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Anwar A, Gorka V, Chahal HS, Sharma S, Tandon S, Singhal N, Narwade PC, Chauhan N, Bansal N, Kaur S. Comparison of Efficacy and Safety of a Combination of Tamsulosin and Mirabegron versus Tamsulosin Alone in the Management of Overactive Bladder in Males with Lower Urinary Tract Symptoms - TAME-Overactive Bladder: An Open-labeled Randomized Controlled Trial. Int J Appl Basic Med Res 2023; 13:218-223. [PMID: 38229731 PMCID: PMC10789471 DOI: 10.4103/ijabmr.ijabmr_331_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 01/18/2024] Open
Abstract
Background Overactive bladder (OAB) is a common condition in elderly men with coexisting benign prostatic enlargement (BPE), and it significantly impairs their quality of life (QoL). Aim This study aimed to assess the safety and efficacy of adding beta-3 adrenergic receptor agonist (mirabegron 50 mg) to tamsulosin 0.4 mg for symptomatic men with BPE and OAB symptoms (OABS). Materials and Methods It was an open-labeled randomized controlled trial. Ninety men with BPE and International Prostate Symptom Score (IPSS) of more than seven with predominant OABS were enrolled for the study. A detailed history, uroflowmetry, and baseline scores, including IPSS, OABS score (OABSS), and QoL assessment, were done for each patient. After written informed consent, patients were randomized into two groups of 45 each. Group-1 received tamsulosin 0.4 mg and placebo, and Group-2 received a combination of tamsulosin 0.4 mg plus mirabegron 50 mg once daily at bedtime. Follow-up of patients was done at 2nd, 4th, and 8th weeks. Efficacy at 8 weeks was assessed using repeat history for symptoms, uroflowmetry, IPSS, OABSS, and QoL score. Results After 8 weeks of therapy, collected data were compared to baseline parameters in both groups. Significant improvement with respect to OABSS (P = 0.046), IPSS (P = 0.006), and QoL (P = 0.038) was observed with combination therapy versus tamsulosin alone. There were mild adverse effects, which were self-limiting. Conclusions A combination of tamsulosin with mirabegron is effective and safe in improving the OABSS, IPSS, and QoL in men with BPE who have predominant OABS.
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Affiliation(s)
- Azhar Anwar
- Department of Urology, Galaxy Hospital, Varanasi, Uttar Pradesh, India
| | - Vivek Gorka
- Department of Urology, Fortis Hospital, Amritsar, Punjab, India
| | | | - Sandeep Sharma
- Department of Urology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sunit Tandon
- Department of Urology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Naman Singhal
- Department of Urology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Nikhil Chauhan
- Department of Urology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Namita Bansal
- Department of Research and Development, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Simran Kaur
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Gandi C, Sacco E. Pharmacological Management of Urinary Incontinence: Current and Emerging Treatment. Clin Pharmacol 2021; 13:209-223. [PMID: 34858068 PMCID: PMC8630428 DOI: 10.2147/cpaa.s289323] [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: 07/26/2021] [Accepted: 11/05/2021] [Indexed: 12/16/2022] Open
Abstract
Pharmacological management of urinary incontinence (UI) is currently based on antimuscarinic and beta-3-agonist drugs. Botulinum toxin A detrusor injections represent an effective but more invasive alternative. This review covers the latest developments of the currently available drugs and the emerging compounds for the treatment of UI. Evidence shows that new antimuscarinics and beta-3-agonists with improved safety profiles may offer unique options to patients intolerant to currently available drugs. Combination therapy proved to be a non-invasive alternative for patients refractory to first-line monotherapy. Exciting advances are ongoing in the research to improve the efficacy/tolerability profile of botulinum toxin, through innovative routes of administration. Several new agents emerged from preclinical studies, some of which have now entered the clinical phase of development and could represent, in the coming years, a new way for the treatment of UI. Recent evidence on the existence of different overactive bladder phenotypes could be the key to tailored treatment. Rather than discovering new molecules, reaching the ability to identify the right drug for the right patient could be the real gamechanger of the future.
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Affiliation(s)
- Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University School of Medicine, Rome, Italy
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3
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Rosen DP, Husmann DA, Mynderse LA, Kelly TF, Alizad A, Fatemi M. Detrusor overactivity assessment using ultrasound bladder vibrometry. Physiol Meas 2021; 42:10.1088/1361-6579/ac2c5c. [PMID: 34598174 PMCID: PMC8609921 DOI: 10.1088/1361-6579/ac2c5c] [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: 05/14/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022]
Abstract
Objective. Detrusor overactivity (DO) is a urodynamic observation characterized by fluctuations in detrusor pressure (Pdet) of the bladder. Although detecting DO is important for the management of bladder symptoms, the invasive nature of urodynamic studies (UDS) makes it a source of discomfort and morbidity for patients. Ultrasound bladder vibrometry (UBV) could provide a direct and noninvasive means of detecting DO, due to its sensitivity to changes in elasticity and load in the bladder wall. In this study, we investigated the feasibility and applying UBV toward detecting DO.Approach. UBV and urodynamic study (UDS) measurements were collected in 76 neurogenic bladder patients (23 with DO). Timestamped group velocity squared (cg2) data series were collected from UBV measurements. ConcurrentPdetdata series were identically analyzed for comparison and validation. A processing approach is developed to separate transient fluctuations in the data series from the larger trend of the data and a DO index is proposed for characterizing the transient peaks observed in the data.Main Results.Applying the DO index as a classifier for DO produced sensitivities and specificities of 0.70 and 0.75 forcg2data series and 0.70 and 0.83 forPdetdata series respectively.Significance. It was found that DO can be feasibly detected from data series of timestamped UBV measurements. Collectively, these initial results are promising, and further refinement to the UBV measurement process is likely to improve and clarify its capabilities for noninvasive detection of DO.
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Affiliation(s)
- David P. Rosen
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
| | - Douglas A. Husmann
- Department of Urology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Lance A. Mynderse
- Department of Urology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Troy F. Kelly
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
- Department of Radiology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
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Kim M, Harvey J, Gusev A, Norton JM, Miran S, Bavendam T. A Scoping Review of the Economic Burden of Non-Cancerous Genitourinary Conditions. Urology 2021; 166:29-38. [PMID: 34688770 DOI: 10.1016/j.urology.2021.10.008] [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] [Received: 04/13/2021] [Revised: 09/16/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide a scoping review of the economic burden of non-cancerous genitourinary conditions (NCGUCs). METHODS A scoping review of the literature surrounding the economic costs associated with NCGUCs was conducted for literature published between 1990-2020. The articles were screened and relevant articles were selected for review. These articles were abstracted with information pertaining to the costs surrounding NCGUCs. A descriptive analysis of the data was conducted. RESULTS We found 3298 articles in our scoping review. Of these, we found 38 relevant articles related to pelvic floor dysfunction and pelvic organ prolapse, interstitial cystitis, neurogenic bladder, nocturia, urinary tract infections, urolithiasis, urinary incontinence, benign prostatic hyperplasia, overactive bladder, and erectile dysfunction of which the data is reviewed. CONCLUSION Although the data in estimating the economic burden is limited, existing evidence demonstrates a significant component of health care spending on NCGUCs. Much of the spending is out-of-pocket and indirect costs that are difficult to measure which may increase the magnitude of the costs. There is a need for future research that takes a holistic look at the economic impact of NCGUCs.
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Affiliation(s)
- Michelle Kim
- Department of Urology, Massachusetts General Hospital, Harvard Medical School Boston, MA.
| | - Joshua Harvey
- Department of Urology, Massachusetts General Hospital, Harvard Medical School Boston, MA
| | - Andrew Gusev
- Department of Urology, Massachusetts General Hospital, Harvard Medical School Boston, MA
| | - Jenna M Norton
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Saadia Miran
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Tamara Bavendam
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Yang SJ, Park JH, Oh Y, Kim H, Kong M, Moon J. Association of decreased grip strength with lower urinary tract symptoms in women: a cross-sectional study from Korea. BMC Womens Health 2021; 21:96. [PMID: 33663465 PMCID: PMC7934376 DOI: 10.1186/s12905-021-01241-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) including frequency, nocturia, urgency, and incontinence, are common in women and cause significant discomfort in daily life. However, diagnosis and treatment of LUTS are often delayed because many patients with such symptoms do not complain to the physician of discomfort and do not seek medical attention. LUTS are known to be associated with muscle weakness. We investigated the association between grip strength and LUTS in women of different ages. METHODS This study included 4225 women (mean age 48.6 years) who underwent self-referred health screening between April 2015 and December 2019. LUTS were evaluated using a self-reported questionnaire, and the overactive bladder symptom score was used to screen for an overactive bladder. Low muscle strength was defined as a hand grip strength of < 18 kg (decreased grip strength). RESULTS We observed decreased grip strength in 13.7% (n = 580) of the participants. Nocturia, urgency, incontinence, and overactive bladder were more common in women with decreased grip strength than in women with normal grip strength. After adjusting for age, comorbidities (hypertension, diabetes, hyperlipidemia), smoking status, alcohol consumption, regular exercise, and stress, nocturia (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.01-1.52), urinary incontinence (OR 1.32, 95% CI 1.01-1.72), and an overactive bladder (OR 1.75, 95% CI 1.35-2.27) were significantly associated with decreased grip strength. CONCLUSIONS The findings suggest that LUTS, especially nocturia, incontinence, and an overactive bladder are associated with decreased grip strength in women. Therefore, physicians should be aware that patients may not seek help, even if they are uncomfortable, and it is important to obtain a detailed medical history and perform additional tests, even in the absence of complaints, in patients with low grip strength, who are at high risk of LUTS.
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Affiliation(s)
- Su-Jin Yang
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Jung Ha Park
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea
| | - Yunhwan Oh
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Hyeonju Kim
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Mihee Kong
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Jihyun Moon
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea.
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea.
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Sacco E, Gandi C, Li Marzi V, Lamberti G, Serati M, Agro' EF, Soligo M. Extensive impact of COVID-19 pandemic on pelvic floor dysfunctions care: A nationwide interdisciplinary survey. Neurourol Urodyn 2021; 40:695-704. [PMID: 33492706 PMCID: PMC8013427 DOI: 10.1002/nau.24610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 12/25/2022]
Abstract
Aims To investigate the impact of COVID‐19 pandemic on health‐care provision to patients suffering from pelvic floor dysfunctions in Italy. Methods A retrospective web‐based interdisciplinary survey was mailed by the Italian Society of Urodynamics to members involved in pelvic floor dysfunctions management from June 22, 2020 to July 17, 2020. The 84‐item questionnaire investigated the period March–June 2020 (first epidemic wave) and showed high content validity. The primary outcome was the mean rate of cancellation for health‐care services. Secondary outcomes included estimation of the accumulated surgeries backload until return to baseline activity and of the recovery pattern, using linear regression and scenario‐based forecasting. Results A total of 85 participants provided complete responses. Respondents were mostly urologists (47%), followed by gynecologists (29.5%) and physiatrists (17.6%). On average, 78.4% of outpatient services and 82.7% of functional surgeries were canceled, without significant differences by geographical distribution. An impact on patients' quality of life was anticipated by most of the respondents (87%) and 48.2% also reported potentially serious health risks for patients. Thirty‐three percent of the respondents reported the use of telemedicine. If the nation‐wide surgical activity increases by 20% postpandemic, it would take 37 months to clear the backlog of functional surgeries. We acknowledge the inherent limitations of the survey methodology and retrospective design. Conclusions Access to care for patients suffering from pelvic floor dysfunctions has been dramatically affected by the COVID‐19 outbreak. The indirect effects of this unprecedented disruption on pelvic floor dysfunctions care may last for several months.
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Affiliation(s)
- Emilio Sacco
- Clinica Urologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Gandi
- Clinica Urologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Li Marzi
- Department of Urology Clinic, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianfranco Lamberti
- Department of Spinal Unit and Intensive Rehabilitation of the AUSL of Piacenza, Piacenza, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Enrico Finazzi Agro'
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Marco Soligo
- Department of Obstetrics & Gynecology, Ospedale Maggiore di Lodi - ASST Lodi, Lodi, Italy
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Botulinum toxin in low urinary tract disorders - over 30 years of practice (Review). Exp Ther Med 2020; 20:117-120. [PMID: 32509003 DOI: 10.3892/etm.2020.8664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/03/2020] [Indexed: 01/22/2023] Open
Abstract
Botulinum toxin is a substance produced by Clostridium Botulinum and is responsible for human botulism. This substance is a poison, a neurotoxin, but used in limited quantities it can be a cure for some diseases. It is well connected to a large variety of medical applications. The mechanism of action relies on blocking the acetylcholine at the neuromuscular junction, which blocks the transmission of the nervous impulse with secondary flaccid paralysis. In urology, its role in idiopathic overactive bladder and neurogenic bladder is well known. We performed a thorough review using PubMed and other databases, revising the mechanisms of botulinum toxin action in urologic pathology, treatment procedures and other options. Botulinum toxin is a well-studied substance with a large number of applications in medicine. In urologic pathology, overactive bladder and neurogenic bladder are backed by robust studies that support the therapeutic role of this substance. The toxin has multiple effects, such as inhibition of the nerve growth factor, blocking the bladder sensory afferent pathway and apoptotic effect on the prostate tissue, by inhibiting the substance P, altering the nociceptive pathways. Interstitial cystitis and other rare pathologies show promising results, but further studies are needed. The role of botulinum toxin in benign prostatic hyperplasia is still not elucidated.
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Wu SJ, Xu YQ, Gao ZY, Wang ZP, Zhao F, Liu L, Wang S. Clinical outcomes of botulinum toxin A management for neurogenic detrusor overactivity: meta-analysis. Ren Fail 2019; 41:937-945. [PMID: 31599184 PMCID: PMC6807649 DOI: 10.1080/0886022x.2019.1655448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this work was to evaluate the efficacy and safety of botulinum toxin A (BTX-A) treatment in patients with neurogenic detrusor overactivity. PUBMED, EMBASE, and Cochrane Library were identified on 13 May 2017 to identify relevant randomized controlled trials. All data obtained were analyzed using Stata 12.0. Five randomized controlled trials were included in this study. Compared to placebo, the BTX-A groups had significantly fewer urinary incontinence (UI) episodes per day and per week (BTX-A with 300 U for frequency of UI per day at week 2, mean difference (MD): −1.13, 95% confidence interval (CI): −1.89 to −0.37; 200 U; BTX-A with 300 U for frequency of UI per week at week 6, MD: −11.42, 95% CI: −13.91 to −8.93; BTX-A with 200 U for frequency of UI per week at week 6, MD: −10.72, 95% CI: −13.40 to −8.04), increased in maximum cystometric capacity at week 6 (BTX-A with 300 U, MD: 154.88, 95% CI: 133.92–175.84; BTX-A with 200 U, MD: 141.30, 95% CI: 121.28–161.33), decreased maximum detrusor pressure at week 6 (BTX-A with 300 U, MD: −31.72, 95% CI: −37.69 to −25.75; BTX-A with 200 U, MD: −33.47, 95% CI: −39.20 to −27.73). For adverse effects, BTX-A was often associated with more complications and urinary tract infections (BTX-A with 300 U: relative risk (RR):1.42, 95% CI: 1.15–1.76; BTX-A with 200 U: RR: 1.42, 95% CI: 1.11–1.82). This meta-analysis suggests that treatment with BTX-A is effective and safe for neurogenic detrusor overactivity, and recommends using BTX-A with 300 U or with 200 U, as suitable dosage.
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Affiliation(s)
- Shang-Jun Wu
- Department of Urology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University , Huangshi , China
| | - Yu-Qiong Xu
- Peking University Shenzhen Hospital , Shenzhen , China
| | - Zheng-Yan Gao
- Department of Urology, The Sixth People's Hospital of Yancheng City , Yancheng , China
| | - Zhi-Peng Wang
- Department of Urinary Surgery, Linzi District People's Hospital, Binzhou Medical University , Yantai , China
| | - Feng Zhao
- Department of Transfusion Medicine, Linzi District People's Hospital, Binzhou Medical University , Yantai , China
| | - Lin Liu
- Department of Biotherapy, Linzi District People's Hospital, Binzhou Medical University , Yantai , China
| | - Sheng Wang
- Medical Intensive Care Unit, PKUCare Luzhong Hospital , Zibo , China
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Suditu N, Negru I, Miron A, Novac B, Ciuta C. Is nocturnal enuresis a predisposing factor for the overactive bladder? Turk J Med Sci 2019; 49:703-709. [PMID: 31203588 PMCID: PMC7018347 DOI: 10.3906/sag-1604-116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background/aim This study aimed to perform a limited observational study to ascertain whether there is statistical support that nocturnal enuresis (NE) is a predisposing factor in the development of overactive bladder (OAB). Materials and methods The authors recruited patients diagnosed with OAB over a period of twelve months, and those who declared a history of NE were asked additional questions regarding the features of their NE. Results A total of 285 patients were diagnosed with overactive bladder, and 98 (34.38%) of them had previously displayed NE symptoms that had diminished before reaching the median age of 9.83. Separation of patients by sex revealed a male majority (58.16%). Additionally, most patients had urban origins (75.51%). The median time span from remission of NE to diagnosis of OAB was 24.79 years, and the median age at which patients began to suffer was 31.80 years. Behavioral factors (smoking, alcohol consumption) and psychological and infectious factors (past history of urinary tract infection) were identified at varying degrees. Conclusion The presence of NE in a third of the patients who developed over time OAB and the earlier onset of OAB for these patients suggests a causal physiopathological relationship between NE and OAB. The preponderance of urban patients confirms the existence of acquired urban triggering factors of OAB (nutritious, social, or professional).
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Affiliation(s)
| | - Irina Negru
- Department of Surgery, Arcadia Hospital, Iaşi, Romania
| | - Adelina Miron
- Department of Urology and Kidney Transplant, “Dr. C.I. Parhon” Clinical Hospital, Iaşi, Romania
| | - Bogdan Novac
- Department of Urology and Kidney Transplant, “Dr. C.I. Parhon” Clinical Hospital, Iaşi, Romania
| | - Catalin Ciuta
- Department of Urology and Kidney Transplant, “Dr. C.I. Parhon” Clinical Hospital, Iaşi, Romania
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10
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Characterizing the Health-Related Quality of Life Burden of Overactive Bladder Using Disease-Specific Patient-Reported Outcome Measures: A Systematic Literature Review. Adv Ther 2019; 36:548-562. [PMID: 30715686 PMCID: PMC6824512 DOI: 10.1007/s12325-019-0880-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Indexed: 01/29/2023]
Abstract
Introduction The objective was to identify the most commonly used patient-reported outcome (PRO) instruments for overactive bladder (OAB), determine which are the most useful for measuring burden in OAB and characterize the findings of recent studies that have employed PRO instruments to assess OAB symptoms and the effects of treatment. Methods A systematic search of OAB literature published between January 2006 and November 2017 using Medline/PubMed and EMBASE databases. Results Of 3425 abstracts and 500 full-text articles reviewed, 58 studies (both clinical trials and observational studies) were included in the review. The most commonly used PRO instruments were the OAB Questionnaire (OAB-q; 64%), followed by the King’s Health Questionnaire (KHQ; 31%) and the Patient Perception of Bladder Condition (PCBC; 21%). Synthesis of data from studies using the OAB-q showed that OAB treatment with antimuscarinics, mirabegron and onabotulinumtoxinA all improve health-related quality of life (HRQoL) and symptoms beyond the benefits observed with placebo. The OAB-q could detect dose–response relationships in some studies and demonstrated there were no significant differences across therapies from different drug classes. Conclusion The HRQoL burden of OAB and response to treatment can be reliably measured by PRO instruments, and the OAB-q is the most commonly used instrument in OAB, particularly in clinical trials of OAB interventions. These data will be useful to provide benchmarks of burden levels for PRO scores obtained among those on contemporary therapies for comparison with outcomes from patients managed with emerging treatments. Funding Astellas Pharma Global Development, Inc. Electronic supplementary material The online version of this article (10.1007/s12325-019-0880-8) contains supplementary material, which is available to authorized users.
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11
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Klee NS, McCarthy CG, Lewis S, McKenzie JL, Vincent JE, Webb RC. Urothelial Senescence in the Pathophysiology of Diabetic Bladder Dysfunction-A Novel Hypothesis. Front Surg 2018; 5:72. [PMID: 30564582 PMCID: PMC6288180 DOI: 10.3389/fsurg.2018.00072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/12/2018] [Indexed: 12/11/2022] Open
Abstract
Diabetic bladder dysfunction (DBD) is a well-recognized and common symptom affecting up to 50% of all diabetic patients. DBD has a broad range of clinical presentations ranging from overactive to underactive bladder symptoms that develops in middle-aged to elderly patients with long standing and poorly controlled diabetes. Low efficacy of current therapeutics and lifestyle interventions combined with high national healthcare costs highlight the need for more research into bladder dysfunction pathophysiology and novel treatment options. Cellular senescence is an age-related physiologic process in which cells undergo irreversible growth arrest induced by replicative exhaustion and damaging insults. While controlled senescence negatively regulates cell proliferation and promotes tissue regeneration, uncontrolled senescence is known to result in tissue dysfunction through enhanced secretion of inflammatory factors. This review presents previous scientific findings and current hypotheses that characterize diabetic bladder dysfunction. Further, we propose the novel hypothesis that cellular senescence within the urothelial layer of the bladder contributes to the pro-inflammatory/pro-oxidant environment and symptoms of diabetic bladder dysfunction. Our results show increased cellular senescence in the urothelial layer of the bladder; however, whether this phenomenon is the cause or effect of DBD is unknown. The urothelial layer of the bladder is made up of transitional epithelia specialized to contract and expand with demand and plays an active role in transmission by modulating afferent activity. Transition from normal functioning urothelial cells to secretory senescence cells would not only disrupt the barrier function of this layer but may result in altered signaling and sensation of bladder fullness; dysfunction of this layer is known to result in symptoms of frequency and urgency. Future DBD therapeutics may benefit from targeting and preventing early transition of urothelial cells to senescent cells.
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Affiliation(s)
- Nicole S Klee
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Cameron G McCarthy
- Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
| | - Steven Lewis
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Jaine L McKenzie
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States.,Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Julie E Vincent
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - R Clinton Webb
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States
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Meta-Analysis of the Efficacy and Safety of Mirabegron Add-On Therapy to Solifenacin for Overactive Bladder. Int Neurourol J 2017; 21:212-219. [PMID: 28954464 PMCID: PMC5636960 DOI: 10.5213/inj.1734934.467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/03/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE We performed a meta-analysis to evaluate the efficacy and safety of mirabegron add-on therapy to solifenacin for patients with overactive bladder (OAB). METHODS We conducted a systematic literature review to identify all randomized, double-blind, controlled trials (RCTs) of this combination (mirabegron and solifenacin) for OAB. Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched. A manual search was also performed to investigate relevant references from the retrieved studies. RESULTS Four publications describing 5 RCTs that compared combination therapy with solifenacin, including a total of 3,309 patients, were analyzed. The mean number of micturitions per 24 hours (mean difference [MD], -0.45; 95% confidence interval [CI], -0.65 to -0.26; P<0.00001), number of episodes of incontinence per 24 hours (MD, -0.71; 95% CI, -0.14 to -0.02; P=0.04), volume voided per micturition, and number of urgency episodes per 24 hours demonstrated that combination therapy was more effective than solifenacin therapy alone. Safety assessments, including common treatment-emergent adverse events (odds ratio, 1.09; 95% CI, 0.95-1.27; P=0.23) and discontinuations due to adverse events (P=0.30), demonstrated that the combination therapy was well tolerated. CONCLUSIONS This meta-analysis suggests that mirabegron therapy as an add-on to solifenacin provides a satisfactory therapeutic effect for OAB symptoms with a low occurrence of side effects.
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Gu HY, Song JK, Zhang WJ, Xie J, Yao QS, Zeng WJ, Zhang C, Niu YM. A systematic review and meta-analysis of effectiveness and safety of therapy for overactive bladder using botulinum toxin A at different dosages. Oncotarget 2017; 8:90338-90350. [PMID: 29163833 PMCID: PMC5685754 DOI: 10.18632/oncotarget.20056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the effectiveness and safety of botulinum toxin A (BTX-A) at different dosages for overactive bladder (OAB). Materials and Methods The MEDLINE, EMBASE, and Cochrane Controlled Trials Register databases were searched through November 3, 2016 to identify relevant randomized controlled trials (RCTs). Results Eleven studies were identified in this meta-analysis. Compared with placebo, the urinary incontinence (UI) episodes per week as the primary outcomes, urodynamic parameters including maximum cystometric capacity (MCC), and maximum detrusor pressure (MDP) for neurogenic detrusor overactivity (NDO) at 6 weeks, and for idiopathic detrusor overactivity (IDO) at 36 weeks were evaluated. These and other outcomes for effectiveness of BTX-A at different dosages in two observation periods indicate that a dose greater than 50 U is significantly more effective for certain symptoms of OAB compared with placebo. However, there were no significant differences between some dosages. Compared with placebo, the outcomes of total adverse events for NDO and for IDO show that doses of 300 U and 200 U for NDO are associated with more complications. Conclusions In consideration that the treatments of BTX-A were with minimal, local, and manageable adverse effects, this meta-analysis demonstrates that BTX-A 200 U is recommended for management of NDO for short-term treatment for there was no significant difference from the larger dose of 300U. The short-term efficacies of BTX-A for IDO remain to be investigated.
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Affiliation(s)
- Hui-Yun Gu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Ju-Kun Song
- Department of Oral and Maxillary Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Wen-Jun Zhang
- Department of Ultrasound, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Jin Xie
- Administrative Office, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Qi-Sheng Yao
- Department of Urinary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Wen-Jing Zeng
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Yu-Ming Niu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China.,Department of Urinary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
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Zhou X, Yan HL, Cui YS, Zong HT, Zhang Y. Efficacy and safety of onabotulinumtoxinA in treating neurogenic detrusor overactivity: a systematic review and meta-analysis. Chin Med J (Engl) 2015; 128:963-8. [PMID: 25836619 PMCID: PMC4834015 DOI: 10.4103/0366-6999.154318] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: OnabotulinumtoxinA is widely used in treating neurogenic detrusor overactivity (NDO). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating NDO. Methods: We searched the following databases: Medline, EMBASE, and the Cochrane Controlled Trials Register. All published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of NDO were identified in the analysis. The reference lists of the retrieved studies were also investigated. Results: Four publications involving a total of 807 patients were identified in the analysis, which compared onabotulinumtoxinA with placebo. The changes of the mean number of urinary incontinence per week (the standardized mean difference [SMD] = −10.91, 95% confidence intervals [CIs] = −14.18–−7.63, P < 0.0001); maximum cystometric capacity (SMD = 146.09, 95% CI = 126.19–165.99, P < 0.0001) and maximum detrusor pressure (SMD = −32.65, 95% CI = −37.83–−27.48, P < 0.0001) indicated that onabotulinumtoxinA was more effective than the placebo, despite the doses of onabotulinumtoxinA. Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with more complications. Urinary tract infections (relative risk [RR] =1.48, 95% CI = 1.20–1.81, P = 0.0002); hematuria (RR = 1.81, 95% CI = 1.00–3.24, P = 0.05) and urinary retention (RR = 5.87, 95% CI = 3.61–9.56, P < 0.0001). Conclusions: This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for NDO with side effects primarily localized to urinary tract.
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Affiliation(s)
| | | | | | | | - Yong Zhang
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University; Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing 100050, China
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Sacco E, Bientinesi R. Innovative pharmacotherapies for women with overactive bladder: where are we now and what is in the pipeline? Int Urogynecol J 2014; 26:629-40. [PMID: 25377296 DOI: 10.1007/s00192-014-2557-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/18/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impressive prevalence of overactive bladder (OAB) and the relevant limitations of current treatments urge the need for novel therapeutic approaches. METHODS A systematic literature and web search was performed to identify investigational drugs that entered the early and late phases of clinical development for women with OAB symptoms. RESULTS Approved pharmacological therapies for OAB (antimuscarinics, beta-3 agonists, and botulinum toxin) are evolving with the development of alternative administration methods, combination strategies, and novel compounds, expected to improve effectiveness, bladder selectivity, and dose flexibility. A wealth of investigational compounds, developed with both public and companies' indoor nonclinical disease-oriented studies, entered the early and late stages of clinical development in the last decade. Most non-anticholinergic compounds in ongoing clinical trials target central and peripheral neurotransmitter receptors involved in neurological modulation of micturition, nonadrenergic-noncholinergic mechanisms, cyclic nucleotide metabolism, different subtypes of ion channels or peripheral receptors of prostaglandins, vanilloids, vitamin D3, and opioids. Fascinating advances are ongoing also in the field of genetic therapy. CONCLUSIONS New pharmaceutical formulations and drug combinations are expected to be available in the next decade in order to overcome the limitations of current drugs for OAB. Although proof-of-concept, patient-oriented studies yielded disappointing results for several tentative drugs, a lot of clinical research is ongoing that is expected to provide clinicians with novel therapeutic agents in the near future.
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Affiliation(s)
- Emilio Sacco
- Department of Urology, "Agostino Gemelli" Hospital, Catholic University Medical School, Rome, Italy,
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Odoemene AC. PATTERN OF OVERACTIVE BLADDER IN SOUTHEAST NIGERIA. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2014; 4:100-20. [PMID: 26457269 PMCID: PMC4553233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Overactive bladder is a distressing condition characterized by the syndrome of uncontrollable urgency, day time frequency, nocturia with or without urgency urinary incontinence. AIM To determine the pattern of overactive bladder in two tertiary health institutions in South-East Nigeria. STUDY DESIGN The study is prospective. SETTING Federal Teaching Hospital, Abakaliki and Niger Foundation Hospital and Diagnostic centre Enugu in southeastern Nigeria. METHOD The study involved 383 patients who were diagnosed with overactive bladder in the two hospitals during the study period. Their demographics, clinical feature, management options and outcome were analyzed.Tolterodine was the anticholinegic used to treat the syndrome while the underlying pathology was treated accordingly. RESULT There were 383 patients out of which 363 (94.8%) patients were males while 20 (5.2%) patients were females with the age range of 37yrs to103yrs with a mean of 63.4yrs. A total of 313 (81.7%) patients had prostatic disease (benign prostatic hyperplasia and cancer of the prostate), while 99 (25.8%) patients had diabetes mellitus. Among the 313(82 %) with prostate disease, two hundred and eighty nine (75.5%) had benign prostatic hyperplasia while twenty four (6.3%) had cancer of the prostate. Urgency, urinary incontinence and fecal incontinence were observed simultaneously in 133 (34.7%) patients during the episode of involuntary painful bladder contraction. In 271 (71%) patients, the overactive bladder was treated with Tolterodine alone and management of the underlying pathology with resolution of symptoms. Few patients benefitted from behavioral therapy. CONCLUSION Overactive bladder in this environment is associated commonly with prostate diseases with urgency of urine, urine and fecal incontinence but responds well to anticholinergic.
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Affiliation(s)
- A C Odoemene
- Department of Surgery, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Cui Y, Zong H, Yang C, Yan H, Zhang Y. The efficacy and safety of mirabegron in treating OAB: a systematic review and meta-analysis of phase III trials. Int Urol Nephrol 2013; 46:275-84. [PMID: 23896942 DOI: 10.1007/s11255-013-0509-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/26/2013] [Indexed: 01/16/2023]
Abstract
PURPOSE Mirabegron, a potent and selective β3-adrenoceptor agonist, has been developed for the treatment of overactive bladder (OAB). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating OAB. METHODS A literature review was performed to identify all published randomized double-blind, placebo-controlled phase III trials of mirabegron for the treatment of OAB. The search included the following databases: MEDLINE, EMBASE and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. A systematic review and meta-analysis of phase III trials were conducted. RESULTS Four publications involving a total of 5,761 patients were used in the analysis, including four phase III RCTs that compared mirabegron with placebo. We found that mirabegron was effective in treating OAB in our meta-analysis. Co-primary efficacy end points: the mean number of incontinence episodes per 24 h (the standardized mean difference (SMD) = -0.44, 95 % confidence interval (CI) -0.59 to -0.29, p < 0.00001); the mean number of micturitions per 24 h (SMD = -0.62, 95 % CI -0.80 to -0.45, p < 0.00001) and key secondary efficacy end points: mean volume voided per micturition; mean number of urgency episodes per 24 h indicated that mirabegron was more effective than the placebo. Safety assessments included common treatment-emergent adverse events (TEAEs) [OR 1.10, 95 % CI 0.93-1.31, p = 0.25), hypertension, cardiac arrhythmia TEAEs, urinary retention and discontinuations due to adverse event indicated that mirabegron was well tolerated. CONCLUSIONS This meta-analysis indicates that mirabegron to be an effective and safe treatment for OAB symptoms with a low occurrence of side effects. It offers promise as an effective oral agent for the treatment of OAB with a distinct efficacy/tolerability balance.
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Affiliation(s)
- Yuanshan Cui
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, No. 6 Tiantan Xi Li, Dongcheng District, Beijing, 100050, China
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Sacco E, Bientinesi R. Mirabegron: a review of recent data and its prospects in the management of overactive bladder. Ther Adv Urol 2012; 4:315-24. [PMID: 23205058 PMCID: PMC3491758 DOI: 10.1177/1756287212457114] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mirabegron is a novel, once-daily, orally active, first-in-class, potent β(3)-adrenoceptor agonist recently approved by Food and Drug Administration for overactive bladder therapy. Phase II studies and four large-scale phase III multinational randomized, controlled trials have supported the efficacy and tolerability of mirabegron in the clinical trial setting of patients with overactive bladder for up to 12 weeks of therapy and in the long term (12 months). The reported incidence and severity of treatment-emergent and serious adverse effects were similar to antimuscarinics, but with a more than threefold lower incidence of dry mouth compared with tolterodine. However, the effects on the cardiovascular system, pharmacokinetic interactions with other drugs, and increased incidence of new malignant events will require careful evaluation in the near future.
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Affiliation(s)
- Emilio Sacco
- Clinica Urologica, Policlinico Gemelli, Largo Gemelli 8, 00168 Roma, Italy
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Colli J. Editorial foreword. Open Access J Urol 2011; 3:121-2. [PMID: 24198644 PMCID: PMC3818945 DOI: 10.2147/oaju.s22405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Janet Colli
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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