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Padmanabhan P, Roberts LH, Chancellor MB, Peters KM, Zwaans BMM. Prospective follow-up of overactive bladder symptoms in patients with prior SARS-CoV-2 infection. Neurourol Urodyn 2024; 43:1514-1522. [PMID: 38828830 DOI: 10.1002/nau.25509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/21/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE SARS-CoV-2 infection can result in genitourinary symptoms, such as frequency, urgency, nocturia, and pain/pressure. In this study, we followed the progression of overactive bladder (OAB) symptoms in patients that reported new or worsening OAB symptoms after coronavirus disease-19 (COVID-19) diagnosis. MATERIALS AND METHODS Individuals from a COVID-19 serology study were invited to participate in a follow-up study. Respondents were divided into three groups based on prior COVID-19 testing. Patients scored symptoms retrospectively before the pandemic, at study onset, and prospectively during 12-month follow-up. Genitourinary symptoms were assessed using international consultation on incontinence questionaire for OAB (ICIQ-OAB). Change in ICIQ-OAB scores from baseline were calculated. The minimal important difference of one on ICIQ-OAB is considered a significant change. RESULTS 26.0% of participants previously had positive COVID polymerase chain reaction (PCR) test (PCR+), 5.6% a positive serology test only (Ser+), and 65.5% were COVID naïve (COVID-). 23.8% of participants reported a significant increase in ICIQ-OAB score at study onset compared to prepandemic. ICIQ-OAB scores were similar at prepandemic but significantly higher at study start (p < 0.001) in PCR+ group. During follow-up, change in ICIQ-OAB scores from baseline remained unchanged for COVID- group, but gradually reduced for PCR+, reaching similar levels as COVID- group by 12 months. By 12 months, 71.4% of PCR+, 42.9% of Ser+, and 68.8% of COVID- participants still reported significant increase in ICIQ-OAB scores. CONCLUSIONS Most COVID-19 patients experienced return of symptoms to baseline, indicative of the potential resolution of COVID-associated cystitis. A subset of cases did not, raising questions about the underlying factors contributing to this outcome. Additional research is needed to assess long COVID on urological health.
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Affiliation(s)
- Priya Padmanabhan
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Ly Hoang Roberts
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael B Chancellor
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Kenneth M Peters
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Bernadette M M Zwaans
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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Kodama ST, Khandpur R, Dunlap J, Smolen J, Keshishian C, O’Connell KA, Burkett LS, Siff LN, Speich JE, Klausner AP. Steps toward identification of a novel cue-positive overactive bladder phenotype in women with high-bother urinary urgency. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2024; 12:173-182. [PMID: 39308596 PMCID: PMC11411182 DOI: 10.62347/zzjf7946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/12/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE The objective of this study was to investigate the relationship between situational cues (running water, stress, cold, etc.) and overactive bladder (OAB) symptoms. METHODS Women scheduled for urodynamic studies for clinical indications completed surveys to characterize OAB (ICIQ-OAB and OAB-V3) and responses to situational cues (validated long-form cues survey and a novel short-form cues survey). Participants were divided into two groups (Low-Bother urgency vs. High-Bother urgency), and OAB and cue survey responses were compared. RESULTS A total of 47 participants were enrolled in the study with 36 meeting inclusion criteria (15 Low-Bother and 21 High-Bother) with an overall mean age of 60.0 ± 10.0 years. The High-Bother urgency group scored significantly higher on multiple cue items in the long-form (P<0.05) and only "running water" in the short-form cues survey (P<0.05). In addition, "running water" was the only cue that was scored higher in both surveys (P<0.05). CONCLUSIONS This study showed that patients with High-Bother urgency may have increased symptom responses to environmental, mood, and cognitive cues. These findings suggest increased sensitivity to cues, especially "running water" in participants with bothersome OAB and the potential presence of a cue-specific OAB phenotype.
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Affiliation(s)
- Sarah T Kodama
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
| | - Ria Khandpur
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
| | - Jared Dunlap
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
| | - Julia Smolen
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
| | - Chris Keshishian
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
| | | | - Linda S Burkett
- Department of Obstetrics and Gynecology, Virginia Commonwealth UniversityRichmond, VA, USA
| | - Lauren N Siff
- Department of Obstetrics and Gynecology, Virginia Commonwealth UniversityRichmond, VA, USA
| | - John E Speich
- Department of Mechanical and Nuclear Engineering of Engineering, College of Engineering, Virginia Commonwealth UniversityRichmond, VA, USA
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
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Lin C, Lyu J, Feng Z. Intake of dietary flavonoids in relation to overactive bladder among U.S. adults: a nutritional strategy for improving urinary health. Front Nutr 2024; 11:1437923. [PMID: 39114124 PMCID: PMC11303291 DOI: 10.3389/fnut.2024.1437923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024] Open
Abstract
Background The increasing influence of overactive bladder (OAB) on physical as well as mental health of individuals is becoming more pronounced annually, as evidenced by the urge urinary incontinence and nocturia. Symptoms in OAB patients may be influenced by inflammation and oxidative stress. Flavonoids are recognized as significant anti-inflammatory and antioxidant agents, which are commonly available in fruits, tea, vegetables, etc. Previous research has demonstrated the therapeutic potential of flavonoids and their subclasses in treating inflammation, and oxidative stress. Despite this, there remains a paucity of research exploring the potential correlation between flavonoid consumption, specifically within distinct subclasses, and OAB. Thus, our study aims to investigate the relationship between flavonoid intake and OAB to identify possible dietary interventions for OAB management. Methods We utilized the survey data from the National Health and Nutrition Examination Survey (NHANES) and the USDA Food and Nutrient Database for Dietary Studies (FNDDS) to investigate the relationship between dietary intake of total and subclass flavonoids and the risk of OAB based on 13,063 qualified American adults. The dietary flavonoid intake was estimated from two 24-h dietary recalls. Weighted multivariate logistic regression model, quantile-based g-computation, restricted cubic spline model, and stratified analysis were used to explore the association between flavonoid intake and OAB, respectively. Results The participants diagnosed with OAB exhibited a higher percentage of being female, older, Non-Hispanic Black, unmarried, former drinkers, having a lower annual household income, lower poverty to income ratio, lower educational attainment, and a higher likelihood of being obese and smokers. Upon adjusting for confounding factors, the weighted logistic regression models revealed that the third quartile of consumption of anthocyanidin and the second quartile of consumption of flavone were significantly associated with the reduced odds of OAB, while total flavonoid consumption did not show a significant correlation with the risk of OAB. The quantile-based g-computation model indicated that flavone, anthocyanidin and flavonol were the primary contributors to the observed negative correlation. Furthermore, the restricted cubic spline models demonstrated a J-shaped non-linear exposure-response association between anthocyanidin intake and the risk of OAB (P nonlinear = 0.00164). The stratified and interaction analyses revealed that the relationship between anthocyanidin intake and the risk of OAB was significantly influenced by age (P interaction = 0.01) and education level (P interaction = 0.01), while the relationship between flavone intake and the risk of OAB was found to vary by race (P interaction = 0.02) and duration of physical activity (P interaction = 0.05). Conclusion Our research suggests that consuming a diet rich in flavonoid subclass anthocyanidin and flavone is associated with a reduced risk of OAB, potentially offering clinical significance in the prevention of OAB development. This underscores the importance of dietary adjustments in the management of OAB symptoms.
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Affiliation(s)
- Chaohuan Lin
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China
- Postgraduate Training Base Alliance of Wenzhou Medical University, Wenzhou, China
| | - Jie Lyu
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China
- Postgraduate Training Base Alliance of Wenzhou Medical University, Wenzhou, China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, Zhejiang, China
| | - Zhen Feng
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China
- College of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Li M, Xu M, Zhou H, Pan Y, Liu X. The association between different levels of depression and overactive bladder: A cross-sectional study of the 2005-2018 National Health and Nutrition Examination Survey. Neurourol Urodyn 2024. [PMID: 39032101 DOI: 10.1002/nau.25563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND There is growing evidence of a possible correlation between depression and overactive bladder (OAB). However, few studies have classified depression according to its severity. Whether there is an association between different levels of depression and OAB symptoms remains unclear. METHODS Participants with complete information about depression, OAB, and covariates in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. Depression symptoms were assessed by the Patient Health Questionnaire-9. OAB symptoms were evaluated by the Overactive Bladder Symptom Score. Weighted multivariate logistic regression models were applied to analyze the relationship between depression and OAB. RESULTS A total of 30 359 participants were included in this study, consisting of 6245 OAB patients and 24 114 non-OAB participants. The multivariate logistic regression suggested depression independently correlated with OAB (odds ratio [OR] = 2.764, 95% confidence interval [CI] = 2.429-3.146, p < 0.001). Further, mild (OR = 2.355, 95% CI = 2.111-2.627, p < 0.001), moderate (OR = 3.262, 95% CI = 2.770-3.841, p < 0.001), and moderately severe to severe depression (OR = 3.927, 95% CI = 3.246-4.752, p < 0.001) were all associated with OAB. Additionally, depression was also correlated with urgency urinary incontinence (OR = 2.249, 95% CI = 1.986-2.548, p < 0.001) and nocturia (OR = 2.166, 95% CI = 1.919-2.446, p < 0.001). CONCLUSION This study indicated different levels of depression, even mild depression, were independent risk factors for OAB. Given the frequent coexistence and potential interactions between depression and OAB, clinicians should be aware of the importance of assessing both physical and psychological symptoms in these patients. Early diagnosis and holistic treatment may improve the treatment outcomes, particularly for those suffering from both conditions.
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Affiliation(s)
- Muwei Li
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingming Xu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hang Zhou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Pan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Zhang Y, Wu X, Liu G, Feng X, Jiang H, Zhang X. Association between overactive bladder and depression in American adults: A cross-sectional study from NHANES 2005-2018. J Affect Disord 2024; 356:545-553. [PMID: 38642902 DOI: 10.1016/j.jad.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/12/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND AIM Overactive bladder (OAB) and depression are both common disorders and there is research suggesting an association between the two, but there is a lack of studies with large samples. The aim of this study is to investigate the association between OAB and depressive symptoms. METHODS We used data from the National Health and Nutrition Examination Survey (NHANES) database for the period 2005 to 2018. OAB was characterized by the Overactive Bladder Symptom Score (OABSS, score > 3) and depression was diagnosed by the Patient Health Questionnaire (PHQ-9, score ≥ 10). There were three models employed in our analysis: (1) Crude model was unadjusted; (2) Model 1 was adjusted for age, sex, race/ethnicity, educational level, and marital status; (3) Model 2 was adjusted for factors in Model 1 plus the remained potential covariates. We used survey-weighted logistic regression models to assess the association between OAB and depression. Subsequently, subgroup analyses and smoothed curve analyses were used to evaluate the reliability of the findings. RESULTS Finally, a total of 6612 participants were included in our study, consisting of 1005 participants with diagnosis of OAB and 5607 participants without diagnosis of OAB. After adjusting for all covariates, there was a significant positive association between OAB and depression (OR: 2.89, 95 % CI: 1.91, 4.37). The severity of OAB was also positively associated with depression. Compared to participants without OAB, the fully adjusted ORs for depression were 2.76 (95 % CI: 1.64, 4.65) for those with mild OAB, 3.79 (95 % CI: 1.68, 8.55) for those with moderate OAB, and 5.21 (95 % CI: 1.39, 19.53) for those with severe OAB. CONCLUSIONS This study revealed a strong association between OAB and depression and a progressive increase in the risk of depression as the severity of OAB (mild, moderate, and severe) increased. Therefore, it is important for clinicians to recognize the assessment of OAB symptoms in patients who are at risk for or have developed depressive symptoms, as well as the mental health of patients with OAB.
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Affiliation(s)
- Yuyang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Xu Wu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Guodong Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Xingliang Feng
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| | - Hui Jiang
- Department of Urology, Peking University First Hospital Institute of Urology, Peking University Andrology Center, Beijing, China.
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China.
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Celenay ST, Altay H, Bulbul SB, Oskay K. Black box in overactive bladder: Central sensitization and its relationship with urinary symptom severity and quality of life. Neurourol Urodyn 2024; 43:620-627. [PMID: 38221860 DOI: 10.1002/nau.25394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
AIM To examine central sensitization (CS), and to investigate the relationship between CS, and urinary symptom severity, and quality of life (QoL) in women with overactive bladder (OAB). MATERIALS AND METHODS A total of 144 women with OAB included the study. CS with the Central Sensitization Inventory (CSI), urinary symptom with the Overactive Bladder Questionnaire-Version 8 (OAB-V8), bladder diary and Patients' Perception of Intensity of Urgency Scale (PPIUS) and QoL with the King's Health Questionnaire (KHQ) were assessed. RESULTS It was found that 47.9% (n = 69) of women with OAB had CS. It was observed that the CSI score was related to the OAB-V8 score (ρ = 0.327; p < 0.001) and the average number of voids/day (ρ = 0.291; p < 0.001). Additionally, urgency severity was higher in women with OAB with CS than in women with OAB without CS (p = 0.006). There was a relationship between the CSI score and KHQ-incontinence impact (ρ = 0.250; p = 0.012), KHQ-personal relationship (ρ = 0.253; p = 0.002), KHQ-sleep/energy (ρ = 0.180; p = 0.031), KHQ-emotional state (ρ = 0.310; p < 0.001) and KHQ-severity measurement scores (ρ = 0.391; p < 0.001). CONCLUSION In this study, it was observed that the majority of women with OAB had CS. It was found that more severe symptoms of CS were associated with worse urinary symptom severity and QoL in these patients. It may be beneficial to evaluate CS in the management of OAB and to consider CS when determining treatment strategies.
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Affiliation(s)
- Seyda T Celenay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Hafize Altay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Mardin Artuklu University, Mardin, Turkey
| | - Saliha B Bulbul
- Physiotherapy and Rehabilitation Doctorate Program, Institute of Health Science, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Kemal Oskay
- Department of Urology, Ankara Gazi Mustafa Kemal Occupational and Environmental Diseases Hospital, Ankara, Turkey
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Smith AR, Mansfield SA, Bradley CS, Kenton KS, Helmuth ME, Cameron AP, Kirkali Z, Emi Bretschneider C, Andreev V, Sarma A, Lane G, Collins SA, Cella D, Henry Lai H, Harte SE, Griffith JW. Relationships Between Urinary and Nonurinary Symptoms in Treatment-Seeking Women in LURN. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:123-131. [PMID: 37428882 PMCID: PMC10751379 DOI: 10.1097/spv.0000000000001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
IMPORTANCE Physical health and psychological health represent modifiable factors in the causal pathway of lower urinary tract symptoms (LUTS). OBJECTIVES Understand the relationship between physical and psychological factors and LUTS over time. STUDY DESIGN Adult women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study completed the LUTS Tool and Pelvic Floor Distress Inventory, including urinary (Urinary Distress Inventory), prolapse (Pelvic Organ Prolapse Distress Inventory), and colorectal anal (Colorectal-Anal Distress Inventory) subscales at baseline, 3 months, and 12 months. Physical functioning, depression, and sleep disturbance were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires; relationships were assessed using multivariable linear mixed models. RESULTS Of 545 women enrolled, 472 had follow-up. Median age was 57 years; 61% and 78% reported stress urinary incontinence and overactive bladder, respectively; and 81% reported obstructive symptoms. The PROMIS depression scores were positively associated with all urinary outcomes (range, 2.5- to 4.8-unit increase per 10-unit increase in depression score; P < 0.01 for all). Higher sleep disturbance scores were associated with higher urgency, obstruction, LUTS Total Severity, Urinary Distress Inventory, and Pelvic Floor Distress Inventory (1.9- to 3.4-point increase per 10-unit increase, all P < 0.02). Better physical functioning was associated with less severe urinary symptoms except stress urinary incontinence (2.3- to 5.2-point decrease per 10-unit increase, all P < 0.01). All symptoms decreased over time; however, no association was detected between baseline PROMIS scores and trajectories of LUTS over time. CONCLUSIONS Nonurologic factors demonstrated small to medium cross-sectional associations with urinary symptom domains, but no significant association was detected with changes in LUTS. Further work is needed to determine whether interventions targeting nonurologic factors reduce LUTS in women.
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Affiliation(s)
| | | | | | | | | | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | | | | | | | - Sarah A. Collins
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - H. Henry Lai
- Washington University in St. Louis, St. Louis, MO
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
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Jensen S, Walker D, Elsouda D, Lockefeer A, Kenton K, Peipert JD, Jackson KL, Helfand BT, Glaser AP, Cella D. An observational, patient-reported outcome study of sleep quality and depression among individuals with overactive bladder syndrome. Neurourol Urodyn 2024; 43:437-448. [PMID: 38108212 DOI: 10.1002/nau.25348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/06/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Overactive bladder (OAB) can adversely affect health-related quality-of-life (HRQoL) and adherence to treatments; however, the extent of their association is unknown. This study sought to characterize Sleep Disturbance, Depression, Fatigue, and patient-reported medication adherence among adults with OAB in the United States. MATERIALS AND METHODS: In this descriptive, observational study, patients completed patient-reported outcome (PRO) measures of urinary symptoms, anxiety, depression, fatigue, sleep quality, and medication adherence. PRO scores were compared across age, sex, body mass index, and sleep and antidepressant medication-taking subgroups. Exploratory analyses compared PRO scores between groups and estimated the effect size of differences. RESULTS Of 1013 patients contacted, 159 completed the assessments (female: 67.3%; ≥65 years of age: 53.5%; most severe OAB symptom: nocturia). Scale scores for Sleep Disturbance, Fatigue, and Depression were consistent with US population norms. No correlations of moderate or greater magnitude were observed between the severity of lower urinary tract symptoms and Sleep Disturbance, Fatigue, or Depression. When comparing individuals receiving antidepressants with those who were not, almost all outcomes including urinary symptoms, anxiety, and depression were significantly worse. Patients taking antidepressants also had poorer adherence to their OAB medications. CONCLUSION In this cohort of individuals with OAB, Sleep Disturbance, Fatigue, and Depression scores were in line with general population reference values; however, among the subgroups analyzed, patients on antidepressants had worse HRQoL and more substantial impacts on medication adherence, highlighting the importance of the assessment and management of depression in this population.
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Affiliation(s)
- Sally Jensen
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, USA
| | - David Walker
- Astellas Pharma Global Development Inc., Northbrook, Illinois, USA
| | - Dina Elsouda
- Astellas Pharma Global Development Inc., Northbrook, Illinois, USA
| | - Amy Lockefeer
- Astellas Pharma Global Development Inc., Northbrook, Illinois, USA
| | | | - John Devin Peipert
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, USA
| | - Kathryn L Jackson
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, USA
| | | | | | - David Cella
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, USA
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Zholos AV, Melnyk MI, Dryn DO. Molecular mechanisms of cholinergic neurotransmission in visceral smooth muscles with a focus on receptor-operated TRPC4 channel and impairment of gastrointestinal motility by general anaesthetics and anxiolytics. Neuropharmacology 2024; 242:109776. [PMID: 37913983 DOI: 10.1016/j.neuropharm.2023.109776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
Acetylcholine is the primary excitatory neurotransmitter in visceral smooth muscles, wherein it binds to and activates two muscarinic receptors subtypes, M2 and M3, thus causing smooth muscle excitation and contraction. The first part of this review focuses on the types of cells involved in cholinergic neurotransmission and on the molecular mechanisms underlying acetylcholine-induced membrane depolarisation, which is the central event of excitation-contraction coupling causing Ca2+ entry via L-type Ca2+ channels and smooth muscle contraction. Studies of the muscarinic cation current in intestinal myocytes (mICAT) revealed its main molecular counterpart, receptor-operated TRPC4 channel, which is activated in synergy by both M2 and M3 receptors. M3 receptors activation is of permissive nature, while activation of M2 receptors via Gi/o proteins that are coupled to them plays a direct role in TRPC4 opening. Our understanding of signalling pathways underlying mICAT generation has vastly expanded in recent years through studies of TRPC4 gating in native cells and its regulation in heterologous cells. Recent studies using muscarinic receptor knockout have established that at low agonist concentration activation of both M2 receptor and the M2/M3 receptor complex elicits smooth muscle contraction, while at high agonist concentration M3 receptor function becomes dominant. Based on this knowledge, in the second part of this review we discuss the cellular and molecular mechanisms underlying the numerous anticholinergic effects on neuroactive drugs, in particular general anaesthetics and anxiolytics, which can significantly impair gastrointestinal motility. This article is part of the Special Issue on "Ukrainian Neuroscience".
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Affiliation(s)
- Alexander V Zholos
- Educational and Scientific Centre "Institute of Biology and Medicine", Taras Shevchenko National University of Kyiv, Kyiv, Ukraine.
| | - Mariia I Melnyk
- Educational and Scientific Centre "Institute of Biology and Medicine", Taras Shevchenko National University of Kyiv, Kyiv, Ukraine; A.A. Bogomoletz Institute of Physiology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Dariia O Dryn
- A.A. Bogomoletz Institute of Physiology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
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Lai HH, Walker D, Elsouda D, Lockefeer A, Gallington K, Bacci ED. Sleep Disturbance Among Adults With Overactive Bladder: A Cross-sectional Survey. Urology 2023; 179:23-31. [PMID: 37356462 DOI: 10.1016/j.urology.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To examine differences in sleep disturbance, nocturia, and depression among adults with overactive bladder (OAB) by treatment type. METHODS A cross-sectional survey of adults with OAB assessed sleep disturbance, nocturia, and depression using patient-reported outcome measures, including the Patient Reported Outcomes Measurement Information System (PROMIS)-29 Profile v2.1 (Sleep Disturbance and Depression domains), Lower Urinary Tract Dysfunction Research Network Symptom Index-10, and PROMIS Sleep Disturbance Short Form 8B. Treatment groups included antimuscarinics, β-3 adrenergic agonists, and no treatment. Analysis of covariance (ANCOVA) was used to test for differences in study endpoints; Bonferroni-adjusted pairwise tests (P < .05/3) were performed to compare differences in least squares means between groups. RESULTS One hundred participants were included per treatment group. The overall mean (standard deviation) age across all groups was 47.8 (11.8) years. Symptom scores across all PROMIS domains in all three treatment groups were higher than the US general population. There were no statistically significant differences in outcomes across treatment groups. CONCLUSION Adults with OAB reported being affected by sleep disturbance and depression, regardless of treatment. The mirabegron group trended toward the lowest symptom impact across all outcomes, however, comparisons were not significant. Future research should examine temporal associations between OAB treatment, sleep disturbance, and outcomes.
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Affiliation(s)
- H H Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - D Walker
- Astellas Global Pharma Development, Inc., Northbrook, IL.
| | - D Elsouda
- Astellas Global Pharma Development, Inc., Northbrook, IL
| | - A Lockefeer
- Astellas Global Pharma Development, Inc., Northbrook, IL
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11
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Jaekel AK, Watzek J, Nielsen J, Butscher AL, Zöhrer P, Schmitz F, Kirschner-Hermanns RKM, Knüpfer SC. Neurogenic Lower Urinary Tract Symptoms, Fatigue, and Depression-Are There Correlations in Persons with Multiple Sclerosis? Biomedicines 2023; 11:2193. [PMID: 37626690 PMCID: PMC10452515 DOI: 10.3390/biomedicines11082193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
The symptoms of multiple sclerosis (MS) frequently include fatigue, depression, and neurogenic lower urinary tract symptoms (LUTS), causing severe burdens on affected individuals. The relationships between these symptoms have not been intensively researched and there are no studies on the detailed influence of the different neurogenic LUTS. We aimed to investigate the relationships between fatigue, depression, and neurogenic LUTS as recorded in bladder diaries by persons with MS. We analyzed the bladder diaries of 274 people and their scores on the Fatigue Scale for Motor and Cognitive Functions and the Centre for Epidemiologic Studies Depression Scale (German version). The neurogenic LUTS were defined as urgency, reduced voided volume, increased standardized voiding frequency, nocturia, and urinary incontinence. Those suffering from incontinence, nocturia, reduced voided volume, or urgency had higher fatigue scores compared to those without these symptoms. Those with nocturia showed significantly higher scores for depression. The severity of urgency and voided volume had the greatest effect on the severity of individuals' fatigue and depression levels. With increasing urgency, the risk of clinically significant fatigue and depression was expected to increase. Urgency and voided volume correlated most with fatigue and depression. A prospective longitudinal study investigating fatigue/depression after the successful treatment of neurogenic LUTS is needed to clarify causality and offer possible treatment options for fatigue and depression.
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Affiliation(s)
- Anke K. Jaekel
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Department of Neuro-Urology, Johanniter Neurological Rehabilitation Center Godeshoehe GmbH, 53177 Bonn, Germany
| | - Julius Watzek
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Jörn Nielsen
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Center Godeshoehe GmbH, 53177 Bonn, Germany
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Anna-Lena Butscher
- Department of Neuro-Urology, Johanniter Neurological Rehabilitation Center Godeshoehe GmbH, 53177 Bonn, Germany
| | - Pirmin Zöhrer
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Franziska Schmitz
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Ruth K. M. Kirschner-Hermanns
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Department of Neuro-Urology, Johanniter Neurological Rehabilitation Center Godeshoehe GmbH, 53177 Bonn, Germany
| | - Stephanie C. Knüpfer
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
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12
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Girard BM, Campbell SE, Vizzard MA. Stress-induced symptom exacerbation: Stress increases voiding frequency, somatic sensitivity, and urinary bladder NGF and BDNF expression in mice with subthreshold cyclophosphamide (CYP). FRONTIERS IN UROLOGY 2023; 3:1079790. [PMID: 37811396 PMCID: PMC10558155 DOI: 10.3389/fruro.2023.1079790] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Symptom exacerbation due to stress is prevalent in many disease states, including functional disorders of the urinary bladder (e.g., overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS)); however, the mechanisms underlying the effects of stress on micturition reflex function are unclear. In this study we designed and evaluated a stress-induced symptom exacerbation (SISE) mouse model that demonstrates increased urinary frequency and somatic (pelvic and hindpaw) sensitivity. Cyclophosphamide (CYP) (35 mg/kg; i.p., every 48 hours for a total of 4 doses) or 7 days of repeated variate stress (RVS) did not alter urinary bladder function or somatic sensitivity; however, both CYP alone and RVS alone significantly (p ≤ 0.01) decreased weight gain and increased serum corticosterone. CYP treatment when combined with RVS for 7 days (CYP+RVS) significantly (p ≤ 0.01) increased serum corticosterone, urinary frequency and somatic sensitivity and decreased weight gain. CYP+RVS exposure in mice significantly (p ≤ 0.01) increased (2.6-fold) voiding frequency as we determined using conscious, open-outlet cystometry. CYP+RVS significantly (p ≤ 0.05) increased baseline, threshold, and peak micturition pressures. We also evaluated the expression of NGF, BDNF, CXC chemokines and IL-6 in urinary bladder in CYP alone, RVS alone and CYP+RVS mouse cohorts. Although all treatments or exposures increased urinary bladder NGF, BDNF, CXC and IL-6 content, CYP+RVS produced the largest increase in all inflammatory mediators examined. These results demonstrated that CYP alone or RVS alone creates a change in the inflammatory environment of the urinary bladder but does not result in a change in bladder function or somatic sensitivity until CYP is combined with RVS (CYP+RVS). The SISE model of CYP+RVS will be useful to develop testable hypotheses addressing underlying mechanisms where psychological stress exacerbates symptoms in functional bladder disorders leading to identification of targets and potential treatments.
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Affiliation(s)
- Beatrice M Girard
- The Larner College of Medicine at The University of Vermont, Department of Neurological Sciences, Burlington, VT, 05405
| | - Susan E Campbell
- The Larner College of Medicine at The University of Vermont, Department of Neurological Sciences, Burlington, VT, 05405
| | - Margaret A Vizzard
- The Larner College of Medicine at The University of Vermont, Department of Neurological Sciences, Burlington, VT, 05405
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Jung J, Kim A, Yang SH. The Innovative Approach in Functional Bladder Disorders: The Communication Between Bladder and Brain-Gut Axis. Int Neurourol J 2023; 27:15-22. [PMID: 37015721 PMCID: PMC10072998 DOI: 10.5213/inj.2346036.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/21/2023] [Indexed: 04/06/2023] Open
Abstract
Functional bladder disorders including overactive bladder and interstitial cystitis may induce problems in many other parts of our body such as brain and gut. In fact, diagnosis is often less accurate owing to their complex symptoms. To have correct diagnosis of these diseases, we need to understand the pathophysiology behind overlapped clinical presentation. First, we focused on reviewing literatures that have reported the link between bladder and brain, as the patients with bladder disorders frequently accompanied mood disorders such as depression and anxiety. Second, we reviewed literatures that have described the relationship between bladder and gut. There exist many evidences of patients who suffered from both bladder and intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, at the same time. Furthermore, the interaction between brain and gut, well-known as brain-gut axis, might be a key factor that could change the activity of bladder and vice versa. For example, the affective disorders could alter the activity of efferent nerves or autonomic nervous system that modulate the gut itself and its microbiota, which might cause the destruction of homeostasis in bladder eventually. In this way, the communication between bladder and brain-gut axis might affect permeability, inflammation, as well as infectious etiology and dysbiosis in bladder diseases. In this review, we aimed to find an innovative insight of the pathophysiology in the functional bladder disorders, and we could provide a new understanding of the overlapped clinical presentation by elucidating the pathophysiology of functional bladder disorders.
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Affiliation(s)
- Jiwon Jung
- Department of Biomedical Engineering, College of Life Science and Biotechnology, Dongguk University, Seoul, Korea
| | - Aram Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seung-Hoon Yang
- Department of Biomedical Engineering, College of Life Science and Biotechnology, Dongguk University, Seoul, Korea
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14
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Anticholinergic Use for OAB in the Older Woman: An Update. CURRENT GERIATRICS REPORTS 2023. [DOI: 10.1007/s13670-023-00380-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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15
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Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:S1-S19. [PMID: 36548636 DOI: 10.1097/spv.0000000000001272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications. OBJECTIVES The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment. STUDY DESIGN The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets. RESULTS Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk. CONCLUSIONS The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment.
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16
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Hargreaves E, Baker K, Barry G, Harding C, Zhang Y, Kandala NB, Zhang X, Kernohan A, Clarkson CE. Acupuncture for treating overactive bladder in adults. Cochrane Database Syst Rev 2022; 9:CD013519. [PMID: 36148895 PMCID: PMC9502659 DOI: 10.1002/14651858.cd013519.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Overactive bladder is a common, long-term symptom complex, which includes frequency of micturition, urgency with or without associated incontinence and nocturia. Around 11% of the population have symptoms, with this figure increasing with age. Symptoms can be linked to social anxiety and adaptive behavioural change. The cost of treating overactive bladder is considerable, with current treatments varying in effectiveness and being associated with side effects. Acupuncture has been suggested as an alternative treatment. OBJECTIVES To assess the effects of acupuncture for treating overactive bladder in adults, and to summarise the principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (including In-Process, Epub Ahead of Print, Daily), ClinicalTrials.gov and WHO ICTRP (searched 14 May 2022). We also searched the Allied and Complementary Medicine database (AMED) and bibliographic databases where knowledge of the Chinese language was necessary: China National Knowledge Infrastructure (CNKI); Chinese Science and Technology Periodical Database (VIP) and WANFANG (China Online Journals), as well as the reference lists of relevant articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs and cross-over RCTs assessing the effects of acupuncture for treating overactive bladder in adults. DATA COLLECTION AND ANALYSIS Four review authors formed pairs to assess study eligibility and extract data. Both pairs used Covidence software to perform screening and data extraction. We assessed risk of bias using Cochrane's risk of bias tool and assessed heterogeneity using the Chi2 testand I2 statistic generated within the meta-analyses. We used a fixed-effect model within the meta-analyses unless there was a moderate or high level of heterogeneity, where we employed a random-effects model. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 15 studies involving 1395 participants in this review (14 RCTs and one quasi-RCT). All included studies raised some concerns regarding risk of bias. Blinding of participants to treatment group was only achieved in 20% of studies, we considered blinding of outcome assessors and allocation concealment to be low risk in only 25% of the studies, and random sequence generation to be either unclear or high risk in more than 50% of the studies. Acupuncture versus no treatment One study compared acupuncture to no treatment. The evidence is very uncertain regarding the effect of acupuncture compared to no treatment in curing or improving overactive bladder symptoms and on the number of minor adverse events (both very low-certainty evidence). The study report explicitly stated that no major adverse events occurred. The study did not report on the presence or absence of urinary urgency, episodes of urinary incontinence, daytime urinary frequency or episodes of nocturia. Acupuncture versus sham acupuncture Five studies compared acupuncture with sham acupuncture. The evidence is very uncertain about the effect of acupuncture on curing or improving overactive bladder symptoms compared to sham acupuncture (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -1.03 to 0.31; 3 studies; 151 participants; I2 = 65%; very low-certainty evidence). All five studies explicitly stated that there were no major adverse events observed during the study. Moderate-certainty evidence suggests that acupuncture probably makes no difference to the incidence of minor adverse events compared to sham acupuncture (risk ratio (RR) 1.28, 95% CI 0.30 to 5.36; 4 studies; 222 participants; I² = 0%). Only one small study reported data for the presence or absence of urgency and for episodes of nocturia. The evidence is of very low certainty for both of these outcomes and in both cases the lower confidence interval is implausible. Moderate-certainty evidence suggests there is probably little or no difference in episodes of urinary incontinence between acupuncture and sham acupuncture (mean difference (MD) 0.55, 95% CI -1.51 to 2.60; 2 studies; 121 participants; I2 = 57%). Two studies recorded data regarding daytime urinary frequency but we could not combine them in a meta-analysis due to differences in methodologies (very low-certainty evidence). Acupuncture versus medication Eleven studies compared acupuncture with medication. Low-certainty evidence suggests that acupuncture may slightly increase how many people's overactive bladder symptoms are cured or improved compared to medication (RR 1.25, 95% CI 1.10 to 1.43; 5 studies; 258 participants; I2 = 19%). Low-certainty evidence suggests that acupuncture may reduce the incidence of minor adverse events when compared to medication (RR 0.34, 95% CI 0.26 to 0.45; 8 studies; 1004 participants; I² = 51%). The evidence is uncertain regarding the effect of acupuncture on the presence or absence of urinary urgency (MD -0.40, 95% CI -0.56 to -0.24; 2 studies; 80 participants; I2 = 0%; very low-certainty evidence) and episodes of urinary incontinence (MD -0.33, 95% CI -2.75 to 2.09; 1 study; 20 participants; very low-certainty evidence) compared to medication. Low-certainty evidence suggests there may be little to no effect of acupuncture compared to medication in terms of daytime urinary frequency (MD 0.73, 95% CI -0.39 to 1.85; 4 studies; 360 participants; I2 = 28%). Acupuncture may slightly reduce the number of nocturia episodes compared to medication (MD -0.50, 95% CI -0.65 to -0.36; 2 studies; 80 participants; I2 = 0%, low-certainty evidence). There were no incidences of major adverse events in any of the included studies. However, major adverse events are rare in acupuncture trials and the numbers included in this review may be insufficient to detect these events. AUTHORS' CONCLUSIONS The evidence is very uncertain about the effect acupuncture has on cure or improvement of overactive bladder symptoms compared to no treatment. It is uncertain if there is any difference between acupuncture and sham acupuncture in cure or improvement of overactive bladder symptoms. This review provides low-certainty evidence that acupuncture may result in a slight increase in cure or improvement of overactive bladder symptoms when compared with medication and may reduce the incidence of minor adverse events. These conclusions must remain tentative until the completion of larger, higher-quality studies that use relevant, comparable outcomes. Timing and frequency of treatment, point selection, application and long-term follow-up are other areas relevant for research.
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Affiliation(s)
- Emma Hargreaves
- Department of Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Christopher Harding
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Yingying Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ngianga-Bakwin Kandala
- Warwick Medical School, University of Warwick, Coventry, UK
- Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Xiaowen Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Carl E Clarkson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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17
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Hou G, Gao M, Zheng Y, Hou N, Zhang S, Sun J, Jannini TB, Zhang L, Dun X, Wang F, Jannini EA, Yuan J. Nomogram for stratifying patients with lifelong premature ejaculation before using the PHQ-9: An observational study. Eur J Clin Invest 2022; 52:e13809. [PMID: 35514259 DOI: 10.1111/eci.13809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/24/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A PHQ-9 score ≥ 15, represented as PHQ-9+ , indicates major depressive disorder (MDD). On using PHQ-9, the psychological burden of several patients with lifelong premature ejaculation (LPE) gets aggravated, which may lead to LPE development. We aim to construct a nomogram for predicting the individual risk of PHQ-9+ in patients with LPE and discerning those with low risks, who should avoid the PHQ-9. METHODS The nomogram was constructed by analysing data of 802 patients from Xijing Hospital and Northwest Women's & Children's Hospital. The LASSO and multivariable logistic regressions were used to identify independent predictors of PHQ-9+ , used for developing the nomogram. The discrimination, calibration and clinical usefulness of the nomogram were assessed in the derivation cohort and an independent validation cohort, which was composed of 505 prospectively enrolled patients from Daxing Hospital and Xijing Hospital. RESULTS The duration of PE, IELT, a history of PE exacerbation, IIEF-5 score, urinary frequency and physical pain score were identified as independent predictors. The nomogram showed excellent calibration, discrimination and clinical usefulness in the derivation and validation cohorts, with a predictive accuracy of 0.781 and 0.763, respectively. Based on this nomogram, patients were divided into not recommended, recommended and strongly recommended PHQ-9 filling groups, with PHQ-9+ rates of 3.5%, 9.3% and 30.7%, respectively. CONCLUSION A nomogram to discern LPE patients with low risks of PHQ-9+ was established. This tool can increase the positivity of MDD screening and may improve the therapeutic outcomes of those in the low-risk group.
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Affiliation(s)
- Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming Gao
- Department of Andrology, Xi'an Daxing Hospital, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Yu Zheng
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Department of Anatomy, Histology and Embryology, Fourth Military Medical University, Xi'an, China.,Medical Innovation Center, Fourth Military Medical University, Xi'an, China
| | - Niuniu Hou
- Department of General Surgery, Eastern Theater Air Force Hospital of PLA, Nanjing, China.,Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Siyan Zhang
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianhua Sun
- Assisted Reproduction Center, Northwest Women's & Children's Hospital, Xi'an, China
| | - Tommaso B Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Lei Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xinlong Dun
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fuli Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | | | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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18
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Matta R, Gomes T, Juurlink D, Jarvi K, Herschorn S, Nam RK. Receipt of Overactive Bladder Drugs and Incident Dementia: A Population-based Case-control Study. Eur Urol Focus 2022; 8:1433-1440. [PMID: 34742663 DOI: 10.1016/j.euf.2021.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/09/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The differential risk of incident dementia associated with receiving various overactive bladder (OAB) drugs is unknown. OBJECTIVE To estimate the association of antimuscarinic OAB drug (exposure), compared with a β-3 agonist (mirabegron), and incident dementia. DESIGN, SETTING, AND PARTICIPANTS A population-based nested case-control study was conducted in patients treated with OAB medications in Ontario, Canada. A total of 11 392 patients aged ≥66 yr with a new diagnosis of dementia between 2010 and 2017, and 29 881 age- and sex-matched controls without dementia were included in the study. INTERVENTION Receipt of an antimuscarinic OAB drug or receipt of mirabegron, within the previous 6-12 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cases developed dementia and Alzheimer's disease. Controls were derived from the general population and matched to cases based on important baseline characteristics. Odds ratios (ORs) for incident dementia, adjusted for demographic and health-related characteristics, were determined. RESULTS AND LIMITATIONS Patients receiving solifenacin (OR 1.24; 95% confidence interval 1.08-1.43) and darifenacin (OR 1.30; 95% CI 1.08-1.56) in the prior 6 mo had increased odds of incident dementia compared with those receiving mirabegron. In the 6 mo to 1 yr prior to diagnosis, receipt of solifenacin (OR 1.34; 95% CI 1.11-1.60), darifenacin (OR 1.49; 95% CI 1.19-1.86), tolterodine (OR 1.21; 95% CI 1.02-1.45), and fesoterodine (OR 1.39; 95% CI 1.14-1.71) was associated with increased odds of incident dementia compared with receipt of mirabegron. No effect was seen with oxybutynin or trospium. Limitations included misclassification of the outcome and residual confounding associated with the use of health administrative databases. CONCLUSIONS Older adults receiving solifenacin and darifenacin in the 6 mo prior to diagnosis, and those receiving solifenacin, darifenacin, tolterodine, or fesoterodine in the year prior to diagnosis, have increased odds of incident dementia, compared with those receiving mirabegron. Oxybutynin and trospium were not associated with dementia, likely due to a protopathic bias. Careful drug selection is warranted when treating patients with OAB. PATIENT SUMMARY In a large Canadian cohort of patients who developed dementia after starting an overactive bladder (OAB) medication, those taking some anticholinergic medications for OAB have an increased risk of dementia compared with those taking mirabegron.
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Affiliation(s)
- Rano Matta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Tara Gomes
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David Juurlink
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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19
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Westwell-Roper C, Best JR, Naqqash Z, Afshar K, MacNeily AE, Stewart SE. Bowel and Bladder Dysfunction Is Associated with Psychiatric Comorbidities and Functional Impairment in Pediatric Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol 2022; 32:358-365. [PMID: 35404114 DOI: 10.1089/cap.2021.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Neuropsychiatric disorders are common in children with bowel and bladder dysfunction (BBD), a syndrome associated with urinary frequency, urgency, holding, incontinence, and constipation. We evaluated BBD symptom severity in children and youth attending a tertiary care obsessive-compulsive disorder (OCD) clinic. Methods: Consecutive patients attending initial OCD assessments between 2016 and 2020 were invited to participate in a registry study. Diagnosis of OCD and comorbidities was established by structured clinical interview. OCD severity and impact were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and the Child Obsessive Compulsive Impact Scale (COIS-R; self-report), respectively. BBD symptoms were quantified with the Vancouver Symptom Score (VSS), a validated self-report measure. Results: One hundred twelve participants completed the VSS (mean age 13.5 ± 3.3, range 7-20). Based on a cutoff score of 11 corresponding to pediatric urologist-diagnosed BBD, 30.4% of participants screened positive, including more females than males (39.3% vs. 21.4%; p = 0.04). Daytime urinary incontinence was present in a greater proportion of participants with OCD forbidden thoughts (34.8% vs. 8.2%, p = 0.002), major depressive disorder (MDD; 38.5% vs. 6.8%, p = 0.001), and somatization disorder (60% vs. 9%, p = 0.001) compared with those without. A regression model including CY-BOCS, COIS-R, psychiatric comorbidities, medications, age, and gender explained 52.2% of the variance in VSS; COIS-R, tic disorder, and MDD were significant predictors. Conclusion: BBD symptoms are common and associated with high OCD-related impairment and psychiatric comorbidities. Standardized assessment may facilitate identification of BBD symptoms in this population and is critical to mitigating long-term physical and mental health impacts. Further studies are required to assess the relationship between BBD and OCD treatment outcomes.
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Affiliation(s)
- Clara Westwell-Roper
- Provincial OCD Program, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Psychiatry and Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - John R Best
- Provincial OCD Program, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Psychiatry and Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Zainab Naqqash
- Provincial OCD Program, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Psychiatry and Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Division of Pediatric Urology, BC Children's Hospital, Vancouver, Canada
| | - Andrew E MacNeily
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Division of Pediatric Urology, BC Children's Hospital, Vancouver, Canada
| | - S Evelyn Stewart
- Provincial OCD Program, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Psychiatry and Faculty of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health and Substance Use Research Institute, Vancouver, Canada
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Schönburg S, Murgas S, Fornara P, Michel MC. Associations between the Patient Perception of Bladder Condition score and overactive bladder syndrome symptoms at baseline and upon treatment. Neurourol Urodyn 2022; 41:1399-1405. [PMID: 35593001 DOI: 10.1002/nau.24960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patient-reported outcomes such as the Patient Perception of Bladder Condition (PPBC) score are frequently used to characterize overactive bladder syndrome (OAB) patients and their treatment outcomes. However, little information is available on the relationship of such scores to OAB symptoms at the individual patient level. METHODS We have performed a post hoc analysis of two large noninterventional studies (n = 1345 and 745) in which patients received propiverine extended release (30 or 45 mg/day) for 12 weeks to determine the strength of nonparametric correlations between PPBC and OAB symptoms at baseline, after treatment and with treatment-associated changes thereof. RESULTS PPBC was not correlated with age but with episode frequencies of urgency, incontinence, micturitions, and nocturia, but the strength of correlations was only moderate (Spearman rank correlation coefficient 0.2045-0.3553). Similarly moderate correlations were observed after treatment and when changes in PPBC were compared to those of OAB symptoms, although these correlations were somewhat stronger. CONCLUSIONS PPBC is only moderately correlated to OAB symptoms indicating that it characterizes patients beyond what is captured by their symptoms.
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Affiliation(s)
- Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | | | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
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21
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Chermansky CJ, Guirguis MO. Pharmacologic Management of Interstitial Cystitis/Bladder Pain Syndrome. Urol Clin North Am 2022; 49:273-282. [DOI: 10.1016/j.ucl.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Mehr AA, Kreder KJ, Lutgendorf SK, Ten Eyck P, Greimann ES, Bradley CS. Daily symptom associations for urinary urgency and anxiety, depression and stress in women with overactive bladder. Int Urogynecol J 2022; 33:841-850. [PMID: 34842938 PMCID: PMC9039964 DOI: 10.1007/s00192-021-05033-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Women with overactive bladder (OAB) report psychological distress, anxiety and depression, but short-term associations between these symptoms are poorly studied. Our objectives were to study daily associations between OAB symptoms and psychological symptoms and test whether these associations were stable when reassessed after 3 months. We hypothesized that OAB symptoms are positively associated with anxiety and depression symptoms over a short-term (daily) basis. METHODS Female patients with OAB [bothersome urgency and/or urgency urinary incontinence (UUI)] assessed OAB and mood symptoms at baseline and 3 months using a 3-day bladder diary and visual analog scale (VAS) ratings (0-100 mm) for anxiety, depression and stress. Daily OAB and mood symptom associations were tested using Spearman correlations. Generalized estimating equation (GEE) models tested associations between daily urgency scores and each psychological rating adjusting for covariates, time and a time-symptom interaction term. RESULTS Participants (n = 69) had mean (SD) age 63.3 (13.4) years. Baseline diary outcomes [median (IQR)/day] included day voids 8 (7-11), nocturia 0 (0-1), UUI episodes 1 (0-3) and urgency score 1.75 (1-2.25). Anxiety and depression diagnoses (dx) and treatment (tx) were common (anxiety dx 30.4%, tx 21.7%; depression dx 47.8%, tx 37.7%), but daily anxiety, depression and stress ratings were low [median (IQR) mm 10 (3-35), 5 (1-16), and 16 (4-39), respectively]. Daily urgency scores correlated with anxiety (r = 0.30-0.40, days 1-3, p ≤ 0.01 for all), depression (r = 0.24-0.35, p ≤ 0.05 all) and stress (r = 0.27-0.34, p ≤ 0.03 all). GEE models indicated no significant change in these associations between baseline and 3 months, and OAB treatment did not impact the associations. CONCLUSIONS Urgency scores were positively associated with same-day ratings of anxiety, depression and stress in OAB patients.
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Affiliation(s)
- Allen A Mehr
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Karl J Kreder
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Susan K Lutgendorf
- Departments of Psychological and Brain Sciences and Urology, University of Iowa, Iowa City, IA, USA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Emma S Greimann
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Catherine S Bradley
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Frankel J, Staskin D, Varano S, Kennelly M, Newman DK, Rosenberg MT, Jankowich RA, Shortino D, Mudd PN, Girman CJ. Interpretation of the Meaningfulness of Symptom Reduction with Vibegron in Patients with Overactive Bladder: Analyses from EMPOWUR. Adv Ther 2022; 39:959-970. [PMID: 34921665 PMCID: PMC8866263 DOI: 10.1007/s12325-021-01972-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Reductions in bothersome symptoms of overactive bladder (OAB) demonstrate improvement in clinical trials, but patient perception of meaningfulness of such improvement is lacking. In the 12-week phase 3 EMPOWUR trial, vibegron significantly reduced average daily number of micturitions, urgency episodes, and urge urinary incontinence (UUI) episodes vs placebo (P < 0.01 each). This analysis assessed meaningfulness of reductions in clinical endpoints observed in EMPOWUR using patient perception of improvement. METHODS An anchor-based approach using Patient Global Impression of Change (PGI-C) applied to phase 2 data allowed predefining phase 3 responder definitions. To confirm in phase 3, median change from baseline at week 12 in average daily number of micturitions, urgency episodes, and UUI episodes was generated for each PGI-C category and pooled across treatments. Based on predefined meaningful responder definitions, percentages of patients achieving ≥ 15% reduction in micturitions (post hoc), ≥ 50% reduction in urgency episodes (predefined), and ≥ 75% (predefined) and ≥ 90% (post hoc) reduction in UUI episodes were determined for patients receiving vibegron or placebo. RESULTS Across treatments, for micturitions, urgency episodes, and UUI episodes, median change from baseline to week 12 increased with greater subjective improvement based on PGI-C scores, and median reductions pooled across treatment groups were higher than the responder definitions that patients perceived as improved. Significantly more patients receiving vibegron vs placebo achieved ≥ 15% reduction in micturitions (56.3% vs 44.6%, respectively), ≥ 50% reduction in urgency episodes (39.5% vs 32.8%), ≥ 75% reduction in UUI episodes (49.3% vs 32.8%), and ≥ 90% reduction in UUI episodes (35.2% vs 23.5%) at week 12 (P < 0.05 each). CONCLUSION Significantly more patients treated with vibegron vs placebo in EMPOWUR achieved meaningful reductions in micturitions, urgency episodes, and UUI episodes that were associated with patient-perceived improvement. Results of these analyses support the meaningfulness of reductions in clinical endpoints observed in the 12-week EMPOWUR trial. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier, NCT03492281.
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Affiliation(s)
| | - David Staskin
- Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Cynthia J Girman
- CERobs Consulting, LLC, 2612 Lumina Avenue North, Wrightsville Beach, Chapel Hill, NC, 28480, USA.
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24
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Reynolds WS, Kaufman M, Bruehl S, Dmochowski R, McKernan LC. Compensatory bladder behaviors ("coping") in women with overactive bladder. Neurourol Urodyn 2022; 41:195-202. [PMID: 34524704 PMCID: PMC8738122 DOI: 10.1002/nau.24788] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023]
Abstract
AIMS There is little information on how often or within what contexts individuals with OAB use compensatory behaviors ("coping") to manage symptoms. We sought to examine how frequently women with OAB report using coping behaviors and whether these are associated with psychosocial factors. METHODS One hundred twenty adult women with OAB completed the OAB questionnaire (OAB-q), ICIQ-FLUTS questionnaire, PROMIS Anxiety and Depression, Perceived Stress Scale, patient perception of bladder condition, and demographic and clinical data. Responses from five items from the OAB-q Quality-of-Life scale asking about coping with OAB symptoms (i.e., "compensatory coping behaviors") were summed to generate a total Coping Score. Linear regression was used to identify associations between individual coping behaviors, total Coping Scores, and exposure variables. RESULTS Most (88%) subjects reported using at least one compensatory coping behavior at least "a little of the time," with "locating the nearest restroom in a new place" the most frequent. Higher BMI, lower education, using OAB medication, and urgency incontinence as well as urinary symptom severity were all associated with higher coping scores. Beyond the influence of OAB severity, higher anxiety (β = 0.15, 95% CI [0.05-0.26], p = 0.004) and stress (β = 0.16 [0.03-0.25], p = 0.02) were significantly associated with higher total coping scores, although depression was not. CONCLUSIONS Compensatory bladder behaviors (coping) were common in women with OAB and were associated with greater urinary symptom severity and higher anxiety and stress. Further study is needed to understand how coping behaviors and psychosocial factors relate, as these may represent important opportunities for interventions.
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Affiliation(s)
- W. Stuart Reynolds
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsey C. McKernan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN,Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
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Biao W, Long Z, Yang Z, Hua G, Shuangkun W. Abnormal resting-state brain activity and connectivity of brain-bladder control network in overactive bladder syndrome. Acta Radiol 2021; 63:1695-1702. [PMID: 34851160 DOI: 10.1177/02841851211057278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neuroimaging studies have shown that the brain is involved in the mechanism of overactive bladder disease (OAB). PURPOSE To explorer spatial patterns of spontaneous neural activities and functional integration in patients with OAB. MATERIAL AND METHODS In total, 28 patients with OAB and 28 matched healthy controls (HC) underwent resting-state functional magnetic resonance imaging and completed questionnaires to assess clinical symptoms. The amplitude of low-frequency fluctuation (ALFF) and ROI-based functional connectivity (FC) within the brain-bladder control network (BBCN) were calculated and compared between the two groups using a two-sample t-test. Pearson correlation analysis was performed to investigate the relationship between ALFF and the clinical score of patients with OAB. RESULTS Compared with HCs, patients with OAB exhibited significantly decreased ALFF in the left superior medial middle gyrus (SFGmed) and superior dorsal frontal gyrus (SFGdor), and increased ALFF in the right hippocampus. Furthermore, ALFF values in the left SFGmed were negatively correlated with OABSS scores. FC in patients with OAB was significantly increased between the bilateral caudate nucleus (CAU) and bilateral SFGdor, the bilateral CAU and bilateral supplementary motor area (SMA), the bilateral thalamus and SMA; the left CAU and bilateral SFGmed, the left CAU and bilateral anterior cingulate gyrus, and the left CAU and left insula. Additionally, decreased FC was found between the bilateral amygdala and bilateral SFGmed and the left SMA and left insula. CONCLUSION These abnormal activities and connectivities of BBCN may indicate impaired cortical control of micturition in OAB, suggesting a possible neural mechanism of OAB.
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Affiliation(s)
- Wang Biao
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Zuo Long
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Zhou Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Gu Hua
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Wang Shuangkun
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
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27
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Doumouchtsis SK, Loganathan J, Pergialiotis V. The Role of Obesity on Urinary and Anal Incontinence in women: a review. BJOG 2021; 129:162-170. [PMID: 34312978 DOI: 10.1111/1471-0528.16848] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/30/2022]
Abstract
Obesity is increasing worldwide with significant healthcare implications. We searched PubMed/MEDLINE, Embase and Cochrane Library for articles registered until June 2020 to explore the relationship between obesity, urinary (UI) and anal incontinence (AI). Obesity is associated with low-grade, systemic inflammation and pro-inflammatory cytokine release, producing reactive oxygen species and oxidative stress (1). This alters collagen metabolism and, in combination with increased intraabdominal pressure, contributes to UI development. Whereas in AI, stool consistency may be a factor. Weight loss can reduce UI and should be a management focus, however effect on AI is less clear. Keywords: Obesity, Urinary incontinence, Anal incontinence.
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Affiliation(s)
- Stergios K Doumouchtsis
- Epsom and Saint, Helier University Hospitals NHS Trust, Obstetrics and Gynaecology, Surrey, UK
| | - Jemina Loganathan
- Epsom and Saint, Helier University Hospitals NHS Trust, Obstetrics and Gynaecology, Surrey, UK
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Hargreaves E, Harding C, Clarkson C. Acupuncture in addition to standard conservative treatment for overactive bladder; a feasibility trial for a randomized controlled study. Neurourol Urodyn 2021; 40:1770-1779. [PMID: 34289514 DOI: 10.1002/nau.24741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/29/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022]
Abstract
AIMS This study aims to assess the feasibility of an randomized controlled trial (RCT) to test treatment efficacy of acupuncture for symptoms of overactive bladder syndrome (OAB), a common long-term condition with physical, psychological, social and sexual consequences. METHODS A total of 30 participants were recruited and randomized to either standard conservative management for OAB or standard conservative management plus acupuncture. Standard care consisted of individually tailored advice regarding bladder health, pelvic floor exercises and lifestyle adjustments. The intervention group received 6 sessions of acupuncture over an 8-week period. Outcomes measured included adherence to the study protocol, recruitment rate, participant attrition rate and adverse events. A 3-day bladder diary and Incontinence Questionnaire-short form questionnaire were used to assess symptoms. The ICEpop CAPability measure for Adults measure was used to assess well-being. Outcomes were collected at baseline, after 8 weeks of intervention and 6 weeks after completing intervention. An exit questionnaire captured participant experience data. RESULTS Comparison of the two groups at baseline did not detect statistically significant differences in demographics and symptom profile. A total of 23 participants completed all study proceedures. Recruitment was completed in 11 months, quicker than anticipated. No serious adverse events occurred; minor adverse events were recorded in 11/114 (9.6%) treatments. A total of seven participants failed to complete one or more study proceedures with an overall attrition rate of 23.3%. CONCLUSIONS Most participants completed all aspects of the study and found the protocol acceptable. The interventions appear safe and well tolerated. The concept of a large-scale RCT with a similar protocol was proven and appears feasible based on this pilot work.
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Affiliation(s)
- Emma Hargreaves
- Physiotherapy Department, Clinical Specialist Physiotherapist, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris Harding
- Urology Department, Consultant Urologist, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Carl Clarkson
- Department of Sport, Exercise and Rehabilitation, Programme Lead BSc Physiotherapy, Northumbria University, Newcastle upon Tyne, UK
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West EG, Sellers DJ, Chess-Williams R, McDermott C. The anxiolytic sertraline reduces the impact of psychological stress on bladder function in mice. Life Sci 2021; 278:119598. [PMID: 33984361 DOI: 10.1016/j.lfs.2021.119598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023]
Abstract
AIMS To determine if treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline reduces the bladder dysfunction caused by water avoidance stress in mice. MAIN METHODS Adult female mice were randomly allocated to (1) Unstressed, (2) Stressed or (3) Stress + Sertraline experimental groups. Stressed mice were subjected to water avoidance for 1 h/day for 10 days and received sertraline or vehicle in drinking water, starting 10-days prior to the first stress exposure. Age matched control/unstressed mice were house under normal conditions without stress exposure. Voiding behaviour was assessed throughout the experimental protocol. After the final stress exposure, a blood sample was taken to measure plasma corticosterone levels and bladders were removed, catheterised and intravesical pressure responses recorded during distension and in response to pharmacological agents. KEY FINDINGS Plasma corticosterone levels in sertraline-treated animals were equivalent to unstressed controls and significantly decreased compared to the stressed group. Voiding frequency was significantly increased in the stressed group, and treatment with sertraline significantly decreased voiding frequency, however, this remained elevated compared to unstressed control animals. Bladders from stressed mice displayed enhanced maximal contractile response to the muscarinic agonist carbachol and greater release of ACh in the serosal fluid, which was reduced to control levels by sertraline treatment. Spontaneous phasic contractions were not altered by stress but were significantly reduced in bladders from sertraline treated animals, relative to controls. SIGNIFICANCE These results indicate that management of voiding dysfunction caused by psychological stress may be aided by the addition of an SSRI such as sertraline.
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Affiliation(s)
- Eliza G West
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Donna J Sellers
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Russ Chess-Williams
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Catherine McDermott
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia.
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Abstract
BACKGROUND Overactive bladder is a heterogenous condition with poorly characterized clinical phenotypes. To discover potential patient subtypes in patients with overactive bladder (OAB), we used consensus clustering of their urinary symptoms and other non-urologic factors. METHODS Clinical variables included in the k-means consensus clustering included OAB symptoms, urinary incontinence, anxiety, depression, psychological stress, somatic symptom burden, reported childhood traumatic exposure, and bladder pain. RESULTS 48 OAB patients seeking care of their symptoms were included. k-means consensus clustering identified two clusters of OAB patients: a urinary cluster and a systemic cluster. The systemic cluster, which consisted of about half of the cohort (48%), was characterized by significantly higher psychosocial burden of anxiety (HADS-A, 9.5 vs. 3.7, p < 0.001), depression (HADS-D, 6.9 vs. 3.6, p < 0.001), psychological stress (PSS, 21.4 vs. 12.9, p < 0.001), somatic symptom burden (PSPS-Q, 28.0 vs. 7.5, p < 0.001), and reported exposure to traumatic stress as a child (CTES, 17.0 vs. 5.4, p < 0.001), compared to the urinary cluster. The systemic cluster also reported more intense bladder pain (3.3 vs. 0.8, p = 0.002), more widespread distribution of pain (34.8% vs. 4.0%, p = 0.009). The systemic cluster had worse urinary incontinence (ICIQ-UI, 14.0 vs. 10.7, p = 0.028) and quality of life (SF-36, 43.7 vs. 74.6, p < 0.001). The two clusters were indistinguishable by their urgency symptoms (ICIQ-OAB, OAB-q, IUSS, 0-10 ratings). The two OAB clusters were different from patients with IC/BPS (worse urgency incontinence and less pain). CONCLUSIONS The OAB population is heterogeneous and symptom-based clustering has identified two clusters of OAB patients (a systemic cluster vs. a bladder cluster). Understanding the pathophysiology of OAB subtypes may facilitate treatments.
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Kawahara T, Ninomiya S, Tsutsumi S, Ito H, Yao M, Uemura H. Impact of depression on overactive bladder. Int J Urol 2020; 28:245-246. [PMID: 33174244 PMCID: PMC7894284 DOI: 10.1111/iju.14434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.,Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Sahoko Ninomiya
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Sohgo Tsutsumi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroki Ito
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
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West EG, Sellers DJ, Chess-Williams R, McDermott C. Bladder overactivity induced by psychological stress in female mice is associated with enhanced bladder contractility. Life Sci 2020; 265:118735. [PMID: 33166589 DOI: 10.1016/j.lfs.2020.118735] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/25/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022]
Abstract
AIMS To investigates the effects of water avoidance stress on voiding behaviour and functional bladder responses in mice. MAIN METHODS Mice in the Stress group were exposed to water avoidance stress (WAS) for 1 h/day for 10 days, Controls were age-matched and housed normally. Voiding behaviour was measured periodically throughout the stress protocol and bladders were isolated 24-h after final stress exposure to measure bladder compliance, spontaneous phasic activity, contractile responses, and release of urothelial mediators. KEY FINDINGS Repeated stress exposure induced a significant increase in plasma corticosterone levels in the WAS group compared to control. An overactive bladder phenotype was observed in WAS mice, causing a significant increase in the number of voiding events observed from as early as day-3, and a 7-fold increase following 10-days' stress. This increase in voiding frequency was associated with a significant decrease in void size, an increase in the number of small voids, but no change in total voided volume. Bladders from stressed mice showed a significant increase in the maximum responses to the muscarinic agonist carbachol (p < 0.01), in addition to enhanced pressure responses to the purinergic agonists ATP (p < 0.05) and αβ-mATP (p < 0.05), and non-receptor mediated contractions to KCl (p < 0.05) compared to controls. Nerve-mediated bladder contractions to electric field stimulation were not significantly affected by stress, nor were spontaneous phasic contractions or release of urothelial ATP and acetylcholine. SIGNIFICANCE Repeated exposure to water avoidance stress produced an overactive bladder phenotype, confirmed by increased voiding frequency, and associated with enhanced bladder contractile responses.
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Affiliation(s)
- Eliza G West
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Donna J Sellers
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Russ Chess-Williams
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Catherine McDermott
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia.
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Increased Healthcare Resource Utilization and Direct and Indirect Costs in Patients with Depression and Comorbid Overactive Bladder: Evidence From a Retrospective, Matched Case-Control Cohort Analysis. Adv Ther 2020; 37:4599-4613. [PMID: 32910419 PMCID: PMC7547960 DOI: 10.1007/s12325-020-01485-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Introduction This study sought to compare healthcare resource utilization (HCRU), costs, and workplace productivity among patients with depression, with and without overactive bladder (OAB). Methods This retrospective, case–control cohort analysis compares HCRU, costs, and workplace productivity among propensity score matched patients with depression and OAB (case cohort) and patients with depression without OAB (control cohort). Patients were aged 18 years or older, insured/on Medicare, and had diagnosed depression and an antidepressant medication claim pre index. First OAB-related event was index for cases; controls were assigned a proxy (study period 12 months). Comparisons of HCRU and costs and regression models assessed the relationship between OAB and costs. For the workplace productivity subset analyses cases and controls were balanced on baseline covariates for the short-term disability analyses but as they were unbalanced for the absentee analyses, multivariate regression analyses were used for this subset. Results The study criteria were met by 39,085 cases and 308,736 controls, from which, 37,997 patients were successfully matched 1:1 (mean age 55 years; 81% female). Most depression-related HCRU measures were similar across cohorts; however, outpatient visits, ER visits, and number of unique depression medications were significantly higher (all p < 0.05) among cases. Cases also had 13% higher total depression-related costs (p < 0.0001). Total mean (standard deviation [SD]) depression-related costs were $1796 ($4235) for cases versus $1597 ($3863) for controls (p < 0.0001). For workplace productivity (absentee data: cases [n = 686], controls [n = 642]; short-term disability data: cases [n = 4395], controls [n = 4433]) absentee outcomes were similar across cohorts. However, a higher percentage of cases used short-term disability benefits compared to controls (21.3% versus 16.9%; p < 0.0001) and cases experienced more case days (11.0 versus 8.6 mean days) and received higher mean payments than controls ($1226 versus $1033; p < 0.0001) in this subset. Conclusions OAB was associated with 13% higher depression-related costs and 4.4% more cases used short-term disability benefits. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01485-w) contains supplementary material, which is available to authorized users.
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Sullivan R, McNicholas T, Claffey P, Kenny RA, Briggs R. Unreported urinary incontinence: population-based prevalence and factors associated with non-reporting of symptoms in community-dwelling people ≥ 50 years. Eur Geriatr Med 2020; 12:405-412. [PMID: 33029753 DOI: 10.1007/s41999-020-00412-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Concerns exist around under-detection and under-treatment of urinary incontinence (UI) in specific patient groups, particularly older people. The aim of this study is to ascertain the prevalence of unreported UI in a large sample of older adults, to profile factors associated with under-reporting of UI and the association of unreported UI with quality of life (QOL). METHODS This study was embedded within the Irish Longitudinal Study on Ageing, involving a population-representative sample of almost 7,000 older adults (55% female, mean age 65 years). UI was defined as involuntary loss of urine from the bladder occurring on average at least twice per month. Unreported UI had not yet been reported to a healthcare professional. QOL was measured using the Control, Autonomy, Self-realisation and Pleasure-19 Scale (CASP-19). RESULTS Almost 40% (285/750) of participants with UI had not reported symptoms to a healthcare professional despite visiting their general practitioner (GP) on average over 4 times in the last year. Logistic regression modelling demonstrated that under-reporting of UI was associated with female sex, taking < 5 medications, less severe symptoms and lower number of GP visits. Linear regression models show that unreported UI was associated with significantly lower CASP-19 (β = - 1.20 (95% CI: - 2.19 to - 0.20)). CONCLUSION Only 40% of older people with UI report symptoms to a healthcare professional despite frequent symptoms, and a significant association with poorer QOL. This highlights the need to educate older people around seeking help for UI, as well as opportunistically addressing UI as part of comprehensive age-attuned care.
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Affiliation(s)
- Rachel Sullivan
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Triona McNicholas
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Paul Claffey
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Robert Briggs
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland.
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland.
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
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Shim M, Kim JK, Bang WJ, Lee YS, Cho ST, Cho JS, Joo KJ, Hyun JS, Kim BH, Lee JB, Seo YJ, Oh CY. Efficacy and safety of dose escalation in male patients with overactive bladder showing poor efficacy after low-dose antimuscarinic treatment: A retrospective multicenter study. Investig Clin Urol 2020; 61:600-606. [PMID: 32985146 PMCID: PMC7606123 DOI: 10.4111/icu.20200053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 01/25/2023] Open
Abstract
Purpose To analyze the efficacy and safety of standard-dose antimuscarinic treatment on male patients with overactive bladder (OAB) symptoms showing poor efficacy after low-dose antimuscarinics. Materials and Methods We retrospectively reviewed the data of 566 male patients aged ≥40 with OAB symptoms between January 2017 and June 2018. They were treated with low-dose antimuscarinics for at least 4 weeks and showed poor efficacy; therefore, they were switched to standard dose antimuscarinic treatment (5 mg of solifenacin) for ≥12 weeks. The international prostate symptom score (IPSS) and overactive bladder symptom score (OABSS) at baseline (V0), 4 weeks (V1), and 12 weeks (V2) were analyzed. Post void residual urine volume (PVR) was also recorded. Results The median age, body mass index, and prostate-specific antigen levels were 69.0 years, 24.2 kg/m2, and 1.24 ng/dL, respectively. The mean value of the total IPSS and OABSS significantly decreased between V0 and V2 (from 16.73 to 13.69 and 7.33 to 5.34, respectively, all p<0.001). All component scores from each questionnaire demonstrated a significant decrease except for numbers three and six on the IPSS questionnaire. PVR was increased from V0 to V2 (36.40 to 68.90 mL, p=0.015). Four and nine patients experienced constipation and thirst, respectively, and all adverse effects were graded as ≤2. Conclusions Standard dose antimuscarinic treatment using solifenacin (5 mg) may be a safe and effective treatment for patients with OAB symptoms refractory to low-dose antimuscarinic treatment.
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Affiliation(s)
- Myungsun Shim
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jong Keun Kim
- Department of Urology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Tae Cho
- Department of Urology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kwan Joong Joo
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Byung Hoon Kim
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Jong Bok Lee
- Department of Urology, National Medical Center, Seoul, Korea
| | - Young Jin Seo
- Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
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Brucker BM, Lee RK, Newman DK. Optimizing Nonsurgical Treatments of Overactive Bladder in the United States. Urology 2020; 145:52-59. [PMID: 32598892 DOI: 10.1016/j.urology.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Overactive bladder syndrome is a prevalent condition impacting quality of life, activities of daily living, work productivity, physical and psychological health, sleep, and sexuality. Published guideline recommendations and effective behavioral, pharmacologic, and neuromodulatory therapies exist; however, adherence can be poor. Clinicians have important roles educating patients, setting treatment expectations, and providing follow-up. Determining patient goals, routinely assessing and adjusting therapy, and combining treatment strategies may improve outcomes. We review the benefits and challenges of overactive bladder treatments and propose approaches to improve patient management, with the goals of initiating therapy earlier and achieving better patient satisfaction, functioning, and quality of life.
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Affiliation(s)
| | | | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Steibliene V, Aniuliene R, Aniulis P, Raskauskiene N, Adomaitiene V. Affective Symptoms and Health-Related Quality of Life Among Women with Stress Urinary Incontinence: Cross-Sectional Study. Neuropsychiatr Dis Treat 2020; 16:535-544. [PMID: 32158213 PMCID: PMC7047965 DOI: 10.2147/ndt.s236234] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/15/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To evaluate the relationship between affective symptoms, clinical variables of uro-gynaecological history and health-related quality of life (QoL) among women with stress urinary incontinence (SUI) in comparison to healthy controls. PATIENTS AND METHODS In a cross-sectional study, 80 women 30 to 80 years of age diagnosed with SUI and 97 controls without symptoms of SUI provided sociodemographic data and answered the King's Health Questionnaire (KHQ) for assessing the QoL among individuals with urinary incontinence. Symptoms of anxiety and depression were assessed by Hospital Anxiety and Depression (HAD) scale with a threshold ≥7. A multiple regression was performed to reveal the cross-sectional predictors of affective symptoms and QoL among women with SUI. RESULTS Women with SUI had a significantly higher prevalence of symptoms of anxiety and depression than the controls (50% vs 11% and 29% vs 3.1%, respectively; both p<0.001) and worse health-related QoL on all domains of the KHQ. In multiple logistic regression models adjusted for sociodemographic and clinical variables of uro-gynaecological history, perceived symptoms of mild-to-severe depression were associated with a higher amount of leakage (OR=3.59; 1.04-12.4), older age (≥55 years old vs <55 years old) (OR=5.82; 1.47-23.1) and higher BMI (OR=1.13; 1.01-1.27). In addition, when controlled for all domains of the KHQ, perceived depressive symptoms were associated with the "emotions" domain of the KHQ (OR=1.06; 1.02-1.09). Perceived anxiety symptoms (independent of age) were related to shorter duration of SUI, low parity, absence of comorbidities and to higher scores on the "personal relationships" and "emotions" domains of the KHQ. CONCLUSION Women with SUI have a significantly poorer QoL than their counterparts without SUI. It was determined that one-half of women with SUI had anxiety symptoms, while one-third of women with SUI had depressive symptoms. In addition, this study indicated that QoL was associated with anxiety symptoms in middle-aged women and with depressive symptoms in older women, especially those with a shorter duration of SUI.
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Affiliation(s)
- Vesta Steibliene
- Clinic of Psychiatry, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rosita Aniuliene
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Aniulis
- Department of Urology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Nijole Raskauskiene
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Duloxetine reverses the symptoms of overactive bladder co-existing with depression via the central pathways. Pharmacol Biochem Behav 2020; 189:172842. [DOI: 10.1016/j.pbb.2019.172842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/04/2019] [Accepted: 12/28/2019] [Indexed: 12/20/2022]
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Hargreaves E, Baker K, Barry G, Harding C, Zhang Y, Kandala NB, Clarkson CE. Acupuncture for treating overactive bladder in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Emma Hargreaves
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Department of Physiotherapy; Royal Victoria Infirmary Newcastle upon Tyne Tyne and Wear UK NE1 4LP
| | - Katherine Baker
- Northumbria University; Department of Sport, Exercise and Rehabilitation; Coach Lane Campus Newcastle upon Tyne Tyne and Wear UK NE7 7XA
| | - Gill Barry
- Northumbria University; Department of Sport, Exercise and Rehabilitation; Coach Lane Campus Newcastle upon Tyne Tyne and Wear UK NE7 7XA
| | - Christopher Harding
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Department of Urology; Freeman Hospital Newcastle upon Tyne UK NE7 7DN
| | - Yingying Zhang
- Beijing University of Chinese Medicine; Centre for Evidence-Based Chinese Medicine; Beijing China
| | - Ngianga-Bakwin Kandala
- Northumbria University; Department of Mathematics, Physics & Electrical Engineering (MPEE), Faculty of Engineering and Environment; Ellison Building (EBD) Room 2018 Newcastle upon Tyne UK NE1 8ST
| | - Carl E Clarkson
- Northumbria University; Department of Sport, Exercise and Rehabilitation; Coach Lane Campus Newcastle upon Tyne Tyne and Wear UK NE7 7XA
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Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause 2019; 25:1069-1085. [PMID: 30179986 DOI: 10.1097/gme.0000000000001174] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is a new appreciation of the perimenopause - defined as the early and late menopause transition stages as well as the early postmenopause - as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: 1) epidemiology; 2) clinical presentation; 3) therapeutic effects of antidepressants; 4) effects of hormone therapy; and 5) efficacy of other therapies (eg, psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (ie, vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (ie, antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
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Shiota T, Torimoto K, Okuda M, Iwata R, Kumamoto H, Miyake M, Hirayama A, Tanaka N, Fujimoto K. Cognitive burden and polypharmacy in elderly Japanese patients treated with anticholinergics for an overactive bladder. Low Urin Tract Symptoms 2019; 12:54-61. [PMID: 31460706 DOI: 10.1111/luts.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/09/2019] [Accepted: 07/26/2019] [Indexed: 12/14/2022]
Abstract
This study aimed to investigate the cognitive burden and polypharmacy in elderly patients treated with anticholinergics for an overactive bladder. We conducted a retrospective study of patients with an overactive bladder receiving treatment at two hospitals in Japan (Nara Medical University Hospital and Saiseikai Nara Hospital). Prescription data were collected from the medical records of the patients registered between January 2013 and April 2014. The Anticholinergic Cognitive Burden Scale was used to estimate the severity of the anticholinergic effects on the cognition of each patient. We collected the prescription data of 584 and 246 patients from the Nara Medical University Hospital and Saiseikai Nara Hospital, respectively. The mean daily total Anticholinergic Cognitive Burden score ranged between 3 and 4 (3.59 ± 1.16 at Nara Medical University Hospital vs 3.32 ± 0.78 at Saiseikai Nara Hospital, P < 0.01). At both hospitals, the mean number of prescriptions was >5 in patients ≥75 years (5.95 ± 4.43 and 5.64 ± 3.90 at Nara Medical University Hospital and Saiseikai Nara Hospitals, respectively). Our findings suggest that 10%-20% of elderly patients (≥65 years) receiving treatment with anticholinergics for an overactive bladder are in a state of polypharmacy. The total anticholinergic cognitive burden of each patient mainly depends on the anticholinergics being used for treating the overactive bladder. Especially for elderly patients with a high risk of adverse effects, including cognitive impairment, careful attention needs to be paid during selection of drugs for treating patients with an overactive bladder.
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Affiliation(s)
- Takako Shiota
- Department of Urology, Nishi Nara Central Hospital, Nara, Japan
| | | | - Masahiro Okuda
- Department of Pharmacy, Saiseikai Nara Hospital, Nara, Japan
| | - Ryo Iwata
- Department of General Affairs, Saiseikai Nara Hospital, Nara, Japan
| | | | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | - Akihide Hirayama
- Department of Urology, Kindai University Nara Hospital, Nara, Japan
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Is overactive bladder independently associated with anxiety? Int Urogynecol J 2019; 30:1763-1769. [PMID: 31302716 DOI: 10.1007/s00192-019-04018-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/31/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Although some psychiatric anxiety questionnaires include overactive bladder (OAB) questions, there are few controlled data to confirm such an association. We tested the association between OAB and anxiety using a control group of women with non-OAB lower urinary tract symptoms (LUTS). METHODS Patients referred to a urogynecology clinic for LUTS completed two questionnaires: the International Consultation on Incontinence Modular Questionnaire for Overactive Bladder (ICIQ-OAB), and the Generalized Anxiety Disorder 7-Item Scale (GAD-7). Based on ICIQ-OAB scores, patients were dichotomized as having OAB versus LUTS-other, and GAD-7 scores categorized patients as having anxiety. A 2-tailed Fisher's exact test was used to test the association between OAB and anxiety. Demographic variables were collected and significant confounders were included in a logistic regression analysis. Sample size calculation indicated a need for 100 subjects, but we recruited 105 subjects to account for incomplete questionnaires. RESULTS One hundred and five subjects were enrolled (one excluded owing to incomplete questionnaires). Sixty-five patients had OAB and 39 had LUTS-other. Of the OAB patients, 17 out of 65 (26.2%) had anxiety, compared with 3 out of 39 (7.7%) of the LUTS-other group (p = 0.038 by Fisher's exact test, with a slight drop to p = 0.056 in the regression analysis). CONCLUSIONS There appears to be an association between OAB and anxiety and it may be of clinical importance to assess for anxiety in patients that present with OAB symptoms. The drop in statistical significance from p = 0.038 to a borderline significance of p = 0.056 in the regression analysis may be a reflection of the sample size.
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Zuo L, Zhou Y, Wang S, Wang B, Gu H, Chen J. Abnormal Brain Functional Connectivity Strength in the Overactive Bladder Syndrome: A Resting-State fMRI Study. Urology 2019; 131:64-70. [PMID: 31150692 DOI: 10.1016/j.urology.2019.05.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the whole-brain functional connectivity strength (FCS) of patients with the overactive bladder syndrome (OAB). METHODS This study investigates the changes of intrinsic whole brain functional connectivity pattern in OAB using FCS. We acquired resting-state fMRI data from 26 OAB patients and 28 healthy controls. FCS was used to compute the long-range and short-range FCS values for each voxel in the brain of each subject. The long or short-range FCS maps were compared between OAB patients and healthy controls. Pearson's correlation coefficients was also performed between abnormal FCS regions and clinical/psychometric scores in patients. RESULTS Compared with healthy control subjects, the OAB patients exhibited significantly decreased short-range FCS in the right medial superior frontal gyrus and bilateral anterior cingulate gyrus, and increased short-range FCS in the middle frontal gyrus, the precentral gyrus, and bilateral caudate nucleus. In addition, significantly decreased long-range FCS was found in bilateral middle cingulate gyrus and posterior cingulate gyrus. Furthermore, the abnormal FCS values in the right caudate nucleus showed significantly negative correlation with Self-Rating Depression Scale of OAB patients. CONCLUSION Patients with OAB have abnormal short-range and long-range FCS in brain regions associated with brain-bladder network. Our study provides new insights into the underlying brain network topology of OAB.
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Affiliation(s)
- Long Zuo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang Zhou
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuangkun Wang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Biao Wang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hua Gu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingnan Chen
- School of Economics and Management, Beihang University, Beijing, China
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Chin KS, Rose GE, Ervin CF, Ong TJ, Whishaw DM, Bower WF. Does successful treatment of overactive bladder improve co-morbidities in patients with nocturia? Australas J Ageing 2019; 38:242-248. [PMID: 30865375 DOI: 10.1111/ajag.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether treatment of overactive bladder (OAB), one comorbidity of nocturia, could reduce waking to void and improve other co-existing symptoms. METHODS A prospective cohort study was conducted at Royal Melbourne Hospital. Participants received 12 weeks of standard treatment, including lifestyle interventions and pharmacotherapy. Outcome measures were nocturia episodes, severity of urinary urgency/incontinence, sleep quality, daytime somnolence, anxiety and depression scores, quality of life and change in blood pressure. RESULTS Twenty participants completed the study. Nocturia frequency improved by one void per night. Overactive Bladder Symptom Score, sleep quality, first uninterrupted sleep time and systolic blood pressures improved. There were no significant changes in daytime somnolence, mood or quality of life. CONCLUSIONS In this pilot study, nocturia and other co-morbid dysfunctions appeared to improve when the severity of OAB was reduced. Treatment of OAB co-morbid with nocturia reduces urinary symptoms and may improve sleep parameters and positively impact return to health.
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Affiliation(s)
- Kai Sin Chin
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Georgie E Rose
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Claire F Ervin
- Department of Sub-Acute Care Services, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tee Juan Ong
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David M Whishaw
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Wendy F Bower
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Services, The University of Melbourne, Melbourne, Victoria, Australia
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Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. J Womens Health (Larchmt) 2019; 28:117-134. [DOI: 10.1089/jwh.2018.27099.mensocrec] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Pauline M. Maki
- Department of Psychiatry and Department of Psychology, University of Illinois at Chicago, Chicago Illinois
| | - Susan G. Kornstein
- Department of Psychiatry and Institute of Women's Health, Virginia Commonwealth University, Richmond, Virginia
| | - Hadine Joffe
- Connors Center for Women's Health and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute/Harvard Medical School, Boston, Massachusetts
| | - Joyce T. Bromberger
- Department of Epidemiology, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ellen W. Freeman
- Department of Obstetrics and Gynecology and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geena Athappilly
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford Massachusetts; Harvard Medical School, Boston Massachusetts
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Lee S. Cohen
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Claudio N. Soares
- Department of Psychiatry, Queen's University School of Medicine, Ontario Canada
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Feng LR, Fuss T, Dickinson K, Ross A, Saligan LN. Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer. Oncology 2019; 96:183-191. [PMID: 30625479 DOI: 10.1159/000494620] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/17/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Cancer-related fatigue is one of the most debilitating side effects of cancer and cancer therapy. We aimed to investigate co-occurring symptoms associated with persistent fatigue in men receiving external beam radiation therapy (EBRT) for nonmetastatic prostate cancer. METHODS A sample of 47 men with prostate cancer scheduled to receive radiotherapy (RT) were followed at baseline and 1 year after RT. Clinical and demographic data were obtained from chart review. Symptom measurements included urinary dysfunction (American Urological Association symptoms score), fatigue (Functional Assessment of Cancer Therapy - Fatigue questionnaire), sleep disturbance (Patient-Reported Outcomes Measurement Information System - Sleep Disturbance form), pain (physical well-being domain pain item of the Functional Assessment of Cancer Therapy - General), and depressive symptoms (Hamilton Depression Rating Scale). Paired t tests, correlations, general linear models, and logistic regressions were used to determine associations between fatigue and other symptom scores. RESULTS At 1 year after RT, 34% of subjects continued to experience fatigue. Urinary dysfunction was the best clinical predictor of persistent fatigue. Pain and depressive symptoms further improved the predictive power of the model. A multivariate linear regression model containing all these three clinical variables (urinary dysfunction, pain, and depressive symptoms) explained 74% of total variance associated with persistent fatigue after RT. CONCLUSIONS Persistent fatigue at 1 year after EBRT in prostate cancer survivors is likely related to a cluster of symptoms elicited by chronic inflammation. Therapies that target each of these symptoms will likely reduce fatigue in this patient population.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Timothy Fuss
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristin Dickinson
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander Ross
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA,
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Sarikaya S, Yildiz FG, Senocak C, Bozkurt OF, Karatas OF. Urinary incontinence as a cause of depression and sexual dysfunction: Questionnaire-based study. Rev Int Androl 2018; 18:50-54. [PMID: 30470663 DOI: 10.1016/j.androl.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Urinary incontinence is a severe and common health problem. In this study, we aimed to assess severity of sexual dysfunction and depression in patients with urinary incontinence. MATERIALS AND METHODS The study has been conducted between 2015 and 2017. Age, body mass index, accompanying health problems, Over Active Bladder (OAB) symptom score, Type of urinary incontinence, Beck Depression Scale were assessed for all patients. International Index of Erectile Function-5 (IIEF-5) was used for male patients in order to assess sexual dysfunction. Index of Female Sexual Function (IFSF) and Female Sexual Distress Scale (FSDS) were used in female patients in order to assess sexual dysfunction. RESULTS 33 patients have been included in the study (Male-12: Urge-10/Stress-1/Mixed-1/Female-21: Urge-10/Stress-6/Mixed-5). Mean age of all patients was 47.9 (Male-49.3/Female-47.2). Mean Body Mass Index for all patients was 23.2 (Male-25.9/Female-21.8). Mean OAB score was 24.3 for all patients (Male-27.5: Urge-28.6/Stress-17/Mixed-27/Female-22.5: Urge-24.2/Stress:21.3/Mixed-20.6). Mean Beck Depression Result for all patients was 20.9 (Male-18.5: Urge-20.2/Stress-9/Mixt-11/Female-22.4: Urge-19.1/Stress-20.3/Mixed-31.6). Mean IIEF-5 score for male patients was 39.5 (Urge-41.4/Stress-55/Mixed-5). Mean IFSF score for female patients was 19.9 (Urge-17.9/Stress-21.3/Mixed-22.4) and mean FSDS score for female patients was 22.1 (Urge-22.3/Stress-23.1/Mixed-20.8). DISCUSSION Most of the patients that have been included in the study were diagnosed as urge incontinence. When assessing the OAB scores, they were higher in urge incontinence group. Beck depression results showed higher scores in female patients and it was higher in urge group of male patients and mixt group of female patients. Sexual dysfunction rates were found to be higher for both genders.
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Affiliation(s)
- Selcuk Sarikaya
- Gulhane Research and Training Hospital, Department of Urology, Ankara, Turkey.
| | - Fatma Gokcem Yildiz
- Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Cagri Senocak
- Kecioren Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Omer Faruk Bozkurt
- Kecioren Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Omer Faruk Karatas
- Gulhane Research and Training Hospital, Department of Urology, Ankara, Turkey
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Mühlstädt S, Mischner S, Kranz J, Anheuser P, Mohammed N, Steffens JA, Fornara P. Quo Vadis Botulinum Toxin: Normative Constraints and Quality of Life for Patients With Idiopathic OAB? Front Surg 2018; 5:61. [PMID: 30386782 PMCID: PMC6198085 DOI: 10.3389/fsurg.2018.00061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/14/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Idiopathic overactive bladder (iOAB), with or without urge incontinence (UI), has significant psychosocial effects on patients' quality of life (QoL). The first choice of treatment for iOAB is anticholinergics and, alternatively, the β-3-adrenoceptor agonist mirabegron. However, systemic side effects and contraindications should be considered for both medications. Objective: We report the efficacy, safety and effects on QoL of botulinum toxin therapy (onabotulinum toxin type A, BOTOX®, Allergan) among patients with iOAB ± UI. Patients and Methods: Between 2005 and 2013, 51 patients were treated with onabotulinum toxin A (100 units). The inclusion criteria were the presence of confirmed iOAB ± UI with previous use of anticholinergic medication. Micturition frequency, pad count, postvoid residual volume and QoL were evaluated using two validated questionnaires [the Client Satisfaction Questionnaire-8 (CSQ-8) and the King's Health Questionnaire (KHQ)]. Statistical analysis was performed with SPSS 24.0 (p < 0.05). Results: After botulinum toxin injection, a significant improvement in iOAB ± UI symptoms was observed. The micturition frequency decreased from 10.4 ± 0.5 to 5.2 ± 0.4 micturitions per day (p = 0.026), and the pad count decreased from 3.6 ± 1.0 to 1.2 ± 0.3 pads per day (p = 0.033). Anticholinergics were not used during the administration of botulinum toxin therapy. Complications and postoperative need for intermittent self-catheterization (ISC) were not observed. Overall, 72 and 24% of patients reported being “satisfied” or “very satisfied” with the treatment. Additionally, 66% of patients would choose botulinum toxin again for the treatment of iOAB. Conclusion: Botulinum toxin therapy is an efficient, safe, and life-improving treatment for iOAB.
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Affiliation(s)
- Sandra Mühlstädt
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Shahidul Mischner
- Department of Orthopaedics, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany
| | - Jennifer Kranz
- Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Clinic, Hamburg, Germany
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Joachim A Steffens
- Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
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Siddiqui NY, Wiseman JB, Cella D, Bradley CS, Lai HH, Helmuth ME, Smith AR, Griffith JW, Amundsen CL, Kenton KS, Clemens JQ, Kreder KJ, Merion RM, Kirkali Z, Kusek JW, Cameron AP. Mental Health, Sleep and Physical Function in Treatment Seeking Women with Urinary Incontinence. J Urol 2018; 200:848-855. [PMID: 29730202 PMCID: PMC6146022 DOI: 10.1016/j.juro.2018.04.076] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms. MATERIALS AND METHODS This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity. RESULTS We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Caucasian, 47% were obese and 14% reported diabetes. Urinary incontinence was reported by 420 women (82.4%), including stress urinary incontinence in 70, urgency urinary incontinence in 85, mixed urinary incontinence in 240 and other urinary incontinence in 25. On adjusted analyses there was no difference in any mental health, sleep or physical function measure based on the presence vs the absence of urinary incontinence. Among women with urinary incontinence PROMIS anxiety and sleep disturbance scores were higher in those with mixed urinary incontinence than stress urinary incontinence. Increasing urinary incontinence severity was associated with higher PROMIS depression and anxiety scores, and higher PSS scores. However, higher urinary incontinence severity was not associated with a difference in sleep or physical function. CONCLUSIONS Among treatment seeking women with lower urinary tract symptoms, increasing urinary incontinence severity rather than the presence or type of urinary incontinence was associated with increased depression, anxiety and stress.
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Affiliation(s)
- Nazema Y Siddiqui
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Catherine S Bradley
- Departments of Obstetrics and Gynecology and Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - H Henry Lai
- Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Cindy L Amundsen
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Kimberly S Kenton
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Karl J Kreder
- Departments of Obstetrics and Gynecology and Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Ivchenko A, Bödeker RH, Neumeister C, Wiedemann A. Anticholinergic burden and comorbidities in patients attending treatment with trospium chloride for overactive bladder in a real-life setting: results of a prospective non-interventional study. BMC Urol 2018; 18:80. [PMID: 30217174 PMCID: PMC6137886 DOI: 10.1186/s12894-018-0394-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Elderly people are representative for the patients most likely to be treated with anticholinergics for overactive bladder (OAB). They often receive further drugs with anticholinergic properties for concomitant conditions. This increases the risk for side effects, including central nervous system disorders. Data on comorbidities and baseline anticholinergic burden of OAB patients seen in urological practice is scarce. Therefore, we included an epidemiological survey on these issues in our study which assessed the effectiveness and tolerability of trospium chloride (TC) in established dosages under routine conditions. METHODS Outpatients (≥ 65 years of age), for whom treatment with TC was indicated, were eligible to participate in this non-interventional, prospective study performed in 162 urological practices in Germany. Epidemiological questions were evaluated by the Anticholinergic Burden (ACB) scale and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) at baseline. Efficacy was assessed by changes in symptom-related variables of OAB after treatment. Dosage regimen, duration of treatment, adverse events, withdrawals, and ease of subdivision of the prescribed SNAP-TAB tablet were documented. Patients and physicians rated efficacy and tolerability of treatment. Statistics were descriptive. RESULTS Four hundred fourty-five out of 986 (47.54%) patients in the epidemiological population had a baseline ACB scale score > 0, 100 (24.72%) of whom a score ≥ 3. The median CIRS-G comorbidity index score for all patients was 5. 78.55% (608/774) of patients in the efficacy population received a daily dose of 45 mg TC. 60.03% (365/608) of them took this dose by dividing the SNAP-TAB tablet in three equal parts. Before-after-comparisons of the core symptoms of OAB showed clear improvements. An influence of the dosage scheme (1 × 45 mg TC/d vs 3 × 15 mg TC/d) on clinical outcome could not be observed. Most urologists and patients rated TC treatment as effective and well tolerated. 44 (4.37%) out of 1007 patients in the safety collective ended their treatment prematurely, while 75 patients (7.45%) experienced adverse events. CONCLUSIONS Anticholinergic burden and comorbidities in elderly OAB patients are frequent. The acceptance of the SNAP-TAB tablet, which facilitates flexible dosing with TC, was high, which is supportive in ensuring adherence in therapy. TRIAL REGISTRATION This non-interventional study was registered on October 29, 2014 with the number DRKS00007109 at the German Register of Clinical Studies (DRKS).
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Affiliation(s)
- A. Ivchenko
- Department of Urology, Evangelisches KrankenhausWitten gGmbH, UniversityWitten/Herdecke, Pferdebachstrasse 27, 58455 Witten, Germany
| | - R.-H. Bödeker
- Department of Statistics, Institute of Medical Informatics, University Clinic Giessen, Rudolf-Buchheim-Strasse 6, 35392 Gießen, Germany
| | - C. Neumeister
- Department of Medical Science/Clinical Research, Dr. R. Pfleger GmbH, Dr.-Robert-Pfleger-Strasse 12, 96052 Bamberg, Germany
| | - A. Wiedemann
- Department of Urology, Evangelisches KrankenhausWitten gGmbH, UniversityWitten/Herdecke, Pferdebachstrasse 27, 58455 Witten, Germany
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