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Isali I, McClellan P, Wong TR, Sun C, Stout AC, Schumacher FR, Markt S, Wilfred Wu CH, Penney KL, El-Nashar S, Hijaz A, Sheyn D. A systematic review and in silico study of potential genetic markers implicated in cases of overactive bladder. Am J Obstet Gynecol 2023; 228:36-47.e3. [PMID: 35932882 PMCID: PMC10152473 DOI: 10.1016/j.ajog.2022.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The contribution of genetic factors to the presence of an overactive bladder is recognized. This study aimed to (1) assemble and synthesize available data from studies assessing differential gene expression in patients with overactive bladder vs controls without overactive bladder and (2) determine possible correlations and functional pathways between genes. DATA SOURCES We searched PubMed, Ovid or Medline, and Wiley Cochrane Central Register of Controlled Trials databases between January 1, 2000, and December 15, 2021. STUDY ELIGIBILITY CRITERIA Studies were included if gene expression was detected and quantified using molecular approaches performed on human bladder tissue specimens directly and excluded if the gene expression analysis was carried out from blood and urine specimens alone. METHODS A systematic review was completed to identify publications that reported differently expressed gene candidates among patients with overactive bladder vs healthy individuals. Gene networking connections and pathway analysis were performed employing Metascape software, where inputs were identified from our systematic review of differentially expressed genes in overactive bladder. RESULTS A total of 9 studies were included in the final analysis and 11 genes were identified as being up-regulated (purinergic receptor P2X 2 [P2RX2], smoothelin [SMTN], growth-associated protein 43 [GAP43], transient receptor potential cation channel subfamily M member 8 [TRPM8], cadherin 11 [CDH1], gap junction protein gamma 1 [GJC1], cholinergic receptor muscarinic 2 [CHRM2], cholinergic receptor muscarinic 3 [CHRM3], and transient receptor potential cation channel subfamily V member 4 [TRPV4]) or down-regulated (purinergic receptor P2X 2 [P2RX3] and purinergic receptor P2X 5 [P2RX5]) in patients with overactive bladder. Gene network analysis showed that genes are involved in chemical synaptic transmission, smooth muscle contraction, blood circulation, and response to temperature stimulus. Network analysis demonstrated a significant genetic interaction between TRPV4, TRPM8, P2RX3, and PR2X2 genes. CONCLUSION Outcomes of this systematic review highlighted potential biomarkers for treatment efficacy and have laid the groundwork for developing future gene therapies for overactive bladder in clinical settings.
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Affiliation(s)
- Ilaha Isali
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Phillip McClellan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Thomas R Wong
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Clara Sun
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | | | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Sarah Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Chen-Han Wilfred Wu
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH; Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH
| | - Kathryn L Penney
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sherif El-Nashar
- Department of Obstetrics and Gynecology, Mayo Clinic, Jacksonville, FL
| | - Adonis Hijaz
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH.
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Holmes-Martin K, Zhu M, Xiao S, Arab Hassani F. Advances in Assistive Electronic Device Solutions for Urology. MICROMACHINES 2022; 13:mi13040551. [PMID: 35457855 PMCID: PMC9028141 DOI: 10.3390/mi13040551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022]
Abstract
Recent technology advances have led urology to become one of the leading specialities to utilise novel electronic systems to manage urological ailments. Contemporary bladder management strategies such as urinary catheters can provide a solution but leave the user mentally and physically debilitated. The unique properties of modern electronic devices, i.e., flexibility, stretchability, and biocompatibility, have allowed a plethora of new technologies to emerge. Many novel electronic device solutions in urology have been developed for treating impaired bladder disorders. These disorders include overactive bladder (OAB), underactive bladder (UAB) and other-urinary-affecting disorders (OUAD). This paper reviews common causes and conservative treatment strategies for OAB, UAB and OUAD, discussing the challenges and drawbacks of such treatments. Subsequently, this paper gives insight into clinically approved and research-based electronic advances in urology. Advances in this area cover bladder-stimulation and -monitoring devices, robot-assistive surgery, and bladder and sphincter prosthesis. This study aims to introduce the latest advances in electronic solutions for urology, comparing their advantages and disadvantages, and concluding with open problems for future urological device solutions.
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Fontaine C, Papworth E, Pascoe J, Hashim H. Update on the management of overactive bladder. Ther Adv Urol 2021; 13:17562872211039034. [PMID: 34484427 PMCID: PMC8411623 DOI: 10.1177/17562872211039034] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
Overactive bladder (OAB) syndrome is a common condition characterised by urinary
urgency, with or without urgency incontinence, frequency and nocturia, in the
absence of any other pathology. Clinical diagnosis is based upon patient
self-reported symptomology. Currently there is a plethora of treatments
available for the management of OAB. Clinical guidelines suggest treatment
via a multidisciplinary pathway including behavioural
therapy and pharmacotherapy, which can be commenced in primary care, with
referral to specialist services in those patients refractory to these
treatments. Intradetrusor botulinum A and sacral neuromodulation provide safe
and efficacious management of refractory OAB. Percutaneous tibial nerve
stimulation and augmentation cystoplasty remain available and efficacious in a
select group of patients. Unfortunately, there remains a high rate of patient
dissatisfaction and discontinuation in all treatments and thus there remains a
need for emerging therapies in the management of OAB.
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Affiliation(s)
- Christina Fontaine
- Specialist Registrar in Urology, University Hospitals Plymouth, Derriford Road, Devon, PL6 8AU, UK
| | - Emma Papworth
- Bristol Urological Institute, Southmead Hospital, Bristol, Somerset, UK
| | | | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, Somerset, UK
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Kang TW, Kim SJ, Kim MH, Jung JH. Beta 3 Adrenoreceptor Agonist for the Management of Lower Urinary Tract Symptoms in Men With Benign Prostatic Hyperplasia: A Systematic Review. Int Neurourol J 2021; 25:182-191. [PMID: 34610712 PMCID: PMC8497732 DOI: 10.5213/inj.2142068.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/03/2021] [Indexed: 11/08/2022] Open
Abstract
Beta-3 adrenoceptor (B3AR) agonist which mediate detrusor relaxation has been tried as a new treatment modality for men with benign prostatic hyperplasia (BPH). However, it remains unclear whether the B3AR agonist has more clinical benefits and fewer adverse effects in men with BPH than in women. We performed a comprehensive search using multiple databases, trials registries, other sources of grey literature, and conference proceedings regardless of language or publication status and included randomized controlled trials. Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. Primary outcomes were urologic symptom scores, quality of life (QoL), and overall adverse events. We found 4 randomized controlled trials with 1,105 participants in 3 comparisons. All studies reported short-term outcomes (ranged from 8 weeks to 12 weeks). Mirabegron, tamsulosin, silodosin, fesoterodine, and tadalafil were administrated as intervention. While B3AR agonist can improve the patient-important outcomes within group (before and after treatment), B3AR agonist combination therapy with current standard BPH treatment such as alpha blocker or anticholinergic may not have additional effects on urological symptom scores and QoL compared to alpha blocker or anticholinergic monotherapy. B3AR agonist therapy with phosphodiesterase 5 inhibitor (PDE5I) showed statistical improvement on urological symptom scores or QoL compared to PDE5I monotherapy. For safety profile, B3AR agonist in all 3 comparisons may not increase adverse event rate. While B3AR agonists may be used for the treatment of lower urinary tract symptoms in men with BPH if storage symptoms with standard BPH treatment are insufficient, B3AR agonists appear to have trivial or similar effects compared to current standard BPH treatment.
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Affiliation(s)
- Tae Wook Kang
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Su Jin Kim
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
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Engin S, Kaya Yasar Y, Barut EN, Getboga D, Erac Y, Sezen SF. The inhibitory effect of trimetazidine on detrusor contractility - a potential repositioning of trimetazidine for the treatment of overactive bladder. J Pharm Pharmacol 2021; 74:94-102. [PMID: 34109981 DOI: 10.1093/jpp/rgab072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to identify the effect of trimetazidine (TMZ), an antianginal drug, on detrusor smooth muscle (DSM) contractility and its possible mechanisms of action. METHODS We performed in-vitro contractility studies on isolated mouse DSM strips and investigated the effect of TMZ on Ca2+ levels in fura-2-loaded A7r5 cells. KEY FINDINGS TMZ (300 or 1000 µM) inhibited carbachol (CCh)- and KCl-induced contractions and produced a concentration-dependent (10-1000 µM) relaxation in KCl-precontracted DSM strips. TMZ-induced relaxation was markedly decreased by BaCl2, an inward-rectifying K+ channel blocker, but was not altered by preincubation with tetraethylammonium, glibenclamide, 4-aminopyridine, propranolol, L-NAME or methylene blue. TMZ (300 or 1000 µM) reduced both the CaCl2-induced contraction of depolarized DSM strips under Ca2+-free conditions and the CCh-induced contraction of DSM strips preincubated with nifedipine in Ca2+-containing Krebs solution. Furthermore, TMZ (1000 µM) significantly decreased the Ca2+ levels in fura-2-loaded A7r5 cells. CONCLUSIONS TMZ decreased DSM contractility and caused a concentration-dependent relaxation of the tissue possibly through its actions on Ca2+ transients and K+ channels. Our results provide preclinical evidence that TMZ would be a potential candidate to treat disorders related to the overactivity of the bladder.
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Affiliation(s)
- Seckin Engin
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey
| | - Yesim Kaya Yasar
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey.,Drug and Pharmaceutical Technology Application and Research Center, Karadeniz Technical University, Trabzon, Turkey
| | - Elif Nur Barut
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey
| | - Damla Getboga
- Department of Pharmacology, Faculty of Pharmacy, Ege University, İzmir, Turkey
| | - Yasemin Erac
- Department of Pharmacology, Faculty of Pharmacy, Ege University, İzmir, Turkey
| | - Sena F Sezen
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey.,Drug and Pharmaceutical Technology Application and Research Center, Karadeniz Technical University, Trabzon, Turkey
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Lee J, Park E, Kang W, Kim Y, Lee KS, Park SM. An Efficient Noninvasive Neuromodulation Modality for Overactive Bladder Using Time Interfering Current Method. IEEE Trans Biomed Eng 2020; 68:214-224. [PMID: 32746006 DOI: 10.1109/tbme.2020.2995841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study aimed to evaluate a new tibial nerve stimulation (TNS) modality, which uses interferential currents, in terms of the stimulation electric field penetration efficiency into the body and physiological effectiveness. METHODS In silico experiments were performed to analyze the penetration efficiency of proposed interferential current therapy (ICT). Based on this, we performed in vivo experiments to measure excitation threshold of ICT for the tibial nerve, which is related to stimulation field near the nerve. Regarding analysis of the physiological effectiveness, in vivo ICT-TNS was performed, and changes in bladder contraction frequency and voiding volume were measured. The penetration efficiency and physiological effectiveness of ICT were evaluated by comparison with those of conventional TNS using transcutaneous electrical nerve stimulation (TENS). RESULTS Simulation results showed that ICT has high penetration efficiency, thereby generating stronger field than TENS. These results are consistent with the in vivo results that nerve excitation threshold of ICT is lower than that of TENS. Moreover, ICT-TNS decreased contraction frequency and increased voiding volume, and its performance was profound compared with that of TENS-TNS. CONCLUSION The proposed ICT is more efficient in inducing the stimulation field near the tibial nerve placed deep inside the body compared with conventional TENS and shows a good clinical effectiveness for TNS. SIGNIFICANCE The high efficiency of ICT increases the safety of noninvasive neurostimulation; therefore, it has clinical potential to become a promising modality for TNS to treat OAB and other peripheral neurostimulations.
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Abstract
This review examines the effectiveness of hypnotherapy for the relief of overactive bladder (OAB) symptoms. Ten studies examining outcomes of hypnotherapy for OAB were located from searches of electronic databases. Most reports were case studies or observational, but there were two randomized, controlled trials. Hypnotherapeutic treatment regimens were idiosyncratic and tailored to individual patients. All studies suggested benefits from hypnotherapy as an adjunct treatment for OAB, especially in terms of subjective reports of symptoms and increasing self-efficacy. These benefits suggest hypnotherapy increases patients' abilities to engage in relaxation, reduces condition-associated anxiety, and improves patients' perceptions of their symptom-coping abilities. Although strong objective evidence of improvement in OAB symptoms is lacking, these subjective improvements, combined with increasing use and acceptance of hypnotherapy in obstetric and gynecological settings, suggest the utility of hypnotherapy as a psychological adjunctive procedure in the treatment of OAB.
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Affiliation(s)
- Lisa A Osborne
- a Women and Child Health , Abertawe Bro Morgannwg University Health Board , Swansea , UK
| | - Phil Reed
- b Department of Psychology , Swansea University , Swansea , UK
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Lo T, Nagashu S, Hsieh W, Uy‐Patrimonio MC, Yi‐Hao L. Predictors for detrusor overactivity following extensive vaginal pelvic reconstructive surgery. Neurourol Urodyn 2017; 37:192-199. [DOI: 10.1002/nau.23273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/26/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Tsia‐Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial HospitalKeelung Medical CenterKeelung, TaiwanPeople's Republic of China
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
- Department of Obstetrics and Gynaecology, Chang Gung Memorial HospitalXiamen Medical CenterXiamenPeople's Republic of China
- Chang Gung UniversitySchool of MedicineTaoyuan, TaiwanPeople's Republic of China
| | - Shailaja Nagashu
- Department of Obstetrics and GynaecologyPeoples Education Society Medical College and Research CentreKuppam, Andhra PradeshIndia
- Fellow, Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
| | - Wu‐Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
| | - Ma Clarissa Uy‐Patrimonio
- Fellow, Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
- Department of Obstetrics and GynecologyDr. Pablo O. Torre Memorial HospitalBacolod CityPhilippines
| | - Lin Yi‐Hao
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
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Shimizu S, Shimizu T, Higashi Y, Saito M. Lower urinary tract symptoms as a vascular dysfunction: the effect of nicorandil as a vasodilator. Nihon Yakurigaku Zasshi 2015; 146:21-6. [PMID: 26165338 DOI: 10.1254/fpj.146.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Odoemene AC. PATTERN OF OVERACTIVE BLADDER IN SOUTHEAST NIGERIA. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2014; 4:100-20. [PMID: 26457269 PMCID: PMC4553233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Overactive bladder is a distressing condition characterized by the syndrome of uncontrollable urgency, day time frequency, nocturia with or without urgency urinary incontinence. AIM To determine the pattern of overactive bladder in two tertiary health institutions in South-East Nigeria. STUDY DESIGN The study is prospective. SETTING Federal Teaching Hospital, Abakaliki and Niger Foundation Hospital and Diagnostic centre Enugu in southeastern Nigeria. METHOD The study involved 383 patients who were diagnosed with overactive bladder in the two hospitals during the study period. Their demographics, clinical feature, management options and outcome were analyzed.Tolterodine was the anticholinegic used to treat the syndrome while the underlying pathology was treated accordingly. RESULT There were 383 patients out of which 363 (94.8%) patients were males while 20 (5.2%) patients were females with the age range of 37yrs to103yrs with a mean of 63.4yrs. A total of 313 (81.7%) patients had prostatic disease (benign prostatic hyperplasia and cancer of the prostate), while 99 (25.8%) patients had diabetes mellitus. Among the 313(82 %) with prostate disease, two hundred and eighty nine (75.5%) had benign prostatic hyperplasia while twenty four (6.3%) had cancer of the prostate. Urgency, urinary incontinence and fecal incontinence were observed simultaneously in 133 (34.7%) patients during the episode of involuntary painful bladder contraction. In 271 (71%) patients, the overactive bladder was treated with Tolterodine alone and management of the underlying pathology with resolution of symptoms. Few patients benefitted from behavioral therapy. CONCLUSION Overactive bladder in this environment is associated commonly with prostate diseases with urgency of urine, urine and fecal incontinence but responds well to anticholinergic.
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Affiliation(s)
- A C Odoemene
- Department of Surgery, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Dambros M, Dambros MC, Lorenzetti F, Dassen E, van Koeveringe G. The use of Hypochlorous Acid as a Model for Investigating Bladder Overactivity. Int Braz J Urol 2014; 40:408-13. [DOI: 10.1590/s1677-5538.ibju.2014.03.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/14/2014] [Indexed: 11/22/2022] Open
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Tuğcu-Demiröz F, Acartürk F, Erdoğan D. Development of long-acting bioadhesive vaginal gels of oxybutynin: Formulation, in vitro and in vivo evaluations. Int J Pharm 2013; 457:25-39. [DOI: 10.1016/j.ijpharm.2013.09.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
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Abstract
The benefit that patients with overactive bladder (OAB) experience with conservative management is an important aspect in the evaluation of this therapy. The first-line options include behavioral interventions, and several techniques are available. Clinical research indicates amelioration of individual symptoms with these techniques, but few studies have shown a positive effect on health-related quality-of-life parameters. After failure of behavioral therapy or in combination with a training program, pharmacological therapy with anticholinergics is the next step. Extensive clinical research into different pharmacological compounds has shown significant effects on the symptomatic elements of OAB. The clinical relevance and the effects on quality-of-life parameters with pharmacological therapy have also been evaluated and show a significant effect on specific aspects. Recently, clinical research in conservative management of patients with OAB has focused more on evaluating patients' perceptions of their condition and the effects of treatment with patient-reported outcome instruments. Future studies should include these tools in the evaluation of any therapy in OAB.
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Nocturia × disturbed sleep: a review. Int Urogynecol J 2011; 23:255-67. [DOI: 10.1007/s00192-011-1525-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 07/21/2011] [Indexed: 11/24/2022]
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Tunuguntla HSGR, Tunuguntla R, Barone J, Kanagarajah P, Gousse AE. Voiding dysfunction in the female patient: is the "syndrome" paradigm valid? Curr Urol Rep 2011; 12:377-80. [PMID: 21728066 DOI: 10.1007/s11934-011-0207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Voiding dysfunction in the female patient significantly affects the patient's quality of life. The condition is poorly understood, has varied etiology and clinical presentation, and lacks standard definitions with no consensus on diagnostic criteria. It consists of a constellation of symptoms involving both phases of the micturition cycle. Appropriate diagnosis and treatment of female lower urinary tract symptoms (LUTS) is of paramount importance. However, the differentiation of female LUTS into various syndromes is currently controversial. This article comprehensively reviews the commonly encountered female non-neurogenic LUTS (overactive bladder, interstitial cystitis, and painful bladder syndrome); discusses the contemporary management of these syndromes; and emphasizes a syndromic approach to the condition.
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Affiliation(s)
- Hari Siva G R Tunuguntla
- Division of Urology, Section of Voiding Dysfunction, Neuro-Urology, Female Urology, Pelvic Reconstruction & Urodynamics, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
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Digesu GA, Panayi D, Hendricken C, Camarata M, Fernando R, Khullar V. Women’s perspective of botulinum toxin treatment for overactive bladder symptoms. Int Urogynecol J 2010; 22:425-31. [DOI: 10.1007/s00192-010-1315-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 10/28/2010] [Indexed: 11/24/2022]
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Gupta K, Kaur K, Aulakh BS, Kaushal S. Fesoterodine for overactive bladder: A review of the literature. Curr Ther Res Clin Exp 2010; 71:273-88. [PMID: 24688149 DOI: 10.1016/j.curtheres.2010.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Overactive bladder (OAB) is a chronic condition affecting both men and women, with prevalence increasing with age. Antimuscarinics form the cornerstone of treatment of OAB. Fesoterodine, a nonselective muscarinic-receptor antagonist, was approved by the US Food and Drug Administration in late 2008 for once daily, oral administration in the treatment of OAB to relieve the symptoms of urinary urge incontinence, urgency, and frequency. OBJECTIVE The aim of this review was to provide an overview of the mechanism of action of and clinical trial data for fesoterodine, and to discuss the present status of fesoterodine in the management of OAB. METHODS The MEDLINE and Google Scholar databases were searched (June 1, 1999-December 1, 2009) using the terms fesoterodine, overactive bladder, and muscarinic antagonists. Full-text articles in English were selected for reference, and articles presenting the mechanism of action, pharmacokinetics, and data from clinical trials were included. The parameters measured were tolerability, efficacy, and health-related quality of life (HRQoL). Trials involving animals and Phase I studies were excluded. RESULTS The initial literature search yielded 48 papers. A total of 20 articles fulfilled the inclusion criteria. In two 12-week, randomized, multicenter, Phase III clinical trials involving patients with increased micturition frequency and urgency and/or urinary urge incontinence (n = 836 and 1132 in each trial), both fesoterodine 4 and 8 mg were associated with significantly improved symptoms of OAB (frequency of micturition, urgency, and urge incontinence) compared with placebo (P < 0.05). In a post hoc analysis of pooled data of the Phase III trials, HRQoL improved significantly with both doses. In a 12-week, Phase Illb trial, fesoterodine 4 and 8 mg led to treatment satisfaction in ∼80% of patients (of 516 enrolled) who were initially unsatisfied with their previous treatment. CONCLUSION A review of the literature suggests that fesoterodine is an efficacious and well-tolerated treatment option for patients with OAB.
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Affiliation(s)
- Kanchan Gupta
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kirandeep Kaur
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | - Sandeep Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
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Kanagarajah P, Ayyathurai R, Gousse AE. Lower Urinary Tract Symptoms: Defining Syndromes in Urology. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0068-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Panicker JN, de Sèze M, Fowler CJ. Rehabilitation in Practice: Neurogenic lower urinary tract dysfunction and its management. Clin Rehabil 2010; 24:579-89. [PMID: 20584864 DOI: 10.1177/0269215509353252] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is ‘the trainee consistent demonstrates a knowledge of the pathophysiology of various specific impairments including bladder dysfunction’ and ‘management approaches for specific impairments including bladder dysfunction’. The lower urinary tract (bladder and urethra) has two roles: storage of urine and emptying at appropriate times. The optimal and coordinated activity of the lower urinary tract is subject to a complex neural control which involves all levels of the nervous system, from cortex to peripheral innervation. The complexity of the neural control of lower urinary tract explains the high prevalence of urinary disturbances in neurologic disease. Information obtained from history taking and supplemented by use of a bladder diary forms the cornerstone of evaluation. Ultrasonography is used to assess the degree of incomplete bladder emptying, and for assessing the upper tracts. Urodynamic tests, with or without simultaneous fluoroscopic monitoring, assess detrusor and bladder outlet function and give fundamental information about detrusor pressure and thus the risk factor for upper tract damage. Impaired emptying is most often managed by clean intermittent self-catheterization and this should be initiated if the post-void residual urine is greater than 100 mL or exceeds one third of bladder capacity, or rarely if spontaneous voiding is dangerous due to high detrusor pressure. Storage symptoms are most often managed using antimuscarinic medications. Other options include desmopressin to reduce urine output or intradetrusor injection of botulinum toxin type A to reduce detrusor overactivity. Understanding of the underlying mechanism of lower urinary tract dysfunction is crucial for effective management.
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London (UCL) Hospitals NHS Foundation Trust, UCL Institute of Neurology
| | - Marianne de Sèze
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London (UCL) Hospitals NHS Foundation Trust, UCL Institute of Neurology and Physical Medicine and Rehabilitation Department, London, UK, Neuro-urological Unit, Bordeaux University Hospital, Tastet Girard Pellegrin Hospital, Bordeaux, France
| | - Clare J Fowler
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London (UCL) Hospitals NHS Foundation Trust, UCL Institute of Neurology, London, UK
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Rantell A. Lower urinary tract symptoms in women with multiple sclerosis: 2. ACTA ACUST UNITED AC 2009; 18:920, 922-5. [DOI: 10.12968/bjon.2009.18.15.43561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Arya LA, Asfaw T. The importance of monitoring fluid intake during treatment of overactive bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2009. [DOI: 10.1007/s11884-009-0015-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Current world literature. Adolescent and paediatric gynaecology. Curr Opin Obstet Gynecol 2008; 20:506-8. [PMID: 18797277 DOI: 10.1097/gco.0b013e328312c012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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