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Shang Y, Chen J, Tai Y. Association between weight-adjusted waist index and overactive bladder syndrome among adult women in the United States: a cross-sectional study. BMC Womens Health 2024; 24:488. [PMID: 39232696 PMCID: PMC11373401 DOI: 10.1186/s12905-024-03339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024] Open
Abstract
PURPOSE The weight-adjusted waist index (WWI) is a recently developed index for measuring obesity. The aim of this study was to investigate the association between WWI levels and overactive bladder (OAB) in a nationally representative population. METHODS This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) database between 2007 and 2016. OAB was defined as the Overactive Bladder Syndrome Symptom Score (OABSS, score ≥ 3). The WWI index was calculated as the square root of waist circumference (WC, cm) divided by body weight (kg). We used weighted logistic regression models to assess the relationship between the WWI index and OAB in adult women. The reliability of the findings was assessed using restricted cubic spline, subgroup analysis. RESULTS A total of 10,563 individuals were included in the study, and the prevalence of OAB was 18.6%. Higher WWI was associated with an increased risk of overactive bladder syndrome. In model 1 with unadjusted variables (OR = 1.148; 95% CI = 1.148-1.149, p < 0.001), model 2 (OR = 1.253; 95% CI = 1.253-1.254, p < 0.001) and model 3 with fully adjusted variables (OR = 1.215; 95% CI = 1.214-1.215, p < 0.001) in which the association was significant. The results of the subgroup analyses showed that age stratification and stroke status could modify this association between WWI and OAB. Restricted cubic spline showed a nonlinear relationship between WWI and OAB (p for nonlinear < 0.05). CONCLUSION Weight-adjusted waist circumference index (WWI) values are positively associated with the risk of developing OAB in adult women in the United States, but further studies are needed to elucidate the causal relationship between WWI and OAB.
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Affiliation(s)
- Yilei Shang
- Beijing Normal University Hong Kong Baptist University United International College, Zhuhai, China
| | - Jiexin Chen
- Beijing Normal University Hong Kong Baptist University United International College, Zhuhai, China
| | - Yanghao Tai
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, 030032, China.
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Di Carlo C, Cagnacci A, Murina F, Maffei S, Becorpi A, Lello S. Ospemifene and vulvovaginal atrophy: an update of the clinical profile for post-menopausal women. Expert Opin Pharmacother 2024; 25:1541-1554. [PMID: 39129457 DOI: 10.1080/14656566.2024.2391009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION The demand for effective and safe treatments of genitourinary syndrome (GSM) in post-menopausal women (PMW) is growing. Published data on the efficacy and safety of ospemifene (OSP) prompt an updated literature review to enlighten possible improvements in the GSM treatment. AREA COVERED We searched articles published in English from 2010 to 2023 through Medline (PubMed) and Embase databases with Boolean terms: OSP, PMW, GSM, endometrium, breast cancer, cardiometabolic syndrome, bone metabolism, adherence to treatment, and patient satisfaction. We selected randomized controlled trials (RCTs) and observational and cross-sectional studies and completed the search manually. EXPERT OPINION Of the 157 retrieved records, 25 primary studies met the inclusion criteria (15 regarding efficacy and safety, two for additional effects, and four for adherence and satisfaction with the OSP treatment). Seven RCTs involved nearly 5,000 patients, 10 out of 18 prospective observational studies 563, and six retrospective analyses 356,439. Evidence of OSP treatment in PMW with GSM relies on RCTs and remarkable real-world data. The 25 primary studies showcased the high clinical response to symptoms, the favorable safety profile of OSP with very few adverse events, a neutral impact on the endometrium, breast, bone, and thrombosis, and the possible improvement of cardiovascular risk factors.
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Affiliation(s)
- Costantino Di Carlo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, Academic Unit of Obstetrics and Gynecology, IRCCS-San Martino Hospital of Genoa, Genoa, Italy
| | - Filippo Murina
- Lower Genital Tract Disease Unit, V. Buzzi Hospital-University of the Study of Milan, Milan, Italy
| | - Silvia Maffei
- Department of Cardiovascular Endocrinology and Osteoporosis, Fondazione CNR-Regione Toscana "G. Monasterio" and Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Angelamaria Becorpi
- Department of Obstetrics and Gynaecology, University Hospital AOU Careggi, Firenze, Italy
| | - Stefano Lello
- Department of Woman and Child Health, Catholic University of Sacred Heart, Fondazione Policlinico A. Gemelli-IRCCS, Roma, Italy
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Marchetti G, Taithongchai A, Robinson D. Ospemifene for Genitourinary Syndrome of Menopause: Patient Selection. Int J Womens Health 2024; 16:1049-1053. [PMID: 38855356 PMCID: PMC11162622 DOI: 10.2147/ijwh.s431520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024] Open
Abstract
Vulvar vaginal atrophy is a common condition affecting postmenopausal women, significantly impacting their quality of life. Fortunately, various treatment options are available, ranging from hormonal to non-hormonal therapies. Ospemifene has emerged as a promising non-hormonal alternative for managing vulvar vaginal atrophy. Its targeted approach, unique mechanism of action, favorable safety profile particularly for breast tissue, and efficacy make it a valuable option for women seeking relief from symptoms such as vaginal pain, dryness and dyspareunia and cannot receive estrogen supplementations. This is particularly the case for breast cancer survivors or women with a significant family history of estrogen-dependent cancers. Hence, tailored treatment plans, considering individual preferences and health circumstances, are essential in optimizing outcomes and improving the overall well-being of affected individuals.
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Affiliation(s)
- Giulia Marchetti
- Urogynaecology Department, Irmandade de Misericórdia da Santa Casa de São Paulo, Sao Paulo, Brazil
| | | | - Dudley Robinson
- Urogynaecology Department, King’s College Hospital, London, UK
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Lecointre L, Buttignol M, Faller E, Boisrame T, Martel C, Host A, Gabriele V, Akladios C. Urological procedures performed by gynecologists: Activity profile in a gynecological surgery department, 10-year observation cohort. Eur J Obstet Gynecol Reprod Biol 2023; 288:204-210. [PMID: 37572449 DOI: 10.1016/j.ejogrb.2023.07.015] [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: 04/16/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION The proximity of the urinary tract to the female genital tract explains its possible involvement in pelvic gynaecological cancer or deep endometriosis. Surgical treatment is aimed at improving overall survival and recurrence-free survival of patients, as well as restoring normal anatomy and functional integrity depending on the pathology. These operations are accompanied by significant post-operative complications. Thus, the urological procedures performed must be rigorously justified, and the different resection and reconstruction techniques adapted to the pathology and the level of infiltration. OBJECTIVE To describe the activity profile, over the last ten years, of a gynaecological surgery department in terms of urological procedures in the management of patients with deep endometriosis and pelvic carcinology. STUDY DESIGN This is a monocentric retrospective observational study, including all patients who underwent a urological procedure by a gynaecological surgeon only, as part of the management of pelvic gynaecological cancers or deep endometriosis, at the University Hospital Centre (CHU) of Strasbourg, between January 1st 2010 and April 31st 2021. The variables studied were early postoperative complications, the rate of surgical reintervention, operating time, length of hospital stay, the need for peri-operative drainage or transfusion, and post-operative functional disorders. RESULTS A total of 86 patients were included, 27 in the pelvic gynaecological cancer group and 59 in the deep endometriosis group. 61.6% of patients received uretero-vesical catheterization, 60.5% partial cystectomy, 10.5% psoic bladder ureteral reimplantation, and 3.5% trans-ileal Bricker skin ureterostomy. The mean operating time was 316 min in the pelvic gynaecological cancer group and 198.9 min in the deep endometriosis group. The average hospital stay was 11.5 days, 22.3 days for patients treated for pelvic cancer and 6.3 days for those treated for endometriosis. The rate of minor post-operative complications was 8.2% of cases, and major post-operative complications 17.4% of cases, the majority of which were in the gynecological cancer group. There were no cases of intra- or early post-operative death. Early postoperative urinary complications affected 14.0% of the total patients, mostly in the gynaecological cancer group with 33.3% of patients, but only 5.1% of patients in the deep endometriosis group. The total reoperation rate within 60 days postoperatively was 15.1%, 40.7% for patients treated for gynaecological cancer and 3.4% for those treated for deep pelvic endometriosis. The rate of reoperations for urinary complications was 11.6% of total patients, or 76.9% of total reoperations. 15 patients received labile blood products intra- or postoperatively, 11 in the pelvic gynaecological cancer group and 4 in the endometriosis group. CONCLUSION Our overall results appear comparable to those reported in the literature and are particularly satisfactory in terms of post-operative complications after partial cystectomy in the management of deep endometriosis compared to other gynaecological departments. This work encourages us to continue and improve the training of gynaecological surgeons in terms of multidisciplinary surgical procedures, including urological ones, to obtain a global vision of the pathology and to allow an optimal quality of care for the patients.
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Affiliation(s)
- Lise Lecointre
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France; Insitute of Image-Guided Surgery, IHU-Strasbourg (Institut Hospitalo-Universitaire), 1 place de l'Hôpital, 67000 Strasbourg, France; ICube UMR 7357 - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, CNRS, Université de Strasbourg, Strasbourg, France.
| | - Megane Buttignol
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Emilie Faller
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Thomas Boisrame
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Camille Martel
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Aline Host
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France
| | - Victor Gabriele
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Chérif Akladios
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
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Casiano Evans EA, Hobson DTG, Aschkenazi SO, Alas AN, Balgobin S, Balk EM, Dieter AA, Kanter G, Orejuela FJ, Sanses TVD, Rahn DD. Nonestrogen Therapies for Treatment of Genitourinary Syndrome of Menopause: A Systematic Review. Obstet Gynecol 2023; 142:555-570. [PMID: 37543737 DOI: 10.1097/aog.0000000000005288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/25/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To systematically review the literature and provide clinical practice guidelines regarding various nonestrogen therapies for treatment of genitourinary syndrome of menopause (GSM). DATA SOURCES MEDLINE, EMBASE, ClinicalTrials.gov , and Cochrane databases were searched from inception to July 2021. We included comparative and noncomparative studies. Interventions and comparators were limited to seven products that are commercially available and currently in use (vaginal dehydroepiandrosterone [DHEA], ospemifene, laser or energy-based therapies, polycarbophil-based vaginal moisturizer, Tibolone, vaginal hyaluronic acid, testosterone). Topical estrogen, placebo, other nonestrogen products, as well as no treatment were considered as comparators. METHODS OF STUDY SELECTION We double-screened 9,131 abstracts and identified 136 studies that met our criteria. Studies were assessed for quality and strength of evidence by the systematic review group. TABULATION, INTEGRATION, AND RESULTS Information regarding the participants, details on the intervention and comparator and outcomes were extracted from the eligible studies. Alternative therapies were similar or superior to estrogen or placebo with minimal increase in adverse events. Dose response was noted with vaginal DHEA and testosterone. Vaginal DHEA, ospemifene, erbium and fractional carbon dioxide (CO 2 ) laser, polycarbophil-based vaginal moisturizer, tibolone, hyaluronic acid, and testosterone all improved subjective and objective signs of atrophy. Vaginal DHEA, ospemifene, tibolone, fractional CO 2 laser, polycarbophil-based vaginal moisturizer, and testosterone improved sexual function. CONCLUSION Most nonestrogen therapies are effective treatments for the various symptoms of GSM. There are insufficient data to compare nonestrogen options to each other.
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Affiliation(s)
- Elizabeth A Casiano Evans
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas at San Antonio, San Antonio, the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Division of Urogynecology, ProHealth Women's Services, Waukesha Memorial Hospital, Waukesha, Wisconsin; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Departments of Obstetrics and Gynecology and Urology, MedStar Washington Hospital Center, Georgetown University School of Medicine, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Howard University College of Medicine, Washington, DC; and the Salinas Valley Memorial Healthcare System, Salinas, California
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Wasserman MC, Rubin RS. Urologic view in the management of genitourinary syndrome of menopause. Climacteric 2023; 26:329-335. [PMID: 37104711 DOI: 10.1080/13697137.2023.2202811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Genitourinary syndrome of menopause (GSM) has a variety of effects on the urinary system and is an important consideration in the care provided to perimenopausal and postmenopausal patients when addressing urinary pathology. Here we discuss the common pathologies of the urinary system related to GSM including lower urinary tract symptoms and recurrent urinary tract infections. Female sexual dysfunction is not to be excluded as a critical part of a urologist's management of GSM but will be discussed elsewhere in this issue.
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Affiliation(s)
- M C Wasserman
- Female Pelvic Medicine and Reconstructive Surgery, NYU Langone Health, New York, NY, USA
| | - R S Rubin
- Department of Urology, Georgetown University Hospital, Washington DC, USA
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Huang DR, Goodship A, Webber I, Alaa A, Sasco ER, Hayhoe B, El-Osta A. Experience and severity of menopause symptoms and effects on health-seeking behaviours: a cross-sectional online survey of community dwelling adults in the United Kingdom. BMC Womens Health 2023; 23:373. [PMID: 37452317 PMCID: PMC10347781 DOI: 10.1186/s12905-023-02506-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Almost all women will experience menopause, and the symptoms can have a severely detrimental impact on their quality of life. However, there is limited research exploring health-seeking behaviours and alternative service design or consultation formats. Group consultations have been successfully deployed in perinatal and diabetic care, improving accessibility and outcomes. This cross-sectional online survey was conducted to explore women's personal experiences of menopause, including perspectives on group consultations. METHODS An online survey investigated the experiences of individuals at all stages of menopause and their receptiveness towards group consultations for menopause. Respondents were categorised by menopause stage according to the STRAW + 10 staging system. Associations between menopause stage, acceptability of group consultations and participant demographics were assessed using logistic regression. RESULTS Respondents experienced an average of 10.7 menopausal symptoms, but only 47% of respondents felt they had the knowledge and tools to manage their symptoms. Advice on menopause was sought from a healthcare professional (HCP) by 61% of respondents, the largest trigger for this being severity of symptoms and the main barrier for this was the perception that menopause wasn't a valid enough reason to seek help. Of the respondents seeking advice from HCPs, 32% were prescribed transdermal HRT, 29% received oral HRT, 19% were offered antidepressants, 18% received local oestrogen and 6% were prescribed testosterone. Over three quarters (77%) of respondents indicated that they would join a group consultation for menopause and would be comfortable sharing their experiences with others (75%). Logistic regression indicated premenopausal respondents were 2.84 times more likely than postmenopausal women to be interested in a group consultation where they can meet or learn from others' experiences. CONCLUSIONS This study highlighted a strong willingness of women aged 35-70 to participate in group consultations for menopause, with motivation being strongest amongst premenopausal women. Low awareness of self-management and lifestyle interventions to manage the symptoms of menopause highlight the need for greater outreach, research and interventions to build knowledge and confidence in the general population at scale. Future studies should focus on investigating the effectiveness and economic impact of menopause group consultations and the lived experience of individuals participating in group consultations.
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Affiliation(s)
- David Roy Huang
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, Imperial College, London, W6 8RF UK
| | - Abigail Goodship
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, Imperial College, London, W6 8RF UK
| | - Iman Webber
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, Imperial College, London, W6 8RF UK
| | - Aos Alaa
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, Imperial College, London, W6 8RF UK
| | - Eva Riboli Sasco
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, Imperial College, London, W6 8RF UK
| | - Benedict Hayhoe
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, Imperial College, London, W6 8RF UK
| | - Austen El-Osta
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, Imperial College, London, W6 8RF UK
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Mohamed-Ahmed R, Taithongchai A, da Silva AS, Robinson D, Cardozo L. Treating and Managing Urinary Incontinence: Evolving and Potential Multicomponent Medical and Lifestyle Interventions. Res Rep Urol 2023; 15:193-203. [PMID: 37351339 PMCID: PMC10284157 DOI: 10.2147/rru.s387205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
Incontinence is defined by either ICS 2002 or IUGA/ICS 2010 as the involuntary loss of urine and includes urgency urinary incontinence (UUI), stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). It has a high worldwide prevalence with an associated impact on quality of life. Despite existing management options for the management of urinary incontinence, patients continue to be troubled by symptoms or side effects of existing treatment. There is therefore a requirement for ongoing research into treatment options for the management of UUI and SUI, that are more effective and tolerable to patients. Advances in treatment of UUI include a more selective beta 3 agonist, Vibegron, which has less impact on cardiac function than Mirabegron. Hormonal treatment, including Ospemifene and Prasterone, may improve GSM and in turn symptoms of UUI. There are advances in the types of neuromodulators available, including those that are rechargeable at home and are MRI safe. Laser has shown promising initial results. There is developing interest in the microbiome, and how this may impact future treatment modalities. Advances in treatment of SUI include the use of mobile health applications to support delivery of pelvic floor muscle training. Litoxetine, a selective serotonin reuptake inhibitor, has shown promising results at phase III trials. Functional magnetic stimulation is being developed to improve contractility of pelvic floor muscles. We also discuss interventions that improve tissue elasticity and regeneration, such as platelet rich plasma, autologous stem cell transplantation, laser therapy and radiofrequency treatment, which show short term benefits.
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Affiliation(s)
| | | | | | - Dudley Robinson
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King’s College Hospital, London, UK
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Russo E, Misasi G, Montt-Guevara MM, Giannini A, Simoncini T. Effects of ospemifene on overactive bladder in postmenopausal women with vulvovaginal atrophy. Climacteric 2023; 26:284-288. [PMID: 36912363 DOI: 10.1080/13697137.2023.2184251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Overactive bladder (OAB) is a complex and multifactorial syndrome associated with urinary frequency, urgency and incontinence. The menopause-associated hormonal changes play a role in the development of this condition. Vaginal estrogens are effective in improving OAB in postmenopausal women (PMW) with vulvovaginal atrophy (VVA). Ospemifene is a selective estrogen receptor modulator licensed for the treatment of VVA. This study aimed to evaluate the effects of ospemifene on OAB symptoms in PMW with VVA. METHODS Forty PMW suffering from OAB and VVA received oral ospemifene (60 mg/day) for 12 weeks. All patients were assessed with a urodynamic study, a 3-day bladder diary and validated questionnaires (International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form [ICIQ-UI SF] and International Consultation on Incontinence Questionnaire - Overactive Bladder [ICIQ-OAB]) at enrollment and at the end of the study. RESULTS Cytometric capacity, bladder compliance and verbal sensory threshold responses during bladder filling were improved after treatment. The voiding diary showed a significant reduction of daily voids, urge urinary incontinence episodes and nocturnal events. The median overall scores of the ICIQ-UI and ICIQ-OAB were also significantly improved. CONCLUSIONS Our study suggest that treatment with ospemifene in PMW suffering from OAB is associated with a reduction of OAB symptoms due to a decreased bladder sensitivity and with an improvement in quality of life.
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Affiliation(s)
- E Russo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Misasi
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M M Montt-Guevara
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - T Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Schiavi MC, Zullo MA, Luffarelli P, Di Pinto A, Oliva C, Palazzetti P. Urogynecological survey in a group of Italian women treated for overactive bladder: Symptoms and quality of life analysis during the Covid-19 period. Taiwan J Obstet Gynecol 2021; 60:674-678. [PMID: 34247805 PMCID: PMC8266265 DOI: 10.1016/j.tjog.2021.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives The aim of this study is to assess the impact of life change and social distancing measures, during the Covid-19 outbreak, on the OAB symptoms and quality of life in women underwent different types of treatment. Materials and methods Observational survey analysis in OAB treated patients was performed. The women showed a greater than 50% improvement during specific therapy for OAB. Population had previously completed bladder diary, OAB-Q symptom, OAB HRQL scale, SF-36 and PGI-I questionnaires. Four weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for new evaluation during Covid-19 outbreak. Primary endpoint was changes in number of voids/24h, urgent micturitions/24h, urinary incontinence events/24h, nocturia events. Secondary endpoints were the assessment of the change in the OAB-SF, SF-36 questionnaires and PGI-I satisfaction. Results Six hundred seventy-three patients were considered. The mean age was 63.21 ± 10.24 years. Four weeks after the start of the social distancing measures, the increase in mean number of voids/24h (7.13 ± 1.08 vs 9.76 ± 2.12, p < 0.0001), urgent micturition episodes/24h (2.65 ± 1.11 vs 4.57 ± 1.28, p < 0.0001), nocturia episodes (1.19 ± 1.21 vs 2.83 ± 0.94, p < 0.0001) was observed. The OAB symptom scores (32.67 ± 12.88 vs 51.23 ± 12.11, p < 0.0001), OAB-HRQL (75.45 ± 12.76 vs 48.23 ± 10.34, p < 0.0001), and SF-36 (82.15 ± 11.78 vs 69.39 ± 10.85, p < 0.0001) changed significantly. The satisfaction decreased significantly at the PGI-I during the Covid-19 period 79.8% vs 45% (p < 0.0001). Conclusions The Covid-19 outbreak and the restrictive social distancing measures have negatively influenced the OAB symptoms and quality of life in women underwent different types of treatment.
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Affiliation(s)
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Anna Di Pinto
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Cosimo Oliva
- Department of Gynecological and Obstetric, San Filippo Neri Hospital, Rome, Italy
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D'Oria O, Giannini A, Prata G, Scudo M, Logoteta A, Mondo A, Perniola G, Palaia I, Cascialli G, Monti M, Muzii L, Benedetti Panici P, DI Donato V. Non-invasive treatment of vulvovaginal atrophy in menopause with CO2 laser. Minerva Obstet Gynecol 2021; 73:127-134. [PMID: 32720802 DOI: 10.23736/s2724-606x.20.04612-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Genitourinary syndrome of menopause (GSM) may affect up to 90% of menopausal women, including vulvovaginal atrophy (VVA), burning, pain, bleeding, irritation, dyspareunia, anorgasmia, and urinary symptoms. Vaginal symptoms from lack of estrogens can have a significant impact on the sexual health and quality of life (QoL) in as many as 50% of postmenopausal women. Several therapeutic alternatives, both hormonal and non- hormonal, have been proposed. Microablative CO<inf>2</inf> laser is one of the three non-surgical energy-based therapies, with Erbium:YAG laser and temperature-controlled radiofrequency (RF). Microablative CO<inf>2</inf> laser induces morphological changes in vaginal tissues and results of several clinical trials suggest that this type of laser improves symptoms of GSM. Moreover, this treatment seems to be safe. Given the increasingly widespread use of laser CO<inf>2</inf> as a non-hormonal alternative treatment for GSM, the authors reviewed the current published literature evaluating this therapy, to compare efficacy and safety of different protocols.
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Affiliation(s)
- Ottavia D'Oria
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Andrea Giannini
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Giovanni Prata
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Maria Scudo
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy -
| | - Alessandra Logoteta
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Alessandro Mondo
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Gianluca Cascialli
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Marco Monti
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Violante DI Donato
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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Monti M, Fischetti M, DI Pinto A, Santangelo G, Giannini A, D'Oria O, Golia D'Augè T, Carbone F, Perniola G, DI Donato V, Palaia I, Muzii L, Benedetti Panici P. Update on surgical treatment of female stress urinary incontinence. Minerva Obstet Gynecol 2021; 73:140-144. [PMID: 33103408 DOI: 10.23736/s2724-606x.20.04658-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Urinary incontinence is a common condition that negatively impacts quality of life of millions of women. It is a result of a synergy between the structures of pelvic floor in particular levator ani muscle and pelvic connective tissues. Urinary incontinence, increasing with age, is associated with considerable personal and societal expenditure. EVIDENCE ACQUISITION Systematic data search performed using PubMed/Medline database up to August 20, 2020. Focus was only for English language publications of original studies on urinary incontinence and in particular stress urinary incontinence. EVIDENCE SYNTHESIS Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and surgical procedures of urinary incontinence. CONCLUSIONS Urinary incontinence is an underestimated health problem. Many surgical options exist for women with stress urinary incontinence. Nevertheless, new strategies need to be evaluated in order to improve quality of life of patients.
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Affiliation(s)
- Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Anna DI Pinto
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy -
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Ottavia D'Oria
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Tullio Golia D'Augè
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Fabiana Carbone
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Violante DI Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
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Monti M, Fischetti M, Santangelo G, Galli V, Clemente F, Giannini A, Tibaldi V, DI Pinto A, Pecorini F, Perniola G, DI Donato V, Benedetti Panici P. Urinary incontinence in women: state of the art and medical treatment. Minerva Obstet Gynecol 2021; 73:135-139. [PMID: 32744453 DOI: 10.23736/s2724-606x.20.04635-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Urinary incontinence, the involuntary loss of urine, is a common condition that affects approximately 50% of adult women. This condition increases with age, affecting 10% to 20% of all women and up to 77% of elderly women residing in nursing homes. EVIDENCE ACQUISITION Systematic data search performed using PubMed/MEDLINE database up to July 20, 2020. Focus was only for English language publications of original studies on urinary incontinence. EVIDENCE SYNTHESIS Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and surgical procedures of urinary incontinence. CONCLUSIONS Urinary incontinence is an underestimated health problem. Patients need an overview of their health condition through a detailed anamnestic collection and physical examination to identify the type of incontinence and offer the best treatment.
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Affiliation(s)
- Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy -
| | - Valerio Galli
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | | | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Valentina Tibaldi
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Anna DI Pinto
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Francesco Pecorini
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Violante DI Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
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Monaghan TF, Weiss JP, Everaert K, Wein AJ. Pharmacologic management of nocturnal polyuria: a contemporary assessment of efficacy, safety, and progress toward individualized treatment. Ther Adv Urol 2021; 13:1756287220988438. [PMID: 33796148 PMCID: PMC7970679 DOI: 10.1177/1756287220988438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/26/2020] [Indexed: 12/18/2022] Open
Abstract
This narrative review synthesizes current evidence on the medical management of nocturnal polyuria, including antidiuretic replacement therapy as well as other emerging modalities, with particular emphasis on areas of active investigation and future research directions. Relative to earlier formulations, the pharmacological profiles of novel desmopressin acetate nasal spray and orally disintegrating tablet formulations appear favorable in optimizing the balance between efficacy and safety. Additionally, several highly selective small-molecule arginine vasopressin 2 receptor agonists are under active development, while appropriately timed short-acting diuretics, pharmacotherapy for hypertension, nonsteroidal anti-inflammatory drugs, and sex hormone replacement therapy are also a focal point of extensive ongoing nocturnal polyuria research. Emerging laboratory technologies now make feasible a sub-stratification of nocturnal polyuria patients into substrate-based phenotypes for individualized treatment. An increasingly refined understanding of the pathogenesis of nocturnal polyuria, and arginine vasopressin dysregulation in particular, has also introduced new opportunities for point-of-care testing in patients with nocturnal polyuria.
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Affiliation(s)
- Thomas F. Monaghan
- Department of Urology SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, New York 11203, USA
| | - Jeffrey P. Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Alan J. Wein
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F, Erkkola R, Goulis DG, Kiesel L, Lambrinoudaki I, Hirschberg AL, Lopes P, Pines A, Rees M, van Trotsenburg M, Simoncini T. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas 2020; 143:223-230. [PMID: 33008675 DOI: 10.1016/j.maturitas.2020.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care. AIM The aim of this clinical guide is to provide an evidence-based approach to the management of urinary incontinence in postmenopausal women. MATERIALS AND METHODS Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS Healthcare professionals should consider urinary incontinence a clinical priority and develop appropriate diagnostic skills. They should be able to identify and manage any relevant modifiable factors that could alleviate the condition. A wide range of treatment options is available. First-line management includes lifestyle and behavioral modification, pelvic floor exercises and bladder training. Estrogens and other pharmacological interventions are helpful in the treatment of urgency incontinence that does not respond to conservative measures. Third-line therapies (e.g. sacral neuromodulation, intravesical onabotulinum toxin-A injections and posterior tibial nerve stimulation) are useful in selected patients with refractory urge incontinence. Surgery should be considered in postmenopausal women with stress incontinence. Midurethral slings, including retropubic and transobturator approaches, are safe and effective and should be offered.
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Affiliation(s)
- Eleonora Russo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Marta Caretto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Johannes Bitzer
- Department of Obstetrics and Gynecology, University Hospital, Basel, Switzerland
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain
| | - Iuliana Ceausu
- Department of Obstetrics and Gynecology I, "Dr. I. Cantacuzino" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Peter Chedraui
- Instituto de Investigación e Innovación de Salud Integral (ISAIN), Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Fatih Durmusoglu
- İstanbul Medipol International School of Medicine, Istanbul, Turkey
| | - Risto Erkkola
- Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Ludwig Kiesel
- Department of Gynecology and Obstetrics, University of Münster, Münster, Germany
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Patrice Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain. F 44819 St Herblain France, Université de Nantes F, 44093, Nantes, Cedex, France
| | - Amos Pines
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Mick van Trotsenburg
- Department of Obstetrics and Gynecology, University Hospital St. Poelten, Lilienfeld, Austria
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy.
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Araklitis G, Baines G, da Silva AS, Robinson D, Cardozo L. Recent advances in managing overactive bladder. F1000Res 2020; 9:F1000 Faculty Rev-1125. [PMID: 32968482 PMCID: PMC7489273 DOI: 10.12688/f1000research.26607.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. In this review, we focus on recent advances in the management of OAB. We examine the evidence on the effect of anticholinergic load on OAB patients. Advances in medical treatment include a new beta-3 agonist, vibegron, which is thought to have fewer drug interactions than mirabegron. Treatment of genitourinary syndrome of the menopause with oestrogens and ospemifene have also shown promise for OAB. Botulinum toxin has been shown to be an effective treatment option. We discuss the new implantable neuromodulators that are on the market as well as selective bladder denervation and laser technology.
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Affiliation(s)
- George Araklitis
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - Georgina Baines
- Department of Urogynaecology, King’s College Hospital, London, UK
| | | | - Dudley Robinson
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King’s College Hospital, London, UK
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Low-Intensity Extracorporeal Shock Wave Therapy Ameliorates the Overactive Bladder: A Prospective Pilot Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9175676. [PMID: 32724817 PMCID: PMC7364200 DOI: 10.1155/2020/9175676] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 12/20/2022]
Abstract
Objective In the present clinical trial, we evaluated the therapeutic effects of low-intensity extracorporeal shockwave therapy (LiESWT) on overactive bladder (OAB). Methods Female subjects with ages of 20-75 years and who have been clinically diagnosed with OAB were included in the study. The LiESWT (DUOLITH SD1 T-TOP, AG) applicator was placed on the suprapubic skin area and applied with an intensity of 0.25 mJ/mm2, 3000 pulses, and 3 pulses/second. To assess the therapeutic efficacy, all subjects were required to complete the validated OAB symptoms and life bothersome questionnaires, 3-day urinary diary, uroflowmetry, and post-voided residual urine (PVR) measurement at 4 weeks of LiESWT (W4), 8 weeks of LiESWT (W8), 1-month follow-up (F1), and 3-month follow-up (F3) after LiESWT. Result 82 subjects with the mean age of 56.5 ± 1.2 years were enrolled. The questionnaire scores were significantly improved at W4, W8, F1, and F3 as compared to baseline data (W0). At W8, the mean values of functional bladder capacity were meaningfully increased. According to the 3-day urinary diary, daytime frequency, urgency, and nocturia were significantly decreased. The uroflowmetry results showed that the mean voided urine volume and the maximal flow rate (Qmax) were noticeably increased. PVR volume was also significantly decreased. Conclusions The data demonstrated that 8-week LiESWT ameliorated the OAB symptoms, promoted the uroflow parameters, and improved the quality of life (QoL) in OAB patients, suggesting that LiESWT might serve as an alternative noninvasive therapy for OAB.
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Palacios S. Ospemifene for vulvar and vaginal atrophy: an overview. Drugs Context 2020; 9:2020-3-2. [PMID: 32670378 PMCID: PMC7337588 DOI: 10.7573/dic.2020-3-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/15/2023] Open
Abstract
The menopause-related decline in estrogen levels leads to an array of genital, sexual, and urinary symptoms collectively known as genitourinary syndrome of menopause. The constellation of symptoms associated with vulvar and vaginal atrophy (VVA) can have a profoundly detrimental effect on a woman's sexual function, relationships, and quality of life. Ospemifene is a selective estrogen receptor modulator indicated for treatment of moderate-to-severe symptomatic VVA in postmenopausal women who are not candidates for local vaginal estrogen therapy or have contraindications for estrogen products. Ospemifene is administered orally, thus avoiding the inconveniences of local therapy, and can be used in women with VVA and a history of breast cancer after completing all (including adjuvant) breast cancer treatment. As well as restoring vaginal health in symptomatic VVA, ospemifene may have collateral benefits of importance to postmenopausal women. In this Special Issue entitled "Treatment of Vulvar and Vaginal Atrophy: Clinical Experience with Ospemifene," illustrative case studies examine the experiences of women with VVA during treatment with ospemifene. Specific topics include the effects of ospemifene on bone markers; its use in breast cancer survivors and in women with dyslipidemia, urinary incontinence, or VVA-related sexual dysfunction; and its concomitant use with laser therapy.
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Abstract
Vulvovaginal atrophy (VVA) is a frequent, underreported and underdiagnosed condition. Ospemifene is a third-generation Selective Estrogen Receptor Modulator (SERM) that has been shown to be effective in women with VVA and dyspareunia, vaginal dryness and vulvar vestibular symptoms. Some of the possible side effects included by FDA and EMA are hot flushes, headache, muscle spasms, vaginal bleeding and vaginal discharge. Ospemifene does not increase the incidence of endometrial cancer or hyperplasia. While the efficacy is comparable with that of estrogenic treatments, ospemifene is not only well tolerated and safe but also reduces bone turnover in postmenopausal women, and available data indicate no safety concerns for breast tissue.
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Affiliation(s)
- Lino Del Pup
- University Sanitary Agency Friuli Central, Udine, Italy
- Board of Italian Society of Third Age Gynecology (SIGiTE), Milan, Italy
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20
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Blanco ZE, Lilue M, Palacios S. Experience with ospemifene in patients with vulvar and vaginal atrophy and urinary incontinence: case studies. Drugs Context 2020; 9:dic-2020-3-6. [PMID: 32670381 PMCID: PMC7337599 DOI: 10.7573/dic.2020-3-6] [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: 03/20/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/22/2023] Open
Abstract
Pelvic floor muscle atrophy and collagen loss in connective tissue due to declining estrogen production in women as they age may underlie the increasing prevalence of urge and stress incontinence. Estrogen therapy can correct the deficiency of estrogen receptors in genitourinary structures after menopause, but estrogen is not suitable for all women. A series of retrospective studies showed that urinary symptoms improved in women with overactive bladder syndrome who were receiving ospemifene for vulvovaginal atrophy (VVA), a component of genitourinary syndrome of menopause. Two case studies presented in this article support the findings. The woman in case 1 was 76 years old, had a 4-year history of urinary incontinence (UI), and several risk factors for urinary symptoms. During 15 months' treatment with ospemifene for VVA, her urinary symptoms also improved as evidenced by a reduction (from four/day to one/day) in sanitary pad requirements to manage leakage. The patient in case 2 had predominantly moderate-to-severe VVA and mild mixed UI. During 6 months' treatment with ospemifene, she experienced marked improvement in VVA symptoms, including normalization of vaginal pH and disappearance of dyspareunia, accompanied by a decrease in urinary symptoms, which allowed her to resume a normal exercise program.
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Affiliation(s)
- Zuramis Estrada Blanco
- Obstetrics and Gynecology Service, University Hospital of Southeast of Madrid, and Centro internacional de Investigación, Médico estético, uro-Ginecológico (CIMEG) Madrid, Madrid, Spain
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Novara L, Sgro LG, Mancarella M, Capece R, Canale E, Biglia N. Potential effectiveness of Ospemifene on Detrusor Overactivity in patients with vaginal atrophy. Maturitas 2020; 138:58-61. [PMID: 32631589 DOI: 10.1016/j.maturitas.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/02/2020] [Accepted: 05/01/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To report the effects on the urinary function of ospemifene prescribed for vulvovaginal atrophy (VVA) in patients with overactive bladder (OAB) symptoms refractory to the first line of pharmacologic treatment with antimuscarinic or β3-agonists drugs. We also try to identify any predictors of response to the ospemifene treatment. STUDY DESIGN Twenty-five patients with OAB confirmed by detrusor overactivity at urodynamics, refractory to first-line therapy for OAB, were enrolled for the study. All of them received ospemifene 60 mg for 12 weeks because of concomitant VVA. We performed a clinical examination, a 3-day voiding diary, ultrasound examination of bladder wall thickness (BWT), and evaluation by Visual Analogic Scale (VAS) of vaginal dryness at baseline and at 12 weeks. We evaluated urinary symptoms and their impact on the quality of life with UDI-6 SF and OAB-Q (Qol, sf) questionnaires. RESULTS After 12 weeks of treatment, we observed a significant reduction in the daily (24 h) numbers of episodes of micturition, of nocturia, of urgency and of incontinence. We also found a significant reduction in BWT and vaginal dryness, together with an improvement of OAB-Q and UDI6 SF scores. Among patients who subjectively benefited from the treatment, we found a baseline lower prevalence of constipation and a higher degree of vaginal dryness. CONCLUSIONS Ospemifene might be a useful option for postmenopausal women with VVA and OAB symptoms, refractory to the first line of treatment with β3-agonists or antimuscarinic drugs, before considering invasive options.
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Affiliation(s)
- Lorenzo Novara
- Division of Gynecology and Obstetrics, Umberto I Hospital, Turin, Italy
| | | | - Matteo Mancarella
- Division of Gynecology and Obstetrics, Umberto I Hospital, Turin, Italy
| | - Roberto Capece
- Division of Gynecology and Obstetrics, Umberto I Hospital, Turin, Italy
| | - Elena Canale
- Division of Gynecology and Obstetrics, Umberto I Hospital, Turin, Italy
| | - Nicoletta Biglia
- Division of Gynecology and Obstetrics, Umberto I Hospital, Turin, Italy.
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Archer DF, Simon JA, Portman DJ, Goldstein SR, Goldstein I. Ospemifene for the treatment of menopausal vaginal dryness, a symptom of the genitourinary syndrome of menopause. Expert Rev Endocrinol Metab 2019; 14:301-314. [PMID: 31526199 DOI: 10.1080/17446651.2019.1657008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/14/2019] [Indexed: 01/31/2023]
Abstract
Introduction: Vulvovaginal atrophy (VVA), a component of the genitourinary syndrome of menopause, is a progressive condition due to decline in estrogen leading to vaginal and vulvar epithelial changes. Accompanying symptoms of dryness, irritation, burning, dysuria, and/or dyspareunia have a negative impact on quality of life. Ospemifene is a selective estrogen receptor modulator (SERM) approved by the FDA for moderate to severe dyspareunia and vaginal dryness due to postmenopausal VVA. Areas covered: PubMed was searched from inception to March 2019 with keywords ospemifene and vulvar vaginal atrophy to review preclinical and clinical data describing the safety and efficacy of ospemifene for vaginal dryness and dyspareunia due to VVA. Covered topics include efficacy of ospemifene on vaginal cell populations, vaginal pH, and most bothersome VVA symptoms; imaging studies of vulvar and vaginal tissues; effects on sexual function; and safety of ospemifene on endometrium, cardiovascular system, and breast. Expert opinion: Ospemifene is significantly more effective than placebo in all efficacy analyses studied, working through estrogen receptors and possibly androgen receptors. Safety as assessed by adverse events was generally comparable to that with placebo and to other SERMs, and/or adverse events were not clinically meaningful. No cases of endometrial or breast cancer were reported.
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Affiliation(s)
- David F Archer
- Clinical Research Center, Eastern Virginia Medical School , Norfolk , VA , USA
| | - James A Simon
- School of Medicine, and IntimMedicine Specialists, George Washington University , Washington , DC , USA
| | | | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine , New York , NY , USA
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Schiavi MC, Sciuga V, Giannini A, Vena F, D'oria O, Prata G, Di Tucci C, Savone D, Aleksa N, Capone C, Di Mascio D, Meggiorini ML, Monti M, Zullo MA, Muzii L, Benedetti Panici P. Overactive bladder syndrome treatment with ospemifene in menopausal patients with vulvovaginal atrophy: improvement of sexuality? Gynecol Endocrinol 2018; 34:666-669. [PMID: 29463148 DOI: 10.1080/09513590.2018.1441398] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The aim of this study was to assess the effectiveness of ospemifene in the improvement of sexual function in postmenopausal women with vulvovaginal atrophy (VVA) affected by overactive bladder syndrome (OAB) or urge urinary incontinence (UUI). One hundred five postmenopausal patients with VVA affected by OAB and/or UUI were enrolled for the study. All patients received ospemifene 60 mg for 12 weeks. Clinical examination, 3-d voiding diary and the vaginal health index (VHI) were performed at baseline and at 12 weeks. Patients completed the OAB-Q SF, FSFI, FSDS, and SF-36 questionnaires. The patient's satisfaction was also calculated. After 12 weeks, the reduction of urinary symptoms was observed. The OAB-Q symptoms, OAB-Q (HRQL) score were (55.34 ± 13.54 vs. 23.22 ± 9.76; p < .0001) and (22.45 ± 9.78 vs. 70.56 ± 15.49; p < .0001), before and after treatment. SF-36 questionnaire showed a significant improvement (p < .0001). VHI score increased and the women who regularly practice sexual activity increased after treatment. The total FSFI score increased significantly and the FSDS score changed after 12 weeks (p < .0001). The PGI-I after 12 weeks showed a total success rate of 90.5%. Ospemifene is an effective potential therapy for postmenopausal women with VVA affected by OAB or UUI improving sexual function and quality of life.
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Affiliation(s)
- Michele Carlo Schiavi
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Valentina Sciuga
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Andrea Giannini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Flaminia Vena
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Ottavia D'oria
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Giovanni Prata
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Chiara Di Tucci
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Delia Savone
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Natalia Aleksa
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Carmela Capone
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Daniele Di Mascio
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Maria Letizia Meggiorini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Marco Monti
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Marzio Angelo Zullo
- b Department of Surgery-Week Surgery, Campus Biomedico , University of Rome , Rome , Italy
| | - Ludovico Muzii
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Pierluigi Benedetti Panici
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
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Schiavi MC, Di Pinto A, Sciuga V, Faiano P, Di Tucci C, D'oria O, Martoccia A, Prata G, Carraro C, Ostuni R, Zullo MA, Muzii L, Benedetti Panici P. Prevention of recurrent lower urinary tract infections in postmenopausal women with genitourinary syndrome: outcome after 6 months of treatment with ospemifene. Gynecol Endocrinol 2018; 34:140-143. [PMID: 28853624 DOI: 10.1080/09513590.2017.1370645] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Aim of this study was to evaluate the efficacy of ospemifene in the prevention of recurrent lower urinary tract infections in postmenopausal women with vulvovaginal atrophy. The study have a retrospective design. Thirty-nine patients were enrolled. Patients underwent clinical examination and urine culture. The urinary symptoms and the quality of life were evaluated with UTISA score, PUF and SF-36 questionnaires before and after treatment. All 39 patients received ospemifene 60 mg one tablet/daily for 6 months. Adverse effects and complications were assessed. Thirty-nine patients were enrolled in the study. Two patients experienced one new UTI episode and the mean number of positive urine culture decreased significantly after 6 months (3.65 ± 2.12 vs 0.25 ± 0.17, p < .0001). The mean number of urinary infection symptoms decreased significantly after treatment; dysuria reduced (4.76 ± 2.45 vs 0.89 ± 1.12). PUF score and SF-36 showed a statistically significant change (22.43 ± 5.89 vs 12.14 ± 3.21) and (52.86 ± 9.21 vs 83.43 ± 10.76). No adverse effects were reported and the total success rate was the 92.3% after 6 months at PGI-I. Ospemifene is a valid alternative with excellent tolerability for the UTIS prevention in postmenopausal patients.
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Affiliation(s)
- Michele Carlo Schiavi
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Anna Di Pinto
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Valentina Sciuga
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Pierangelo Faiano
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Chiara Di Tucci
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Ottavia D'oria
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Angela Martoccia
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Giovanni Prata
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Carlo Carraro
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Rosa Ostuni
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Marzio Angelo Zullo
- b Department of Surgery-Week Surgery , University of Rome "Campus Biomedico" , Rome , Italy
| | - Ludovico Muzii
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Pierluigi Benedetti Panici
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
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Schiavi MC, Faiano P, D'Oria O, Zullo MA, Muzii L, Benedetti Panici P. Efficacy and tolerability of treatment with mirabegron compared with solifenacin in the management of overactive bladder syndrome: A retrospective analysis. J Obstet Gynaecol Res 2017; 44:524-531. [PMID: 29271106 DOI: 10.1111/jog.13541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to compare the efficacy and tolerability of solifenacin and mirabegron in patients with overactive bladder (OAB) syndrome. METHODS We carried out a retrospective analysis in 342 women affected by OAB syndrome; 168 were treated with solifenacin 5 mg/daily and 174 with mirabegron 50 mg/daily. A clinical evaluation, 3-day voiding diary, and urodynamic testing was performed. Patients completed the Overactive Bladder Questionnaire - Short Form, the King's Health Questionnaire, and the Patient Global Impression of Improvement questionnaire. The adverse effects were evaluated. The two groups were compared at baseline and at 12 weeks. RESULTS After 12 weeks, a significant reduction in the mean number/24 h of voids and urgent micturition episodes/24 h was observed in both groups. Detrusor overactivity decreased from 58.3% to 13.1% in the solifenacin group and from 58% to 11% in the mirabegron group. Twenty (12%) and 18 (10.7%) patients taking solifenacin reported constipation and dry mouth, respectively, versus four (2.3%) and five (2.9%) patients taking mirabegron, respectively, but there was no difference between the groups in the change in vital signs. The Overactive Bladder Questionnaire - Short Form and King's Health Questionnaire scores did not demonstrate significant differences and the abandonment rates in the solifenacin and mirabegron groups were 25.5% and 20%, respectively. CONCLUSION Solifenacin and mirabegron showed the same efficacy in the treatment of OAB but solifenacin had more adverse effects.
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Affiliation(s)
- Michele C Schiavi
- Department of Gynecological-Obstetric Sciences and Urological Sciences, University of Rome "Sapienza," Umberto I Hospital, Rome, Italy
| | - Pierangelo Faiano
- Department of Gynecological-Obstetric Sciences and Urological Sciences, University of Rome "Sapienza," Umberto I Hospital, Rome, Italy
| | - Ottavia D'Oria
- Department of Gynecological-Obstetric Sciences and Urological Sciences, University of Rome "Sapienza," Umberto I Hospital, Rome, Italy
| | - Marzio A Zullo
- Department of Surgery - Week-Surgery Campus Biomedico, University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological-Obstetric Sciences and Urological Sciences, University of Rome "Sapienza," Umberto I Hospital, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological-Obstetric Sciences and Urological Sciences, University of Rome "Sapienza," Umberto I Hospital, Rome, Italy
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