Is the prevalence of overactive bladder overestimated? A population-based study in Finland

Association between nocturnal polyuria and 24-h blood pressure fluctuations in males with lower urinary tract symptoms: A multicenter prospective study

OBJECTIVES

Nocturnal polyuria (NP) is one of the causes of nocturia that impairs quality of life. It is necessary to consider that NP is latent when the initial treatment for nocturia is unsatisfactory. Therefore, it is important to establish a treatment for NP based on the pathophysiology. We have previously reported the relationship between NP and fluctuation in blood pressure. The present study aimed to investigate the association between NP and 24-h blood pressure fluctuations in a multicenter prospective study.

METHODS

This study included male patients with lower urinary tract symptoms. We categorized the patients into the nonnocturnal polyuria (non-NP) group (≤0.33) and the NP group (>0.33) based on the nocturnal polyuria index from the frequency volume chart. We measured the 24-h diurnal blood pressure and compared the two groups.

RESULTS

Among 90 patients, 46 in the non-NP group and 44 in the NP group were included. There was no significant difference in the systolic and diastolic blood pressure during waking time between the two groups; however, the degree of systolic blood pressure reduction during sleep time in the NP group was significantly less than that in the non-NP group (p = 0.039). In the multivariate analysis, systolic BP during sleep was significantly associated with NP (OR 0.970, p = 0.028).

CONCLUSION

NP is associated with inadequate nocturnal blood pressure reduction in males, suggesting that reduction in nocturnal blood pressure may lead to improvement in nocturia.

Systematic review and meta-analysis of urinary incontinence prevalence and population estimates

INTRODUCTION

Incontinence impacts the quality-of-life of people suffering from the disease. However, there is limited information on the prevalence of incontinence due to the stigma, lack of awareness, and underdiagnosis.

OBJECTIVE

This study aims to conduct a systematic review and meta-analysis of overactive bladder (OAB) and nonobstructive urinary retention (NOUR).

METHODS

The authors conducted a systematic review following the PRISMA guidelines using Embase, MEDLINE, and PubMed databases to identify the relevant publications in the English language. Two reviewers independently assessed the articles and extracted the data. Review papers were assessed for content and references. A meta-analysis of proportions was conducted using the RStudio software. To address the age heterogeneity, a subanalysis was conducted. Pooled data were overlayed on the Canadian population and a sample of 10 populous countries to estimate the number of people suffering from incontinence.

RESULTS

Twenty-eight and eight articles were selected for OAB and NOUR, respectively. The pooled prevalence of OAB in men and women was 12% (95% CI: 9%-16%) and 15% (95% CI: 12%-18%), respectively. The estimated prevalence of NOUR was 15.6%-26.1% of men over 60 and 9.3%-20% of women over 60. The subanalysis pooled prevalence of OAB in men and women was 11% (95% CI: 8%-15%) and 12% (95% CI: 9%-16%), respectively. We estimated that 1.4-2.5 million women and 1.3-2.2 million men suffer from OAB in Canada.

CONCLUSION

Urinary incontinence is an under-reported and underdiagnosed prevalent condition that requires appropriate treatment to improve a patient's quality-of-life.

Progress and challenges in intravesical drug delivery

INTRODUCTION

Intravesical drug delivery (IDD) has gained recognition as a viable approach for treating bladder-related diseases over the years. However, it comes with its set of challenges, including voiding difficulties and limitations in mucosal and epithelial penetration. These challenges lead to drug dilution and clearance, resulting in poor efficacy. Various strategies for drug delivery have been devised to overcome these issues, all aimed at optimizing drug delivery. Nevertheless, there has been minimal translation to clinical settings.

AREAS COVERED

This review provides a detailed description of IDD, including its history, advantages, and challenges. It also explores the physical barriers encountered in IDD, such as voiding, mucosal penetration, and epithelial penetration, and discusses current strategies for overcoming these challenges. Additionally, it offers a comprehensive roadmap for advancing IDD into clinical trials.

EXPERT OPINION

Physical bladder barriers and limitations of conventional treatments result in unsatisfactory efficacy against bladder diseases. Nevertheless, substantial recent efforts in this field have led to significant progress in overcoming these challenges and have raised important attributes for an optimal IDD system. However, there is still a lack of well-defined steps in the workflow to optimize the IDD system for clinical settings, and further research is required to establish more comprehensive in vitro and in vivo models to expedite clinical translation.

Lower Urinary Tract Symptoms and Overactive Bladder in a Large Cohort of Older Poles-A Representative Tele-Survey

BACKGROUND

A reliable reference of population-based parameters for lower urinary tract symptoms (LUTS) and overactive bladder (OAB) is lacking for the elderly. Thus, the objective of this study was to estimate the prevalence, bother, effect on quality of life, and treatment-related behavior for LUTS and OAB in a large population-level cohort of Polish adults aged ≥ 65 years.

METHODS

We used data from the telephone LUTS POLAND survey. Respondents were categorized by sex, age, and residence. All LUTS and OAB were assessed with validated questionnaires and a standard protocol based on the International Continence Society definitions.

RESULTS

The mean (standard deviation) age of 2402 participants (60.4% women) was 72.5 (6.7) years. The prevalence of LUTS was 79.5% (men: 76.6%; women: 81.4%), and the prevalence of OAB was 51.4% (men: 49.4%; women: 52.8%). The prevalence of both conditions increased with age. The most prevalent symptom was nocturia. LUTS and OAB were often bothersome, and almost half of participants who reported LUTS or OAB had decreased quality of life related to their urinary functioning. Nevertheless, only one third of participants sought treatment for their bladder problems, and most of these participants received treatment. We did not observe differences between urban and rural areas in all analyzed population-level parameters.

CONCLUSIONS

LUTS and OAB were prevalent conditions with significant bother and negative effects on quality of life among Polish adults aged ≥ 65 years. Nevertheless, most affected respondents had not sought treatment. Thus, for older persons, there is a need to increase public awareness about LUTS and OAB, and the negative effects of LUTS and OAB on healthy aging. In addition, greater government and healthcare system resources are needed to better manage LUTS and OAB in older patients.

Role of circadian rhythms and melatonin in bladder function in heath and diseases

The circadian system modulates all visceral organ physiological processes including urine storage and voiding. The "master clock" of the circadian system lies within suprachiasmatic nucleus of the hypothalamus while "peripheral clocks" are found in most peripheral tissue and organs, including the urinary bladder. Disruptions of circadian rhythms can cause organ malfunction and disorder or exacerbate pre-existing ones. It has been suggested that nocturia, which develops mostly in the elderly, could be a circadian-related disorder of the bladder. In the bladder, many types of gap junctions and ion channels in the detrusor, urothelium and sensory nerves are likely under strict local peripheral circadian control. The pineal hormone, melatonin, is a circadian rhythm synchroniser capable of controlling a variety of physiological processes in the body. Melatonin predominantly acts via the melatonin 1 and melatonin 2 G-protein coupled receptors expressed in the central nervous system, and many peripheral organs and tissues. Melatonin could be beneficial in the treatment of nocturia and other common bladder disorders. The ameliorating action of melatonin on bladder function is likely due to multiple mechanisms which include central effects on voiding and peripheral effects on the detrusor and bladder afferents. More studies are warranted to determine the precise mechanisms of circadian rhythm coordination of the bladder function and melatonin influences on the bladder in health and diseases.

Nocturia: its characteristics, diagnostic algorithm and treatment

Nocturia is the complaint that an individual has to wake up at night one or more times to urinate. It is a frequent condition among older adults and entails detrimental effects with regard to sleeping, sexual activity, comfort, depression, mental function and vitality. It is clinically important to distinguish it from global polyuria, defined as a urinary rate ≥ 125 ml/h (3000 ml/day), as well as from nocturnal polyuria, which is an abnormally large volume of urine during sleep associated with a decreased daytime urine production. A Frequency Volume Chart (FVC), overnight water deprivation test with renal concentrating capacity test, and the nocturnal bladder capacity index are some of the methods that help establish the underlying pathology of this condition and hence define an adequate treatment plan.

The relationship between overactive bladder and prostate cancer: A scoping review

INTRODUCTION

The relationship between prostate cancer (PCa) and overactive bladder (OAB) is poorly understood. PCa and OAB are frequently diagnosed in elderly populations, so it could be expected that both conditions would be observed in older patients. Whether PCa and OAB occur independently with age, or the presence of PCa leads to the onset of OAB/lower urinary tract symptoms (LUTS) has not been explored. This review aimed to investigate whether men newly diagnosed with PCa are more likely to have OAB compared to the general population, and if the various treatment modalities for PCa are likely to impact the incidence or exacerbation of OAB.

METHODS

The University of Calgary's databases for Medline and PubMed were searched for relevant publications. No restrictions were placed on the study design reported. Any publications reporting OAB and a PCa diagnosis and/or observation relating to PCa diagnosis and rates of OAB/LUTS in an adult population were included for full review.

RESULTS

Of the studies examining the relationship between PCa and LUTS, results varied, but frequently indicated an inverse association between PCa and LUTS in which patients newly diagnosed with PCa were more unlikely to have LUTS compared to the general population. Following treatment, brachytherapy resulted in a higher prevalence of OAB symptoms compared to surgical treatment and external beam radiation therapy.

CONCLUSIONS

Diverse evidence was found regarding the relationship between the prevalence of pre-treatment OAB and PCa diagnosis. However, limited evidence, as well as uncertainty regarding pre-treatment symptoms and their impact on post-treatment outcomes, restricts potential conclusions.

Population-Level Prevalence, Bother, and Treatment Behavior for Urinary Incontinence in an Eastern European Country: Findings from the LUTS POLAND Study

OBJECTIVES

Population-level data are lacking for urinary incontinence (UI) in Central and Eastern European countries. Therefore, the objective of this study was to estimate the prevalence, bother, and behavior regarding treatment for UI in a population-representative group of Polish adults aged ≥ 40 years.

METHODS

Data for this epidemiological study were derived from the larger LUTS POLAND project, in which a group of adults that typified the Polish population were surveyed, by telephone, about lower urinary tract symptoms. Respondents were classified by age, sex, and place of residence. UI was assessed with a standard protocol and established International Continence Society definitions.

RESULTS

The LUTS POLAND survey included 6005 completed interviews. The prevalence of UI was 14.6-25.4%; women reported a greater occurrence compared with men (p < 0.001). For both sexes, UI prevalence increased with age. Stress UI was the most common type of UI in women, and urgency UI was the most prevalent in men. We did not find a difference in prevalence between urban and rural areas. Individuals were greatly bothered by UI. For women, mixed UI was the most bothersome, whereas for men, leak for no reason was most annoying. More than half of respondents (51.4-62.3%) who reported UI expressed anxiety about the effect of UI on their quality of life. Nevertheless, only around one third (29.2-38.1%) of respondents with UI sought treatment, most of whom received treatment. Persons from urban and rural areas did not differ in the degrees of treatment seeking and treatment receiving.

CONCLUSION

Urinary incontinence was prevalent and greatly bothersome among Polish adults aged ≥ 40 years. Consequently, UI had detrimental effects on quality of life. Nonetheless, most affected persons did not seek treatment. Therefore, we need to increase population awareness in Poland about UI and available treatment methods, and we need to ensure adequate allocation of government and healthcare system resources.

Considering non-bladder aetiologies of overactive bladder: a functional neuroimaging study

OBJECTIVES

To better understand the neuropathophysiology of overactive bladder (OAB) in women by characterising supraspinal activity in response to bladder distention and cold stimulation.

SUBJECTS/PATIENTS AND METHODS

We recruited 24 female participants, 12 with OAB (median [interquartile range, IQR] age 40 [32-42] years) and 12 healthy controls (HCs) without lower urinary tract (LUT) symptoms (median [IQR] age 34 [28-44] years), and assessed LUT and cognitive function through neuro-urological examination, 3-day bladder diary, urodynamic investigation, and questionnaires. Functional magnetic resonance (MR) imaging using a 3-T scanner was performed in all participants during automated, repetitive bladder filling and draining (block design) with 100 mL body temperature (37 °C) saline using a MR-compatible and MR-synchronised infusion-drainage device until strong desire to void (HIGH-FILLING/DRAINING) and bladder filling with cold saline (4 °C, i.e. COLD). Whole-brain and region-of-interest analyses were conducted using Statistical Parametric Mapping, version 12.

RESULTS

Significant between-group differences were found for 3-day bladder diary variables (i.e. voiding frequency/24 h, P < 0.001; voided volume/void, P = 0.04; and urinary incontinence [UI] episodes/24 h, P = 0.007), questionnaire scores (International Consultation on Incontinence Questionnaire-Female LUT symptoms [overall, filling, and UI scores, all P < 0.001]; the Overactive Bladder Questionnaire short form [symptoms and quality-of-life scores, both P < 0.001]; the Hospital Anxiety and Depression Scale [anxiety P = 0.004 and depression P = 0.003 scores]), as well as urodynamic variables (strong desire to void, P = 0.02; maximum cystometric capacity, P = 0.007; and presence of detrusor overactivity, P = 0.002). Age, weight and cognitive function (i.e. Mini-Mental State Examination, P = 1.0) were similar between groups (P > 0.05). In patients with OAB, the HIGH task elicited activity in the superior temporal gyrus, ventrolateral prefrontal cortex (VLPFC), and mid-cingulate cortex; and the COLD task elicited activity in the VLPFC, cerebellum, and basal ganglia. Compared to HCs, patients with OAB showed significantly stronger cerebellar activity during HIGH-FILLING and significantly less activity in the insula and VLPFC during HIGH-DRAINING.

CONCLUSIONS

The present findings suggest a sensory processing and modulation deficiency in our OAB group, probably as part of their underlying pathophysiology, as they lacked activity in essential sensory processing areas, such as the insula. Instead, accessory areas, such as the cerebellum, showed significantly stronger activation compared to HCs, presumably supporting pelvic-floor motor activity to prevent UI. The novel findings of the present study provide physiological evidence of the necessity to consider non-bladder aetiologies of bladder symptoms.

Prevalence and bother of lower urinary tract symptoms and overactive bladder in Poland, an Eastern European Study

The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) has been measured by population-based investigations in many parts of the world. However, data are lacking for Eastern Europe, and there has not been any large population-representative study in any country of this region. Therefore, the aim of this study was to evaluate the prevalence and associated bother of LUTS and OAB in a population-representative sample of persons aged ≥ 40 years in Poland. This investigation was conducted as a computer-assisted telephone interview. The survey sample was stratified by age, sex, and place of residence to reflect the entire Polish population. LUTS and OAB were assessed by a standardized protocol based on the International Continence Society definitions and validated questionnaires. Of 6005 participants, 57% were women, and the mean age (range) was 60.7 (40-93) years. The prevalence of LUTS was 69.8% (men 66.2%; women 72.6%). There was no difference in prevalence between urban and rural areas. LUTS were often bothersome among men and women, but women were more likely to be bothered compared with men. There were also statistically significant correlations between the frequency and the bother intensity of each of the LUTS. The prevalence of OAB was higher in women (39.5%) than in men (26.8%), and OAB increased with age. Lastly, LUTS had detrimental effects on the quality of life because one third of the participants had concerns about their urinary-specific quality of life. This investigation was the first nationwide, population-representative epidemiological study of LUTS and OAB in an Eastern-European country. LUTS were highly prevalent, often bothersome, and had negative effects on the quality of life of men and women aged ≥ 40 years. Our findings are comparable with other epidemiologic studies of LUTS and OAB conducted in different regions of the world.Trial registration: NCT04121936.

The Relationship between Overweight and Overactive Bladder Symptoms

BACKGROUND

Several authors have investigated the relationship between obesity - assessed only by body mass index (BMI) - and overactive bladder (OAB) symptoms.

OBJECTIVES

The objective of this study was to determine the relationship between body fat percentage (BFP) and the severity of OAB symptoms with an impact on quality of life.

DESIGN

Cross-sectional study. The sample consisted of 206 overweight women; they were university students (BMI = 25.8 ± 3.0) with an average age of 30.6 ± 2.4 years. Body composition analysis was used, including assessment of BFP, visceral fat area (cm2/level), and other parameters. OAB symptoms were evaluated with an OAB questionnaire (OAB-q), voiding diary, and quality of life scale (I-QoL).

RESULTS

Ninety women had a BFP >32% and 116 had a BFP <32%. The voiding diary and OAB-q confirmed significant differences in 24-h daytime and nighttime frequency of voiding and average urine volume during the day. The OAB-q symptom score was lower in the group with BFP <32%. I-QoL recorded significantly worse parameters in the group with BFP >32% (p < 0.01). The Patient Perception of Intensity of Urgency Scale significantly correlated with BFP (r = 0.466, p < 0.001). Women with a BFP above 32% had a 1.95 times greater chance of developing OAB (odds ratio = 1.95, 95% CI = 1.09-3.52, p < 0.02).

CONCLUSION

Young women with a BFP >32% were 95% more likely to have OAB than other young women with a BPF <32%.

Effect of an exercise programme for reducing abdominal fat on overactive bladder symptoms in young overweight women

INTRODUCTION AND HYPOTHESIS

The effect of exercise in relation to overweight and overactive bladder (OAB) in young women has not been sufficiently supported by studies. The objective of our study was to reduce symptoms of OAB through a 3-month exercise programme in young overweight women with OAB. The sample consisted of 70 women (mean age 26.7 ± 4.8 years), 36 being treated and 34 in the control group.

METHODS

We used a body composition analyser with the assessment of skeletal muscle mass (SMM) (kg), body fat mass (BFM) (kg), body fat percentage (BFP) (%), visceral fat area (VFA) (cm²/level) and the waist/hip circumference index (WHR). OAB symptoms were evaluated using a voiding diary, the overactive bladder questionnaire (OAB-q) and the Patient Perception of Intensity of Urgency Scale (PPIUS). The intervention was a programme for the reduction of abdominal fat (PRAF), with elements of aerobic training, strengthening of the abdominal muscles and stretching.

RESULTS

In the OAB symptoms assessed through the voiding diary (number of voidings per 24 h, nocturia, mean voided volume) as well as in the OAB-q and PPIUS scales after training, significant differences were reported in favour of the treatment group [number of voidings per 24 h: treatment vs. control group, baseline 9.1 ± 0.3 vs. 8.6 ± 0.3, final 6.9 ± 0.2 vs. 8.1 ± 0.2, p < 0.0001; mean voided volume per 24 h (ml): treatment vs. control group, baseline 154.2 ± 9.1 vs. 162.2 ± 9.3, final 201.3 ± 9.3 vs. 164.1 ± 9.6, p < 0.0001] with a large effect size (ES). In the body composition analysis after training, significant differences were also reported in favour of the treatment group in the reduction of body mass index (BMI), BFP and VFA (p < 0.0001), with a large ES.

CONCLUSIONS

Body composition analysis confirmed a reduction of BMI, body weight, body fat percentage, visceral abdominal fat, the WHR index and waist circumference in favour of the treatment group after the 12-week PRAF exercise programme. A reduction in OAB symptoms was also objectively confirmed following the PRAF exercise programme.

Knowledge and attitude for overactive bladder care among women: development and measurement

BACKGROUND

Overactive bladder (OAB) affects millions of women. It is important to assess knowledge and attitude in affected patients. The study objective was to develop surveys to assess OAB knowledge and OAB related attitude, and its association with OAB treatment status.

METHODS

Systematic literature review and qualitative analysis of patient and provider focus groups helped identify OAB knowledge and attitude survey items. We determined psychometric properties of the two surveys in a cross-sectional sample of 104 women, 27% of whom had received OAB treatment.

RESULTS

The OAB-knowledge survey consisted of 16 items and 3 condition-related concepts: perception of OAB; cause and information; and signs of OAB. The OAB-attitude survey consisted of 16 items and its concepts were treatment seeking; decision-making and effects. Both surveys demonstrated good construct validity and test-retest reliability ((≥ 0.60). In the cross-sectional validation sample, OAB-knowledge and attitude discriminated between those with different levels of ICIQ-UI scores. We observed some difference in the OAB knowledge, OAB attitude, and severity of symptoms between those treated for OAB vs. treatment naive.

CONCLUSIONS

OAB knowledge and attitude surveys provide a novel tool to assess OAB domains in women. Though we did not find statistical significance in OAB knowledge and attitude scores across treatment status, they may be potentially modifiable factors that affect OAB treatment uptake and treatment compliance. Refinement of these surveys in diverse sub-populations is necessary. Our study provides effect sizes for OAB knowledge and attitude. These effect sizes can help development of fully powered trials to study the association between OAB knowledge and attitude, type and length of treatment, treatment compliance, and quality of life, leading to interventions for enhancing OAB care.

Overactive bladder - 18 years - Part I

Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Results of a randomized, double-blind, active-controlled clinical trial with propiverine extended release 30 mg in patients with overactive bladder

OBJECTIVE

To compare the efficacy and safety of the 30 mg extended release (ER) formulation of propiverine hydrochloride with the 4 mg ER formulation of tolterodine tartrate in patients with overactive bladder (OAB) in a non-inferiority trial.

PATIENTS AND METHODS

Eligible patients, aged 18-75 years and with symptoms of OAB, were enrolled in this multicentre, randomized, double-blind, parallel-group, active-controlled study. After a 2-week screening period, patients were randomized at a 1:1 ratio to receive either propiverine ER 30 mg or tolterodine ER 4 mg daily during the 8-week treatment period. Efficacy was assessed using a 3-day voiding diary and patient's self-reported assessment of treatment effect. Safety assessment included recording of adverse events, laboratory test results, measurement of post-void residual urine and electrocardiograms.

RESULTS

A total of 324 patients (244 female and 80 male) were included in the study. Both active treatments improved the variables included in the voiding diary and in the patient's self-reported assessment. The change from baseline in the number of voidings per 24 h was significantly greater in the propiverine ER 30 mg group compared with the tolterodine ER 4 mg group after 8 weeks of treatment (full analysis set [FAS] -4.6 ± 4.1 vs -3.8 ± 5.1; P = 0.005). Significant improvements were also observed for the change of urgency incontinence episodes after 2 weeks (P = 0.026) and 8 weeks (P = 0.028) of treatment when comparing propiverine ER 30 mg with tolterodine ER 4 mg. Both treatments were well tolerated, with a similar frequency of adverse drug reactions in both the propiverine ER 30 mg and tolterodine ER 4 mg groups (FAS 40.7 vs 39.5%; P = 0.8). More patients treated with tolterodine ER 4 mg discontinued the treatment because of adverse drug reactions compared with propiverine ER 30 mg (7.4 vs 3.1%).

CONCLUSIONS

Propiverine ER 30 mg was confirmed to be an effective and well-tolerated treatment option for patients with OAB symptoms. This first head-to-head study showed non-inferiority of propiverine ER 30 mg compared with tolterodine ER 4 mg.

Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis

Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.

Persistence and compliance with medication management in the treatment of overactive bladder

Overactive bladder (OAB) is a common and chronic condition that impacts patients' daily activities and quality of life. Pharmaco-therapy for OAB is a mainstay of treatment. Antimuscarinics and β3-adrenoceptor agonists are the two major classes of oral pharmacotherapy and have similar efficacy for treating the symptoms of OAB. Owing to the chronic nature of OAB, long-term use of medication is essential for OAB symptom control and positive health outcomes. However, many patients elect to stop their medications during the treatment period. Unmet expectations of treatment and side effects seem to be the major factors for discontinuing OAB pharmacotherapy. Furthermore, the short- and long-term persistence and compliance with medication management are markedly worse in OAB than in other chronic medical conditions. Improvement in persistence and compliance with OAB pharmacotherapy is a hot topic in OAB treatment and should be an important goal in the treatment of OAB. Effective strategies should be identified to improve persistence and compliance. In this review, we outline what is known about persistence and compliance and the factors affecting persistence with pharmacotherapy in patients with OAB.

Delivery methods for drugs used in the treatment of overactive bladder

INTRODUCTION

Overactive bladder affects a significant portion of the population and results in prescribing of numerous medications for its treatment. Traditional drug delivery systems used in therapy are associated with multiple commonly reported side effects. Adherence rates with use of these medications are low. It is likely that low adherence rates with the use of these drugs are due in some part to drug side effects. It is therefore important that alternate methods for drug delivery be explored to reduce side effect profiles and improve patient compliance.

AREAS COVERED

This article addresses the various forms of drug delivery for overactive bladder medications, focusing on those currently in use. Newer systems of drug delivery are also discussed. Through thorough review of research data, randomized trials and meta analyses, drug delivery systems were evaluated.

EXPERT OPINION

EXPERT OPINION favors the use of the transdermal patch and recognizes the necessity for further research and development of other delivery methods. The patch delivery method offers the most effective means of treating symptoms and minimizing drug related adverse side effects leading to treatment discontinuation. Development of OAB medications aimed at alternate receptor targets has the potential to facilitate the creation of new treatment methods to compete with the current standard of care used in OAB treatment.

Update summarising the conclusions of the international consultation on male lower urinary tract symptoms

The International Consultation on Urological Disease have recently published comprehensive conclusions, based on evidence reviewed by eight committees, on aspects of male lower urinary tract symptoms (LUTS). In this review, we summarise the conclusions from four of the committees, namely, the evidence regarding the epidemiology of male LUTS, patient assessment, nocturia and medical management. It is indisputable that with an expanding and ageing global population the prevalence of male LUTS is likely to increase. Therefore symptom prevention and preservation of quality of life (QoL) feature highly in the guidelines. There are now a number of different medical options, proven to lead to significant improvements in symptom scores, flow rate and QoL available to men with LUTS. Meta-analyses have shown the benefits for alpha blockers, antimuscarinics, 5-α reductase and phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above with alpha blockers and so men with concomitant storage symptoms, prostate volume > 30 mL, PSA > 1.4 or erectile dysfunction may be considered for combination treatment of an alpha blocker with an antimuscarinic, 5-α reductase inhibitor or phosphodiesterase-5 inhibitor respectively. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical management strategy.

Urgency and other lower urinary tract symptoms in men aged ≥ 40 years: a Belgian epidemiological survey using the ICIQ-MLUTS questionnaire

BACKGROUND AND AIMS

The aim of this study was to assess prevalence and associated bother of male lower urinary tract symptoms (LUTS), especially of urgency and other storage symptoms, since these are generally assumed to be underdiagnosed/undertreated in men.

METHODS

Data on bladder condition of men ≥ 40 years were prospectively collected by 124 general practitioners (GPs) during a regular visit for any reason, using the validated ICIQ-MLUTS questionnaire. For 13 symptoms, prevalence (scale 0-4) and bother (scale 0-10) were scored. General bladder-related quality of life (scale 0-3) was also assessed.

RESULTS

Data from 5890 men (mean age: 61.2 years) were analysed. A total of 7.7% had urgency most or all of the time (score ≥ 3) and 6.2% had bothersome urgency (score ≥ 3 + bother score ≥ 5). Nocturia (69.2%) and urgency (58.3%) were the most prevalent and bothersome symptoms. Both prevalence and bother of all LUTS increased with age. Additionally, 28.9% of men reported to be a little bothered by their bladder condition in everyday life, while 11.9% were bothered a lot/very much (2.5% in age group 40-49 years increasing to 29.2% in those > 80 years).

CONCLUSIONS

In the general population of men ≥ 40 years who visited a GP for any reason, 41% indicated to be at least a little bothered by their bladder condition. The prevalence of LUTS, especially nocturia and urgency, is high and a significant number of men indicated to be seriously bothered. Increasing awareness of male LUTS, and storage symptoms in particular, is warranted to discuss management options that could increase quality of life.

Cost effectiveness of fesoterodine and tolterodine for the treatment of overactive bladder with urge urinary incontinence in Spain and Finland

BACKGROUND

Overactive bladder is a prevalent condition worldwide that is associated with a considerable burden, both on the patient and on society.

OBJECTIVE

Our objective was to assess the economic value of fesoterodine compared with tolterodine extended release (ER) for the treatment of overactive bladder (OAB) with urge urinary incontinence (UUI) in Spain and Finland.

METHODS

A decision-tree economic model estimated the 52-week costs and quality-adjusted life-years (QALYs) of OAB/UUI patients initiating treatment with fesoterodine 4 mg/day or tolterodine ER. Individuals were evaluated for treatment response (UUI fewer than one episode/day) and persistence at weeks 4, 12, and 24. Titration from fesoterodine 4 mg/day to 8 mg/day was permitted at week 4. At week 12, non-responders discontinued treatment permanently. Efficacy, discontinuation, and utility data were derived from four clinical trials of fesoterodine. OAB-related costs, including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections, depression, and nursing home) were also included.

RESULTS

A total of 19.5 % and 18.0 % of fesoterodine and tolterodine ER patients remained on treatment until week 52, respectively. QALYs were higher with fesoterodine than tolterodine ER (0.762 vs. 0.760). In Spain, fesoterodine treatment had higher total costs than (generic) tolterodine ER (€6,697 vs. 6,597), resulting in a cost of €15,633/QALY gained. In Finland, fesoterodine was cost saving relative to (non-generic) tolterodine ER (€7,885 vs. 8,024). Sensitivity analysis confirmed that these findings were robust to the expected price decrease for generic tolterodine ER in Finland.

CONCLUSION

Fesoterodine is cost effective or cost saving relative to tolterodine ER for the treatment of OAB with UUI in two European countries. Payers and prescribers should consider a broad scope of costs to make informed cost-conscious choices of antimuscarinic treatment.

Health economics perspective of fesoterodine, tolterodine or solifenacin as first-time therapy for overactive bladder syndrome in the primary care setting in Spain

Background

Overactive bladder (OAB) is associated with high healthcare costs, which may be partially driven by drug treatment. There is little comparative data on antimuscarinic drugs with respect to resource use and costs. This study was conducted to address this gap and the growing need for naturalistic studies comparing health economics outcomes in adult patients with OAB syndrome initiating treatment with different antimuscarinic drugs in a primary care setting in Spain.

Methods

Medical records from the databases of primary healthcare centres in three locations in Spain were assessed retrospectively. Men and women ≥18 years of age who initiated treatment with fesoterodine, tolterodine or solifenacin for OAB between 2008 and 2010 were followed for 52 weeks. Healthcare resource utilization and related costs in the Spanish National Health System were compared. Comparisons among drugs were made using multivariate general linear models adjusted for location, age, sex, time since diagnosis, Charlson comorbidity index, and medication possession ratio.

Results

A total of 1,971 medical records of patients (58.3% women; mean age, 70.1 [SD:10.6] years) initiating treatment with fesoterodine (n = 302), solifenacin (n = 952) or tolterodine (n = 717) were examined. Annual mean cost per patient was €1798 (95% CI: €1745; €1848). Adjusted mean (95% bootstrap CI) healthcare costs were significantly lower in patients receiving fesoterodine (€1639 [1542; 1725]) compared with solifenacin (€1780 [€1699; €1854], P = 0.022) or tolterodine (€1893 [€1815; €1969], P = 0.001). Cost differences occurred because of significantly fewer medical visits, and less use of absorbent products and OAB-related concomitant medication in the fesoterodine group.

Conclusions

Compared with solifenacin and tolterodine, fesoterodine was a cost-saving therapy for treatment of OAB in the primary care setting in Spain.

Global prevalence and economic burden of urgency urinary incontinence: a systematic review

CONTEXT

The prevalence and economic burden of urgency urinary incontinence (UUI) are difficult to ascertain because of overlap with data on overactive bladder and other types of incontinence.

OBJECTIVE

To summarize the evidence on the global prevalence and economic burden of UUI.

EVIDENCE ACQUISITION

A PubMed search was performed used the following terms: (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR cost OR economic OR prevalence). A similar search was conducted using Embase. English-language articles published from 1991 through 2013 on non-neurogenic UUI were retained.

EVIDENCE SYNTHESIS

We retained 54 articles (50 studies); 22 large-scale, population-based surveys indicated varying UUI prevalence estimates with ranges of 1.8-30.5% in European populations, 1.7-36.4% in US populations, and 1.5-15.2% in Asian populations, with prevalence dependent on age and gender. Nineteen smaller-scale studies supported these findings. Despite varying methods, 11 studies estimating the costs of UUI worldwide consistently concluded that the economic burden is substantial and will increase markedly as the population ages. In a 2005 multinational study, the annual cost-of-illness estimate for UUI in Canada, Germany, Italy, Spain, Sweden, and the United Kingdom was €7 billion. A US cost-of-illness study reported a total cost of $66 billion in 2007 US dollars. The costs of routine care and nursing home admissions for UUI were major contributors to the cost.

CONCLUSIONS

UUI affects millions of men and women worldwide. Current evidence demonstrates the substantial economic burden of UUI to patients and society. Worldwide public health and clinical management programs are needed to improve UUI awareness and highlight the need for early diagnosis and management.

Improved coverage and accuracy with strand-conserving sequence enrichment

Targeted next-generation sequencing is becoming a common tool in the molecular diagnostic laboratory. However, currently available methods to enrich for regions of interest in the DNA sequence suffer from drawbacks such as high cost, complex protocols, lack of clinical-level accuracy and uneven target coverage. A target-enrichment approach using complementary long padlock probes described in a recent article significantly improves on previous methods in most of these areas.

See related Research: http://genomemedicine.com/content/5/5/50

Immunological and viral features in patients with overactive bladder associated with human T-cell lymphotropic virus type 1 infection

The majority of patients infected with human T-cell lymphotropic virus-type 1 (HTLV-1) are considered carriers, but a high frequency of urinary symptoms of overactive bladder, common in HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) have been documented in these patients. The aim of this study was to determine if immunological and viral factors that are seen in HAM/TSP are also observed in these patients. Participants were classified as HTLV-1 carriers (n = 45), HTLV-1 patients suffering from overactive bladder (n = 45) and HAM/TSP (n = 45). Cells from HTLV-1 overactive bladder patients produced spontaneously more proinflammatory cytokines than carriers. TNF-α and IL-17 levels were similar in HAM/TSP and HTLV-1 overactive bladder patients. High proviral load was found in patients with overactive bladder and HAM/TSP and correlated with proinflammatory cytokines. In contrast with findings in patients with HAM/TSP, serum levels of Th1 chemokines were similar in HTLV-1 overactive bladder and carriers. Exogenous addition of regulatory cytokines decreased spontaneous IFN-γ production in cell cultures from HTLV-1 overactive bladder patients. The results show that HTLV-1 overactive bladder and HAM/TSP patients have in common some immunological features as well as similar proviral load profile. The data show that HTLV-1 overactive bladder patients are still able to down regulate their inflammatory immune response. In addition, these patients express levels of chemokines similar to carriers, which may explain why they have yet to develop the same degree of spinal cord damage as seen in patients with HAM/TSP. These patients present symptoms of overactive bladder, which may be an early sign of HAM/TSP.

Nocturia: current concepts and future perspectives

Nocturia is a prevalent highly bothersome urinary symptom that may significantly detriment the health and well-being of sufferers. It is characterized by waking at night to void, each void preceded and followed by sleep, hence leading to fragmentation of sleep and day-time tiredness. This may result in reduced productivity in the workplace, which contributes to the significant burden to the wider society that nocturia incurs. Nocturia was traditionally viewed as one of the many urinary tract symptoms that occur due to lower urinary tract dysfunction. However, recently it has been recognized that due to its multi-factorial aetio-pathogenesis, nocturia should be viewed as distinct clinical condition in its own right. Careful assessment of the nocturic patient is essential so that treatment strategies are guided by the likely causes. Much research is currently being undertaken into the underlying causes and the optimal management approaches. This review will explore the contemporary status of research on nocturia with a focus on the current and newly available pharmacotherapies.

Overactive bladder, differential diagnosis, and clinical utility of fesoterodine

Overactive bladder is a symptom syndrome with urgency, frequency and, in many cases, nocturia. Urge incontinence is not present in all. There is no direct correlation with detrusor overactivity, an objective finding during urodynamic testing where involuntary contractions can be noticed. In the pathophysiology, much more attention has been given to the afferent/sensory arm of the micturition reflex in the last decade. Anatomical and infectious causes have to be diagnosed or ruled out. Diagnosis of overactive bladder is made mostly by history-taking, but other tests can be necessary in specific patients. Treatment consists of behavioral measures, a good explanation of the condition, training, and pelvic floor physiotherapy. Drugs are often used. Until recently, antimuscarinic drugs have been the mainstay of pharmacological therapy. Fesoterodine is a newer antimuscarinic agent which is more pharmacodynamically stable then tolterodine. Fesoterodine has been extensively researched using different dosages and compared with placebo and tolterodine, in different age groups, and under different conditions. Fesoterodine is superior to placebo and to tolterodine in the short term and long term. Its safety is very acceptable.

Comparative persistence and adherence to overactive bladder medications in patients with and without diabetes

AIMS

This retrospective administrative claims-based study evaluated comparative persistence and adherence to overactive bladder (OAB) medications in US patients with and without diabetes.

METHODS

Patients ≥ 18 years who initiated OAB medications between 1 January 2005 and 30 June 2008 were analysed from the Truven Health MarketScan Commercial and Medicare Supplemental databases. A 12-month baseline period prior to OAB medication initiation was used to classify patients into diabetes and non-diabetes cohorts, and measure demographic and clinical characteristics. Patients in each cohort were directly matched 1 : 1 based on index year, age, gender and geographic region. Multiple logistic regression was used to compare cohorts on outcomes of ≥ 80% adherence to OAB medications and refilling a second OAB medication prescription. Cox's proportional hazards model compared time to non-persistence with OAB medications between both cohorts.

RESULTS

In total, 36,560 patients were included in each cohort. Compared with the non-diabetes cohort, the diabetes cohort had 21.5% higher odds of ≥ 80% adherence to OAB medications, 16.6% higher odds of filling a second OAB medication prescription and 10.3% lower hazard of non-persistence with OAB medications during a 12-month evaluation period.

CONCLUSIONS

Patients with diabetes were more persistent and adherent to OAB medications and had higher odds of filling a second medication prescription than patients without diabetes. Further research is needed to identify factors responsible for these findings.

Lower urinary tract symptoms from childhood to adulthood: a population based study of 594 Finnish individuals 4 to 26 years old

PURPOSE

We evaluated voiding habits and lower urinary tract symptoms by age and gender in a large population of individuals from childhood to adulthood.

MATERIALS AND METHODS

We studied a cross-sectional sample of 594 individuals 4 to 26 years old randomly selected from the population register of Finland. Participants anonymously answered a detailed postal questionnaire on lower urinary tract symptoms. Parents assisted respondents younger than 16 years. Results were analyzed by age group (4 to 7, 8 to 12, 13 to 17 and 18 to 26 years) and gender. A p value of less than 0.05 was considered statistically significant.

RESULTS

The prevalence of urge incontinence significantly decreased with age (45% in respondents 4 to 7 years vs 10% in respondents 13 to 17 years, p <0.05). Urinary tract infections and urge and stress incontinence were more common in females (16% to 32%) than in males (2% to 4%) older than 12 years (p <0.05). The occurrence of some type of minor daytime urinary incontinence was reported by approximately a fourth of the study population, with a significant decline in prevalence between ages 4 to 7 years and 8 to 12 years (p <0.05). Minor urinary incontinence was significantly more common in females older than 12 years. Frequent urinary incontinence affected only 4% of respondents, most of whom were younger than 12 years.

CONCLUSIONS

Bladder control and urinary function exhibit considerable variation with age and gender. Due to the imperfections in bladder control in the general population, the evaluation of urinary tract disorders and outcomes of surgery in children and adolescents should be conducted with reference to control data according to age and gender.

Prevalence and effect on health-related quality of life of overactive bladder in older americans: results from the epidemiology of lower urinary tract symptoms study

OBJECTIVE

To evaluate the prevalence and effect of overactive bladder (OAB) on healthcare-seeking behavior, mental health, and generic and condition-specific health-related quality of life (HRQL) in older adults.

DESIGN

Secondary analysis of the U.S. sample of the Epidemiology of Lower Urinary Tract Symptoms (EpiLUTS) study-a population-based, cross-sectional, Internet-based survey.

SETTING

Community.

PARTICIPANTS

Two thousand four hundred eighty-five men and 2,877 women aged 65 and older.

MEASUREMENTS

Prevalence and effect on HRQL of urinary symptoms, including OAB. OAB was defined as the presence of urinary urgency and/or urinary urgency incontinence. Descriptive analyses and subgroup comparisons were conducted to evaluate the prevalence of OAB in men and women aged 65 and older and the effect of OAB on various aspects of HRQL.

RESULTS

The survey response rate was 46.9% of men and 61.0% of women. Prevalence rates of OAB at least "sometimes" were 40.4% in men and 46.9% in women. OAB was associated with significant impairments across all domains of patient-reported outcomes, including general HRQL (Medical Outcomes Study 12-item Short-Form Survey), ratings of anxiety and depression (Hospital Anxiety and Depression Scale), and urinary condition-specific outcomes (Overactive Bladder Questionnaire Short Form and Patient Perception of Bladder Condition) (P<.001).

CONCLUSION

OAB is common in older adults in the United States and is associated with substantial impairment in mental health and HRQL, but rates of treatment seeking behavior are low. Older patients should be assessed for OAB.

Novel biomarkers for overactive bladder

Biomarkers constitute any objectively measurable indicator of a biological process. The classic biomarker used in the diagnosis of overactive bladder (OAB) has been detrusor overactivity, which is assessed urodynamically. In the search for a reliable, noninvasive alternative to urodynamics, interest has focused on genetic, imaging, and urinary factors. Along with other cytokines detectable in urine, prostaglandin E2 and nerve growth factor are indicators of low-grade inflammation. Although they correlate with OAB symptom severity, they have not been shown to have independent prognostic benefit. Imaging biomarkers have been investigated since the earliest days of video urodynamics. Despite extensive research on the ultrasonographic estimation of bladder wall thickness, further standardization of the technique is required before conclusions can be reached regarding diagnostic accuracy. Genetic factors contribute approximately half of the total risk for urgency incontinence. Functional polymorphisms of the cytochrome P450 IID6 gene significantly alter the metabolism of some commonly used anticholinergic drugs, but no genetic loci that influence risk of OAB have been definitively identified. The first genome-wide association studies for OAB are in progress, and should identify new susceptibility genes. Although current putative biomarkers correlate with OAB severity, much future work is required to assess their prognostic value, and establish their role in clinical practice.

Patient-selected goals in overactive bladder: a placebo controlled randomized double-blind trial of transdermal oxybutynin for the treatment of urgency and urge incontinence

OBJECTIVE

To assess patient selected goal improvement with transdermal oxybutynin, in a representative population of adult women with overactive bladder (OAB).

SUBJECTS AND METHODS

Adult women with ≥ 3 month history of OAB symptoms, with or without urgency urinary incontinence, were recruited from a tertiary referral urogynaecology unit. Participants were allocated to either transdermal oxybutynin 3.9 mg/day or matching placebo patches in a double-blind, randomized parallel group design, over 4 weeks. Patient-selected goal achievement was defined as the primary outcome measure. Participants selected their own goals for treatment at baseline, and subsequently scored achievement of these goals on a visual analogue scale. They completed 3-day bladder diaries incorporating the Patients Perception of Intensity of Urgency Scale (PPIUS) to assess urgency and urgency incontinence episodes. Quality of life was assessed using the King's Health Questionnaire (KHQ).

RESULTS

A total of 96 women were randomized; 78 (81.3%) participants completed 4 weeks double-blind treatment. There was no significant difference between mean goal achievement in the transdermal oxybutynin and placebo groups (41.9% (SD 31.3) vs 32.2% (SD 27.3), P= 0.203). Transdermal oxybutynin was associated with significant improvements in urgency episodes (-1.23 episodes/day (SD1.40) vs -0.21 episodes/day (SD 1.58), P= 0.01). Both groups made non-significantly different improvements in KHQ scores; 18 (38.2%) patients in the transdermal oxybutynin group experienced either erythema or pruritus, with 7 (14.9%) experiencing at least one systemic adverse event.

CONCLUSIONS

In women with OAB, in comparison with placebo, transdermal oxybutynin 3.9 mg/day leads to significant objective improvements in urinary urgency, but with no significant difference observed in achievement of patients' own goals for therapy, or improvement in disease specific quality of life.

National community prevalence of overactive bladder in the United States stratified by sex and age

OBJECTIVE

To estimate the prevalence of and bother associated with overactive bladder (OAB) in adults aged ≥40 years in the United States, using current International Continence Society definitions.

METHODS

Internet-based panel members were selected randomly to participate in EpiLUTS, a cross-sectional, population-representative survey. Participants used Likert scales to rate how often they experienced individual lower urinary tract symptoms during the previous 4 weeks and how much bother they experienced. Based on responses to questions regarding urgency and urgency urinary incontinence, OAB symptoms were categorized as occurring at least "sometimes" or at least "often." Symptom bother was categorized as at least "somewhat" or at least "quite a bit."

RESULTS

The response rate was 59.6%, with a final sample of 9416 men and 10,584 women. Prevalence of OAB symptoms at least "sometimes" was 27.2% and 43.1% for men and women, respectively; prevalence of OAB at least "often" was 15.8% and 32.6%, respectively. Among men with OAB symptoms at least "sometimes," 60.0% were bothered at least "somewhat" and 27.8% were bothered at least "quite a bit." Among women, bother rates were 67.6% and 38.9%, respectively. Among respondents with OAB at least "often," 67.8% and 38.2% of men and 73.0% and 47.1% of women reported being bothered at least "somewhat" and at least "quite a bit," respectively. We estimate that 29.8 million adults aged ≥40 years in the United States have bothersome OAB symptoms.

CONCLUSIONS

Bothersome OAB symptoms are highly prevalent among men and women aged ≥40 years in the United States.

Risk factors for overactive bladder in the elderly population: a community-based study with face-to-face interview

OBJECTIVES

The aim of this study was to measure the prevalence of and risk factors for overactive bladder (OAB) in the elderly.

METHODS

A cross-sectional study of elderly subjects was conducted by analyzing data from a community-based Comprehensive Geriatric Assessment on people aged 70 years or older. Trained interviewers performed face-to-face interviews for the assessment of urological symptoms. OAB definition was based on urgency and eight or more episodes of urination per day. The subjects completed a self-administered questionnaire including lifestyle evaluation, Geriatric Depression Scale, Mini-Mental Status Examination and medical history. Brachial-ankle pulse wave velocity was recorded to assess atherosclerotic disease. The analysis included 833 subjects, after the exclusion of 115 subjects who provided insufficient information.

RESULTS

Based on the definition of OAB, 153 subjects (18.4%) were identified as having OAB. Univariate analysis showed a significant association between OAB and depressive symptoms. Multivariate analysis showed that the risk of having OAB was significantly higher in subjects with depressive symptoms, current drinkers, and overweight subjects with odds ratios of 2.37 (1.60-3.52, 95% confidence interval), 1.65 (1.04-2.62), and 1.51 (1.02-2.24), respectively.

CONCLUSIONS

This is the first report to show an association between OAB and depressive symptoms and alcohol intake in an epidemiological study of elderly people. The reasons for these correlations remain unclear, but should be the foci of future OAB studies.

The association between overactive bladder and diuretic use in the elderly

Several recent population-based studies have provided insight into the clinical importance and impact of overactive bladder (OAB). Although OAB can affect anyone at any age, the prevalence tends to increase with advancing age. Diuretic use is also common among older adults, as the prevalence of clinical conditions such as hypertension and heart failure requiring its use increases markedly with age. By causing increased formation of urine by the kidneys, diuretics increase urinary frequency and may cause urinary urgency and incontinence. This review provides a summary of available data, focusing on the association between OAB and diuretic use in the elderly. Although there is very little research work in this area, available studies have provided insight into the possible contribution of diuretic use to OAB in the elderly. Based on a recent report, OAB symptoms are common among older adults using diuretics, particularly the loop-type, and are associated with poor quality of life. More studies are required to fully understand the association between diuretic use and OAB, particularly its impact on health-related quality of life.

Reliability and normal ranges for the Patient's Perception of Intensity of Urgency Scale in asymptomatic women

STUDY TYPE

Symptom prevalence (prospective cohort).

LEVEL OF EVIDENCE

1b.

OBJECTIVE

To measure the test-retest reliability of a 7-day bladder diary incorporating the Patient's Perception of Intensity of Urgency Scale (PPIUS), and to establish the normal values of the scale in a population of asymptomatic women.

SUBJECTS AND METHODS

Women volunteers, aged > or =18 years, were screened with the International Consultation on Incontinence Modular Questionnaire - Female Lower Urinary Tract Symptoms Long Form, to exclude those with bothersome lower urinary tract symptoms. Participants completed two separate 7-day bladder diaries with a 1-week interval between. Reliability was assessed using intraclass correlation, Spearman's correlation, and Student's t-test.

RESULTS

Forty volunteers were recruited. Most (67.5%) reported no urgency episodes. Convenience voids accounted for 26.8% of all voids. There was a significant positive effect of age (r = 0.34, P = 0.034) on urgency episodes, but no effect on mean urge scores (r = -0.03, P = 0.843). The reliability of assessment of frequency (0.86), nocturia (0.84), and the mean urge scores (0.85), were better than the reliability of assessment of urgency episodes (0.56), which occurred infrequently. The 95th centile for daily urinary frequency was 7.27 and for weekly urgency episodes was 2.00.

CONCLUSION

The PPIUS is a reliable tool for assessing urinary urge sensation in women. Inclusion of this measure in bladder diaries does not compromise the recording of other variables.

A systematic evaluation of factors associated with nocturia--the population-based FINNO study

In a case-control study with prevalence sampling, the authors explored the correlates for nocturia and their population-level impact. In 2003–2004, questionnaires were mailed to 6,000 subjects (aged 18–79 years) randomly identified from the Finnish Population Register (62.4% participated; 53.7% were female). Questionnaires contained items on medical conditions, medications, lifestyle, sociodemographic and reproductive factors, urinary symptoms, and snoring. Nocturia was defined as ≥2 voids/night. In age-adjusted analyses, factors associated with nocturia were entered into a multivariate model. Backward elimination was used to select variables for the final model, with adjustment for confounding. Although numerous correlates were identified, none affected ≥50% of nocturia cases of both sexes. The factors with the greatest impact at the population level were (urinary) urgency (attributable number/1,000 subjects (AN) = 24), benign prostatic hyperplasia (AN = 19), and snoring (AN = 16) for men and overweight and obesity (AN = 40), urgency (AN = 24), and snoring (AN = 17) for women. Moreover, correlates included prostate cancer and antidepressant use for men, coronary artery disease and diabetes for women, and restless legs syndrome and obesity for both sexes. Although several correlates were identified, none accounted for a substantial proportion of the population burden, highlighting the multifactorial etiology of nocturia.

Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland

BACKGROUND

Nocturia (ie, waking at night to void) is common and disrupts sleep. Traditionally, one nightly episode has been regarded as clinically meaningless, yet the justification for this belief remains weak.

OBJECTIVE

To evaluate the association among frequency of nocturia and bother and health-related quality of life (HRQoL).

DESIGN, SETTING, AND PARTICIPANTS

In 2003-2004, a survey was mailed to a random sample of 6000 subjects aged 18-79 yr who were identified from the Finnish Population Register Centre (response proportion was 62.4%; 53.7% were females).

MEASUREMENTS

HRQoL and bother from nocturia were examined in relation to self-reported nocturia frequency (using the American Urological Association Symptom Index and the Danish Prostatic Symptom Score). Bother from nocturia was assessed on a four-point scale (none, small, moderate, major). HRQoL was measured with the generic 15D instrument on a 0-1 scale with a minimum clinically important difference of 0.03.

RESULTS AND LIMITATIONS

Degree of bother increased with nocturia frequency (p<0.01). The most commonly cited degree of bother for those with one, two, and three nightly voids was no bother, small bother, and moderate bother, respectively. The mean age-adjusted 15D score for men (and women) without nocturia was 0.953 (0.950) and 0.925 (0.927) with one void per night, 0.898 (0.890) with two voids per night, and 0.833 (0.840) with three or more voids per night. Statistically significant decreases were found in 15D score and in all 15D dimensions except eating. Although the response rate was high, approximately one third of those contacted did not participate in the study.

CONCLUSIONS

At least two voids per night is associated with impaired HRQoL. The majority of people report having bother when the number of nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from nocturia and, thus, is not a suitable criterion for clinically relevant nocturia.