiveness of OnabotulinumtoxinA for Neurogenic Detrusor Overactivity in the United States. Clin Ther 2013; 35:414-24. [DOI: 10.1016/j.clinthera.2013.02.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 01/30/2013] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
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Staskin DR, Peters KM, MacDiarmid S, Shore N, de Groat WC. Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care. Curr Urol Rep 2012; 13:327-34. [PMID: 22893501 PMCID: PMC3438389 DOI: 10.1007/s11934-012-0274-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Overactive bladder affects millions of adults, with profound personal and economic costs. Although antimuscarinic drugs can cause a reduction in voiding symptoms, the effect is modest, and many patients are intolerant of the side effects, or do not experience sufficient relief. For these patients, the modulation of bladder reflex pathways via percutaneous tibial nerve stimulation (PTNS) or via implanted sacral nerve stimulation (SNS) has been acknowledged as a logical next step in the algorithm of care. This review examines the mechanism of action, the relative benefits, adverse effects, and costs of percutaneous nerve stimulation compared to other treatment modalities.
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Affiliation(s)
- David R Staskin
- Department of Urology, Tufts University School of Medicine, Boston, MA, USA.
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Sajadi KP, Goldman HB. Bladder augmentation and urinary diversion for neurogenic LUTS: current indications. Curr Urol Rep 2012; 13:389-93. [PMID: 22865207 DOI: 10.1007/s11934-012-0271-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Augmentation cystoplasty and urinary diversion are no longer commonplace in the management of patients with neurogenic bladder, but remain an important surgical treatment for those with refractory LUTS who have failed neuromodulation and onabotulinum toxin treatment or who are not candidates for those treatments. Augmentation is an option in patients who can perform intermittent catheterization and is usually performed with ileum or large intestine. Some patients benefit from continent cutaneous catherizable channels. Supravesical urinary diversion may be necessary in more severe cases. Ileovesicostomies are being supplanted by indwelling suprapubic catheters, and when catheters fail conduits may be a better option. When feasible, the diverted bladder should be excised to avoid pyocystis.
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Affiliation(s)
- Kamran P Sajadi
- Division of Urology, Oregon Health & Science University, CH10U, 3303 SW Bond Ave, Portland, OR 97239, USA.
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Angioli R, Montera R, Plotti F, Aloisi A, Montone E, Zullo MA. Success rates, quality of life, and feasibility of sacral nerve stimulation in elderly patients: 1-year follow-up. Int Urogynecol J 2012; 24:789-94. [PMID: 22961496 DOI: 10.1007/s00192-012-1928-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 08/11/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urgency urinary incontinence (UUI) frequently occurs in elderly. International guidelines recommend pharmacological therapy as first-line treatment, but elderly do not respond in many cases. The purpose of this study was to report cure rates, quality of life, and feasibility of sacral neurostimulation (SNS) as an alternative option in the elderly. MATERIALS AND METHODS From October 2008 to April 2010, women >65 years with UUI who were refractory to pharmacological treatments were enrolled in this study and underwent SNS. At 12 months after surgery, patients were asked to compile a 3-day voiding diary and a urogynecologic standardized questionnaire: the Overactive Bladder Questionnaire (OAB-q). RESULTS Eighteen patients met our inclusion criteria. Fifteen (83.3 %) underwent implantation of the neuromodulator. Twelve months after surgery, an overall success rate of 83.3 % was registered. A statistically significant difference (P<0.0001) between baseline and postsurgery OAB-q scores was recorded. CONCLUSIONS SNS can be considered an alternative treatment for UUI in older women.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynaecology, University of Rome Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128, Rome, Italy
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Peters KM, Carrico DJ, MacDiarmid SA, Wooldridge LS, Khan AU, McCoy CE, Franco N, Bennett JB. Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study. Neurourol Urodyn 2012; 32:24-9. [DOI: 10.1002/nau.22266] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 04/10/2012] [Indexed: 11/07/2022]
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Gomelsky A, Dmochowski RR. Update on Neuromodulation. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0093-8] [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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Abstract
BACKGROUND The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence. METHODS A literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized. RESULTS Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%-70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4-5. The odds of incident urinary incontinence over 5-10 years increase by approximately 30%-60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence. CONCLUSION Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence.
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Affiliation(s)
- Emily L Whitcomb
- Southern California Permanente Medical Group, Female Pelvic Medicine and Reconstructive Surgery, Orange County-Irvine Medical Center, Irvine, CA, USA
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Abstract
Overactive bladder (OAB) is a highly prevalent syndrome defined as "urinary urgency, usually accompanied by frequency and nocturia with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology." It is known to generate a large degree of bother and can lead to significant morbidity. Augmentation cystoplasty (AC) historically has been reserved for patients refractory to conservative management. Over time, the treatment options for OAB have grown. We now have multiple pharmacological agents approved by the US Food and Drug Administration to treat OAB. In addition, neuromodulation and botulinum toxin now are viable options for patients who have suboptimal outcomes after treatment with anticholinergics and/or pelvic floor behavioral therapy. This may suggest that AC no longer is utilized as a mainstay therapy for OAB. However, despite these many possible treatment options, AC remains an important, time-tested tool in the armamentarium of the urologist to combat the patient with refractory OAB.
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Doggweiler R. Will Posterior Tibial Nerve Stimulation Replace Sacral Nerve Root Stimulation as the Salvage Management of Drug Resistant Urinary Urge Incontinence? J Urol 2010; 184:1835-6. [DOI: 10.1016/j.juro.2010.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ragi Doggweiler
- Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
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29
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Smith CP. Botox® in urology--will it become standard of care for urge urinary incontinence? J Urol 2010; 184:2235-6. [PMID: 20952015 DOI: 10.1016/j.juro.2010.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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