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Iwaniak P, Dobrowolski P, Wróbel J, Kluz T, Wdowiak A, Bojar I, Stangel-Wójcikiewicz K, Poleszak E, Jakimiuk A, Misiek M, Zapała Ł, Wróbel A. The Assessment of the Efficacy of Imperatorin in Reducing Overactive Bladder Symptoms. Int J Mol Sci 2023; 24:15793. [PMID: 37958777 PMCID: PMC10648619 DOI: 10.3390/ijms242115793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Overactive bladder syndrome (OAB) is a prevalent condition that affects the elderly population in particular and significantly impairs quality of life. Imperatorin, a naturally occurring furocoumarin, possesses diverse pharmacological properties that warrant consideration for drug development. The aim of this study was to investigate the potential of imperatorin (IMP) to attenuate the cystometric and biochemical changes typically associated with retinyl acetate-induced overactive bladder (OAB) and to assess its viability as a pharmacological intervention for OAB patients. A total of 60 rats were divided into four groups: I-control, II-rats with rapamycin (RA)-induced OAB, III-rats administered IMP at a dose of 10 mg/kg/day, and IV-rats with RA-induced OAB treated with IMP. IMP or vehicle were injected intraperitoneally for 14 days. The cystometry and assessment of bladder blood flow were performed two days after the last dose of IMP. The rats were then placed in metabolic cages for 24 h. Urothelial thickness measurements and biochemical analyses were performed. Intravesical infusion of RA induced OAB. Notably, intraperitoneal administration of imperatorin had no discernible effect on urinary bladder function and micturition cycles in normal rats. IMP attenuated the severity of RA-induced OAB. RA induced increases in urothelial ATP, calcitonin gene-related peptide (CGRP), organic cation transporter 3 (OCT3), and vesicular acetylcholine transporter (VAChT), as well as significant c-Fos expression in all micturition areas analyzed, which were attenuated by IMP. Furthermore, elevated levels of Rho kinase (ROCK1) and VAChT were observed in the detrusor, which were reversed by IMP in the context of RA-induced OAB in the urothelium, detrusor muscle, and urine. Imperatorin has a mitigating effect on detrusor overactivity. The mechanisms of action of IMP in the bladder appear to be diverse and complex. These findings suggest that IMP may provide protection against RA-induced OAB and could potentially develop into an innovative therapeutic strategy for the treatment of OAB.
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Affiliation(s)
- Paulina Iwaniak
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland
| | - Piotr Dobrowolski
- Department of Functional Anatomy and Cytobiology, Faculty of Biology and Biotechnology, Maria Curie-Sklodowska University, Akademicka 19, 20-033 Lublin, Poland
| | - Jan Wróbel
- Medical Faculty, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Tomasz Kluz
- Department of Gynecology, Gynecology Oncology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, Rejtana 16c, 35-959 Rzeszow, Poland;
| | - Artur Wdowiak
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Medical University of Lublin, Staszica 4-6, 20-081 Lublin, Poland;
| | - Iwona Bojar
- Department of Women’s Health, Institute of Rural Health in Lublin, ul. Jaczewskiego 2, 20-090 Lublin, Poland; (I.B.); (M.M.)
| | - Klaudia Stangel-Wójcikiewicz
- Department of Gynecology and Oncology, Jagiellonian University Medical College, M. Kopernika 23, 31-501 Kraków, Poland;
| | - Ewa Poleszak
- Department of Applied and Social Pharmacy, Laboratory of Preclinical Testing, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland;
| | - Artur Jakimiuk
- Department of Obstetrics and Gynecology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland;
- Center for Reproductive Health, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Marcin Misiek
- Department of Women’s Health, Institute of Rural Health in Lublin, ul. Jaczewskiego 2, 20-090 Lublin, Poland; (I.B.); (M.M.)
| | - Łukasz Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005 Warsaw, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland;
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Masurkar PP, Chatterjee S, Sherer JT, Chen H, Johnson ML, Aparasu RR. Risk of overactive bladder associated with cholinesterase inhibitors in dementia. J Am Geriatr Soc 2021; 70:820-830. [PMID: 34854475 DOI: 10.1111/jgs.17579] [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: 07/27/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although cholinesterase inhibitors (ChEIs) are the primary treatment for dementia, they are associated with overactive bladder (OAB), necessitating antimuscarinic use. Limited data exist regarding the risk of OAB across individual ChEIs in dementia. This study evaluated the risk of OAB associated with individual ChEIs in older adults with dementia. METHODS This was a new user retrospective cohort study using Medicare claims data involving Parts A, B, and D claims dataset from 2013 to 2015. The study included older adults (aged 65 and older) with a diagnosis of dementia using donepezil, galantamine, or rivastigmine. New ChEI claims were identified with a 6-month baseline washout period. Patients with OAB diagnosis or any antimuscarinic or mirabegron use in the baseline period were excluded. The primary outcome of interest was OAB diagnosis or prescription of antimuscarinics or mirabegron within 6 months of ChEI initiation. Multivariable cox proportional hazards regression with propensity scores (PS) as covariates and inverse probability of treatment weighting generated using generalized boosted models was used to assess the risk of OAB among donepezil, galantamine, and rivastigmine users. RESULTS The study included 524,975 older adults with dementia who were incident users of ChEIs (donepezil 80.72%, rivastigmine 16.41%, galantamine 2.87%). Overall, OAB diagnosis/antimuscarinic/mirabegron prescription was observed in 5.07% of the cohort within 6 months of ChEIs prescription. The Cox regression model with PS as covariate approach found that donepezil use increased the risk of OAB compared to rivastigmine (aHR, 1.13; 95% CI, 1.08-1.28; p < 0.0001). However, there was no differential risk of OAB between galantamine and rivastigmine. The findings were consistent with the generalized boosted models. CONCLUSIONS The study found that the risk of OAB varies across individual ChEIs with an increased risk of OAB with donepezil compared to rivastigmine. The study findings suggest the need to understand and manage medication-related morbidity in older adults with dementia.
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Affiliation(s)
- Prajakta P Masurkar
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Satabdi Chatterjee
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Jeffrey T Sherer
- Department of Pharmacy Practice and Translational Research, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Michael L Johnson
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
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Kavalci Kol B, Oskay K, Toprak Celenay S. Comparison of lumbopelvic stability, low back pain and well-being of women who have overactive bladder syndrome to asymptomatic controls: cut-off points. Somatosens Mot Res 2021; 38:259-266. [PMID: 34384324 DOI: 10.1080/08990220.2021.1961722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS Overactive bladder (OAB) syndrome has been associated with core muscles weakness, which is important in aetiology of low back pain (LBP) and affects general well-being. This study aimed to compare the lumbopelvic stability, LBP and well-being of women with OAB to asymptomatic controls and to determine the cut-off points. METHODS Women with (OAB group, n = 36) and without OAB syndrome (control group, n = 36) were included. The lumbopelvic stability with the Sahrmann and McGill trunk muscle endurance tests, LBP intensity with the Visual Analogue Scale were assessed. As for general well-being, sleep quality with the Pittsburgh Sleep Quality Index (PSQI), fatigue severity with the Fatigue Severity Index (FSI), anxiety and depression levels with the Hospital Anxiety Depression Scale (HADS-A, HADS-D) were evaluated. RESULTS In the OAB group compared to the control group, the lumbopelvic stability scores were lower (p < 0.001) while LBP prevalence (p < 0.001), pain intensity (p = 0.020), and PSQI, FSI, HADS-A, and HADS-D scores (p < 0.001) were higher. The cut-off points for trunk extension, flexion, right and left lateral flexion endurance tests and Sahrmann test were ≤9.42 sec, ≤8.62 sec, ≤19.26 sec, ≤5.16 sec, and ≤2 level, respectively. The cut-off points for PSQI, FSI, HADS-D, HADS-A were >5, >5.22, >6 and >6 scores, respectively. CONCLUSIONS Women with OAB syndrome had lower lumbopelvic stability, higher LBP prevalence and intensity, lower sleep quality, and more fatigue, anxiety, and depression levels compared to asymptomatic women. The cut-off values were detected between the occurrence of OAB and lumbopelvic stability and general well-being parameters.
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Affiliation(s)
- Basak Kavalci Kol
- Kirsehir Ahi Evran Universitesi, Pilot University Health Coordinating, Kirsehir, Turkey
| | - Kemal Oskay
- Department of Urology, Ankara Gazi Mustafa Kemal Hospital, Ankara, Turkey
| | - Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University, Ankara, Turkey
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Kilis-Pstrusinska K, Rogowski A, Bienkowski P. Bacterial Colonization as a Possible Source of Overactive Bladder Symptoms in Pediatric Patients: A Literature Review. J Clin Med 2021; 10:jcm10081645. [PMID: 33924301 PMCID: PMC8069148 DOI: 10.3390/jcm10081645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 12/13/2022] Open
Abstract
Overactive Bladder (OAB) is a common condition that is known to have a significant impact on daily activities and quality of life. The pathophysiology of OAB is not completely understood. One of the new hypothetical causative factors of OAB is dysbiosis of an individual urinary microbiome. The major aim of the present review was to identify data supporting the role of bacterial colonization in overactive bladder symptoms in children and adolescents. The second aim of our study was to identify the major gaps in current knowledge and possible areas for future clinical research. There is a growing body of evidence indicating some relationship between qualitative and quantitative characteristics of individual urinary microbiome and OAB symptoms in adult patients. There are no papers directly addressing this issue in children or adolescents. After a detailed analysis of papers relating urinary microbiome to OAB, the authors propose a set of future preclinical and clinical studies which could help to validate the concept in the pediatric population.
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Affiliation(s)
- Katarzyna Kilis-Pstrusinska
- Department of Pediatric Nephrology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
- Correspondence: ; Tel.: +48-71-7364400; Fax: +48-71-7364409
| | - Artur Rogowski
- Faculty of Medicine, Cardinal Stefan Wyszyński University in Warsaw, Collegium Medicum, Kazimierza Wóycickiego 1/3, 01-938 Warsaw, Poland;
- Department of Obstetrics and Gynecology, Mother and Child Institute, 01-211 Warsaw, Poland
| | - Przemysław Bienkowski
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland;
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Wróbel A, Serefko A, Szopa A, Poleszak E. Asiatic Acid, a Natural Compound that Exerts Beneficial Effects on the Cystometric and Biochemical Parameters in the Retinyl Acetate-Induced Model of Detrusor Overactivity. Front Pharmacol 2021; 11:574108. [PMID: 33584259 PMCID: PMC7878531 DOI: 10.3389/fphar.2020.574108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
Scientists have been constantly looking for new synthetic and natural compounds that could have beneficial effects in bladder overactivity. Our attention was drawn by asiatic acid that influences a number of molecules and signaling pathways relevant for the proper functioning of the urinary tracts in humans. In the present project we wanted to check whether asiatic acid would have positive effects in the confirmed animal model of detrusor overactivity (DO) and whether it would affect the bladder blood flow, urothelium thickness, inflammatory and oxidative stress markers, neurotrophic and growth factors, and other parameters important for the activity of the urinary bladder. The outcomes of our study showed that a 14-day administration of asiatic acid (30 mg/kg/day) by oral gavage normalizes the cystometric parameters corresponding to DO and reduces the accompanying oxidative stress (measured by the levels of malondialdehyde–61,344 ± 24,908 pg/ml vs. 33,668 ± 5,071 pg/ml, 3-nitrotyrosine–64,615 ± 25,433 pg/ml vs. 6,563 ± 1,736 pg/ml, and NOS2–2,506 ± 411.7 vs. 3,824 ± 470.1 pg/ml). Moreover, it decreases the urinary secretion of neurotrophins (BDNF–304.4 ± 33.21 pg/ml vs. 119.3 ± 11.49 pg/ml and NGF–205.5 ± 18.50 vs. 109.7 ± 15.94 pg/ml) and prevents the changes in a range of biomarkers indicating the dysfunction of the urinary bladder, CGRP (421.1 ± 56.64 vs. 108.1 ± 11.73 pg/ml), E-Cadherin (773.5 ± 177.5 pg/ml vs. 1,560 ± 154.5 pg/ml), OCT3 (3,943 ± 814.6 vs. 1,018 ± 97.07 pg/ml), SNAP-23 (6,763 ± 808.9 pg/ml vs. 3,455 ± 554.5 pg/ml), SNAP-25 (2,038 ± 162.7 pg/ml vs. 833.3 ± 65.48), substance P (171.7 ± 16.86 pg/ml vs. 65.07 ± 8.250 pg/ml), SV2A (1,927 ± 175.3 pg/ml vs. 1,154 ± 254.9 pg/ml), tight junction protein 1 (360.1 ± 95.05 pg/ml vs. 563.4 ± 65.43 pg/ml), VAChT (16,470 ± 2,419 pg/ml vs. 7,072 ± 1,339 pg/ml), VEGFA (318.3 ± 37.89 pg/ml vs. 201.5 ± 22.91 pg/ml). The mentioned parameters are associated with smooth muscle contractions, urothelial barrier, transportation and release of transmitters, or bladder compensation. Thus, the presented findings allow to suggest a possible future role of asiatic acid in the prevention of conditions accompanied by DO, such as overactive bladder.
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Affiliation(s)
- Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Anna Serefko
- Chair and Department of Applied and Social Pharmacy, Laboratory of Preclinical Testing, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Szopa
- Chair and Department of Applied and Social Pharmacy, Laboratory of Preclinical Testing, Medical University of Lublin, Lublin, Poland
| | - Ewa Poleszak
- Chair and Department of Applied and Social Pharmacy, Laboratory of Preclinical Testing, Medical University of Lublin, Lublin, Poland
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Lower Urinary Tract Functional Assessment of Men Undergoing Radical Prostatectomy: Correlation of Preoperative Clinical and Urodynamic Parameters. Int Neurourol J 2021; 25:157-163. [PMID: 33504129 PMCID: PMC8255822 DOI: 10.5213/inj.2040238.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/18/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess baseline clinical and urodynamic profiles of a contemporary cohort of men undergoing radical prostatectomy (RP) as part of the ROSE (Robotic and Open Surgery for Prostate Cancer: A Prospective, Multi-centre, Comparative Study of Functional and Oncological Outcomes) study. METHODS Men with localized prostate cancer undergoing RP were prospectively recruited to undergo clinical assessment and urodynamic testing prior to surgery as part of a clinical trial. The International Prostate Symptoms Score (IPSS) was used to determine participants' degree of lower urinary tract symptoms (LUTS). RESULTS Eighty-five men with a median age of 64.5 years and a median prostate-specific antigen level of 6.3 ng/mL were prospectively recruited. Of patients with complete baseline data, 36 (50.7%), 28 (39.4%), and 7 (9.9%) had mild (IPSS<8), moderate (IPSS 8-19), and severe (IPSS>20) LUTS, respectively. Obstruction was identified in 18 men (29.5%), and 9 (14.8%) showed detrusor underactivity. Of the 15 patients with detrusor overactivity, 12 (80%) reported overactive bladder (OAB). Of men with urodynamic obstruction, 5 (31.3%), 10 (62.5%), and 1 (6.3%) reported mild, moderate, and severe LUTS, respectively. Of men without OAB, 4 (11.8%, P=0.002) showed filling phase abnormalities, 13 (46.4%, P=0.611) had flow rates of <15 mL/sec, and 7 (30.4%, P=0.767) showed obstruction. Of men with mild or no LUTS, 5 (20%, P=0.072) showed obstruction and 4 (16%, P=0.524) showed poor contractility. CONCLUSION LUTS and OAB were common in men with localized prostate cancer undergoing RP. Detrusor overactivity and urodynamic filling phase abnormalities were strongly correlated with OAB. IPSS did not show a strong correlation with bladder outflow obstruction or detrusor underactivity. Urodynamic filling abnormalities were found in 11.8% of men without OAB. Symptomatic and functional assessment may therefore have a role in the preoperative counselling of patients and possibly guide postoperative management of LUTS, especially if OAB is present.
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Yao HHI, Crump RT, Charbonneau C, Khan A, Barton C, Brotherhood H, Jiang J, Carlson KV, Baverstock RJ. Baseline patient reported outcomes data shows high prevalence of overactive bladder, sexual dysfunction, depression and anxiety in Canadian men with newly diagnosed localized prostate cancer. Transl Androl Urol 2020; 9:2046-2053. [PMID: 33209668 PMCID: PMC7658156 DOI: 10.21037/tau-20-689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Research on prostate cancer survivorship patients has largely been on oncological outcome, incontinence and erectile dysfunction, with less data on the relationship between prostate cancer, bladder function and mental health. This study aims to elucidate the prevalence of lower urinary tract symptoms (LUTS), overactive bladder (OAB), sexual dysfunction, depression and anxiety in Canadian men with newly diagnosed localised prostate cancer. Methods This is a single-centre prospective cross-sectional study of men with newly diagnosed localized prostate cancer recruited from June 2017 to July 2018. The patient-reported outcomes (PRO) instruments used in this study included the international prostate symptoms score (IPSS), OAB-V8, EQ-5D™, and the Expanded Prostate Cancer Index Composite short form (EPIC-26). Clinico-pathological data were extracted from medical records. The prevalence of LUTS, OAB, sexual dysfunction, depression and anxiety were determined from the PROs. Results A total of 83 patients were included in this study. The median age was 63. Based on IPSS scores, 55.3% of men had mild LUTS, 36.8% had moderate LUTS and 7.9% had severe LUTS. Based on OAB-V8 scores, 55.8% of men had a score of 8 or higher, suggestive of OAB. Only 55.8% of men reported erections adequate for intercourse. 23.1% of men reported to have a moderate to big problem with depression, and 28.8% of men reported to have a degree of anxiety or depression. Conclusions OAB is a significant problem in men with newly diagnosed localized prostate cancer, with a prevalence of 55.8% based on this study. Baseline sexual dysfunction, anxiety and depression are also prevalent in this population.
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Affiliation(s)
- Henry Han-I Yao
- Vesia (Alberta Bladder Centre), Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | | | - Asher Khan
- Vesia (Alberta Bladder Centre), Calgary, Alberta, Canada
| | - Carly Barton
- Vesia (Alberta Bladder Centre), Calgary, Alberta, Canada
| | - Hilary Brotherhood
- Vesia (Alberta Bladder Centre), Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jing Jiang
- Vesia (Alberta Bladder Centre), Calgary, Alberta, Canada
| | - Kevin V Carlson
- Vesia (Alberta Bladder Centre), Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Richard J Baverstock
- Vesia (Alberta Bladder Centre), Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Urodynamics for the “Failed” Midurethral Sling. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Song S, Jin C, Kamal P, Suskind AM. The association between frailty and detrusor overactivity in older adults. Neurourol Urodyn 2020; 39:1584-1591. [PMID: 32483874 DOI: 10.1002/nau.24414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/25/2020] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To explore the relationship between frailty, age, and detrusor overactivity (DO) in older adults presenting to an academic urology practice. MATERIALS AND METHODS This study uses the University of California, San Francisco Geriatric Urology Database to examine all adults ages ≥65 years who underwent urodynamic testing from December 2015 to April 2019. All subjects had a timed up and go test (TUGT) as a measure of frailty and were categorized as fast (≤10 seconds), intermediate (11-14 seconds), or slow (≥15 seconds), corresponding to not frail, pre-frail, and frail, respectively. Urodynamic studies were reviewed for the presence of DO. Univariate and multivariate logistic regression were used to examine the relationship between frailty, age, and the presence of DO. RESULTS In total, 549 older adults underwent urodynamics during the study period, and 48.5% had a study that demonstrated DO. Individuals with DO tended to be older (18.4% vs 11.0% were ≥80 years; P = .01) and more frail (19.5% vs 13.4% with TUGT ≥5 seconds; P < .01). Multivariate regression demonstrated that DO was associated with both pre-frail and frail TUGT times (adjusted odds ratio [aOR], 2.1; 95% confidence interval [CI], 1.3-3.4; P < .01 for TUGT 11-14 seconds, and aOR, 2.1; 95% CI, 1.1-4.0; P = .02 for TUGT ≥15 seconds). Age was not found to be significantly associated with DO (P's > .05). CONCLUSIONS Frailty, not age, is associated with DO among older adults undergoing urodynamics. Further research on the role of frailty in the evaluation and management of older adults with DO is warranted to best serve the needs of this population.
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Affiliation(s)
- Sikai Song
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Chengshi Jin
- Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, California
| | - Puneet Kamal
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Anne M Suskind
- Department of Urology, University of California-San Francisco, San Francisco, California
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Matsukawa Y, Majima T, Ishida S, Funahashi Y, Kato M, Gotoh M. Useful parameters to predict the presence of detrusor overactivity in male patients with lower urinary tract symptoms. Neurourol Urodyn 2020; 39:1394-1400. [DOI: 10.1002/nau.24352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/26/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Yoshihisa Matsukawa
- Department of UrologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Tsuyoshi Majima
- Department of UrologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Shohei Ishida
- Department of UrologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Yasuhito Funahashi
- Department of UrologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Masashi Kato
- Department of UrologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Momokazu Gotoh
- Department of UrologyNagoya University Graduate School of Medicine Nagoya Japan
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Hartigan SM, Dmochowski RR. Gender specific pharmacokinetic and pharmacodynamic considerations for antimuscarinic drugs for overactive bladder treatment. Expert Opin Drug Metab Toxicol 2020; 16:103-110. [PMID: 31918590 DOI: 10.1080/17425255.2020.1714591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Overactive bladder (OAB) has a heterogeneous presentation that varies between individuals and by gender. Treatment with antimuscarinic medications is standard first line pharmacotherapy for most patients with OAB. However, gender specific differences in the pharmacokinetics and pharmacodynamics of antimuscarinic therapy are often overlooked and not discussed.Areas covered: This review will explore differences by gender between the presentation and treatment of OAB. We will discuss the differences between sexes in terms of lower urinary tract anatomy, muscarinic receptors, and hormone variation. The effect of antimuscarinics on males and females as well as adherence and persistence patterns will be reviewed in order to fully review all available literature on the gender specific pharmacokinetic and pharmacodynamic considerations for antimuscarinic use in the treatment of OAB.Expert opinion: Despite extensive research into various antimuscarinic formulations and therapeutic regimens for the treatment of OAB, identification of gender specific pharmacokinetic and pharmacodynamics considerations remains scant. As our knowledge and understanding of OAB, muscarinic receptors, and antimuscarinic medications evolve, we will hopefully be better able to understand and implement gender-specific and genomic-sprecific treatment regimens and considerations for improved clinical outcomes.
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Affiliation(s)
- Siobhan M Hartigan
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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Hsu CC, Liang CC, Chang SD, Chien CW, Hsieh WC. Comparison of urodynamic results and quality of life between women with interstitial cystitis and overactive bladder. Taiwan J Obstet Gynecol 2020; 59:39-42. [DOI: 10.1016/j.tjog.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 10/25/2022] Open
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Yunanto A, Rahardjo HE. Urodynamic profile in the Department of Urology, Cipto Mangunkusumo Hospital Between 2010 and 2015. MEDICAL JOURNAL OF INDONESIA 2019. [DOI: 10.13181/mji.v28i2.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND This study was aimed to describe urodynamic profiles, the role and advantages of urodynamics for urinary problems detection, and to analyze whether urodynamic examination has been ordered based on accurate indications following guidelines in the Department of Urology Cipto Mangunkusumo Hospital between 2010 and 2015. METHODS Data was retrieved from the patient’s medical records who underwent urodynamic examinations in the Department of Urology Cipto Mangunkusumo Hospital between July 2010 to August 2015. RESULTS 1,091 patients undergone urodynamic procedures in the Department of Urology Cipto Mangunkusumo Hospital. In 553 lower urinary tract symptoms (LUTS) patients, there were 186 (34%) small bladder capacity, 84 (15%) detrusor overactivity (DO), 180 (33%) bladder outlet obstruction (BOO), and 198 (36%) bladder atony patients. In the 317 urinary retention patients, there were 121 (38%) patients with BOO and 2 (1%) patients with a normal voiding phase. In 80 overactive bladder patients, there were 51 (64%) with DO, 17 (21%) with DO incontinence, and 22 (28%) with urodynamic stress incontinence (SI). Among 81 patients with SI problems, there were 63 (78%) urodynamic SI, 9 (11%) DO, and 9 (11%) DO incontinence patients. In 60 (6%) pediatric patients, most LUTS and urinary retention patients were caused by impaired bladder contraction. CONCLUSIONS This study shows the role and superiority of urodynamics in diagnosing patients with voiding disorders, especially if with mixed components in it. Urodynamics played essential roles in detecting urinary problems at Cipto Mangunkusumo Hospital.
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Urodynamic and Bladder Diary Factors Predict Overactive Bladder-wet in Women: A Comparison With Overactive Bladder-dry. Int Neurourol J 2019; 23:69-74. [PMID: 30943696 PMCID: PMC6449656 DOI: 10.5213/inj.1836212.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 02/19/2019] [Indexed: 01/03/2023] Open
Abstract
Purpose To identify factors predicting the presence of overactive bladder syndrome (OAB)-wet, compared with OAB-dry. Methods Between September 2007 and September 2013, the medical records of 623 women with OAB who completed a 3-day bladder diary and underwent urodynamic studies in a medical center were retrospectively reviewed. OAB-wet was diagnosed in patients who complained of at least one episode of urgency incontinence in the previous month; otherwise, OAB-dry was diagnosed. Multivariable logistic regression analysis was used to predict the presence of OAB-wet. Results Age (odds ratio [OR], 1.05; P<0.001), maximal flow rate (Qmax) (OR,1.06; P<0.001), voided volume (OR, 0.996; P=0.001), detrusor pressure at maximal flow rate (PdetQmax) (OR, 1.02; P=0.003), urgency episodes (OR, 1.04; P<0.001) and urodynamic stress incontinence (OR,1.78; P=0.01) were independent predictors for the presence of OAB-wet vs. OAB-dry. If we use bladder contractility index as a variable for multivariable logistic regression analysis, bladder contractility index (OR, 1.012; P<0.001) become an independent predictor for OAB-wet. Conclusions A smaller bladder capacity and more frequent urgency episodes were predictors of OAB-wet, and the above findings indicate that OAB-wet and OAB-dry might be a continuum of OAB. Old age, high Qmax, high PdetQmax and urodynamic stress incontinence were also predictors for OAB-wet, and the above results reveal that OAB-wet and OAB-dry have partially different clinical and urodynamic features. Further studies might be performed to elucidate whether different treatment strategies between OAB-dry and OAB-wet can improve treatment efficacy.
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Dekhtiar YM, Kostyev FI, Zacheslavsky OM, Kuznietsov DO. Urodynamic characteristics of lower urinary tract of patients with idiopathic overactive bladder. Urol Ann 2019; 11:83-86. [PMID: 30787577 PMCID: PMC6362788 DOI: 10.4103/ua.ua_37_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims The aims of this study were to determine the frequency and clinical significance of individual urodynamic signs, which revealed on the basis of the results of comprehensive urodynamic examination of patients with the idiopathic overactive bladder (IOAB), to produce definitions of these features, and to describe any necessary remedial action. Materials and Methods To identify the most common features and artifacts, we conducted a combined urodynamic examination of 137 patients with IOAB (105 women and 32 men). Age, comorbidities, and urodynamic parameters were analyzed to determine the association between bladder sensation and contractility. Results It was found that most patients suffer from the same type of bladder function impairment, often related to the decrease in the average effective capacity of the bladder, frequent urination, urgency urination, and urgent urinary incontinence events. Imperative nature of urination in patients with IOAB leads to the reduction maximum cystometric capacity in 75.9% of patients, increased bladder sensitivity threshold in 70.8%, detrusor overactivity in 35.8%, change in bladder compliance in 43.1%, and urethral instability in 24.8% of patients. Conclusions Decreased ability of the bladder to accumulate and hold the urine under the normal or low intravesical pressure and frequent association of bladder instability with signs of obstructive urination are major peculiarities of the impaired urodynamics of the lower urinary tract in patients with IOAB.
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Affiliation(s)
- Yuriy M Dekhtiar
- Department of Urology and Nephrology, Odessa National Medical University, Odessa, Ukraine
| | - Fedir I Kostyev
- Department of Urology and Nephrology, Odessa National Medical University, Odessa, Ukraine
| | | | - Dmytro O Kuznietsov
- Department of Urology and Nephrology, Odessa National Medical University, Odessa, Ukraine
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Haeberlin A, Schürch K, Niederhauser T, Sweda R, Schneider MP, Obrist D, Burkhard F, Clavica F. Cardiac electrophysiology catheters for electrophysiological assessments of the lower urinary tract-A proof of concept ex vivo study in viable ureters. Neurourol Urodyn 2018; 38:87-96. [DOI: 10.1002/nau.23816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/16/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Andreas Haeberlin
- ARTORG Center for Biomedical Engineering Research; University of Bern; Bern Switzerland
- Department of Cardiology; Bern University Hospital and University of Bern; Bern Switzerland
| | - Klaus Schürch
- ARTORG Center for Biomedical Engineering Research; University of Bern; Bern Switzerland
| | - Thomas Niederhauser
- Institute for Human Centered Engineering; University of Applied Sciences; Biel Switzerland
| | - Romy Sweda
- ARTORG Center for Biomedical Engineering Research; University of Bern; Bern Switzerland
- Department of Cardiology; Bern University Hospital and University of Bern; Bern Switzerland
| | | | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research; University of Bern; Bern Switzerland
| | - Fiona Burkhard
- Department of Urology; Bern University Hospital; Bern Switzerland
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research; University of Bern; Bern Switzerland
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Age-related changes in function and gene expression of the male and female mouse bladder. Sci Rep 2018; 8:2089. [PMID: 29391518 PMCID: PMC5794976 DOI: 10.1038/s41598-018-20406-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/17/2018] [Indexed: 12/24/2022] Open
Abstract
We investigated age-related changes in in vivo and in vitro functions and gene expression of the bladder of male and female mice. Mature and aged (12 and 27–30 month old) C57BL/6 mice of both sexes were used. Frequency volume, conscious free-moving cystometry and detrusor contractile and relaxant properties in in vitro organ bath were evaluated. mRNA expression level of muscarinic, purinergic, and β-adrenergic receptors and gene expression changes by cDNA microarray analysis of the bladder were determined. Cystometry demonstrated storage and voiding dysfunctions with ageing in both sexes. Detrusor strips from aged mice showed weaker contractile responses particularly in the cholinergic component and weaker relaxant responses to isoproterenol. These age-related impairments were generally severer in males. mRNA expression of bladder tissue was decreased for M3 muscarinic receptors in aged males and β2-adrenoceptors in aged females. cDNA microarray analysis results, albeit substantial sex difference, indicated “cell-to-cell signaling and interaction” as the most common feature of age-related gene expression. In summary, aged mice demonstrated voiding and storage dysfunctions resembling to detrusor hyperactivity with impaired contractility (DHIC), which were more pronounced in males. Genomic changes associated with aging may contribute to the age-related bladder functional deterioration in mice.
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Is it possible to cure the symptoms of the overactive bladder in women? Int Urol Nephrol 2018; 50:433-439. [DOI: 10.1007/s11255-017-1777-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/20/2017] [Indexed: 01/16/2023]
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Ruth KH, Ralf A, Nariman G, Ing G, Adele C, Nadine H. Urethral Pressure Variation: A neglected contributing factor in patients with overactive bladder syndrome? Int Braz J Urol 2017; 43:272-279. [PMID: 27819757 PMCID: PMC5433367 DOI: 10.1590/s1677-5538.ibju.2016.0308] [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: 05/30/2016] [Accepted: 08/03/2016] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To study urethral pressure variations during the whole filling phase among different groups of patients. MATERIAL AND METHODS We investigated 79 consecutive patients from January 2011 to June 2012. All patients were recruited within our routine practice in our continence clinic and were evaluated with urodynamic exam according to the standards of the International Continence Society (ICS) with an additional continuous measurement of the urethral pressure profile (cUPP) that was done in a supine position. Patients with genital prolapse >grade I, as well as patients with impaired cognitive function or neurogenic disorders were excluded. Bacteriuria at the time of investigation was excluded by urine analysis. Urethral pressure changes higher than 15cmH2O were considered as 'urethral instability'. RESULTS From 79 investigated patients, 29 were clinically diagnosed with OAB syndrome, 19 with stress urinary incontinence (SUI) and 31 with mixed (OAB and SUI) incontinence. The prevalence of 'urethral instability' as defined in this study was 54.4% (43/79). The mean Δp in patients with OAB (36.5cmH2O) was significantly higher (p<0.05) than in groups with pure stress (14.9cmH2O) and mixed urinary incontinence (19.3cmH2O). CONCLUSIONS Etiology of 'urethral instability' is unknown, but high prevalence among patients with overactive bladder syndrome, especially concomitant with detrusor activity can raise a fair question and direct further diagnostic as well as treatment efforts.
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Affiliation(s)
- Kirschner-Hermanns Ruth
- Departament of Neuro-urology, University Hospital Friederich Wilhelms, University Bonn, Germany
| | - Anding Ralf
- Departament of Neuro-urology, University Hospital Friederich Wilhelms, University Bonn, Germany
| | - Gadzhiev Nariman
- Department of Urology, The Federal State Institute of Public Health, The Nikiforov Russian Center of Emergency and Radiation Medicine, Saint-Petersburg, Russian Federation
| | | | | | - Huppertz Nadine
- Departament of Neuro-urology, University Hospital Friederich Wilhelms, University Bonn, Germany
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Niederhauser T, Gafner ES, Cantieni T, Grämiger M, Haeberlin A, Obrist D, Burkhard F, Clavica F. Detection and quantification of overactive bladder activity in patients: Can we make it better and automatic? Neurourol Urodyn 2017; 37:823-831. [DOI: 10.1002/nau.23357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/19/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Niederhauser
- Institute for Human Centered Engineering; Bern University of Applied Sciences; Biel Switzerland
| | - Elena S. Gafner
- Department of Urology; Bern University Hospital; Bern Switzerland
| | | | | | - Andreas Haeberlin
- ARTORG Center; University of Bern; Bern Switzerland
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | | | - Fiona Burkhard
- Department of Urology; Bern University Hospital; Bern Switzerland
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Yamada Y, Fujimura T, Fukuhara H, Sugihara T, Miyazaki H, Nakagawa T, Kume H, Igawa Y, Homma Y. Overactive bladder is a negative predictor of achieving continence after robot-assisted radical prostatectomy. Int J Urol 2017; 24:749-756. [PMID: 28697538 DOI: 10.1111/iju.13411] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate predictors of continence outcomes after robot-assisted radical prostatectomy. METHODS Clinical records of 272 patients who underwent robot-assisted radical prostatectomy were investigated. Preoperative Overactive Bladder Symptom Score, International Prostate Symptom Score and clinicopathological factors were investigated, and relationships between factors and recovery of continence after robot-assisted radical prostatectomy were assessed. The presence of overactive bladder was defined as having urgency for more than once a week and having ≥3 points according to the Overactive Bladder Symptom Score. RESULTS Age (≤66 years) was significantly associated with continence within 6 months after robot-assisted radical prostatectomy (P = 0.033). The absence of overactive bladder and lower Overactive Bladder Symptom Score (<3) were significantly associated with recovery of continence within 12 months after surgery (both variables P = 0.009). In terms of achieving recovery of continence after robot-assisted radical prostatectomy, Kaplan-Meier curves showed earlier recovery in "age ≤66 years," "prostate weight ≤40 g" and "overactive bladder symptom score <3" (P = 0.0072, 0.0172 and 0.0140, respectively). Multivariate analysis showed that the presence of overactive bladder was an independent negative predictor for recovery of continence within 12 months after surgery (P = 0.019). CONCLUSIONS The presence of baseline overactive bladder seems to represent an independent negative predictor for recovery of continence at 12 months after robot-assisted radical prostatectomy.
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Affiliation(s)
- Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Sugihara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sheng W, Zhang H, Ruth KH. Could urinary nerve growth factor be a biomarker for overactive bladder? A meta-analysis. Neurourol Urodyn 2017; 36:1703-1710. [DOI: 10.1002/nau.23210] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/26/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Wei Sheng
- University Clinic; Rheinisch Friedrich-Wilhelms University-Clinic of Urology/Neuro-Urology; Bonn Germany
| | - Hongwei Zhang
- Department of Urology; The First People's Hospital of Changde; Changde China
| | - Kirschner-Hermanns Ruth
- University Clinic; Rheinisch Friedrich-Wilhelms University-Clinic of Urology/Neuro-Urology; Bonn Germany
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Patil S, Sen S, Bral M, Reddy S, Bradley KK, Cornett EM, Fox CJ, Kaye AD. The Role of Acupuncture in Pain Management. Curr Pain Headache Rep 2016; 20:22. [PMID: 26896946 DOI: 10.1007/s11916-016-0552-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acupuncture is a traditional Chinese practice of medicine that has gained popularity in Western culture and around the world. It involves the insertion of thin needles into the skin to stimulate nerves, muscles, and connective tissues throughout the body with the goal of alleviating pain, tension, and stress. More broadly, acupuncture is actually a family of different procedures. Conceptually, it is believed to stimulate the body's meridians, or energy-carrying channels, in an attempt to correct imbalances and to restore health. These benefits are thought to be derived from the proximity of acupoints with nerves through intracellular calcium ions. This lesson outlines a brief history of acupuncture and how it may be used to treat various types of physical and emotional pain and specific conditions, including overactive bladder and psoriasis. Acupuncture has been demonstrated to enhance endogenous opiates, such as dynorphin, endorphin, encephalin, and release corticosteroids, relieving pain and enhancing the healing process. There are associated risks; however, serious side effects are rare. When compared to traditional methods of pain management, more studies are warranted in order to establish the efficacy of acupuncture and its place in pain management.
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Affiliation(s)
| | - Sudipta Sen
- Department of Anesthesiology, LSUHSC, Shreveport, LA, USA
| | - Matthew Bral
- Department of Anesthesiology, LSUHSC, Shreveport, LA, USA
| | - Shanthi Reddy
- Department of Anesthesiology, LSUHSC, Shreveport, LA, USA
| | | | | | - Charles J Fox
- Department of Anesthesiology, LSUHSC, Shreveport, LA, USA
| | - Alan David Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center, 1542 Tulane Ave, New Orleans, LA, 70112, USA.
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Zhang NZ, Ma L, Jun C, Guo YX, Yuan HQ. Changes in mast cell infiltration: a possible mechanism in detrusor overactivity induced by visceral hypersensitivity. Int Braz J Urol 2016; 42:373-82. [PMID: 27256194 PMCID: PMC4871401 DOI: 10.1590/s1677-5538.ibju.2015.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 08/02/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To establish the detrusor overactivity (DO) model induced by visceral hypersensitivity (VH) and investigate the relationship between mast cell (MC) infiltration and DO. MATERIALS AND METHODS Sixty rats are divided into 4 groups randomly: Group 1:Baseline group; Group 2: DO group; Group 3: CON group; Group 4: VH group. The colorectal distension (CRD) and abdominal withdral reflex (AWR) scores are performed to evaluate VH. The cystometric investigation and histological test of MC infiltration are assessed. RESULTS The threshold pressure of CRD in the VH group is significantly lower than that in the CON group (P<0.001). At the distension pressure ≥20 mmHg, the AWR scores of the VH group are significantly higher than those of the CON group (10 mmHg: P=0.33; 20 mmHg: P=0.028; 40 mmHg: P<0.001; 60 mmHg: P<0.001; 80 mmHg: P<0.001). DO model is successfully established in the VH group (DO rate=100%). Compared with the CON group, the numbers of MC infiltration are significantly increased in the VH group, including submucosa of bladder (P<0.001), mucosa lamina propria/mesentery of small intestine (P<0.001), and mucosa lamina propria/mesentery of large intestine (P<0.001). Furthermore, more MC activation as well as degranulation are observed in the VH group. CONCLUSIONS It is indicated that DO model can be established in the VH rats. The MC infiltration may play an important role in DO induced by VH, and may be helpful to understand the mechanisms of DO in VH patients.
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Affiliation(s)
- Nian-Zhao Zhang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China
| | - Lin Ma
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China
| | - Chen Jun
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China
| | - Yan-Xia Guo
- Department of Biochemistry and Molecular Biology, Shandong University School of Medicine, Shandong University, Jinan, P.R. China
| | - Hui-Qing Yuan
- Department of Biochemistry and Molecular Biology, Shandong University School of Medicine, Shandong University, Jinan, P.R. China
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Hsieh PF, Chiu HC, Chen KC, Chang CH, Chou ECL. Botulinum toxin A for the Treatment of Overactive Bladder. Toxins (Basel) 2016; 8:toxins8030059. [PMID: 26938559 PMCID: PMC4810204 DOI: 10.3390/toxins8030059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 11/16/2022] Open
Abstract
The standard treatment for overactive bladder starts with patient education and behavior therapies, followed by antimuscarinic agents. For patients with urgency urinary incontinence refractory to antimuscarinic therapy, currently both American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggested that intravesical injection of botulinum toxin A should be offered. The mechanism of botulinum toxin A includes inhibition of vesicular release of neurotransmitters and the axonal expression of capsaicin and purinergic receptors in the suburothelium, as well as attenuation of central sensitization. Multiple randomized, placebo-controlled trials demonstrated that botulinum toxin A to be an effective treatment for patients with refractory idiopathic or neurogenic detrusor overactivity. The urinary incontinence episodes, maximum cystometric capacity, and maximum detrusor pressure were improved greater by botulinum toxin A compared to placebo. The adverse effects of botulinum toxin A, such as urinary retention and urinary tract infection, were primarily localized to the lower urinary tract. Therefore, botulinum toxin A offers an effective treatment option for patients with refractory overactive bladder.
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Affiliation(s)
- Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan.
| | - Hung-Chieh Chiu
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan.
| | - Kuan-Chieh Chen
- Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan.
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan.
- School of Medicine, China Medical University, Taichung 40402, Taiwan.
| | - Eric Chieh-Lung Chou
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan.
- School of Medicine, China Medical University, Taichung 40402, Taiwan.
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Chughtai B, Hauser N, Anger J, Asfaw T, Laor L, Mao J, Lee R, Te A, Kaplan S, Sedrakyan A. Trends in surgical management and pre-operative urodynamics in female medicare beneficiaries with mixed incontinence. Neurourol Urodyn 2015; 36:422-425. [PMID: 26678948 DOI: 10.1002/nau.22946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/24/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We sought to examine the surgical trends and utilization of treatment for mixed urinary incontinence among female Medicare beneficiaries. METHODS Data was obtained from a 5% national random sample of outpatient and carrier claims from 2000 to 2011. Included were female patients 65 and older, diagnosed with mixed urinary incontinence, who underwent surgical treatment identified by Current Procedural Terminology, Fourth Edition (CPT-4) codes. Urodynamics (UDS) before initial and secondary procedure were also identified using CPT-4 codes. Procedural trends and utilization of UDS were analyzed. RESULTS Utilization of UDS increased during the study period, from 38.4% to 74.0% prior to initial surgical intervention, and from 28.6% to 62.5% preceding re-intervention. Sling surgery (63.0%) and injectable bulking agents (28.0%) were the most common surgical treatments adopted, followed by sacral nerve stimulation (SNS) (4.8%) and Burch (4.0%) procedures. Re-intervention was performed in 4.0% of patients initially treated with sling procedures and 21.3% of patients treated with bulking agents, the majority of whom (51.7% and 76.3%, respectively) underwent injection of a bulking agent. Risk of re-intervention was not different among those who did or did not receive urodynamic tests prior to the initial procedure (8.5% vs. 9.3%) CONCLUSIONS: Sling and bulk agents are the most common treatment for MUI. Preoperative urodynamic testing was not related to risk of re-intervention following surgery for mixed urinary incontinence in this cohort. Neurourol. Urodynam. 36:422-425, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
| | - Nicholas Hauser
- Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
| | - Jennifer Anger
- Department of Surgery, Division of Urology, Urologic Reconstruction, Urodynamics, and Female Urology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tirsit Asfaw
- Department of Obstetrics and Gynecology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
| | - Leanna Laor
- Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
| | - Jialin Mao
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
| | - Richard Lee
- Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
| | - Alexis Te
- Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
| | - Steven Kaplan
- Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
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Wang CC, Liao CH, Kuo HC. Clinical guidelines for male lower urinary tract symptoms associated with non-neurogenic overactive bladder. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mo Q, Wang Y, Ye Y, Yu J, Liu Z. Acupuncture for adults with overactive bladder: a systematic review protocol. BMJ Open 2015; 5:e006756. [PMID: 25573525 PMCID: PMC4289716 DOI: 10.1136/bmjopen-2014-006756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 11/25/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Overactive bladder (OAB) is a symptom syndrome defined by the International Continence Society (ICS) as 'the presence of urinary urgency (both daytime and nighttime), usually accompanied by increased frequency and nocturia with or without urge urinary incontinence in the absence of a urinary tract infection or other obvious pathology'. Clinical studies indicate that acupuncture could reduce micturition over 24 h, urgency episodes over 24 h, and improve quality of life among people with OAB. This systematic review protocol details the proposed methods for evaluating the effectiveness and safety of acupuncture for OAB. METHODS AND ANALYSIS The following databases will be searched for relevant studies: the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Incontinence Group Trials Register, MEDLINE, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), Chinese Scientific Journal Database (VIP database), Wan-Fang Data, and China National Knowledge Infrastructure (CNKI) and will hand search a list of medical journals as a supplement. Any randomised controlled trials in English or Chinese without restriction of publication status will be included with treatment of OAB. Outcomes will mainly include number of micturition episodes over 24 h, number of urgency episodes over 24 h and number of incontinence episodes over 24 h. Two reviewers will independently screen the titles, abstracts or even full texts, and extract data. Two other reviewers will assess study quality. Revman 5.1 software will be used to conduct meta-analysis and calculate the risk ratio for dichotomous data. Weighted mean difference or standard mean difference will be calculated for continuous data. The Cochrane collaboration's tool will be used to assess the risk of bias. DISSEMINATION This systematic review protocol will provide information on acupuncture therapy for OAB. The results will be disseminated through peer-reviewed publication or conference presentations. PROTOCOL REGISTRATION PROSPERO CRD42014010181.
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Affiliation(s)
- Qian Mo
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Wang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yongming Ye
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinna Yu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Liu Y, Liu L, Wang X. Electroacupuncture at points Baliao and Huiyang (BL35) for post-stroke detrusor overactivity. Neural Regen Res 2014; 8:1663-72. [PMID: 25206463 PMCID: PMC4145909 DOI: 10.3969/j.issn.1673-5374.2013.18.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/18/2013] [Indexed: 11/18/2022] Open
Abstract
Acupuncture is used extensively in China for the treatment of stroke and other neurological disorders. The National Institutes of Health recommends acupuncture as an adjunctive therapy for stroke recovery. This study included patients with post-stroke detrusor overactivity who were treated in the Department of Neurology, Fourth Hospital of Harbin Medical University, China. Subjects received either electroacupuncture or sham electroacupuncture at points Baliao [including bilateral Shangliao (BL31), bilateral Ciliao (BL32), bilateral Zhongliao (BL33), and bilateral Xialiao (BL34)] and Huiyang (BL35). Our results showed that electroacupuncture significantly improved cystometric capacity and bladder compliance, decreased detrusor leak point pressure, ameliorated lower urinary tract symptoms, and decreased the risk of upper urinary tract damage. These findings indicate that electroacupuncture at points Baliao and Huiyang is an effective treatment for post-stroke detrusor overactivity.
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Affiliation(s)
- Yan Liu
- Department of Urinary Surgery, Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Luran Liu
- Department of Neurology, Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Xiaomin Wang
- Department of Urinary Surgery, Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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Improving the clinical prediction of detrusor overactivity by utilizing additional symptoms and signs to overactive bladder symptoms alone. Int Urogynecol J 2014; 25:1115-20. [DOI: 10.1007/s00192-014-2362-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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Lee SH, Cho ST, Na HR, Ko SB, Park MH. Urinary incontinence in patients with Alzheimer's disease: Relationship between symptom status and urodynamic diagnoses. Int J Urol 2014; 21:683-7. [DOI: 10.1111/iju.12420] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Seong Ho Lee
- Department of Urology; College of Medicine; Hallym University; Seoul Korea
| | - Sung Tae Cho
- Department of Urology; College of Medicine; Hallym University; Seoul Korea
| | - Hae Ri Na
- Department of Neurology; Bobath Memorial Hospital; Seongnam-si Korea
| | - Seok Bum Ko
- Department of Neurology; Bobath Memorial Hospital; Seongnam-si Korea
| | - Moon Ho Park
- Department of Neurology; College of Medicine; Korea University; Seoul Korea
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32
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Patra PB, Patra S. Sex differences in the physiology and pharmacology of the lower urinary tract. Curr Urol 2013; 6:179-88. [PMID: 24917740 DOI: 10.1159/000343536] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 12/04/2012] [Indexed: 12/13/2022] Open
Abstract
Sexual dimorphism is not only noticed in the prevalence of many diseases, but also in multiple physiological functions in the body. This review has summarized findings from published literature on the sex differences of the pathophysiology and pharmacology of the lower urinary tract (LUT) of humans and animals. Sex differences have been found in several key areas of the LUT, such as overactive bladder, expression and function of neurotransmitter receptors in the bladder and urethra, and micturition patterns in humans and animals. It is anticipated that this review will not only evoke renewed interest for further research on the mechanism of sex differences in the pathophysiology of the LUT (especially for overactive bladder), but might also open up the possibilities for gender-based drug development by pharmaceutical industries in order to find separate cures for men and women with diseases of the LUT.
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Elliott CS, Payne CK. Interstitial Cystitis and the Overlap With Overactive Bladder. Curr Urol Rep 2012; 13:319-26. [DOI: 10.1007/s11934-012-0264-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nonselective Blocking of the Sympathetic Nervous System Decreases Detrusor Overactivity in Spontaneously Hypertensive Rats. Int J Mol Sci 2012; 13:5048-5059. [PMID: 22606029 PMCID: PMC3344265 DOI: 10.3390/ijms13045048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/20/2012] [Accepted: 04/20/2012] [Indexed: 11/23/2022] Open
Abstract
The involuntary dual control systems of the autonomic nervous system (ANS) in the bladder of awake spontaneously hypertensive rats (SHRs) were investigated through simultaneous registrations of intravesical and intraabdominal pressures to observe detrusor overactivity (DO) objectively as a core symptom of an overactive bladder. SHRs (n = 6) showed the features of overactive bladder syndrome during urodynamic study, especially DO during the filling phase. After injection of the nonselective sympathetic blocking agent labetalol, DO disappeared in 3 of 6 SHRs (50%). DO frequency decreased from 0.98 ± 0.22 min−1 to 0.28 ± 0.19 min−1 (p < 0.01), and DO pressure decreased from 3.82 ± 0.57 cm H2O to 1.90 ± 0.86 cm H2O (p < 0.05). This suggests that the DO originating from the overactive parasympathetic nervous system is attenuated by the nonselective blocking of the sympathetic nervous system. The detailed mechanism behind this result is still not known, but parasympathetic overactivity seems to require overactive sympathetic nervous system activity in a kind of balance between these two systems. These findings are consistent with recent clinical findings suggesting that patients with idiopathic overactive bladder may have ANS dysfunction, particularly a sympathetic dysfunction. The search for newer and better drugs than the current anticholinergic drugs as the mainstay for overactive bladder will be fueled by our research on these sympathetic mechanisms. Further studies of this principle are required.
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