1
|
European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. Eur Urol 2022; 82:49-59. [PMID: 35216856 DOI: 10.1016/j.eururo.2022.01.045] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guideline expands the remit to include these symptoms and conditions. OBJECTIVE To summarise the diagnostic section of the non-neurogenic female LUTS guideline and the management of female overactive bladder (OAB), stress urinary incontinence (SUI), and mixed urinary incontinence (MUI). EVIDENCE ACQUISITION New literature searches were carried out in September 2021 and evidence synthesis was conducted using the modified GRADE criteria as outlined for all EAU guidelines. A new systematic review (SR) on OAB was carried out by the panel for the purposes of this guideline. EVIDENCE SYNTHESIS The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. CONCLUSIONS Non-neurogenic female LUTS are an important cause of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion based on the best available evidence. This guideline serves to present this evidence to health care providers in an easily accessible and digestible format. PATIENT SUMMARY This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to diagnosis of these conditions, as well as the treatment of overactive bladder, stress urinary incontinence, and mixed urinary incontinence.
Collapse
|
2
|
Phé V, Gamé X. Évaluation d’un syndrome clinique d’hyperactivité vésicale non neurologique. Prog Urol 2020; 30:895-903. [DOI: 10.1016/j.purol.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
|
3
|
Ptashnyk T, Hatzinger M, Zeller FL, Kirschner-Hermanns R. Overactive bladder syndrome - focus onto detrusor overactivity. Scand J Urol 2020; 55:56-60. [PMID: 33118417 DOI: 10.1080/21681805.2020.1839130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To determine in patients with overactive bladder (OAB), urodynamic differences as well to compare the characteristics of patient's, with presence of detrusor overactivity on urodynamics with those with absence of detrusor overactivity. METHODS Taking into account the urodynamic findings, the patients with OAB symptoms were categorized into one of two groups: group 1 (with detrusor overactivity) or group 2 (without detrusor overactivity), and comparative analyses for both groups were performed (epidemiological data, patient history, urodynamic criteria, bladder diaries, IC-OAB, IC-OABqol - questionnaires). RESULTS There was a significant difference in age as well in the disease duration between group 1 and group 2. Although the mean number of micturitions and nocturia episodes was comparable, the numbers of urgency episodes differed significantly. The number of 'wet' patients was significantly higher in the group 1 with the significantly higher number of incontinence episodes. Group 1 demonstrated higher OAB symptom scores and higher impact on the patients' quality of life. CONCLUSIONS More than half of the patients complaining of urgency-frequency do not have detrusor overactivity upon urodynamic testing, and only half have detrusor overactivity that correlates with urge perception. The patients with no detrusor overactivity appear to be significantly younger and have fewer symptoms, with a less pronounced impact on quality of life. They also have significantly higher maximal bladder capacity. This data supports the hypothesis that both conditions are different phases (early and late) of the same pathological state, or may be two different subtypes of OAB.
Collapse
Affiliation(s)
- Taras Ptashnyk
- Department of Urology, Diakonissen Hospital, Mannheim, Germany
| | | | - Federico L Zeller
- Clinic of Urology/Neuro-Urology, University Clinic Rheinischen Friedrich-Wilhelms Universität Bonn and Neurologisches Rehabilitationszentrum Godeshoehe e.V. Bonn, Bonn, Germany
| | - Ruth Kirschner-Hermanns
- Clinic of Urology/Neuro-Urology, University Clinic Rheinischen Friedrich-Wilhelms Universität Bonn and Neurologisches Rehabilitationszentrum Godeshoehe e.V. Bonn, Bonn, Germany
| |
Collapse
|
4
|
The Role of Urodynamic Testing Prior to Third-Line OAB Therapy. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
5
|
Serati M, Cantaluppi S, Coluccia AC, Scancarello C, Cimmino C, Braga A, Salvatore S, Finazzi Agrò E, Ghezzi F. Is urodynamic evaluation able to change and improve the management of women with idiopathic overactive bladder? Minerva Urol Nephrol 2020; 73:823-830. [PMID: 32573171 DOI: 10.23736/s2724-6051.20.03801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND For women with overactive bladder (OAB), current guidelines recommend the use of urodynamic studies (UDS) only in complicated cases. This study aimed to investigate whether UDS can also be helpful in uncomplicated cases. Specific aims of the study were: 1) to evaluate objective benefit and subjective patient satisfaction with tailored treatment based on the UDS diagnosis compared to the outcomes of the pharmacological treatment only based on the symptoms; 2) to investigate the correlation between symptoms and UDS findings in women with uncomplicated idiopathic OAB symptoms; 3) to assess the ability of UDS to modify management decisions in these patients. METHODS Women presenting to our clinic with a history of uncomplicated OAB symptoms for the past three months or more, and who completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), were considered for this study. We proposed UDS to all participants. In women who accepted UDS (group 1), management decisions were made on the basis of urodynamic findings and post-treatment evaluation was scheduled at three months. The outcomes of treatments in these patients were compared to the results in women who did not accept UDS and who received pharmacological treatment symptoms-based (group 2). Objective outcomes were based on completion of a 3-day micturition diary. Subjective outcomes were captured using the Overactive Bladder Questionnaire Short Form (OABq-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a patient satisfaction scale. RESULTS A total of 680 women were enrolled in the study; 478 underwent UDS and 202, at the contrary, declined UDS. In 53.6% of cases, UDS led to modification of the proposed management approach. At the 3-month follow-up, the overall patient satisfaction rate in group 1 and group 2 was 77% and 65.8%, respectively (P=0.003). CONCLUSIONS We showed that OAB management tailored according to the UDS diagnosis results in higher subjective satisfaction if compared with a pharmacological treatment symptoms-based. Our study confirmed a lack of correlation between OAB symptoms and the urodynamically proven diagnosis of detrusor overactivity (DO). It also suggested that UDS can determine the underlying pathophysiology of every woman with OAB syndrome, whether complicated or uncomplicated, allowing treatment to be appropriately tailored with better results.
Collapse
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Simona Cantaluppi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Anna C Coluccia
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Chiara Cimmino
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Stefano Salvatore
- Unit of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Unit of Urology, Tor Vergata University Hospital, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| |
Collapse
|
6
|
Serati M, Iacovelli V, Cantaluppi S, Braga A, Balzarro M, Pletto S, Soligo M, Finazzi Agrò E. Impact of urodynamic evaluation on the treatment of women with idiopathic overactive bladder: a systematic review. MINERVA UROL NEFROL 2020; 72:420-426. [PMID: 32026667 DOI: 10.23736/s0393-2249.20.03685-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a common clinical condition affecting women. The impact of urodynamics (UDS) on the management of idiopathic OAB in women is highly debated. This systematic review analyzes the impact of UDS on the choice and on the outcomes of treatment of female idiopathic OAB. EVIDENCE ACQUISITION A systematic literature search in the PubMed/Medline, Web of Science, Scopus and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement to identify clinical trials, randomized controlled trials, meta-analyses, and guidelines on female OAB and UDS published from 2000. A total of 1554 records were initially identified and 12 articles were included in the final qualitative synthesis. EVIDENCE SYNTHESIS UDS represents the main tool to diagnose detrusor overactivity (DO) in OAB female patients which is considered one of the major OAB underlying pathophysiology factor. UDS can underline the presence of voiding dysfunction that could be considered as another underlying cause of uncomplicated female OAB. On the basis of this urodynamic findings, we can better define different aspects of OAB syndrome leading to a more tailored and proper treatment. CONCLUSIONS UDS can have a useful role in the diagnosis of idiopathic OAB in women given the possibility to gain a precise diagnosis and, therefore, a tailored treatment based on the underlying cause. The integration of clinics with UDS and all the other diagnostic available tools is desirable.
Collapse
Affiliation(s)
- Maurizio Serati
- Unit of Urogynecology, Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy -
| | - Valerio Iacovelli
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy.,San Carlo di Nancy General Hospital, Rome, Italy
| | - Simona Cantaluppi
- Unit of Urogynecology, Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, Beata Vergine Hospital, Mendrisio, Switzerland
| | | | - Simone Pletto
- School of Specialization in Urology, Tor Vergata University, Rome, Italy
| | - Marco Soligo
- Department of Obstetrics and Gynecology, Buzzi Hospital - ASST FBF Sacco, University of Milan, Milan, Italy
| | - Enrico Finazzi Agrò
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy
| |
Collapse
|
7
|
Brière R, Versi E, Richard PO, Gratton M, Tu LM. A Preliminary Study on the Impact of Detrusor Overactivity on the Efficacy of Selective Bladder Denervation for the Treatment of Female Refractory Overactive Bladder. Urology 2019; 136:88-94. [PMID: 31794815 DOI: 10.1016/j.urology.2019.08.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether the presence of detrusor overactivity (DO) is associated with the 12-week and 12-month clinical outcomes of selective bladder denervation (SBD) in women with refractory overactive bladder (OAB). METHODS Prospective single institutional study of refractory OAB females who underwent a urodynamic study and were categorized according to DO status (DO- vs DO+) prior to receiving SBD. RESULTS Among the 23 patients, 10 were DO- and 13 were DO+. Both groups reported improvement at 12 weeks on the 24-hour pad weight test, in urgency urinary incontinence (UUI) and urgency. At 12 months, both groups still reported improvement in urgency, but only the DO- group reported reduction on the pad weight test and only the DO+ group maintained improvement in the UUI rate. Clinical success (≥50% reduction in UUI) was achieved by all DO- and by 69% of DO+ patients at 12 weeks, and by 60% of DO- and 92% of DO+ patients at 12 months. Treatment benefit (Treatment Benefit Scale ≤2) was reported in 90% of DO- and 85% of DO+ patients at 12 weeks, and in 60% of DO- and 85% of DO+ patients at 12 months. When directly comparing both group outcomes, the only significant difference was the greater reduction of UUI in the DO- group at 12 weeks (-9.0 vs -6.5; P = .045). CONCLUSION Refractory OAB females appear to be effectively treated by SBD regardless of baseline DO status. DO status does not seem to be associated with the 12-week and 12-month outcomes of SBD.
Collapse
Affiliation(s)
| | - Eboo Versi
- Department of Obstetrics, Gynecology, Reproductive Sciences, Rutgers, New Brunswick, NJ
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Faculty of Medicine and Health Sciences, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Matthieu Gratton
- Division of Urology, Department of Surgery, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Le Mai Tu
- Division of Urology, Department of Surgery, Faculty of Medicine and Health Sciences, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, Québec, Canada.
| |
Collapse
|
8
|
Jiménez-Cidre M, López-Fando L, Mora A. Clinical and urodynamic impact of detrusor overactivity in women with overactive bladder. Actas Urol Esp 2019; 43:221-227. [PMID: 30862379 DOI: 10.1016/j.acuro.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/17/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the clinical and urodynamic differences (associated with the presence or absence of detrusor overactivity [DO]) in women with overactive bladder (OAB) referred to Functional Urology and Urodynamic Units in Spain. MATERIAL AND METHODS Observational, cross-sectional, multicenter and prospective study conducted in Spain in women with clinical diagnosis of OAB, who had been referred to urodynamic study (UDS) of which centralized reading was performed. Patients completed the 3-day voiding diary (DM3d) with the PPIUS scale (Patient Perception of Intensity of Urgency Scale), the B-SAQ (Bladder Self-Assessment Questionnaire) and the OABq-SF (Overactive Bladder Questionnaire Short Form). The questionnaires and UDS variables of women with OAV, with or without DO, were compared using the Mann-Whitney test (continuous variables) and the chi-square test (χ2) (categorical variables). RESULTS A total of 247 women with OAB were evaluated, and 103 of them had DO. According to the presence or absence of DO, significant differences were observed in the number of episodes of urge urinary incontinence (UUI), urinary frequency, nocturia, mean micturition volume and number of pads (P<.05 for all comparisons). A higher percentage of patients with OAB and DO presented reduced bladder capacity, urgency, urge urinary incontinence (UUI) and lower volume for first voiding desire, strong desire to void and maximum cystomanometric capacity in UDS compared with patients without DO (P<.05 for all comparisons). The only significant differences between both groups were regarding the B-SAQ symptoms scale (P=.011). CONCLUSIONS The presence of DO in women with OAB is related to a more severe alteration of the bladder filling phase.
Collapse
|
9
|
|
10
|
Schneider MP, Tubaro A, Burkhard FC. Does Urodynamics Impact the Outcomes of Third-line Therapy of Refractory OAB (or Refractory Urgency Urinary Incontinence)? CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0480-5] [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]
|
11
|
Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A, Bedretdinova DA, Ambühl D, Farag F, Lombardo R, Schneider MP, Burkhard FC. EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence. Eur Urol 2018; 73:596-609. [PMID: 29398262 DOI: 10.1016/j.eururo.2017.12.031] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/27/2017] [Indexed: 11/28/2022]
Abstract
CONTEXT The European Association of Urology guidelines on urinary incontinence (UI) have been updated in cyclical fashion with successive major chapters being revised each year. The sections on assessment, diagnosis, and nonsurgical treatment have been updated as of mid-2016. OBJECTIVE We present a condensed version of the full guideline on assessment and nonsurgical management of UI, with the aim of improving accessibility and increasing their dissemination. EVIDENCE ACQUISITION Our literature search was updated from the previous cut-off of July 2010 up to April 2016. Evidence synthesis was carried out by a pragmatic review of current systematic reviews and any newer subsequent high-quality studies, based on Population, Interevention, Comparator, and Outcome questions. Appraisal was conducted by an international panel of experts, working on a strictly nonprofit and voluntary basis, to develop concise evidence statements and action-based recommendations using modified Oxford and GRADE criteria. EVIDENCE SYNTHESIS The guidelines include algorithms that summarise the suggested pathway for standard, uncomplicated patients with UI and are more useable in daily practice. The full version of the guideline is available at http://uroweb.org/guideline/urinary-incontinence/. CONCLUSIONS These updated guidelines provide an evidence-based summary of the assessment and nonsurgical management of UI, together with a clear clinical algorithm and action-based recommendations. Although these guidelines are applicable to a standard patient, it must be remembered that therapy should always be tailored to individual patients' needs and circumstances. PATIENT SUMMARY Urinary incontinence is a very common condition which negatively impacts patient's quality of life. Several types of incontinence exist and since the treatments will vary, it is important that the diagnostic evaluation establishes which type is present. The diagnosis should also identify patients who need rapid referral to an appropriate specialist. These guidelines aim to provide sensible and practical evidence-based guidance on the clinical problem of urinary incontinence.
Collapse
Affiliation(s)
- Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK.
| | - Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Francisco Cruz
- Department of Urology, Hospital São João/Faculty of Medicine of Porto, Porto, Portugal
| | - Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Centre, TX, USA
| | - Nikesh Thiruchelvam
- Urology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Andrea Tubaro
- Department of Urology, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | | | - David Ambühl
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Riccardo Lombardo
- Department of Urology, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Marc P Schneider
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Fiona C Burkhard
- Department of Urology, University Hospital Bern, Bern, Switzerland
| |
Collapse
|
12
|
Bray R, Cacciatore S, Jiménez B, Cartwright R, Digesu A, Fernando R, Holmes E, Nicholson JK, Bennett PR, MacIntyre DA, Khullar V. Urinary Metabolic Phenotyping of Women with Lower Urinary Tract Symptoms. J Proteome Res 2017; 16:4208-4216. [PMID: 28937771 DOI: 10.1021/acs.jproteome.7b00568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lower urinary tract symptoms (LUTS), including urinary incontinence, urgency and nocturia, affect approximately half of women worldwide. Current diagnostic methods for LUTS are invasive and costly, while available treatments are limited by side effects leading to poor patient compliance. In this study, we aimed to identify urine metabolic signatures associated with LUTS using proton nuclear magnetic resonance (1H NMR) spectroscopy. A total of 214 urine samples were collected from women attending tertiary urogynecology clinics (cases; n = 176) and healthy control women attending general gynecology clinics (n = 36). Despite high variation in the urine metabolome across the cohort, associations between urine metabolic profiles and BMI, parity, overactive bladder syndrome, frequency, straining, and bladder storage were identified using KODAMA (knowledge discovery by accuracy maximization). Four distinct urinary metabotypes were identified, one of which was associated with increased urinary frequency and low BMI. Urine from these patients was characterized by increased levels of isoleucine and decreased levels of hippurate. Our study suggests that metabolic profiling of urine samples from LUTS patients offers the potential to identify differences in underlying etiology, which may permit stratification of patient populations and the design of more personalized treatment strategies.
Collapse
Affiliation(s)
- Rhiannon Bray
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | | | - Beatriz Jiménez
- Imperial Clinical Phenotyping Centre, QEQM Building, Imperial College London, Saint Mary's Hospital , London W21NY, U.K
| | - Rufus Cartwright
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | - Alex Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | - Ruwan Fernando
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | | | | | - Phillip R Bennett
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust , London W12 0HS, U.K
| | | | - Vik Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| |
Collapse
|
13
|
Corcos J, Przydacz M, Campeau L, Witten J, Hickling D, Honeine C, Radomski SB, Stothers L, Wagg A. CUA guideline on adult overactive bladder. Can Urol Assoc J 2017; 11:E142-E173. [PMID: 28503229 PMCID: PMC5426936 DOI: 10.5489/cuaj.4586] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christiane Honeine
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sidney B. Radomski
- Division of Urology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Lynn Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
14
|
Cho KJ, Kim HS, Koh JS, Kim JC. Evaluation of female overactive bladder using urodynamics: relationship with female voiding dysfunction. Int Braz J Urol 2016; 41:722-8. [PMID: 26401865 PMCID: PMC4757001 DOI: 10.1590/s1677-5538.ibju.2014.0195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/16/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose: To investigate the role of urodynamic study (UDS) in female patients with overactive bladder (OAB) analyzing the relationship between OAB symptoms and female voiding dysfunction (FVD). Materials and Methods: We analyzed the clinical and urodynamic data of 163 women with OAB symptoms. OAB symptoms were categorized as dry and wet. FVD was described as detrusor underactivity (DUA), which was defined as a maximum flow rate (Qmax) of ≤15mL/s associated with a detrusor pressure at Qmax (PdetQmax) of ≤20cmH2O, along with bladder outlet obstruction (BOO), which was defined as a Qmax of ≤15mL/s with a PdetQmax of >20cmH2O. Clinical and urodynamic results were compared between patients with dry and wet symptoms and between those with and without FVD. Results: 78 (47.9%) had dry, and 85 (52.1%) had wet symptoms. The entire group had a relatively low Qmax (15.1±6.6mL/s) and relatively high number of BOO (42.9%, 70/163) and DUA (8.6%, 14/163). A significantly higher number of patients with wet symptoms had detrusor overactivity compared to those with dry, as detected by the UDS (p<0.05). No significant differences were found in BOO and DUA number between dry and wet groups. Further, the international prostate symptom score did not different significantly between patients with and without FVD. Conclusion: A significant number of women with OAB had voiding dysfunction. However, the OAB symptoms themselves were not useful for predicting the presence of FVD. Therefore, UDS may be necessary for accurate diagnosis in women with OAB symptoms.
Collapse
Affiliation(s)
- Kang Jun Cho
- Department of Urology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Hyo Sin Kim
- Department of Urology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Jun Sung Koh
- Department of Urology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Joon Chul Kim
- Department of Urology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| |
Collapse
|
15
|
Basu M, Balachandran A, Duckett J. Is pretreatment cystometry important in predicting response to mirabegron in women with overactive bladder symptoms? Int Urogynecol J 2016; 27:427-31. [PMID: 26282091 DOI: 10.1007/s00192-015-2809-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/20/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to evaluate for any association between pretreatment cystometry results and outcome of treatment with mirabegron in women with overactive bladder (OAB) symptoms. METHODS This was a prospective observational study of women with OAB symptoms that proved refractory to conservative management. All women underwent filling and voiding subtraction cystometry prior to further treatment. Women were treated with mirabegron 50 mg once daily, and outcomes were evaluated after 6 weeks' treatment. The primary outcome measure was change in symptoms as indicated by response to the Patient Global Impression of Improvement (PGI-I) scale. The presence of detrusor overactivity (DO), the highest detrusor pressure recorded during the filling phase, the presence of urodynamic stress incontinence (USI), cystometric capacity, voided volume, maximum flow rate and detrusor pressure at maximum flow were all compared between responders and nonresponders. RESULTS The study population consisted of 169 women; response rate to mirabegron was 69.8 %. There was no association between the presence of DO or maximum detrusor pressure during filling and USI, cystometric capacity, maximum flow rate and detrusor pressure at maximum flow and treatment response. In a subgroup with OAB symptoms refractory to previous treatment with antimuscarinics, there was an association between the presence of DO and a positive treatment response (p = 0.02). CONCLUSIONS Overall, there is no association between urodynamic findings and response to treatment with mirabegron. This may reflect the fact that mirabegron's mode of action mechanisms are not measurable using cystometry. In women with refractory symptoms, however, the presence of DO is associated with a positive response to treatment.
Collapse
Affiliation(s)
- Maya Basu
- Department of Urogynaecology, Medway Maritime Hospital, Windmill Road, , Gillingham, Kent, ME7 5NY, UK.
| | - Aswini Balachandran
- Department of Urogynaecology, Medway Maritime Hospital, Windmill Road, , Gillingham, Kent, ME7 5NY, UK
| | - Jonathan Duckett
- Department of Urogynaecology, Medway Maritime Hospital, Windmill Road, , Gillingham, Kent, ME7 5NY, UK
| |
Collapse
|
16
|
Truzzi JC, Gomes CM, Bezerra CA, Plata IM, Campos J, Garrido GL, Almeida FG, Averbeck MA, Fornari A, Salazar A, Dell’Oro A, Cintra C, Sacomani CAR, Tapia JP, Brambila E, Longo EM, Rocha FT, Coutinho F, Favre G, Garcia JA, Castaño J, Reyes M, Leyton RE, Ferreira RS, Duran S, López V, Reges R. Overactive bladder - 18 years - Part II. Int Braz J Urol 2016; 42:199-214. [PMID: 27176185 PMCID: PMC4871379 DOI: 10.1590/s1677-5538.ibju.2015.0367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/09/2015] [Indexed: 12/25/2022] Open
Abstract
Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.
Collapse
Affiliation(s)
- Jose Carlos Truzzi
- Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo, SP, Brasil
| | | | | | | | - Jose Campos
- Departamento de Urología, Escuela Médico Militar, Cidade do México, Mexico
| | - Gustavo Luis Garrido
- Cátedra de Urologia, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Fernando G. Almeida
- Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo, SP, Brasil
| | | | - Alexandre Fornari
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - Anibal Salazar
- Departamento de Urologia, AC Camargo Hospital, SP, Brasil
| | - Arturo Dell’Oro
- Hospital Clinico de la Fuerza Area de Chile, Santiago, Chile
| | - Caio Cintra
- Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasi
| | | | | | | | - Emilio Miguel Longo
- Servicio de Urología, del Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina
| | | | | | - Gabriel Favre
- Centro Policlínico Valencia “La Viña”, Valencia, Venezuela
| | | | | | - Miguel Reyes
- Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil
| | | | | | - Sergio Duran
- Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil
| | - Vanda López
- Servicio de Urología, del Hospital Universitario de Caracas, Caracas, Venezuela
| | - Ricardo Reges
- Divisão de Urologia, Universidade Federal do Ceará, CE, Brasil
| |
Collapse
|
17
|
Futyma K, Nowakowski Ł, Bogusiewicz M, Ziętek A, Wieczorek AP, Rechberger T. Use of uroflow parameters in diagnosing an overactive bladder-Back to the drawing board. Neurourol Urodyn 2015; 36:198-202. [PMID: 26451870 DOI: 10.1002/nau.22898] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/15/2015] [Indexed: 02/03/2023]
Abstract
AIMS The aim of our study was to analyze whether uroflowmetry parameters are helpful in diagnosing overactive bladder (OAB). The working hypothesis was that the flow curves of patients with OAB symptoms would appear as a sharp peak flow rate with a short duration and high amplitude, lasting only for a short period during urgency sensation, followed by reduced urine flow. We introduced a new parameter called flow index (FI) defined as an average divided by maximal urine flow rates as a potential marker for diagnosing OAB. METHODS We conducted a retrospective study analyzing 757 urodynamic studies performed in women with lower urinary tract symptoms between 2007-2014. Based on subjective clinical symptoms patients were divided into four groups (pure OAB, mixed urinary incontinence with predominant OAB [MUI-OAB], mixed urinary incontinence with predominant SUI [MUI-SUI], and pure SUI patients). RESULTS When comparing FI between pure OAB and pure SUI patients, a strong statistically significant difference was found (mean 0.45 ± 0.08 vs. 0.53 ± 0.09, respectively; P < 0.001). Similar results were found when comparing the patients with pure OAB and MUI-OAB versus patients with pure SUI and MUI-SUI (mean 0.47 ± 0.11 vs. 0.53 ± 0.09, respectively; P < 0.001). On the other hand, we did not find a statistically significant difference in the FI value between mixed urinary incontinence where SUI is the predominant factor and pure SUI groups (median 0.51 ± 0.09 vs. 0.53 ± 0.09, respectively; P > 0.5). CONCLUSIONS FI may be used as an additional marker for OAB diagnosis. Neurourol. Urodynam. 36:198-202, 2017. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Konrad Futyma
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Nowakowski
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Michał Bogusiewicz
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Alicja Ziętek
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Andrzej P Wieczorek
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Rechberger
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
18
|
Chapple C, Oelke M, Kaplan SA, Scholfield D, Arumi D, Wagg AS. Fesoterodine clinical efficacy and safety for the treatment of overactive bladder in relation to patient profiles: a systematic review. Curr Med Res Opin 2015; 31:1201-43. [PMID: 25798911 DOI: 10.1185/03007995.2015.1032917] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To summarize published evidence on the pharmacology, efficacy, and safety of fesoterodine for the treatment of overactive bladder (OAB) symptoms in relation to patient clinical and demographic profiles. METHODS A systematic review of published articles on fesoterodine was conducted via a PubMed search. Articles were identified using the search term fesoterodine, with limits of human species and abstract available. Review and meta-analysis articles, validation studies, articles focused on treatment compliance/adherence, meeting abstracts, and articles not focused on oral fesoterodine administration in human subjects were excluded. Data from retained articles were summarized descriptively. RESULTS Of 137 articles identified, 61 (15 articles on the pharmacology and 46 articles on the efficacy and/or safety of fesoterodine) met inclusion criteria. Superiority trials demonstrated the additional efficacy of fesoterodine 8 mg versus fesoterodine 4 mg and tolterodine extended release 4 mg in treating OAB. Prospective trials in specific patient populations indicated beneficial effects of fesoterodine in elderly patients, vulnerable elderly patients, patients dissatisfied with or with a suboptimal response to previous antimuscarinic therapy, patients with urge urinary incontinence (UUI) or nocturnal urgency, and men with persistent LUTS during alpha-blocker treatment. With two effective doses, the fesoterodine dose can be adjusted to achieve optimal efficacy and tolerability in individual patients. The most common adverse events during fesoterodine treatment are dry mouth and constipation. CONCLUSIONS Extensive evidence demonstrates the efficacy and safety of fesoterodine in relieving OAB symptoms, including urgency, urinary frequency, UUI, and nocturnal urgency, in patients with various clinical and demographic profiles. Trial results provide valuable information on fesoterodine treatment in specific patient populations, including both elderly and vulnerable elderly patients. Potential limitations of this review are that only English language articles in PubMed were searched and included.
Collapse
|
19
|
Urodynamics in the Elderly. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-014-0115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
20
|
Hanna-Mitchell AT, Kashyap M, Chan WV, Andersson KE, Tannenbaum C. Pathophysiology of idiopathic overactive bladder and the success of treatment: a systematic review from ICI-RS 2013. Neurourol Urodyn 2014; 33:611-7. [PMID: 24844598 DOI: 10.1002/nau.22582] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/10/2014] [Indexed: 12/11/2022]
Abstract
AIMS To investigate the frequency of phenotype profiling of patients with idiopathic overactive bladder (OAB) syndrome, and to determine the effectiveness of treatment among individuals with different pathophysiologic profiles. METHODS The electronic databases MEDLINE, EMBASE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and CINAHL were searched from January 1, 1980 to August 12, 2013 for interventional randomized controlled treatment trials (RCTs) of idiopathic OAB. Phenotying for pathophysiologies originating in the urothelial/mucosal layer of the bladder, the detrusor muscle cell layer, and the central nervous system were sought. Articles that analyzed urgency outcomes based on pathophysiologic profiling were selected. Due to the heterogeneity of the included interventions and outcome assessment measures, meta-analysis was not appropriate and a qualitative synthesis was undertaken. RESULTS Of 239 original RCTs of idiopathic OAB, 48 (20%) profiled participants on underlying pathophysiology. Less than half of these (n = 20) reported treatment efficacy for urgency symptoms by pathophysiological sub-type. One examined the effect of botulinum A toxin on interstitial cell protein expression. Four compared treatment efficacy in OAB patients with and without involuntary detrusor contractions. Fifteen compared the effect of treatment on urgency reduction in patients with detrusor overactivity. There were no consistent trends in treatment efficacy according to pathophysiologic sub-type. No studies examined urothelial dysfunction or abnormal central processing of bladder afferent signaling in response to treatment. CONCLUSIONS In order to advance the field of idiopathic OAB, more trials are needed that profile and test urgency outcomes in participants according to suspected underlying pathophysiology. Neurourol. Urodynam. 33:611-617, 2014. © 2014 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ann T Hanna-Mitchell
- University Hospitals Case Medical Center and Department of Urology, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | | | | |
Collapse
|
21
|
Rantell A, Cardozo L, Srikrishna S. Fesoterodine fumarate and the oxybutynin ring for the treatment of urinary incontinence in women. Expert Opin Pharmacother 2013; 15:385-93. [PMID: 24369895 DOI: 10.1517/14656566.2014.875158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Urinary incontinence (UI) is a prevalent condition among women of all ages. It can have a significant negative impact on women's quality of life causing not only physical but also psychological distress. AREAS COVERED This article aims to provide a review of the pharmacology, efficacy, safety and tolerability of fesoterodine fumarate (the newest anticholinergic launched in the UK) and the oxybutynin vaginal ring (the newest route of drug delivery in development) in the treatment of urgency UI. EXPERT OPINION Fesoterodine is now a well-established treatment option; however, as with all oral anticholinergic agents its use is hindered by side effects. The efficacy of the oxybutynin ring has only been demonstrated in small studies. Larger clinical trials assessing the efficacy, tolerability and acceptability are required before appropriate recommendations can be made.
Collapse
Affiliation(s)
- Angie Rantell
- King's College Hospital , Denmark Hill, London, SE5 9RS , UK +0203 299 3568 ; +0203 299 3449 ;
| | | | | |
Collapse
|
22
|
Maman K, Aballea S, Nazir J, Desroziers K, Neine ME, Siddiqui E, Odeyemi I, Hakimi Z. Comparative efficacy and safety of medical treatments for the management of overactive bladder: a systematic literature review and mixed treatment comparison. Eur Urol 2013; 65:755-65. [PMID: 24275310 DOI: 10.1016/j.eururo.2013.11.010] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/07/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Overactive bladder (OAB) treatment guidelines recommend antimuscarinics as first-line pharmacologic therapy. Mirabegron is a first-in-class β3-adrenoceptor agonist licensed for the treatment of OAB and has shown to be well tolerated and effective in the treatment of OAB symptoms. OBJECTIVE To assess the relative efficacy and tolerability of OAB medications, specifically mirabegron 50 mg versus antimuscarinics in patients with OAB. EVIDENCE ACQUISITION A systematic literature search was performed on published peer-reviewed articles from 2000 to 2013. This review included randomised controlled trials (RCTs) studying changes in symptoms (micturition frequency, incontinence, and urgency urinary incontinence [UUI] episodes) and incidence of the most frequently reported adverse events (dry mouth, constipation) associated with current OAB medications. The following drugs were considered in addition to mirabegron: darifenacin, tolterodine immediate release (IR) and extended release (ER), oxybutynin IR/ER, trospium, solifenacin, and fesoterodine. Bayesian mixed treatment comparisons (MTCs) were performed for efficacy (micturition, incontinence, UUI) and tolerability (dry mouth, constipation, blurred vision). EVIDENCE SYNTHESIS Overall, 44 RCTs involving 27,309 patients were included. The MTCs showed that mirabegron 50 mg was as efficacious as antimuscarinics in reducing the frequency of micturition incontinence and UUI episodes, with the exception of solifenacin 10 mg that was more efficacious than mirabegron 50 mg in improving micturition frequency and frequency of UUI. Mirabegron 50 mg had an incidence of dry mouth similar to placebo and significantly lower than all included antimuscarinics. CONCLUSIONS Mirabegron 50 mg had similar efficacy to most antimuscarinics and lower incidence of dry mouth, the most common adverse event reported with antimuscarinics and one of the main causes of discontinuation of treatment. Despite being a powerful tool for evidence-based health care evaluation, the Bayesian MTC method has limitations. Further head-to-head comparisons between mirabegron and antimuscarinics should be conducted to confirm our results.
Collapse
Affiliation(s)
| | | | | | | | | | - Emad Siddiqui
- Astellas Pharma Europe, Chertsey, UK; Department of Urology, Ealing Hospital, London, UK
| | | | - Zalmai Hakimi
- Astellas Pharma Global Development, Leiden, The Netherlands
| |
Collapse
|
23
|
Serati M, Braga A, Sorice P, Ghezzi F. Words of wisdom. Re: Is there a difference between women with or without detrusor overactivity complaining of symptoms of overactive bladder? Eur Urol 2013; 64:1016. [PMID: 24209451 DOI: 10.1016/j.eururo.2013.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
| | | | | | | |
Collapse
|
24
|
Silva-Ramos M, Silva I, Oliveira O, Ferreira S, Reis MJ, Oliveira JC, Correia-de-Sá P. Urinary ATP may be a dynamic biomarker of detrusor overactivity in women with overactive bladder syndrome. PLoS One 2013; 8:e64696. [PMID: 23741373 PMCID: PMC3669404 DOI: 10.1371/journal.pone.0064696] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 04/17/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Nowadays, there is a considerable bulk of evidence showing that ATP has a prominent role in the regulation of human urinary bladder function and in the pathophysiology of detrusor overactivity. ATP mediates nonadrenergic-noncholinergic detrusor contractions in overactive bladders. In vitro studies have demonstrated that uroepithelial cells and cholinergic nerves from overactive human bladder samples (OAB) release more ATP than controls. Here, we compared the urinary ATP concentration in samples collected non-invasively from OAB women with detrusor overactivity and age-matched controls. METHODS Patients with neurologic diseases, history of malignancy, urinary tract infections or renal impairment (creatinine clearance <70 ml/min) were excluded. All patients completed a 3-day voiding diary, a 24 h urine collection and blood sampling to evaluate creatinine clearance. Urine samples collected during voluntary voids were immediately freeze-preserved for ATP determination by the luciferin-luciferase bioluminescence assay; for comparison purposes, samples were also tested for urinary nerve growth factor (NGF) by ELISA. RESULTS The urinary content of ATP, but not of NGF, normalized to patients' urine creatinine levels (ATP/Cr) or urinary volume (ATP.Vol) were significantly (P<0.05) higher in OAB women with detrusor overactivity (n = 34) than in healthy controls (n = 30). Significant differences between the two groups were still observed by boosting urinary ATP/Cr content after water intake, but these were not detected for NGF/Cr. In OAB patients, urinary ATP/Cr levels correlated inversely with mean voided volumes determined in a 3-day voiding diary. CONCLUSION A high area under the receiver operator characteristics (ROC) curve (0.741; 95% CI 0.62-0.86; P<0.001) is consistent with urinary ATP/Cr being a highly sensitive dynamic biomarker for assessing detrusor overactivity in women with OAB syndrome.
Collapse
Affiliation(s)
- Miguel Silva-Ramos
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
- Serviço de Urologia - Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Isabel Silva
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
| | - Olga Oliveira
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
- Serviço de Urologia - Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Sónia Ferreira
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
- Serviço de Urologia - Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Maria Júlia Reis
- Serviço de Química Clínica - Centro Hospitalar do Porto (CHP), Porto, Portugal
| | | | - Paulo Correia-de-Sá
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
| |
Collapse
|
25
|
Giarenis I, Mastoroudes H, Srikrishna S, Robinson D, Cardozo L. Is there a difference between women with or without detrusor overactivity complaining of symptoms of overactive bladder? BJU Int 2013; 112:501-7. [DOI: 10.1111/j.1464-410x.2012.11652.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ilias Giarenis
- 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
| |
Collapse
|
26
|
Abstract
Overactive bladder is a symptom syndrome with urgency, frequency and, in many cases, nocturia. Urge incontinence is not present in all. There is no direct correlation with detrusor overactivity, an objective finding during urodynamic testing where involuntary contractions can be noticed. In the pathophysiology, much more attention has been given to the afferent/sensory arm of the micturition reflex in the last decade. Anatomical and infectious causes have to be diagnosed or ruled out. Diagnosis of overactive bladder is made mostly by history-taking, but other tests can be necessary in specific patients. Treatment consists of behavioral measures, a good explanation of the condition, training, and pelvic floor physiotherapy. Drugs are often used. Until recently, antimuscarinic drugs have been the mainstay of pharmacological therapy. Fesoterodine is a newer antimuscarinic agent which is more pharmacodynamically stable then tolterodine. Fesoterodine has been extensively researched using different dosages and compared with placebo and tolterodine, in different age groups, and under different conditions. Fesoterodine is superior to placebo and to tolterodine in the short term and long term. Its safety is very acceptable.
Collapse
|
27
|
Buser N, Ivic S, Kessler TM, Kessels AGH, Bachmann LM. Efficacy and adverse events of antimuscarinics for treating overactive bladder: network meta-analyses. Eur Urol 2012; 62:1040-60. [PMID: 22999811 DOI: 10.1016/j.eururo.2012.08.060] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/28/2012] [Indexed: 11/25/2022]
Abstract
CONTEXT Millions of people worldwide experience overactive bladder (OAB), and antimuscarinics are the pharmacologic treatment of choice. Several conventional meta-analyses have been published, but they fail to quantify efficacy and adverse events across drugs, dosages, formulations, and pharmaceutical forms. OBJECTIVE To perform two network meta-analyses summarizing the efficacy and adverse events of antimuscarinics in the treatment of OAB. EVIDENCE ACQUISITION Medline and Scopus searches, previous systematic reviews, conference abstracts, book chapters, and the reference lists of relevant articles were searched. Trialists were contacted. Eligible studies were randomized trials that compared at least one antimuscarinic for treating OAB with placebo or with another antimuscarinic, and that reported efficacy and/or adverse event outcomes. Efficacy was assessed for six outcomes (perception of cure or improvement, urgency episodes per 24h, leakage episodes per 24h, urgency incontinence episodes per 24h, micturitions per 24h, and nocturia episodes per 24h). Adverse events were assessed in seven categories according to the Common Terminology Criteria for Adverse Events. Across all outcomes, a summary efficacy and an adverse event score were computed. Two authors independently extracted data. EVIDENCE SYNTHESIS For the comparison of the efficacy, 76 trials enrolling 38 662 patients were included; for adverse events, 90 trials enrolling 39 919 patients were included. In the subset of studies reporting on treatments and dosages as used in clinical practice, 40 mg/d trospium chloride, 100mg/g per day oxybutynin topical gel, and 4 mg/d fesoterodine had the best efficacy, while higher dosages of orally administered oxybutynin and propiverine had the least favorable relationship of efficacy and adverse events. CONCLUSIONS This is the first study allowing trade-offs between efficacy and adverse events of various drugs and dosages in the treatment of patients with OAB. Differences among the various antimuscarinics call for careful, patient-centered management in which regimen changes should be considered.
Collapse
Affiliation(s)
- Nora Buser
- Horten Center, University of Zurich, Switzerland
| | | | | | | | | |
Collapse
|
28
|
Rutman MP, Cha DY, Blaivas JG. How do urodynamics findings influence the treatment of the typical patient with overactive bladder? Curr Urol Rep 2012; 13:370-8. [PMID: 22843014 DOI: 10.1007/s11934-012-0265-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Overactive bladder (OAB) is a clinical symptom complex whose hallmark is the symptom of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence. Historically, urodynamics (UDS) evaluation has not been recommended in the initial evaluation of OAB, since it is defined primarily by clinical symptoms. As the pathophysiology of the OAB complex has become more clearly elucidated from recent studies, the role of UDS has again become a topic of discussion as a tool that can provide objective data to reflect these new findings. The utility of UDS in the diagnosis and treatment of OAB is still evolving, but in certain clinical scenarios, especially when empiric treatment has failed, it can provide definitive information that can identify associated pathologies and/or alter the treatment course. Herein, we will discuss the current literature regarding use of UDS in OAB patients and offer our own opinions as to its use.
Collapse
Affiliation(s)
- Matthew P Rutman
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
| | | | | |
Collapse
|
29
|
Changes in urinary nerve growth factor and prostaglandin E2 in women with overactive bladder after anticholinergics. Int Urogynecol J 2012; 24:325-30. [DOI: 10.1007/s00192-012-1854-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/03/2012] [Indexed: 11/30/2022]
|
30
|
Jeong SJ, Lee SC, Jeong CW, Hong SK, Byun SS, Lee SE. Clinical and urodynamic differences among women with overactive bladder according to the presence of detrusor overactivity. Int Urogynecol J 2012; 24:255-61. [PMID: 22588142 DOI: 10.1007/s00192-012-1817-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/24/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We tried to determine whether clinical and urodynamic differences exist between women with and without detrusor overactivity (DO) using a large database of overactive bladder (OAB) patients. METHODS We reviewed the medical records of 513 women who underwent urodynamic studies for OAB symptoms without neurogenic or anatomical conditions that affect micturition function. Clinical symptoms were evaluated using a 3-day frequency-volume chart (FVC) including the Urinary Sensation Scale and American Urological Association Symptom Index (AUA-SI). All clinical and urodynamic findings were compared between women with and without DO. RESULTS The patients' mean age was 58.9 years. DO was identified urodynamically in 167 (32.6 %) women. Those with DO were older (62.9 vs 57.0 years, p < 0.001); however, no differences in AUA-SI, episodes of daytime voiding, and episodes of nocturia were observed between the groups. Functional bladder capacity was smaller in women with DO; however, this difference did not reach statistical significance. Women with DO had significantly more urgency incontinence symptoms than those without DO (55.1 vs 29.5 %, p < 0.001). In urodynamic parameters, the volumes at first desire to void and strong desire to void and maximum cystometric capacity were significantly smaller, and detrusor pressure at the opening was significantly higher in women with DO compared to subjects without DO (26.2 vs 21.2 cmH(2)O, p = 0.004). CONCLUSIONS Our findings suggest a more severe disturbance of bladder function when DO exists, although no differences were observed in symptom scores and 3-day FVC parameters among women with OAB symptoms according to the presence of DO.
Collapse
Affiliation(s)
- Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 463-707, Korea.
| | | | | | | | | | | |
Collapse
|
31
|
Colhoun A, Goudelocke C, Rovner ES. Reproduction of Female Lower Urinary Tract Symptoms on Urodynamics. Low Urin Tract Symptoms 2012; 4:59-62. [PMID: 26676526 DOI: 10.1111/j.1757-5672.2011.00114.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Urodynamic testing (UDS) can be a valuable tool in the assessment of urinary incontinence and voiding dysfunction. The success of UDS in reproducing patients' symptoms has not been well defined. We sought to determine the ability of UDS to reliably reproduce various lower urinary tract symptoms and secondarily the ability of UDS to produce disparate findings not associated with patients presenting symptoms. METHODS Following Institutional Review Board approval, patient data was accumulated prospectively over 10 months. Notation was made of primary and secondary symptoms as well as if these stated symptoms were reproduced during the urodynamic procedure. Presenting lower urinary tract symptoms included for analysis were stress, mixed and urge incontinence, urgency, and obstructive symptoms. We also reviewed the number of disparate urodynamic observations that did not correlate with patient history. RESULTS Over a 10-month period, 127 women had interpretable data with respect to whether their presenting symptoms were reproduced during UDS. Presenting symptoms were successfully reproduced on 83% of UDS studies. Disparate urodynamic observations were noted in 60% of patients. CONCLUSIONS Reproduction of patient symptoms during UDS occurred in the majority of cases if the patient was queried regarding this association. Additional disparate urodynamic observations were also noted in a majority of patients undergoing UDS. It remains unclear whether reproduction of symptoms during UDS in females ultimately results in improved interventional outcomes. The implications of new or unexpected UDS findings during UDS are unknown.
Collapse
Affiliation(s)
- Andrew Colhoun
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colin Goudelocke
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
32
|
Dell’Utri C, Digesu GA, Bhide A, Khullar V. Fesoterodine in randomised clinical trials: an updated systematic clinical review of efficacy and safety. Int Urogynecol J 2012; 23:1337-44. [DOI: 10.1007/s00192-012-1696-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
|
33
|
Management of the Failed Transurethral Resection of the Prostate. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
34
|
Bosch JLHR, Cardozo L, Hashim H, Hilton P, Oelke M, Robinson D. Constructing trials to show whether urodynamic studies are necessary in lower urinary tract dysfunction. Neurourol Urodyn 2011; 30:735-40. [DOI: 10.1002/nau.21130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
35
|
Fesoterodine: Individualised Treatment of Urgency Urinary Incontinence Across Patient Groups. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.eursup.2011.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
Rovner E, Kennelly M, Schulte-Baukloh H, Zhou J, Haag-Molkenteller C, Dasgupta P. Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder. Neurourol Urodyn 2011; 30:556-62. [PMID: 21351127 DOI: 10.1002/nau.21021] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 09/21/2010] [Indexed: 12/31/2022]
Abstract
AIMS We assessed the effects of onabotulinumtoxinA (BOTOX®) on clinical and urodynamic variables in patients with idiopathic overactive bladder (OAB) and urinary urgency incontinence (UUI) with or without detrusor overactivity (DO), inadequately managed with anticholinergics. METHODS Three hundred thirteen patients with OAB were randomized to double-blind intradetrusor injection with placebo (n = 44) or 1 of 5 onabotulinumtoxinA doses (50-300 U; n = 269). Primary efficacy variable was change from baseline in UUI episodes/week at week 12. Urodynamic assessments at baseline and weeks 12 and 36 included maximum cystometric capacity (MCC) and volume at first involuntary detrusor contraction (IDC). RESULTS 76.0% of patients had baseline DO. Changes from baseline in MCC and volume at first IDC with onabotulinumtoxinA ≥100 U were superior to placebo at week 12, generally decreasing by week 36. Significant dose-dependent increases in MCC were observed for all onabotulinumtoxinA doses at week 12, and for 150, 200, and 300 U at week 36. Data suggested a dose-response relationship. At week 12 on diary, 15.9% of placebo and 29.8-57.1% of onabotulinumtoxinA 50-300 U recipients, respectively, did not demonstrate UUI. OnabotulinumtoxinA doses >150 U were more commonly associated with post-void residual urine volumes >200 ml. CONCLUSIONS Improvements in urodynamic parameters and clinical outcomes generally trended together following onabotulinumtoxinA treatment. This therapy improved key urodynamic parameters in patients with idiopathic OAB and UUI, with no differences in outcomes between those with and those without baseline DO. Therefore, successful idiopathic OAB treatment with onabotulinumtoxinA does not appear to be related to pretreatment finding of DO.
Collapse
Affiliation(s)
- Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina 29403, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
Biomarkers constitute any objectively measurable indicator of a biological process. The classic biomarker used in the diagnosis of overactive bladder (OAB) has been detrusor overactivity, which is assessed urodynamically. In the search for a reliable, noninvasive alternative to urodynamics, interest has focused on genetic, imaging, and urinary factors. Along with other cytokines detectable in urine, prostaglandin E2 and nerve growth factor are indicators of low-grade inflammation. Although they correlate with OAB symptom severity, they have not been shown to have independent prognostic benefit. Imaging biomarkers have been investigated since the earliest days of video urodynamics. Despite extensive research on the ultrasonographic estimation of bladder wall thickness, further standardization of the technique is required before conclusions can be reached regarding diagnostic accuracy. Genetic factors contribute approximately half of the total risk for urgency incontinence. Functional polymorphisms of the cytochrome P450 IID6 gene significantly alter the metabolism of some commonly used anticholinergic drugs, but no genetic loci that influence risk of OAB have been definitively identified. The first genome-wide association studies for OAB are in progress, and should identify new susceptibility genes. Although current putative biomarkers correlate with OAB severity, much future work is required to assess their prognostic value, and establish their role in clinical practice.
Collapse
|
38
|
|