Survey of Overactive Bladder Symptoms Influencing Bother Before and After Treatment With Tamsulosin Hydrochloride in Japanese Patients With Benign Prostatic Hyperplasia

Validation of the Arabic linguistic version of the International Consultation on Incontinence Questionnaire-overactive bladder (ICIQ-OAB)

Background

Overactive bladder (OAB) is a health burden that needs an Arabic assessment tool. The idea is to validate the Arabic version of the International Consultation on Incontinence Questionnaire-overactive bladder (ICIQ-OAB).

Methods

A multicenter cross-sectional study carried out between March 2019 and February 2020. The translated ICIQ-OAB was used to assess the 227 patients. The enrolled patients were 112 complaining of symptoms suggestive of OAB, 115 healthy without LUTS symptoms. Additionally, patients with and without BOO symptoms were included. The reliability assessment of the internal consistency was done using Cronbach’s α test. With the aid of Spearman’s correlation coefficient (r), the interdomain associations were assessed. The Mann–Whitney test was used to assess the discrimination validity.

Results

A high internal consistency between the mean scores of women with and those without OAB as well as BOO groups, Cronbach’s alpha value was 0.82. A strong correlation obviates among whole ICIQ domains in OAB set (P ≤ 0.001). Equally, a high correlation exists among each domain in the BOO group, and Cronbach’s alpha value was 0.82. In comparison with control, highly significant scores exist for all ICIQ-OAB domains and entire points in the BOO as well as OAB sets (P < 0.001). The ICIQ-OAB was found to have good discriminant validity.

Conclusion

A formulated and approved ICIQ-OAB -Arabic release is a value tool for addressing OAB symptom complex. The easy questionnaire will be a useful tool in grading the bother symptoms in Arabic speaking inhabitant.

Efficacy and Safety of Vibegron Add-on Therapy in Men With Persistent Storage Symptoms After Receiving Alpha 1-Blocker or Phosphodiesterase 5 Inhibitor: A Preliminary Study

OBJECTIVE

To investigate the efficacy and safety of vibegron add-on therapy in men with persistent storage symptoms receiving α-1 blockers or PDE5 inhibitor for benign prostatic hyperplasia and then determine the independent factors affecting the efficacy of vibegron.

METHODS

Vibegron 50 mg was administered for 12 weeks to 42 patients (72.0 ± 8.2 years) with persistent storage symptoms who had taken α-1 blockers (22 patients) or PDE5 inhibitor (20 patients). The primary endpoint was change in the overactive Bladder (OAB) Symptom Score from baseline to end of treatment. The secondary endpoints were changes in each question of several questionnaires, maximum flow rate and residual urine volume. Finally, independent factors affecting the efficacy of vibegron were investigated.

RESULTS

Total OAB Symptom Score was significantly decreased (6.21 ± 3.12 vs 4.38 ± 2.46; P < .001). Although each score of several questionnaires, especially for storage symptoms, improved significantly, no significant improvement was found in stress incontinence, straining, bladder pain and urethral pain in the Core Lower Urinary Tract Symptom score. Maximum flow rate and residual urine volume did not change, and no patient discontinued vibegron because of adverse events. Multiple regression analysis showed that OAB Symptom Score, Core Lower Urinary Tract Symptom score, prostate volume and monotherapy with α-1 blocker were independent factors affecting the efficacy of vibegron.

CONCLUSION

Add-on therapy of vibegron to monotherapy with α-1 blockers or PDE5 inhibitor for patients with benign prostatic hyperplasia and persistent storage symptoms was effective and safe.

Validation of the Arabic linguistic version of the Overactive Bladder Symptoms Score questionnaire

Objective: To validate an Arabic version of the Overactive Bladder Symptom Score (OABSS) questionnaire.

Patients and methods: In all, 301 patients were evaluated using the Arabic-translated OABSS. They were divided into four groups: 112 patients with OAB symptoms, 115 healthy individuals with no OAB symptoms, 38 with bladder outlet obstruction (BOO) associated with storage lower urinary tract symptoms (LUTS), and 36 with BOO without storage LUTS. The reliability of the Arabic version was evaluated for internal consistency using Cronbach’s α test. Interdomain associations were examined using Spearman’s correlation coefficient (r). The discrimination validity was evaluated using the Mann–Whitney test.

Results: Higher internal consistency was found for all OABSS domains in the OAB and BOO groups. There were strong correlations between all domains in the OAB group (P < 0.001). Similarly, there were strong correlations between all domains in the BOO group. For discrimination validity, scores were statistically significant higher for all OABSS domains and overall total scores in the OAB and BOO groups compared with their control groups (P < 0.001).

Conclusion: The Arabic version of OABSS is a reliable and valid instrument that can be used to evaluate symptoms and health-related quality of life in Arabic patients with OAB.

Clinical trial no. (clinicaltrials.gov NCT03533062)

Abbreviations : BOO: bladder outlet obstruction; OAB: overactive bladder; OABSS: Overactive Bladder Symptom Score questionnaire; (U)UI: (urgency) urinary incontinence

Clinical Rating Scales for Urinary Symptoms in Parkinson Disease: Critique and Recommendations

Background

The prevalence of lower urinary tract symptoms (LUTS) is high in Parkinson's disease (PD). These problems negatively affect quality of life and include both storage and voiding problems. The International Parkinson and Movement Disorder Society established a task force to review clinical rating scales/questionnaires for the assessment of urinary symptoms in PD.

Methods

According to prespecified criteria, these scales/questionnaires were classified as "Recommended" or "Recommended with caveats" when clinimetric properties were satisfactory for Recommended status but had not been assessed specifically in PD, "Suggested" or "Listed." These assessments were applied to rate scales as screening tools for the diagnosis of LUTS and for the rating of symptom severity.

Results

Among scales that included LUTS but focused on overall autonomic or non-motor symptoms in PD, no scale reached the clinimetric rigor to be designated as Recommended or Recommended with caveats, but some were Suggested for either diagnostic screening tools or severity measures. Among primary urological scales, most are well validated in urological setting, but none was validated specifically in PD. DAN-PSS (Danish PSS), ICIQ (International Consultation for Incontinence Questionnaire)-MLUTS (Male Lower Urinary Tract Symptoms), OABq, OABq-SF (ICIQ-OABqol), OAB-V8 (as screening tool), and OABSS (OAB Symptom Score) met criteria for Recommended with caveats.

Conclusion

The Task Force does not recommend the development of a new scale. However, all above-mentioned questionnaires need to be studied further and specifically validated in PD.

Lack of Patient-Clinician Concordance in Cancer Patients: Its Relation With Patient Variables

CONTEXT

Patients with cancer are bothered by its diagnosis, treatment, and associated uncertainty. Lack of concordance (LOC) of patients' reporting of their symptoms and quality of life (QOL) with that of their clinicians has been observed in cancer care. However, information regarding the reporting of patients' bother due to aspects of cancer experience and their clinicians' assessment is lacking.

OBJECTIVES

The objective was to describe cancer patients' bother due to aspects of their disease experience and explore the concordance (LOC) or a lack thereof between patients' and clinicians' reporting of patients' bother and factors associated with it.

METHODS

Data from a prospective study of cancer patients' symptoms were analyzed. LOC was defined as any discrepancy between patient-clinician pairs in reporting patients' bother due to disease, cancer treatment, comorbidity, and side effects of symptom management. The relation of LOC to patients' QOL and distress was also explored.

RESULTS

Of the 2597 patients analyzed, a perfect concordance was observed in 37%-42%. Clinicians underestimated the severity of bother in 62%-76% of discordant cases. LOC was significantly associated with patient-reported distress and poor QOL. Referral for symptom management was associated with the clinician's rating of patients' bother, and LOC was associated with likelihood of poor compliance with recommendations for symptom management.

CONCLUSION

Majority of clinicians tended to underestimate cancer patients' bother, and this was associated with poor QOL of cancer patients and their distress. Future studies should examine the LOC and its correlates to confirm the results of this study.

Treatment Patterns and Patient Reported Outcomes in Benign Prostatic Hyperplasia Patients with Overactive Bladder Symptoms

OBJECTIVES

We aimed to examine the treatment patterns, and patient-reported outcomes (PROs) in benign prostatic hyperplasia (BPH) patients with overactive bladder (OAB) symptoms.

METHODS

Seven hundred and forty seven patients were included in this prospective observational study. The primary endpoint was to describe the medical treatment patterns for BPH patients with OAB symptoms. The secondary endpoint was to determine the PROs of these patients. Clinical outcome was assessed using International prostate symptom score (IPSS), and PROs were measured using BPH-Related QoL Questionnaire Korea 1 (BPH QoL K1) and Euroqol-5 Dimension (EQ-5D).

RESULTS

When starting the study, 391 patients (52.3%) received α-blocker monotherapy, whereas 356 (47.7%) received combination therapy with anticholinergics. Of the 369 patients who completed the 6-month treatment, 139 patients (37.7%) still received α-blocker monotherapy, 122 (33.1%) still received combination therapy with anticholinergics, and 108 (29.3%) received subsequent anticholinergics in addition to α-blocker. When the patients were stratified, storage subscore was higher (9.5 vs. 8.8, P = 0.034) and voiding subscore (9.7 vs. 11.6, P = 0.001) was lower in patients with anticholinergics than those without it. Although all treatment groups reported a significant improvement from baseline, no significant between-group differences in changes in IPSS, EQ-5D and BPH QoL K1 was found.

CONCLUSIONS

About one-third of patients received α-blocker monotherapy, one-third received combination therapy with anticholinergics, and another one-third received subsequent anticholinergics in addition to α-blocker. Storage subscore was higher in patients with anticholinergics than those without it, but vice-versa for voiding subscore. Similar improvement on clinical outcomes and PROs was observed in all treatment groups.

Predictors of urgency improvement after Holmium laser enucleation of the prostate in men with benign prostatic hyperplasia

Purpose

To investigate the change in urinary urgency and predictors of urgency improvement after holmium laser enucleation of the prostate (HoLEP) in men with benign prostatic hyperplasia (BPH).

Materials and Methods

We retrospectively analyzed the medical records of patients who were treated with HoLEP for BPH and had preoperative urgency measuring ≥3 on a 5-point urinary sensation scale. Those with prostate cancer diagnosed prior to or after HoLEP, a history of other prostatic and/or urethral surgery, moderate to severe postoperative complications, and neurogenic causes were excluded. Patients who had improved urgency with antimuscarinic medication after HoLEP were excluded. We divided the patients into 2 groups based on urgency symptoms 3 months after HoLEP: improved and unimproved urgency. Improved urgency was defined as a reduction of 2 or more points on the 5-point urinary sensation scale. Preoperative clinical and urodynamic factors as well as perioperative factors were compared between groups.

Results

In total, 139 patients were included in this study. Voiding parameters in all patients improved significantly after HoLEP. Seventy-one patients (51.1%) had improved urgency, while 68 (48.9%) did not show any improvement. A history of acute urinary retention (AUR) and postvoid residual were associated with postoperative urgency improvement in univariate analysis. In multivariate analysis, a history of AUR was an independent factor affecting urgency improvement.

Conclusions

A preoperative history of AUR could influence the change in urgency after HoLEP surgery in patients with BPH.

Reproducibility study of Overactive Bladder Symptom Score questionnaire and its response to treatment (RESORT) in Korean population with overactive bladder symptoms

PURPOSE

The Overactive Bladder Symptom Score (OABSS) is comprised of 4 items with a single total score for quantification of OAB symptoms and has been reported as sensitive to treatment-related changes. The aim of this study was to assess the psychometric properties of the Korean version in patients with OAB symptoms.

METHODS

Two prospective trials were conducted at two teaching hospitals. The Part I study evaluated the internal consistency and test-retest reliability among 42 enrolled patients, and the Part II trial assessed the construct validity and anticholinergic responsiveness in 50 enrolled patients and 50 controls.

RESULTS

Internal consistency was found acceptable, with Cronbach's α of 0.73 for total OABSS score. From a 2-week test-retest, Spearman's rho of each item ranged from 0.53 to 0.82, and the intraclass correlation coefficient of the total score was 0.80, showing the high stability. Acceptable discriminant validity was demonstrated, with substantially different correlations of OABSS scores with an International Prostate Symptom Score-storage and voiding score sum, and significant differences between patients and controls. Convergent validity was acceptable, with moderate correlations between each OABSS item and the corresponding 3-day frequency-volume chart variables. The Korean version was found considerably responsive to symptom changes following 12-week solifenacin treatment, as judged by moderate or large effect sizes, standardized response means, and the Guyatt Responsiveness Index.

CONCLUSIONS

With good psychometric properties and responsiveness, the Korean version of the OABSS may offer researchers and clinicians a valid and reliable measure for the assessment of OAB symptoms in the Korean population.