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Burke CA, Nitti VW, Stothers L. Melatonin and melatonin receptor agonists in the treatment of nocturia: A systematic review. Neurourol Urodyn 2024; 43:826-839. [PMID: 38456646 DOI: 10.1002/nau.25443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
AIM Causes of nocturia may extend beyond primary bladder pathology and it has been commonly associated as a side effect of sleep disorders. This has led to the study of melatonin and melatonin receptor agonists as a primary treatment for nocturia hypothesized to be secondary to sleep disorders. We aim to systematically review the efficacy and reported safety of melatonin and melatonin receptor agonists in the treatment of nocturia. METHODS A search strategy of EMBASE and Pubmed/Medline databases was utilized to identify eligible studies. Two thousand and twenty-eight unique references were identified in concordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines for systematic reviews, of which nine papers met the inclusion criteria. The Cochrane Collaboration risk of bias criteria in the open label and nonplacebo studies was used to assess bias. RESULTS The nine studies identified included 3 randomized double-blinded placebo-controlled trials, 2 randomized non-placebo trial, and 4 prospective open-label trials. Three utilized the melatonin-receptor agonist ramelteon (8 mg) and six utilized melatonin (four 2 mg extended release, two 2 mg normal release). Nocturia improved in 8 studies varying from moderate to low efficacy related to reduction in nocturia episodes. Five studies evaluated sleep parameters finding improvement in both nocturia and sleep quality. Male subjects represented 76.8% of 371 total subjects in prospective and randomized trials. Ramelteon and melatonin were both reported as well tolerated during nocturia treatment. A meta-analysis was not able to be performed due to the heterogeneity of bladder diagnoses. CONCLUSIONS At this time, there is insufficient evidence to routinely recommend melatonin as an effective treatment for nocturia given the limitations of current clinical studies. Randomized placebo-controlled trials and prospective open label studies in non-neurogenic populations report a trend towards nocturia improvement with good tolerability and rare side effects. Therefore, further larger scale randomized trials with focused urologic diagnoses in well-characterized patient populations are warranted.
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Affiliation(s)
- Christine Anh Burke
- Departments of Urology and Gynecology, Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor W Nitti
- Departments of Urology and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lynn Stothers
- Departments of Urology and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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2
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Lec PM, Nitti VW. Bladder outlet obstruction in women: Advanced evaluation. Neurourol Urodyn 2024. [PMID: 38289332 DOI: 10.1002/nau.25298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/21/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Herein, we provide a review of the indications, practical considerations, and interpretation of urodynamics (UDS) with or without fluoroscopy, as well as cystourethroscopy, for women with suspected bladder outlet obstruction (BOO). METHODS AND RESULTS A narrative review was performed focusing on the current primary literature and society guidelines around advanced diagnostic modalities for female BOO patients. UDS studies help diagnose BOO by identifying high-pressure low-flow voiding patterns and/or the characteristic radiographic appearance of the bladder neck and urethra during micturition. Cystourethroscopy aids in evaluating structural aberrations of the bladder outlet, and in surgical planning. CONCLUSIONS UDS studies and cystourethroscopy are useful adjuncts in carefully-selected female patients with suspected BOO.
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Affiliation(s)
- Patrick M Lec
- Departments of Urology and Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Victor W Nitti
- Departments of Urology and Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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3
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Murray B, Miles-Thomas J, Park AJ, Nguyen VB, Tung A, Gillard P, Lalla A, Nitti VW, Chermansky CJ. Cost-effectiveness of overactive bladder treatments from a US commercial and payer perspective. J Comp Eff Res 2023; 12:e220089. [PMID: 36655745 PMCID: PMC10288955 DOI: 10.2217/cer-2022-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/10/2022] [Indexed: 01/20/2023] Open
Abstract
Aim: The cost-effectiveness of treatment options (anticholinergics, β3-adrenoceptor agonists, onabotulinumtoxinA, sacral nerve stimulation and percutaneous tibial stimulation [the latter two including new rechargeable neurostimulators]) for the management of overactive bladder (OAB) were compared with best supportive care (BSC) using a previously published Markov model. Materials & methods: Cost-effectiveness was evaluated over a 15-year time horizon, and sensitivity analyses were performed using 2- and 5-year horizons. Discontinuation rates, resource utilization, and costs were derived from published sources. Results: Using Medicare and commercial costs over a 15-year time period, onabotulinumtoxinA 100U had incremental cost-effectiveness ratios (ICERs) gained of $39,591/quality-adjusted life-year (QALY) and $42,255/QALY, respectively, versus BSC, which were the lowest ICERs of all assessed treatments. The sensitivity analyses at 2- and 5-year horizons also showed onabotulinumtoxinA to be the most cost-effective of all assessed treatments versus BSC. Conclusion: OnabotulinumtoxinA 100U is currently the most cost-effective treatment for OAB.
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Affiliation(s)
- Brian Murray
- Capital Region Urological Surgeons, 319 S Manning Blvd #106, Albany, NY 12208, USA
| | | | - Amy J Park
- Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | | | - Amy Tung
- Allergan, an AbbVie company, 2525 Dupont Drive, Irvine, CA 92612, USA
| | - Patrick Gillard
- Allergan, an AbbVie company, 2525 Dupont Drive, Irvine, CA 92612, USA
| | - Anjana Lalla
- Allergan, an AbbVie company, 2525 Dupont Drive, Irvine, CA 92612, USA
| | - Victor W Nitti
- David Geffen School of Medicine at UCLA, 300 Stein Plaza Driveway, Los Angeles, CA 90095, USA
| | - Christopher J Chermansky
- University of Pittsburgh Medical Center Magee Womens Hospital, 300 Halket St, Suite 2541, Pittsburgh, PA 15213, USA
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4
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Armstrong A, Kroener L, Cohen JG, Han CS, Nitti VW, Rible R, Brennan K. Faculty and applicant perceptions of virtual interviews on subspecialty fellowship match in obstetrics and gynecology. Med Educ Online 2022; 27:2068993. [PMID: 35473575 PMCID: PMC9067945 DOI: 10.1080/10872981.2022.2068993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In response to COVID-19, the AAMC recommended that hospitals conduct interviews in a virtual setting. OBJECTIVE To evaluate whether fellowship video conference interviews (VCIs) are an acceptable alternative to in-person interviews from both the applicant and program perspectives. METHODS Applicants and faculty from a single academic institution with five OBGYN subspecialty fellowship programs were invited to complete surveys regarding their experience using VCIs during the 2020 interview season. Survey responses used a 5-point Likert scale (strongly disagree to strongly agree). Comparative analyses between faculty and applicants responses to survey questions were performed with two-tailed Student's t-tests. RESULTS 45 faculty members and 131 applicants received the survey. Response rate for faculty members and applicants was 95.6% (n = 43) and 46.6% (n = 61), respectively. Faculty and applicants agreed that the VCIs allowed them to accurately represent themselves (83.7% vs. 88.6%, p = 0.48). Most applicants (62.3%, n = 38) reported a fundamental understanding of the fellowship's culture. The majority of applicants (77.1%, n = 47) and faculty (72.1%, n = 31) agreed that they were able to develop connections during the virtual interview (p = 0.77). Faculty and applicants stated that VCIs assisted them in determining whether the candidate or program, respectively, was a good fit (83.7% vs. 67.2%, p = 0.98). CONCLUSIONS The VCI fellowship recruitment process allowed OBGYN fellowship applicants and programs to accurately represent themselves compared to in-person interviews. Most applicants and faculty were able to develop relationships over the virtual platform. Although not explicitly assessed, it is possible that the virtual interviews can achieve a suitable match between applicant and program across all OBGYN subspecialty fellowships. The VCI process may be a long-term resolution to minimize both the financial burden and time commitment presented by traditional in-person interviews. Follow-up studies should assess the performance of the virtually selected fellows compared to those selected in previous years using traditional in-person interviews.
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Affiliation(s)
- Abigail Armstrong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Lindsay Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Joshua G. Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Christina S. Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Victor W. Nitti
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Radhika Rible
- Division of Family Planning, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Kathleen Brennan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
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5
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Van Kuiken M, Volkin D, Zaila Ardines K, Lin FC, Fullerton M, Kwan L, Nitti VW. Sensation of incomplete bladder emptying in women: Lack of correlation to an elevated post-void residual. Neurourol Urodyn 2021; 41:490-497. [PMID: 34913516 DOI: 10.1002/nau.24859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/26/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/BACKGROUND Sensation of incomplete bladder emptying (SIBE) has been shown to be correlated with an elevated post-void residual (PVR) in men, however, the significance of this symptom and whether it correlates with an elevated PVR in women is less clear. In this study, we assessed if SIBE in women is correlated with an elevated PVR and determined the relationship of SIBE to other lower urinary tract symptoms. METHODS/MATERIALS Women ages ≥18 with lower urinary tract symptoms were eligible. SIBE was defined by a response "sometimes", "most of the time", or "all of the time" to the question "How often do you feel that your bladder has not emptied properly after you have urinated?" on the International Consultation on Incontinence Questionnaire. Frequency and bother of other lower urinary tract symptoms were also assessed to compare their relationship to SIBE. Elevated PVR was defined as ≥100 ml via ultrasound. RESULTS We prospectively evaluated 95 women, 59% of whom reported SIBE. Compared to women without SIBE, women with SIBE reported more urinary hesitancy (51% vs. 18%, p = 0.002), intermittency (56% vs. 16%, p < 0.001), weak stream (36% vs. 5%, p < 0.001), dysuria (29% vs. 5%, p = 0.004), and straining (25% vs 5%, p = 0.013). However, there was no difference in elevated PVRs between women with and without SIBE [5/56, 9% vs. 4/39, 10%, (p = 0.99)]. All women, regardless of SIBE, reported higher bother from storage and incontinence symptoms versus voiding symptoms with no difference in overall bother scores. CONCLUSION SIBE is a common complaint in women with lower urinary tract symptoms. While women with SIBE reported more voiding symptoms, they were more bothered by storage symptoms. Importantly, most of these women emptied their bladder well and were not more likely to have an elevated PVR than women without SIBE.
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Affiliation(s)
- Michelle Van Kuiken
- Division of FPMRS, Departments of Urology and Obstetrics and Gynecology, University of California, Los Angeles, California, USA.,Department of Urology, University of California, San Francisco, California, USA
| | - Dmitry Volkin
- Division of FPMRS, Departments of Urology and Obstetrics and Gynecology, University of California, Los Angeles, California, USA
| | - Kassandra Zaila Ardines
- Division of FPMRS, Departments of Urology and Obstetrics and Gynecology, University of California, Los Angeles, California, USA
| | - Frank C Lin
- Division of FPMRS, Departments of Urology and Obstetrics and Gynecology, University of California, Los Angeles, California, USA
| | - Morgan Fullerton
- Division of FPMRS, Departments of Urology and Obstetrics and Gynecology, University of California, Los Angeles, California, USA
| | - Lorna Kwan
- Division of FPMRS, Departments of Urology and Obstetrics and Gynecology, University of California, Los Angeles, California, USA
| | - Victor W Nitti
- Division of FPMRS, Departments of Urology and Obstetrics and Gynecology, University of California, Los Angeles, California, USA
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Sussman RD, Escobar C, Jericevic D, Oh C, Arslan A, Palmerola R, Pape DM, Smilen SW, Nitti VW, Rosenblum N, Brucker BM. Estimation of Urinary Frequency: Does Question Phrasing Matter? Urology 2021; 156:90-95. [PMID: 33901531 DOI: 10.1016/j.urology.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate if question phrasing and patient numeracy impact estimation of urinary frequency. MATERIALS AND METHODS We conducted a prospective study looking at reliability of a patient interview in assessing urinary frequency. Prior to completing a voiding diary, patients estimated daytime, and nighttime frequency in 3 ways: (1) how many times they urinated (2) how many hours they waited in between urinations (3) how many times they urinated over the course of 4 hours. Numeracy was assessed using the Lipkus Numeracy Scale. RESULTS Seventy-one patients completed the study. Correlation of estimates from questions 1, 2, and 3 to the diary were not statistically different. Prediction of nighttime frequency was better than daytime for all questions (correlation coefficients 0.751, 0.754, and 0.670 vs 0.596, 0.575, and 0.460). When compared to the diary, Question 1 underestimated (8.5 vs 9.7, P = .014) while Question 2 overestimated (11.8 vs 9.7, P = .027) recorded voids on a diary. All questions overpredicted nighttime frequency with 2.6, 2.9, and 3.9 predicted versus 1.6 recorded voids (P < .001). Although not statistically significant, for each question, the predicted frequency of numerate patients was more correlated to the diary than those of innumerate patients. CONCLUSION When compared to a voiding diary for daytime urinary frequency, asking patients how many times they urinated underestimated, and asking patients how many hours they waited between urinations overestimated the number recorded voids. Regardless of phrasing, patients overestimated nighttime urination. Patients in our functional urology population have limited numeracy, which may impact accuracy of urinary frequency estimation.
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Affiliation(s)
- Rachael D Sussman
- Department of Urology, New York University Medical Center, New York, NY.
| | - Christina Escobar
- Department of Urology, New York University Medical Center, New York, NY
| | - Dora Jericevic
- Department of Urology, New York University Medical Center, New York, NY
| | - Cheonguen Oh
- Departments of Population Health and Environmental Medicine, New York University Medical Center, New York, NY
| | - Alan Arslan
- Departments of Population Health, Environmental Medicine & Obstetrics and Gynecology New York University Medical Center, New York, NY
| | - Ricardo Palmerola
- Department of Urology, New York University Medical Center, New York, NY
| | - Dominique M Pape
- Department of Urology, New York University Medical Center, New York, NY
| | - Scott W Smilen
- Department of Obstetrics and Gynecology, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune City, NJ
| | - Victor W Nitti
- Department of Urology, UCLA Medical Center, Santa Monica, CA
| | - Nirit Rosenblum
- Department of Urology, New York University Medical Center, New York, NY
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7
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Richard C, Peyronnet B, Drain A, Rosenblum N, Hascoet J, Sussman RD, Freton L, Zhao LC, Nitti VW, Brucker BM. Dorsal Onlay Oral Mucosa Graft Urethroplasty for Female Urethral Stricture. Urology 2021; 158:215-221. [PMID: 34537197 DOI: 10.1016/j.urology.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe and assess the outcomes of dorsal onlay oral mucosa graft urethroplasty for female urethral stricture. METHODS We retrospectively reviewed the charts of all female patients who underwent dorsal onlay oral (buccal or lingual) mucosa urethroplasty for urethral stricture between 2011 and 2020 at two academic institutions. The primary endpoint was clinical success defined as any subjective improvement in LUTS self-assessed by the patients 1-3 months after catheter removal. Four surgeons performed the urethroplasties using a standardized technique: suprameatal incision, dissection and longitudinal opening of the dorsal aspect of the urethra, harvest of the oral mucosa graft, graft onlay sutured into the urethral opening. RESULTS Nineteen patients were included. The clinical success rate was 94.7% at 1-3 months and 90.9% at 1 year. After a median follow-up of 12 months (range 1-49) there was one recurrence (5.3%), clinical success was achieved in 17 patients (89.5%) and both the maximum urinary flow rate and post void residual were significantly improved (15.2 vs 7.4 ml/s preoperatively; P = .008 and 71.5 vs 161.1 ml preoperatively; P = .001 respectively). The de novo stress urinary incontinence rate was 15.7% at 1-3 months and 9.1% at 1 year. CONCLUSION Dorsal onlay oral mucosa graft urethroplasty for female urethral stricture appears feasible across multiple surgeons and is associated with a low perioperative morbidity, satisfactory functional outcomes and a low recurrence rate. Other series with larger sample size and longer follow-up are needed to confirm these findings.
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Affiliation(s)
- Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | | | - Alice Drain
- Department of Urology, New York University Langone Health, New York, NY
| | - Nirit Rosenblum
- Department of Urology, New York University Langone Health, New York, NY
| | | | - Rachael D Sussman
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | - Lee C Zhao
- Department of Urology, New York University Langone Health, New York, NY
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8
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El-Arabi AM, Alam SM, Dai J, Thompson J, Baden M, Siculietano J, Kerley P, Englert S, Nitti VW, Hussman DA, Thrasher JB, Brannigan RE, Sandlow JI, Nangia AK. Impact of Fellowship-Trained Andrology and Sexual Medicine Specialists on Performance on the Annual American Urological Association In-Service Examination. Urology 2021; 157:51-56. [PMID: 34186132 DOI: 10.1016/j.urology.2021.05.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To demonstrate the distribution and impact of fellowship-trained andrology and/or sexual medicine urological specialists (FTAUS) on resident in-service examination (ISE) performance. METHODS Residency program websites were accessed to create a database of FTAUS in the United States between 2007 and 2017. This database was reviewed by three separate FTAUS and cross referenced with membership lists to the Sexual Medicine of North America Society and the Society for the Study of Male Reproduction. De-identified ISE scores were obtained from the American Urological Association from 2007-2017 and scores from trainees at programs with a FTAUS were identified for comparison. Resident performance was analyzed using a linear model of the effect of a resident being at a program with an FTAUS, adjusting for post-graduate year. RESULTS ISE data from 13,757 residents were obtained for the years 2007-2017. The number of FTAUS in the United States increased from 40-102 during this study period. Mean raw scores on the "Sexual Dysfunction, Endocrinopathy, Fertility Problems" (SDEFP) section of the ISE ranged from 52.1% ± 17.7% to 65.7% ± 16% (mean ± SD). Throughout the study period, there was no difference in performance within the SDEFP section (P < .01). Residents at a program with a FTAUS answered 0.95% more questions correctly in the SDEFP than those without a FTAUS (P < .001). For these residents, there was an improvement of approximately 0.66% on the percentage of questions answered correctly on the ISE overall (P < .001). Performance improved significantly as residents progressed from PGY-2-PGY-5. CONCLUSION There is a small but statistically significant improvement in overall ISE and SDEFP sub-section performance.
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Affiliation(s)
- Ahmad M El-Arabi
- Department of Urology, University of Kansas Health System, Kansas City, KS
| | - Syed M Alam
- Department of Urology, University of Kansas Health System, Kansas City, KS
| | - Junqiang Dai
- Department of Biostatistics, University of Kansas Health System, Kansas City, KS
| | - Jeffrey Thompson
- Department of Biostatistics, University of Kansas Health System, Kansas City, KS
| | | | | | - Patrick Kerley
- Office of Education, American Urological Association, Linthicum, MD
| | - Shelby Englert
- Office of Education, American Urological Association, Linthicum, MD
| | - Victor W Nitti
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | | | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Ajay K Nangia
- Department of Urology, University of Kansas Health System, Kansas City, KS.
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9
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Nitti VW, Patel A, Karram M. Diagnosis and management of overactive bladder: A review. J Obstet Gynaecol Res 2021; 47:1654-1665. [PMID: 33592680 DOI: 10.1111/jog.14708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/27/2022]
Abstract
AIM Overactive bladder (OAB) is a common and troublesome condition that can significantly impair quality of life. This review aims to educate providers of obstetrics and gynecology services about available therapies for OAB and what to expect following treatment. METHODS Here, we review published data from studies that have evaluated available treatments for OAB. Relevant articles published over the past 2 decades, including large multicenter trials, were identified through a literature search using PubMed.gov, and the references in those articles were also manually searched to find additional articles. Treatment guidelines and product labels were also reviewed. RESULTS Behavioral therapy is recommended as a first choice for OAB management; pharmacologic treatment (anticholinergics, β3 -adrenoceptor agonists) as second-line treatment; and onabotulinumtoxinA, peripheral tibial nerve stimulation, and sacral nerve stimulation as third-line therapy for patients refractory or intolerant to first- and second-line treatments. A stepwise approach to treatment through first-, second-, and third-line therapies is recommended, recognizing this may not be appropriate for all patients. CONCLUSIONS To optimize symptom control and set realistic expectations, patients should be carefully monitored and counseled appropriately on available treatment options.
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Affiliation(s)
- Victor W Nitti
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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10
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Brandon C, Oh C, Brucker BM, Rosenblum N, Ferrante KL, Smilen SW, Nitti VW, Pape DM. Persistence in Percutaneous Tibial Nerve Stimulation Treatment for Overactive Bladder Syndrome is Best Predicted by Patient Global Impression of Improvement Rather Than Symptom-Specific Improvement. Urology 2020; 148:93-99. [PMID: 33358753 DOI: 10.1016/j.urology.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate whether progression to maintenance percutaneous tibial nerve stimulation (PTNS) was related to perceived global impression of improvement (PGII) rather than symptom-specific improvement in patient with overactive bladder (OAB). We hypothesize that PGII will predict continuation of PTNS long-term. METHODS This prospective observational study included 90 patients with OAB that initiated PTNS. The PGII and OAB short-form questionnaires (OABq-SF) were used to assess bladder symptom severity and improvement. Those that completed the 12-week induction phase were offered to continue PTNS monthly maintenance or pursue other options. The primary outcome was difference in PGII score between those pursuing maintenance therapy versus other options. Descriptive statistics and mixed effect modeling analysis were employed. RESULTS Seventy patients (78%) completed 12 weeks of PTNS. The majority of completers pursued monthly maintenance (P< .01) and had significantly lower median PGII scores compared with those who sought alternatives (P < .01), while OABq-SF scores did not differ significantly (P = .65). Patients that pursued monthly PTNS maintenance had lower body mass index than those who chose alternative therapies (P < .01). Only 19% continued PTNS therapy for at least 1 year. CONCLUSION More patients pursued PTNS monthly maintenance over any other therapy, and this was significantly associated with lower PGII scores. Global improvement, and not symptom-specific response, predicts long-term PTNS maintenance. No symptom-specific predictors were identified in those who pursued maintenance over other options. One-year continuation rates are low.
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Affiliation(s)
- Caroline Brandon
- New York University Langone Health, Department of Urology and Obstetrics & Gynecology, New York, NY
| | - Cheongeun Oh
- New York University Langone Health, Department of Population Health, New York, NY
| | - Benjamin M Brucker
- New York University Langone Health, Department of Urology and Obstetrics & Gynecology, New York, NY
| | - Nirit Rosenblum
- New York University Langone Health, Department of Urology and Obstetrics & Gynecology, New York, NY
| | - Kimberly L Ferrante
- Kaiser Permanente San Diego, Department of Obstetrics & Gynecology, San Diego, CA
| | - Scott W Smilen
- Jersey Shore University Medical Center, Department of Obstetrics & Gynecology, Neptune City, NJ
| | - Victor W Nitti
- University of California Los Angeles, Department of Urology, Los Angeles, CA
| | - Dominique Malacarne Pape
- New York University Langone Health, Department of Urology and Obstetrics & Gynecology, New York, NY.
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11
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Hoffman D, Sussman RD, Pape DM, Smilen SW, Rosenblum N, Nitti VW, Brucker BM. Radiation exposure during videourodynamic testing: Is dose reduction possible using a standardized protocol? Neurourol Urodyn 2019; 39:715-720. [PMID: 31846117 DOI: 10.1002/nau.24258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
AIMS To evaluate the impact of a protocol for standardized image capture during video urodynamics (VUD) on radiation exposure. Secondly, to categorize radiation exposure by condition warranting VUD and to identify clinical variables that correlate with increased radiation exposure. METHODS One hundred fifty patients underwent VUD using our standardized protocol. All images were taken using low dose and pulsed settings. Four images are captured: one scout image, one filling image, one voiding image, and one post-void image. If the patient is unable to void with the catheter in place, the catheter is removed and a second image is taken during an attempt at unintubated flow. If vesicoureteral reflux (VUR) is identified, an alternate protocol is entered to document parameters. The mean radiation exposure measured in dose area product (DAP), fluoroscopy time, and number of images were noted and compared with previously published fluoroscopy data collected at our institution before protocol implementation. RESULTS The mean fluoroscopy exposure after the implementation of our protocol was 273.5 mGy/cm2 taking 5.2 images in 4.5 seconds. Protocol implementation leads to a 51.2% reduction in radiation exposure calculated by mean DAP (P < .0001) and a 96.5% reduction in fluoroscopy time (P < .0001). The presence of VUR, fluoroscopy time, and body mass index (BMI) > 25 were associated with higher radiation exposure (P < .0001). CONCLUSION Implementation and adherence to a standardized protocol for fluoroscopy led to a reduction in radiation exposure fluoroscopy time. The presence of VUR, fluoroscopy time, and BMI > 25 were associated with higher radiation exposure.
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Affiliation(s)
- Daniel Hoffman
- Department of Urology, University of South Florida, Tampa, Florida
| | - Rachael D Sussman
- Department of Urology, New York University Medical Center, New York, New York
| | - Dominique M Pape
- Department of Urology, New York University Medical Center, New York, New York
| | - Scott W Smilen
- Department of Urology, New York University Medical Center, New York, New York
| | - Nirit Rosenblum
- Department of Urology, New York University Medical Center, New York, New York
| | - Victor W Nitti
- Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Benjamin M Brucker
- Department of Urology, New York University Medical Center, New York, New York
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12
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Palmerola R, Peyronnet B, Rebolos M, Khan A, Sussman RD, Escobar C, Smith S, Rosenblum N, Nitti VW. Trends in Stress Urinary Incontinence Surgery at a Tertiary Center: Midurethral Sling Use Following the AUGS/SUFU Position Statement. Urology 2019; 131:71-76. [PMID: 31229514 DOI: 10.1016/j.urology.2019.04.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate trends in stress urinary incontinence (SUI) surgery before and after the 2011 Foods and Drug Administration notification and the 2014 (American Urogynecologic Society [AUGS]/Society for Urodynamics Female Pelvic Medicine and Urogenital Reconstruction [SUFU]) position statement. METHODS A retrospective chart review was performed to identify patients presenting for evaluation of SUI by 2 Female Pelvic Medicine and Reconstructive Surgery specialists between June 1, 2010 and May 31, 2017. Rates of surgical treatment modality (synthetic midurethral slings [MUS] versus autologous fascial pubovaginal sling versus bulking agents) were analyzed at 6-month intervals. RESULTS Over fourteen 6-month intervals, the number of new patients presenting for evaluation of SUI increased consistently. There was a decrease in the proportion of new patients who underwent antiincontinence surgical procedures, specifically MUS, between December 2011 and December 2013. After the integration of the 2014 AUGS/SUFU position statement in patient counseling, this trend reverted and we noted a sustained increase in the proportion of patients electing surgical management. This paralleled an increase in new patient visits for SUI and MUS. The number autologous fascial pubovaginal sling remained stable throughout the study period. Conversely, MUS composed the highest proportion of procedures performed, accounting for 60 %-87.2% off all antiincontinence procedures. CONCLUSION After the Foods and Drug Administration Public Health Notification in 2011, we observed a decline in the number of new patients presenting with SUI electing surgical management, specifically MUS. However, after the AUGS/SUFU position statement publication and integration into counseling, we observed a reversal in the previous year's trends, noting a resurgence of MUS utilization.
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Affiliation(s)
- Ricardo Palmerola
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY.
| | - Benoit Peyronnet
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Mark Rebolos
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Aqsa Khan
- Department of Urology, Mayo Clinic, Phoenix, AZ
| | - Rachael D Sussman
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Christina Escobar
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | | | - Nirit Rosenblum
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Victor W Nitti
- Departments of Urology and Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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13
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Drangsholt S, Peyronnet B, Arcila-Ruiz M, Sussman RD, Palmerola R, Pape DR, Rosenblum N, Nitti VW, Brucker BM. Nocturia in female patients: Current clinical features, treatment patterns and outcomes at a tertiary referral centre. Arab J Urol 2019; 17:82-86. [PMID: 31258948 PMCID: PMC6583713 DOI: 10.1080/2090598x.2019.1589792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 01/16/2023] Open
Abstract
Objective: To report the current clinical features, treatment patterns and outcomes of female patients who were seen at a tertiary referral centre with a primary diagnosis of nocturia, and to assess the predictive factors of therapeutic management failure. Patients and methods: A retrospective chart review of all new female patients seen in a single-centre functional urology practice with the diagnosis of nocturia was performed. Up to three visits within a 12-month period from the time of presenting were reviewed. The primary endpoint was patient-reported improvement assessed at each follow-up visit and the change in the number of nocturia episodes. Results: In all, 239 female patients were included for analysis. The prevalence of nocturnal polyuria, reduced bladder capacity, and global polyuria were 75%, 40.2%, and 18.1%, respectively. Within the first two visits, 72.7% of patients had started a treatment beyond behavioural therapies. Anticholinergics were the most commonly initiated treatment (47.2% of patients). At the latest considered visit, 80 patients reported improvement in nocturia (45.5%) and there was a mean – 0.8 decrease in the number of nocturia episodes from 4 to 3.2, which was statistically significant (P < 0.001). There was no statistically significant association between any of the bladder diary findings and treatment outcomes. A smaller number of nocturia episodes was the only predictive factor of therapeutic management failure in multivariate analysis (odds ratio 0.10; P = 0.01). Conclusions: Whilst the prevalence of nocturnal polyuria in women with nocturia is high, the therapeutic management until 2016 seemed to rely mostly upon overactive bladder medications with a relatively low success rate. Abbreviations: BD: bladder diary; BPS: bladder pain syndrome; ICD(−9)-(10): International Classifications of Disease (ninth revision) (10th revision); NPI: Nocturnal Polyuria Index; OAB: overactive bladder; OR: odd ratio; POP: pelvic organ prolapse
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Affiliation(s)
- Siri Drangsholt
- Department of Urology, New York University, New York, NY, USA
| | | | | | | | | | | | - Nirit Rosenblum
- Department of Urology, New York University, New York, NY, USA
| | - Victor W Nitti
- Department of Urology, New York University, New York, NY, USA
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14
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Syan R, Peyronnet B, Drain A, Enemchukwu E, Malacarne DR, Rosenblum N, Nitti VW, Brucker BM. Exploring stress urinary incontinence outcomes after sling excision for perforation or exposure. Low Urin Tract Symptoms 2019; 11:206-210. [PMID: 30900401 DOI: 10.1111/luts.12263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study assessed stress urinary incontinence (SUI) outcomes after sling excision for urinary tract perforation or vaginal exposure, and compared the outcomes of concomitant versus staged autologous fascia pubovaginal sling (AFPVS). METHODS A retrospective chart review of all patients who underwent midurethral sling (MUS) excision for urinary tract perforation or vaginal exposure at a tertiary referral center between 2010 and 2015 was performed. Therapeutic strategies were categorized as concomitant AFPVS, staged AFPVS, and no anti-incontinence procedure. RESULTS In all, 32 patients were included for analysis: 13 with vaginal tape exposure (40.6%) and 19 with urinary tract tape exposure (59.4%). In patients who had SUI prior to sling excision (43.8%), the rate of resolved or improved SUI postoperatively was higher in the concomitant AFPVS group than in those who underwent sling excision alone (83.3% vs 12.5%, respectively; P = 0.03). Of 18 patients with no SUI prior to sling excision, 12 experienced recurrent SUI after sling removal (66.7%). The rate of recurrent SUI was lower in patients with vaginal MUS exposure than urinary tract MUS perforation, but this did not reach statistical significance (57.1% vs 72.7%, respectively; P = 0.63). The rates of resolved SUI after AFPVS were comparable in patients with concomitant and staged AFPVS (66.7% vs 71.4%, respectively; P = 0.99). CONCLUSIONS Many patients with MUS perforations or exposures will have SUI at initial presentation or develop SUI after removal of the synthetic sling. The decision to perform a concomitant AFPVS or to stage the surgical management of SUI can be individualized.
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Affiliation(s)
- Raveen Syan
- Department of Urology, New York University Langone Health, New York, New York
| | - Benoit Peyronnet
- Department of Urology, New York University Langone Health, New York, New York
| | - Alice Drain
- Department of Urology, New York University Langone Health, New York, New York
| | - Ekene Enemchukwu
- Department of Urology, New York University Langone Health, New York, New York
| | | | - Nirit Rosenblum
- Department of Urology, New York University Langone Health, New York, New York.,Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Victor W Nitti
- Department of Urology, New York University Langone Health, New York, New York.,Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Benjamin M Brucker
- Department of Urology, New York University Langone Health, New York, New York.,Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
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15
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Peyronnet B, O'Connor E, Khavari R, Capon G, Manunta A, Allue M, Hascoet J, Nitti VW, Gamé X, Gilleran J, Castro-Sader L, Cornu JN, Waltregny D, Ahyai S, Chung E, Elliott DS, Fournier G, Brucker BM. AMS-800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review. Neurourol Urodyn 2018; 38 Suppl 4:S28-S41. [PMID: 30298943 DOI: 10.1002/nau.23833] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/26/2018] [Indexed: 11/06/2022]
Abstract
AIMS To perform a systematic review of studies reporting the outcomes of AMS-800 artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD). METHODS A systematic literature search of the Medline and Embase databases was performed in June 2018 in accordance with the PRISMA statement. No time limit was used. The protocol was registered in PROSPERO (CRD42018099612). Study selection and data extraction were performed by two independent reviewers. RESULTS Of 886 records screened, 17 were included. All were retrospective or prospective non-comparative case series. One study reported on vaginal AUS implantation, 11 on open AUS implantation, two on laparoscopic AUS implantation, two on robot-assisted AUS implantation and one compared open and robot-assisted implantations. The vast majority of patients had undergone at least one anti-incontinence surgical procedure prior to AUS implantation (69.1-100%). The intraoperative bladder neck injury rates ranged from 0% to 43.8% and the intraoperative vaginal injury rates ranged from 0 to 25%. After mean follow-up periods ranging from 5 to 204 months, the complete continence rates ranged from 61.1% to 100%. The rates of explantation, erosion and mechanical failure varied from 0% to 45.3%, 0% to 22.2% and 0% to 44.1%, respectively. CONCLUSIONS AMS-800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. High level of evidence studies are needed to help better define the role of AUS in the female SUI armamentarium.
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Affiliation(s)
| | - Eabhann O'Connor
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | - Marta Allue
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Victor W Nitti
- Department of Urology, New York University, New York, New York
| | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Jason Gilleran
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan
| | - Luis Castro-Sader
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - David Waltregny
- Department of Urology, University Hospital of Liege, Liege, Belgium
| | - Sascha Ahyai
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Eric Chung
- Department of Urology, The University of Queensland, Brisbane, Australia
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16
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Abstract
The use of botulinum toxin A (BTX-A) has revolutionized the treatment of neurogenic lower urinary tract dysfunction (NLUTD) over the past three decades. Initially, it was used as a sphincteric injection for detrusor sphincter dyssynergia but now is used mostly as intradetrusor injection to treat neurogenic detrusor overactivity (NDO). Its use is supported by high-level-of-evidence studies and it has become the gold-standard treatment for patients with NDO refractory to anticholinergics. Several novelties have emerged in the use of BTX-A in neurourology over the past few years. Although onabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA) remains the only BTX-A for which use is supported by large, multicenter, randomized, controlled trials (RCT), and is therefore the only one to be licensed in the United States and Europe, a second BTX-A, abobotulinumtoxinA (Dysport®, Ipsen Biopharmaceuticals, Basking Ridge, NJ), is also supported by high-level-of-evidence studies. Other innovations in the use of BTX-A in neurourology during the past few years include the BTX switch (from abobotulinumtoxinA to onabotulinumtoxinA or the opposite) as a rescue option for primary or secondary failures of intradetrusor BTX-A injection and refinements in intradetrusor injection techniques (number of injection sites, injection into the trigone). There is also a growing interest in long-term failure of BTX-A for NDO and their management, and a possible new indication for urethral sphincter injections.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes Rennes, France.,Department of Urology, New York University New York, NY
| | - Xavier Gamé
- Department of Urology, University of Toulouse Toulouse, France
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17
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Chapple CR, Osman NI, Birder L, Dmochowski R, Drake MJ, van Koeveringe G, Nitti VW, Oelke M, Smith PP, Yamaguchi O, Wein A, Abrams P. Terminology report from the International Continence Society (ICS) Working Group on Underactive Bladder (UAB). Neurourol Urodyn 2018; 37:2928-2931. [DOI: 10.1002/nau.23701] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
| | - Nadir I. Osman
- Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield United Kingdom
| | - Lori Birder
- Pittsburgh University; Pittsburgh Pennsylvania
| | | | - Marcus J. Drake
- University of Bristol and Bristol Urological Institute; Bristol United Kingdom
| | | | | | | | | | | | - Alan Wein
- University of Philadelphia; Philadelphia Pennsylvania
| | - Paul Abrams
- Bristol Urological Institute; Bristol United Kingdom
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18
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Peyronnet B, Vurture G, Palma JA, Malacarne DR, Feigin A, Sussman RD, Biagioni MC, Palmerola R, Gilbert R, Rosenblum N, Frucht S, Kaufmann H, Nitti VW, Brucker BM. Mirabegron in patients with Parkinson disease and overactive bladder symptoms: A retrospective cohort. Parkinsonism Relat Disord 2018; 57:22-26. [PMID: 30037689 DOI: 10.1016/j.parkreldis.2018.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/15/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This study aimed to assess the outcomes of mirabegron for the treatment of overactive bladder (OAB) symptoms in patients with Parkinson disease (PD). METHODS A retrospective study was conducted including patients with PD who received mirabegron 50 mg once daily for OAB symptoms between 2012 and 2017. The primary endpoint was clinical success defined as any improvement in overactive bladder symptoms self-assessed by the patients 6 weeks after mirabegron initiation. Secondary endpoints included number of pads per day, number of nocturia episodes and adverse events. RESULTS Fifty patients (mean 74 years old) were included. Before being treated with mirabegron, 56% had failed prior anticholinergic therapy. After 6 weeks of mirabegron 50 mg, five patients (11.4%) had a complete resolution of their OAB symptoms; 25 patients (50%) reported improvement, 23 (46%) reported no change and 2(4%) reported worsening of their OAB symptoms. The number of pads per day decreased from 1.5 to 0.9 (p = 0.01) and so did the number of nocturia episodes (from 3 to 2.6/night; p = 0.02). Only 2 adverse events were reported during mirabegron treatment (4%): one dizziness and one diaphoresis, that disappeared after mirabegron discontinuation. After a median follow-up of 19 months, 23 patients (46%) persisted on mirabegron. Persistence rates were 51.5%, 44.6% and 36.4% at 1, 2 and 3 years respectively. CONCLUSION Mirabegron has an excellent safety profile and appears to be an effective treatment for overactive bladder symptoms in patients with PD. Further prospective randomized trials are needed to properly assess mirabegron in PD patients.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, New York University School of Medicine, New York, USA; Department of Urology, University of Rennes, Rennes, France.
| | - Gregory Vurture
- Department of Urology, New York University School of Medicine, New York, USA
| | - Jose-Alberto Palma
- Department of Neurology Dysautonomia Center, New York University School of Medicine, New York, USA
| | | | - Andrew Feigin
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Rachael D Sussman
- Department of Urology, New York University School of Medicine, New York, USA
| | - Milton C Biagioni
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Ricardo Palmerola
- Department of Urology, New York University School of Medicine, New York, USA
| | - Rebecca Gilbert
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Nirit Rosenblum
- Department of Urology, New York University School of Medicine, New York, USA
| | - Steven Frucht
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Horacio Kaufmann
- Department of Neurology Dysautonomia Center, New York University School of Medicine, New York, USA
| | - Victor W Nitti
- Department of Urology, New York University School of Medicine, New York, USA
| | - Benjamin M Brucker
- Department of Urology, New York University School of Medicine, New York, USA
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19
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Vurture G, Peyronnet B, Feigin A, Biagioni MC, Gilbert R, Rosenblum N, Frucht S, Di Rocco A, Nitti VW, Brucker BM. Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson's disease. Neurourol Urodyn 2018; 37:2669-2677. [PMID: 29767449 DOI: 10.1002/nau.23717] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/23/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of intradetrusor onabotulinum toxin A injections for the treatment of overactive bladder (OAB) in patients with Parkinson's disease (PD). METHODS All PD patients who underwent intradetrusor injections of onabotulinum toxin A (BoNT-A) for storage symptoms between 2010 and 2017 were included in a retrospective study. A 100 U dose of BoNT-A (Botox®, Allergan Irvine, CA) was used for the first injection in all patients. The primary endpoint was clinical success defined as any subjective improvement in OAB symptoms self-assessed by the patients 4 weeks after the injections. RESULTS Out of 24 patients analyzed, 19 reported improvement of their OAB symptoms 4 weeks after the first injection (79.2%) with complete resolution of urgency urinary incontinence in seven patients (29.1%; P < 0.001). The average post-void residual (PVR) increased significantly after the first injection from 17.6 to 125.3 mL (P < 0.001). Three of the patients had to start clean intermittent catheterization (CIC) after the first injection (12.5%). Out of 49 injections in total, only five caused incomplete bladder emptying requiring the use of CIC (10.2%). Higher pre-injection PVR was significantly associated with both a lower chance of symptomatic improvement (P = 0.04) and a higher risk of incomplete bladder emptying with institution of CIC (P = 0.047). CONCLUSION Intradetrusor injections of BoNT-A 100 U appeared as a safe and effective option in PD patients with OAB symptoms and a low PVR before the injection. Higher preoperative PVR was the strongest predictor of both treatment failure and postoperative urinary retention requiring CIC.
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Affiliation(s)
- Gregory Vurture
- Department of Urology, New York University School of Medicine, New York, New York
| | - Benoit Peyronnet
- Department of Urology, New York University School of Medicine, New York, New York
- Department of Urology, University of Rennes, Rennes, France
| | - Andrew Feigin
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Milton C Biagioni
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Rebecca Gilbert
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Nirit Rosenblum
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Steven Frucht
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Alessandro Di Rocco
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, New York, New York
| | - Victor W Nitti
- Department of Urology, New York University School of Medicine, New York, New York
| | - Benjamin M Brucker
- Department of Urology, New York University School of Medicine, New York, New York
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20
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Weissbart SJ, Zimmern PE, Nitti VW, Lemack GE, Kobashi KC, Vasavada SP, Wein AJ. The history of the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction. Neurourol Urodyn 2018; 37:2015-2025. [DOI: 10.1002/nau.23540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/22/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Victor W. Nitti
- Department of Urology; NYU Langone Medical Center; New York New York
| | - Gary E. Lemack
- Department of Urology; UT Southwestern Medical Center; Dallas Texas
| | - Kathleen C. Kobashi
- Section of Urology and Renal Transplantation; Virginia Mason Medical Center; Seattle Washington
| | - Sandip P. Vasavada
- Department of Urology, Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland Ohio
| | - Alan J. Wein
- Division of Urology; University of Pennsylvania; Philadelphia Pennsylvania
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21
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Tubaro A, Batista JE, Nitti VW, Herschorn S, Chapple CR, Blauwet MB, Siddiqui E, Huang M, Oelke M. Efficacy and safety of daily mirabegron 50 mg in male patients with overactive bladder: a critical analysis of five phase III studies. Ther Adv Urol 2017; 9:137-154. [PMID: 28588652 PMCID: PMC5444577 DOI: 10.1177/1756287217702797] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Oral pharmacotherapies to treat overactive bladder (OAB) are used less in men despite a similar prevalence of storage symptoms as women. The efficacy and safety of once-daily mirabegron 50 mg was evaluated in male OAB patients from five phase III studies that included placebo or antimuscarinic (tolterodine ER 4 mg or solifenacin 5 mg) as a comparator. METHODS Three pooled 12-week placebo-controlled studies (mirabegron 50 mg versus placebo) and one 12-week non-inferiority phase IIIb study (BEYOND; mirabegron 50 mg versus solifenacin 5 mg) were used for efficacy (daily micturition frequency, urgency and incontinence episodes) and safety analyses. An additional 52-week active-controlled phase III safety study (mirabegron 50 mg versus tolterodine ER 4 mg) was included in the safety analysis. Male patients aged ⩾18 years with OAB for ⩾3 months were included in the analyses. Patients may also have a history of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH)/benign prostatic enlargement (BPE) or concomitant use of α1-blockers. RESULTS In the pooled studies, mirabegron 50 mg demonstrated superiority versus placebo (treatment difference: -0.37 [95% confidence interval (CI): -0.74, -0.01]) for reducing micturition frequency; improvements in urgency and incontinence were not significantly different between mirabegron 50 mg and placebo. In BEYOND, mirabegron 50 mg was comparable with solifenacin 5 mg for reducing micturition frequency, urgency, and incontinence episodes. Mirabegron was well tolerated at 12 and 52 weeks and overall treatment-emergent adverse events (AEs) were similar to those with placebo. CONCLUSIONS In a male OAB population with or without LUTS associated with BPH/BPE, mirabegron 50 mg provided similar improvements in urgency, frequency, and incontinence as solifenacin 5 mg, and is a well-tolerated alternative to antimuscarinics. In the three pooled 12-week studies, significant differences were not seen for urgency and incontinence versus placebo, although mirabegron 50 mg did demonstrate significant improvements versus placebo for frequency.
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Affiliation(s)
- Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, ‘Sapienza’ University, Via di Grottarossa 1035–1039, 00189 Rome, Italy
| | - José E. Batista
- Urodynamics Unit, URD/Hospital Quiron Teknon, Barcelona, Spain
| | - Victor W. Nitti
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Sender Herschorn
- Department of Surgery/Urology, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Moses Huang
- Astellas Pharma Europe Ltd, Chertsey, Surrey
| | - Matthias Oelke
- Department of Urology, Academic Medical Hospital, University of Maastricht, The Netherlands
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22
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Drake MJ, Nitti VW, Ginsberg DA, Brucker BM, Hepp Z, McCool R, Glanville JM, Fleetwood K, James D, Chapple CR. Comparative assessment of the efficacy of onabotulinumtoxinA and oral therapies (anticholinergics and mirabegron) for overactive bladder: a systematic review and network meta-analysis. BJU Int 2017; 120:611-622. [PMID: 28670786 DOI: 10.1111/bju.13945] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the efficacy of onabotulinumtoxinA, mirabegron, and anticholinergics in adults with idiopathic overactive bladder (OAB) using network meta-analysis (NMA). PATIENTS AND METHODS Information sources were searched for blinded randomised controlled trials (RCTs), of ≥2 weeks duration, comparing any dose of onabotulinumtoxinA, eligible oral/transdermal anticholinergics, or mirabegron, with each other or placebo, in adults with OAB. Bayesian random-effects models were used to synthesise the results at week 12: NMA for responder analyses and network meta-regression (NMR) for change from baseline analyses. The NMR was used to adjust for differences in baseline severity between studies. Sensitivity analysis, excluding studies considered to be at a high risk of methodological bias, was conducted. RESULTS In all, 56 RCTs were included in the networks. For each outcome, results are reported for all licensed treatment doses. For each NMR, results are based on patients with an average number of episodes of the outcome at baseline. After 12 weeks, all treatments were more efficacious than placebo. Patients who received onabotulinumtoxinA (100 U) had, on average, the greatest reductions in urinary incontinence episodes (UIE), urgency episodes, and micturition frequency, and the highest odds of achieving decreases of 100% and ≥50% from baseline in UIE/day. When comparing onabotulinumtoxinA with other pharmacotherapies, mean differences favoured onabotulinumtoxinA 100 U over all comparators for UIE and urgency episodes (credible intervals excluded zero) and all but two of the comparators for micturition frequency. OnabotulinumtoxinA 100 U was also associated with higher odds of achieving a 100% and ≥50% decrease in UIE/day than most other licensed treatments in the network. The exclusion of studies with a high risk of bias had little impact on the conclusions. CONCLUSION The results indicate that, after 12 weeks, onabotulinumtoxinA 100 U provides greater relief of OAB symptoms compared with most other licensed doses of other pharmacotherapies in the network.
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Affiliation(s)
- Marcus J Drake
- University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Victor W Nitti
- Department of Urology, New York University Langone Medical Center, New York, NY, USA
| | - David A Ginsberg
- Department of Urology, University of Southern California Institute of Urology, Los Angeles, CA, USA
| | - Benjamin M Brucker
- School of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Zsolt Hepp
- Global Health Economics and Outcomes Research, Allergan Inc., Irvine, CA, USA
| | - Rachael McCool
- York Health Economics Consortium (YHEC), University of York, York, UK
| | - Julie M Glanville
- York Health Economics Consortium (YHEC), University of York, York, UK
| | | | | | - Christopher R Chapple
- The Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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23
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Ginsberg DA, Drake MJ, Kaufmann A, Radomski S, Gousse AE, Chermansky CJ, Magyar A, Nicandro JP, Nitti VW. Long-Term Treatment with OnabotulinumtoxinA Results in Consistent, Durable Improvements in Health Related Quality of Life in Patients with Overactive Bladder. J Urol 2017; 198:897-904. [PMID: 28536084 DOI: 10.1016/j.juro.2017.05.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE We present the long-term effects of repeat onabotulinumtoxinA 100 U treatment on health related quality of life in patients with overactive bladder and urinary incontinence who had an inadequate response to and/or were intolerant of an anticholinergic. MATERIALS AND METHODS Patients who completed either of 2, 24-week phase III trials could enter a 3-year extension study and request multiple onabotulinumtoxinA 100 U treatments as needed. Results of the I-QOL (Incontinence-Quality of Life) and KHQ (King's Health Questionnaire) are reported for up to 6 treatments. Consistency of the response to repeat onabotulinumtoxinA treatments was evaluated by classifying patients by the I-QOL response to the first treatment and analyzing responses to treatments 2 to 6. RESULTS After onabotulinumtoxinA treatments 1 to 6, improvements in I-QOL scores were consistently 2 to 3 times the minimally important difference, and improvements in KHQ role limitations and social limitations domain scores were 5 to 6 and 3 to 4 times the minimally important difference, respectively. Most patients achieved or exceeded the minimally important difference for I-QOL and KHQ domain scores. Furthermore, 72.9% of patients who achieved or exceeded the minimally important difference for I-QOL after treatment 1 did so for all subsequent treatments. Of patients with a poor response after treatment 1, 38.3% achieved improvements greater than the minimally important difference for all subsequent treatments. CONCLUSIONS In patients with overactive bladder and incontinence consistent and clinically meaningful improvements in health related quality of life were observed with repeat onabotulinumtoxinA 100 U treatments. A positive response after treatment 1 tended to predict similar responses to subsequent treatments, whereas a lack of response to treatment 1 did not preclude positive response(s) to later treatments.
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Affiliation(s)
| | - Marcus J Drake
- University of Bristol and Bristol Urological Institute, Bristol, United Kingdom
| | | | | | - Angelo E Gousse
- Bladder Health and Reconstructive Urology Institute, Miami, Florida
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Armstrong B, Hoffman D, Zhao L, Nitti VW, Brucker B. V2-06 FEMALE DORSAL ONLAY BUCCAL MUCOSA GRAFT URETHROPLASTY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Drain A, Khan A, Ohmann EL, Brucker BM, Smilen S, Rosenblum N, Nitti VW. Use of Concomitant Stress Incontinence Surgery at Time of Pelvic Organ Prolapse Surgery Since Release of the 2011 Notification on Serious Complications Associated with Transvaginal Mesh. J Urol 2017; 197:1092-1098. [DOI: 10.1016/j.juro.2016.11.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Alice Drain
- New York University Langone Medical Center, New York, New York
| | - Aqsa Khan
- New York University Langone Medical Center, New York, New York
| | - Erin L. Ohmann
- New York University Langone Medical Center, New York, New York
| | | | - Scott Smilen
- New York University Langone Medical Center, New York, New York
| | - Nirit Rosenblum
- New York University Langone Medical Center, New York, New York
| | - Victor W. Nitti
- New York University Langone Medical Center, New York, New York
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26
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Nitti VW, Dmochowski R, Herschorn S, Sand P, Thompson C, Nardo C, Yan X, Haag-Molkenteller C. OnabotulinumtoxinA for the Treatment of Patients with Overactive Bladder and Urinary Incontinence: Results of a Phase 3, Randomized, Placebo Controlled Trial. J Urol 2017; 197:S216-S223. [DOI: 10.1016/j.juro.2016.10.109] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | - Peter Sand
- University of Chicago, Evanston, Illinois
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27
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Nitti VW. Midurethral sling erosion: NYU Case of the Month, August 2017. Rev Urol 2017; 19:185-186. [PMID: 29302242 PMCID: PMC5737346 DOI: 10.3909/riu0773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Victor W Nitti
- Department of Urology, NYU Langone Medical CenterYork, NY
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28
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Brucker BM, Campeau L, Fong E, Kalra S, Rosenblum N, Nitti VW. Radiation Exposure During Videourodynamics: Establishing Risk Factors. Low Urin Tract Symptoms 2016; 10:181-185. [PMID: 27990783 DOI: 10.1111/luts.12161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/09/2016] [Accepted: 09/07/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The use of fluoroscopy during urodynamics can be helpful in the evaluation of patients with lower urinary tract dysfunction. However, fluoroscopy introduces the potential hazards of ionizing radiation, including malignancy. In this study we analyzed the data for radiation exposure during videourodynamic study (VUDS) at our center; we have also tried to establish the factors associated with increased exposure to radiation during VUDS. METHODS We reviewed all VUDS from August 2010 to May 2011. Patients were included if they were ≥18 years old and had data recorded on total radiation exposure (radcm2 ). Age, sex, body mass index, fluoroscopy time, diagnosis, and urodynamic findings were recorded. Multivariate linear regression analysis was used to identify independent risk factors that influenced increased radiation exposure. RESULTS A total of 203 videourodynamic studies were assessed in 106 female and 97 male patients with a mean age of 64.3 and body mass index of 26.8. The average fluoroscopy time was 100.2 sec and exposure was 560.9 radcm2 . The most common indication for videourodynamics was incontinence, 40.9%. On multivariate linear regression analysis body mass index, vesico-ureteral reflux, sex, number of fill cycles, and larger capacity were independent predictors of increased radiation exposure. CONCLUSIONS We have shown that increased radiation exposure as measure with Dose Area Product during VUDS was significantly associated with larger BMI, female gender, larger bladder capacity, presence of VUR, junior operator, and higher number of fill cycles. Further studies are now underway to attempt to reduce exposure based on these findings.
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Affiliation(s)
- Benjamin M Brucker
- Department of Urology, New York University Langone Medical Center, New York, New York, USA
| | - Lysanne Campeau
- Department of Urology, McGill University, Montreal, Quebec, Canada
| | - Eva Fong
- Department of Urology, New York University Langone Medical Center, New York, New York, USA
| | - Sidhartha Kalra
- Department of Urology, New York University Langone Medical Center, New York, New York, USA
| | - Nirit Rosenblum
- Department of Urology, New York University Langone Medical Center, New York, New York, USA
| | - Victor W Nitti
- Department of Urology, New York University Langone Medical Center, New York, New York, USA
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30
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Brucker BM, Nitti VW, Kalra S, Herbert J, Sadiq A, Utomo P, Aponte MM. Barriers experienced by patients with multiple sclerosis in seeking care for lower urinary tract symptoms. Neurourol Urodyn 2016; 36:1208-1213. [PMID: 27548624 DOI: 10.1002/nau.23101] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/29/2016] [Indexed: 11/09/2022]
Abstract
AIM The Actionable Bladder Symptom and Screening Tool (ABSST) is used to identify multiple sclerosis (MS) patients in possible need of evaluation for urinary symptoms. The primary objective of this study was to identify barriers experienced by MS patients in seeking evaluation for urinary symptoms. We also assessed the utility of ABSST tool in identifying patients that will follow up with urologic evaluation. METHODS This was a prospective observational study where 100 patients with MS were enrolled from an MS center. Patients completed demographic information, questions to assess barriers to care, a short form of the ABSST, and incontinence questionnaires. An ABSST score >3 met criteria for referral and evaluation. One year after enrollment, follow up calls assessed whether patients had seen a urinary specialist. RESULTS The most common barriers to seeking care included "Doctor never referred" (16%) and "Doctor never asked" (13%). Thirty-eight percent (n = 8/21) of men stated "Doctor never referred" compared to 10% (n = 8/79) of women (P = 0.002). Twenty-seven patients had an ABSST Score ≥3 and were more interested in seeing a specialist compared to those scoring <3 (88.9%, n = 24/27 vs. 26%, n = 19/73; P = <0.001). After 1 year, 70 patients were reached for follow up. A total of 57.9% (n = 11/19) patients who followed up for evaluation screened positive on the ABSST. CONCLUSIONS The ABSST is a valuable tool to identify MS patients with urinary symptoms who will likely follow up for genitourinary evaluation. However, other barriers beyond awareness exist and prevent patients from being evaluated.
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Affiliation(s)
| | - Victor W Nitti
- Department of Urology, NYU Langone Medical Center, New York, New York
| | - Sidhartha Kalra
- Department of Urology, NYU Langone Medical Center, New York, New York
| | - Joseph Herbert
- Department of Neurology, NYU Langone Medical Center, New York, New York
| | - Areeba Sadiq
- Department of Urology, NYU Langone Medical Center, New York, New York
| | - Puspa Utomo
- Department of Neurology, NYU Langone Medical Center, New York, New York
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31
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Rosa GM, Ferrero S, Nitti VW, Wagg A, Saleem T, Chapple CR. Cardiovascular Safety of β3-adrenoceptor Agonists for the Treatment of Patients with Overactive Bladder Syndrome. Eur Urol 2016; 69:311-23. [DOI: 10.1016/j.eururo.2015.09.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/04/2015] [Indexed: 01/09/2023]
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32
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Wagg A, Nitti VW, Kelleher C, Castro-Diaz D, Siddiqui E, Berner T. Oral pharmacotherapy for overactive bladder in older patients: mirabegron as a potential alternative to antimuscarinics. Curr Med Res Opin 2016; 32:621-38. [PMID: 26828974 DOI: 10.1185/03007995.2016.1149806] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Overactive bladder (OAB) is a particular challenge to treat in older adults with co-morbid conditions taking multiple medications. Antimuscarinics (e.g., solifenacin, fesoterodine) and β3-adrenergic receptor agonists (mirabegron) are similarly efficacious; however, antimuscarinics may be associated with side effects that result in poor persistence and contribute to anticholinergic burden, particularly in those taking other medications with anticholinergic properties. With a mechanism of action distinct from antimuscarinics, mirabegron has a different tolerability profile and does not contribute to anticholinergic burden. The objective of this review was to compare and contrast the tolerability profiles of antimuscarinics and mirabegron in older patients to inform practice. METHODS Prospective trials or retrospective subgroup analyses of antimuscarinics for the treatment of OAB in older patients were identified through a search of PubMed. Tolerability data and results of subgroup analyses of mirabegron in patients aged ≥65 and ≥75 years from a pooled analysis of three trials each of 12 weeks and a 1 year trial are described. RESULTS Anticholinergic adverse events (AEs) including dry mouth and constipation were more frequent with antimuscarinics versus mirabegron. In patients aged ≥65 years, dry mouth occurred with a six-fold higher incidence with tolterodine extended-release (ER) 4 mg than with mirabegron 25 mg or 50 mg over 12 weeks, and a three-fold higher incidence with tolterodine ER than mirabegron 50 mg over 1 year. Mirabegron had a low incidence of central nervous system effects. A systematic review of the cardiovascular safety profile of mirabegron has not identified any clinically significant effects on blood pressure or pulse rate at therapeutic doses amongst patients aged ≥65 years. CONCLUSIONS Mirabegron has a more favorable tolerability profile than antimuscarinics amongst older patients and may provide an improved benefit-to-risk ratio and therefore be considered as an alternative to antimuscarinics for older patients.
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Affiliation(s)
| | | | - Con Kelleher
- c Guy's and St Thomas' NHS Foundation Trust , UK
| | | | - Emad Siddiqui
- e Astellas Pharma Europe Ltd , Chertsey , Surrey , UK
| | - Todd Berner
- f Formerly of Astellas Scientific and Medical Affairs , Northbrook , IL , USA
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Sievert KD, Chapple C, Herschorn S, Joshi M, Zhou J, Nardo C, Nitti VW. OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder. Int J Clin Pract 2014; 68:1246-56. [PMID: 24754838 PMCID: PMC4282287 DOI: 10.1111/ijcp.12443] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION A prespecified pooled analysis of two placebo-controlled, phase 3 trials evaluated whether the number of prior anticholinergics used or reason for their discontinuation affected the treatment response to onabotulinumtoxinA 100U in overactive bladder (OAB) patients with urinary incontinence (UI). METHODS Patients with symptoms of OAB received intradetrusor injections of onabotulinumtoxinA 100U or placebo, sparing the trigone. Change from baseline at week 12 in UI episodes/day, proportion of patients reporting a positive response ('greatly improved' or 'improved') on the treatment benefit scale (TBS), micturition and urgency were evaluated by number of prior anticholinergics (1, 2 or ≥ 3) and reason for their discontinuation (insufficient efficacy or side effects). Adverse events (AE) were assessed. RESULTS Patients had taken an average of 2.4 anticholinergics before study enrolment. OnabotulinumtoxinA reduced UI episodes/day from baseline vs. placebo, regardless of the number of prior anticholinergics (-2.82 vs. -1.52 for one prior anticholinergic; -2.58 vs. -0.58 for two prior anticholinergics; and -2.92 vs. -0.73 for three or more prior anticholinergics; all p < 0.001). The proportion of TBS responders was higher with onabotulinumtoxinA vs. placebo (69.0% vs. 37.2% for one prior anticholinergic; 58.8% vs. 24.8% for two prior anticholinergics and 56.4% vs. 22.5% for three or more prior anticholinergics; all p < 0.001). Similar results were observed regardless of the reason for discontinuation. OnabotulinumtoxinA reduced the episodes of urgency and frequency of micturition vs. placebo in all groups. AEs were well tolerated, with a comparable incidence in all groups. CONCLUSION In patients with symptoms of OAB who were inadequately managed by one or more anticholinergics, onabotulinumtoxinA 100U provided significant and similar treatment benefit and safety profile regardless of the number of prior anticholinergics used or reason for inadequate management of OAB. ClinicalTrials.gov: NCT00910845, NCT00910520.
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Affiliation(s)
- K-D Sievert
- Department of Urology, University of Tuebingen, Tuebingen, Germany
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34
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Wagg A, Cardozo L, Nitti VW, Castro-Diaz D, Auerbach S, Blauwet MB, Siddiqui E. The efficacy and tolerability of the β3-adrenoceptor agonist mirabegron for the treatment of symptoms of overactive bladder in older patients. Age Ageing 2014; 43:666-75. [PMID: 24610862 DOI: 10.1093/ageing/afu017] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION mirabegron is a β3-adrenoceptor agonist developed for the treatment of symptoms of overactive bladder (OAB). As the prevalence of OAB increases with age, a prospective subanalysis of individual and pooled efficacy and tolerability data from three 12-week, randomised, Phase III trials, and of tolerability data from a 1-year safety trial were conducted in order to evaluate the efficacy and tolerability of mirabegron in subgroups of patients aged ≥65 and ≥75 years. METHODS primary efficacy outcomes were change from baseline to final visit in the mean number of incontinence episodes/24 h and the mean number of micturitions/24 h. Tolerability was assessed by the incidence of treatment-emergent adverse events (TEAEs). RESULTS over 12 weeks mirabegron 25 mg and 50 mg once-daily reduced the mean numbers of incontinence episodes and micturitions/24 h from baseline to final visit in patients aged ≥65 and ≥75 years. Mirabegron was well tolerated: in both age groups, hypertension and urinary tract infection were among the most common TEAEs over 12 weeks and 1 year. The incidence of dry mouth, a typical anticholinergic TEAE, was up to sixfold higher among the older patients randomised to tolterodine than any dose of mirabegron. CONCLUSIONS these analyses have demonstrated the efficacy of mirabegron over 12 weeks and the tolerability of mirabegron over 12 weeks and 1 year in OAB patients aged ≥65 and ≥75 years, supporting mirabegron as a therapeutic option in older patients with OAB.
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Affiliation(s)
- Adrian Wagg
- Department of Geriatric Medicine, University of Alberta, Alberta, Canada
| | - Linda Cardozo
- Department of Urogynaecology, Kings College London, London, UK
| | - Victor W Nitti
- Department of Urology, NYU Langone Medical Center, New York City, NY, USA
| | - David Castro-Diaz
- Department of Urology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Tenerife, Spain
| | - Stephen Auerbach
- Department of Urology, Hoag Memorial Presbyterian Hospital, Newport Beach, Long Beach, CA, USA
| | - Mary Beth Blauwet
- Department of Biostatistics, Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | - Emad Siddiqui
- Astellas Pharma Europe Ltd, Chertsey, Surrey, UK and Department of Urology, Ealing Hospital, London, UK
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Nitti VW, Chapple CR, Walters C, Blauwet MB, Herschorn S, Milsom I, Auerbach S, Radziszewski P. Safety and tolerability of the β3 -adrenoceptor agonist mirabegron, for the treatment of overactive bladder: results of a prospective pooled analysis of three 12-week randomised Phase III trials and of a 1-year randomised Phase III trial. Int J Clin Pract 2014; 68:972-85. [PMID: 24703195 DOI: 10.1111/ijcp.12433] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIMS To evaluate the safety and tolerability of the β3 -adrenoceptor agonist, mirabegron, in patients with overactive bladder (OAB). METHODS Tolerability and safety data from three 12-week, randomised, placebo-controlled, double-blind, Phase III trials (Studies 046, 047 and 074) were pooled by treatment group. The three studies were of a similar design, although the assessed doses of mirabegron [25, 50 or 100 mg once daily (qd)] varied, and tolterodine extended release (ER) 4 mg was included as an active-control arm in Study 046 only. Tolerability and safety data from a 1-year, randomised, double-blind, Phase III trial (Study 049) are also presented. Safety variables included the incidence and severity of treatment-emergent adverse events (TEAEs), vital signs and electrocardiogram data. RESULTS Mirabegron (25, 50 or 100 mg qd) was safe and well-tolerated in patients with OAB over 12-week (n = 2736) and 1-year (n = 1632) periods. The incidence of TEAEs and treatment discontinuations as a result of TEAEs was low; the majority were mild in severity and few were serious. Hypertension, nasopharyngitis and urinary tract infection were the most common TEAEs with mirabegron. The mirabegron tolerability profile was similar to that seen with placebo and tolterodine ER 4 mg, except for dry mouth, which occurred, on average, five times less frequently with mirabegron than tolterodine ER 4 mg. In the pooled 12-week analysis, mirabegron 50 mg was associated with placebo-adjusted mean increases of 0.4-0.6 mmHg in blood pressure and approximately one beat per minute in pulse rate, both reversible upon treatment discontinuation. The incidence of Major Adverse Cardiovascular Events as adjudicated by an independent cardiovascular committee was low and similar across treatment groups. CONCLUSION The favourable tolerability profile of mirabegron in patients with OAB may allow improved treatment compliance compared with antimuscarinics, with important implications for patient outcomes.
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Affiliation(s)
- V W Nitti
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
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Brucker BM, Nitti VW. Urodynamics. Urol Clin North Am 2014; 41:xiii. [PMID: 25063604 DOI: 10.1016/j.ucl.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Benjamin M Brucker
- Department of Urology, New York University Langone Medical Center, 150 East 32nd Street, Second Floor, New York, NY 10016, USA.
| | - Victor W Nitti
- Department of Urology, New York University Langone Medical Center, 150 East 32nd Street, Second Floor, New York, NY 10016, USA.
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Comiter CV, Rhee EY, Tu LM, Herschorn S, Nitti VW. The virtue sling--a new quadratic sling for postprostatectomy incontinence--results of a multinational clinical trial. Urology 2014; 84:433-8. [PMID: 24972946 DOI: 10.1016/j.urology.2014.02.062] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/26/2014] [Accepted: 02/28/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To successfully perform male sling surgery, and the surgery must achieve proximal urethral relocation and/or bulbar urethral compression. The Virtue quadratic sling is a novel device that incorporates both mechanisms of action. We report the 1-year results of the Virtue sling with fixation and compare it with the results of the initial "unfixed" sling trial. METHODS A prospective trial was performed to assess the efficacy and safety of the Virtue sling. Objective success was predefined as >50% decrease in 24-hour pad weight and subjective success as a score of "much" or "very much" better on the Patient Global Impression of Improvement. Subgroups were analyzed by baseline incontinence: mild (<100 g), moderate (100-400 g), and severe (>400 g). After analysis of the 1-year data, a second clinical trial incorporating a novel "fixation" technique was performed, with similar outcome measures. RESULTS In the initial cohort, subjective and objective successes were achieved in 41.9% at 12 months. Median pad weight reduction was 51.1% at 12 months and varied with the degree of baseline leakage. In the fixation cohort, subjective and objective successes were 70.9% and 79.2%, median pad weight reduction was 88.3% at 12 months, and efficacy was similar regardless of baseline incontinence. There were no cases of prolonged retention and no severe adverse events. CONCLUSION The Virtue sling with fixation is a safe and efficacious treatment for postprostatectomy incontinence. Superior 12-month results compared with the unfixed device demonstrate that fixation prevents early sling loosening.
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Affiliation(s)
- Craig V Comiter
- Department of Urology, Stanford University Medical School, Stanford, CA.
| | - Eugene Y Rhee
- Department of Urology, Kaiser Permanente Medical Group, San Diego, CA
| | - Le-Mai Tu
- Department of Urology, Universite de Sherbrooke, Quebec, Canada
| | - Sender Herschorn
- Department of Urology, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Victor W Nitti
- Department of Urology, New York University Langone Medical Center, New York, NY
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Cardozo L, Staskin D, Currie B, Wiklund I, Globe D, Signori M, Dmochowski R, MacDiarmid S, Nitti VW, Noblett K. Validation of a bladder symptom screening tool in women with incontinence due to overactive bladder. Int Urogynecol J 2014; 25:1655-63. [PMID: 24859795 PMCID: PMC4234889 DOI: 10.1007/s00192-014-2417-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis The Actionable Bladder Symptom Screening Tool (ABSST) was initially developed to identify patients with multiple sclerosis (MS) who could benefit from lower urinary tract assessment and treatment. Assessment of the measurement properties of the ABSST, including its ability to identify patients experiencing bladder symptoms related to overactive bladder (OAB), was undertaken in a general female population. Methods One hundred women completed the ABSST, OAB Questionnaire Short Form (OAB-q SF), and a patient global impression of severity (PGI-S) scale. Half of the sample had urgency urinary incontinence (UUI), while the other half did not. Descriptive statistics, reliability, and validity were examined, as was sensitivity and specificity of the previous cut-off score established in MS. Results Fifty-three women with UUI/OAB and 47 controls took part (71.0 % Caucasian). Patients with UUI/OAB were older (54.6 vs 40.4 years), had a higher body mass index (31.1 vs 26.4 kg/m2), and more comorbid conditions. The Cronbach’s alpha reliability of ABSST was 0.90. High correlations with OAB-q SF Symptom Bother and Health Related Quality of Life (r = 0.83 and −0.81 respectively) supported concurrent validity. Using the PGI-S severity scores as a reference, the ABSST was able to distinguish patients with differing severity levels (known-group validity). Physician assessment of the need for further evaluation/treatment showed sensitivity (79 %) and specificity (98 %), supporting a cut-off score of ≥3. Conclusions The previous MS ABSST scoring algorithm was validated in a non-neurogenic female population. ABSST is a reliable, valid, and sensitive tool for screening women with UUI/OAB.
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Affiliation(s)
- Linda Cardozo
- NHS, Department of Urogynaecology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK,
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Affiliation(s)
- Victor W. Nitti
- New York University Langone Medical Center, New York, New York
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Nitti VW, Mourtzinos A, Brucker BM. Correlation of patient perception of pad use with objective degree of incontinence measured by pad test in men with post-prostatectomy incontinence: the SUFU Pad Test Study. J Urol 2014; 192:836-42. [PMID: 24650425 DOI: 10.1016/j.juro.2014.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Many investigators have used the number of pads to determine the severity of post-prostatectomy incontinence and yet the accuracy of this tool remains unproven. We determined whether the patient perception of pad use and urine loss reflects actual urine loss. We also identified a quality of life measure that distinguishes patients by severity of incontinence. MATERIALS AND METHODS We prospectively enrolled 235 men from a total of 18 sites 6 months or more after radical prostatectomy who had incontinence requiring protection. Patients completed a questionnaire on the perception of pad number, size and wetness, a quality of life question, several standardized incontinence questionnaires and a 24-hour pad test that assessed pad number, size and weight. SPSS® was used for statistical analysis. RESULTS Perception of the number of pads used closely agreed with the number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p <0.001). Patients with wet and soaked pads had statistically and clinically significantly different pad weights that were uniquely different from each other and from those of patients who were almost dry and slightly wet. Response to the quality of life question separated the men into 4 statistically significantly different groups based on mean 24-hour pad weight. CONCLUSIONS Patients accurately described the number, size and degree of wetness of pads collected during a 24-hour pad test. These values correlated well with actual urine loss. The single question, "To what extent does urine loss affect your quality of life?" separated men into distinct categories.
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Affiliation(s)
- Victor W Nitti
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts.
| | - Arthur Mourtzinos
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts
| | - Benjamin M Brucker
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts
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Gomes CM, Sammour ZM, Bessa Junior JD, Barbosa ER, Lopes RI, Sallem FS, Trigo-Rocha FE, Bruschini H, Nitti VW, Srougi M. Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease. Clinics (Sao Paulo) 2014; 69:817-22. [PMID: 25627993 PMCID: PMC4286669 DOI: 10.6061/clinics/2014(12)05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/12/2014] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease. METHODS In a prospective study, 33 consecutive men (mean age 59.2 ± 7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated. RESULTS Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4 ± 7.5 to 11.1 ± 6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8 ± 1.1 to 1.0 ± 1.0 (p<0.001) and the maximum urinary flow varied from 9.3 ± 4.4 to 11.2 ± 4.6 ml/s (p=0.025). The severity of neurological impairment was the only predictor of the clinical response. Additionally, patients with a Unified Parkinson's Disease Rating Scale score lower than 70 had a significantly higher chance of clinical improvement with doxazosin treatment than those with higher Unified Parkinson's Disease Rating Scale scores did (RR=3.10, 95% CI=[1.15 to 5.37], p=0.011). CONCLUSIONS Doxazosin resulted in the improvement of lower urinary tract symptoms and the maximum flow rate and was well tolerated in men with Parkinson's disease. The response to treatment is dependent on the severity of neurological disability.
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Affiliation(s)
- Cristiano M Gomes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Zein M Sammour
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Jose de Bessa Junior
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Egberto R Barbosa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil
| | - Roberto I Lopes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Flávio S Sallem
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil
| | - Flavio E Trigo-Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Homero Bruschini
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Victor W Nitti
- New York University, Department of Urology, New York, USA
| | - Miguel Srougi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
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Brucker BM, Nitti VW. Reply: To PMID 24295256. Urology 2013; 82:1429. [PMID: 24295258 DOI: 10.1016/j.urology.2013.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Benjamin M Brucker
- Department of Urology, New York University, Langone Medical Center, New York, NY
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Angulo JC, Khullar V, Nitti VW, Siddiqui E. Evidence available on the use of the selective β3-adrenoceptor agonist mirabegron for the treatment of overactive bladder. Actas Urol Esp 2013; 37:640-51. [PMID: 23850394 DOI: 10.1016/j.acuro.2013.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 11/19/2022]
Abstract
CONTEXT Mirabegron, the selective β3-adrenoceptor agonist, heralds the latest development for the treatment of overactive bladder (OAB). OBJECTIVE To present the evidence available on the efficacy and tolerability of mirabegron and to discuss this treatment's potential in our setting. EVIDENCE ACQUISITION We reviewed 11 studies conducted with mirabegron in patients with OAB (2 phase II, 9 phase III), all studies were compared to placebo with 6 studies also including tolterodine as an additional arm. Greater emphasis shall be given to the main phase III trials performed in Europe, the USA and Australia evaluating efficacy and safety after 12 weeks (NCT00662909, NCT00689104, NCT00912964) and safety after 12 months (NCT00688688). The combined analyses of these 12 week studies is also available, with emphasis on global efficacy (FAS), efficacy with regard to incontinence (FAS i) and safety (SAF). More than 50% of patients had previously discontinued anticholinergics medication for OAB, thus allowing us to obtain data on the effectiveness of mirabegron in patients already treated with anticholinergics. EVIDENCE SYNTHESIS Mirabegron is an efficacious drug which presents a statistically significant reduction in the number of incontinence episodes and in urinary frequency as of 4 weeks, with a higher percentage of dry patients and a higher percentage of patients with reduction ≥50% in the number of incontinence episodes than placebo. The efficacy of mirabegron 50 and 100mg in the reduction of incontinence episodes occurs in de novo patients and who have received antimuscarinics, with adjusted mean difference and improvement in urinary frequency greater in treated patients. Its tolerability is very similar to placebo particularly for the adverse effects of the antimuscarinics (dry mouth, constipation and blurred vision). A minimal, non-clinically significant change is observed in systolic and diastolic blood pressure and pulse. Its efficacy is long-term. Mirabegron at the doses of 50 and 100mg presents an improvement versus placebo in patient satisfaction, health-related quality of life (HRQoL), symptom bother and patient's perception of bladder condition (PPBC). In the 12 week Phase III European study tolterodine delivered a lesser degree of improvement than mirabegron versus placebo in patient satisfaction, HRQoL, symptom bother and PPBC. CONCLUSIONS Mirabegron is the first of a new class of compounds with a novel mechanism of action that is different to the antimuscarinics. It presents significant and clinically important efficacy in the treatment of the symptoms of OAB. It has advantages with regard to the results described by the patient in treatment satisfaction. Studies on its combined use with anticholinergics are ongoing.
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Affiliation(s)
- J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España.
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Hickling DR, Ballert KN, Nitti VW. Complications of Male Incontinence Surgery. Curr Bladder Dysfunct Rep 2013. [DOI: 10.1007/s11884-013-0212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chapple CR, Cardozo L, Nitti VW, Siddiqui E, Michel MC. Mirabegron in overactive bladder: a review of efficacy, safety, and tolerability. Neurourol Urodyn 2013; 33:17-30. [PMID: 24127366 DOI: 10.1002/nau.22505] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/13/2013] [Indexed: 11/11/2022]
Abstract
AIMS Mirabegron, the first β3 -adrenoceptor agonist to enter clinical practice, has a different mechanism of action from antimuscarinic agents. This review presents data on the efficacy, safety, and tolerability of mirabegron in studies conducted to date. METHODS All clinical data on mirabegron that are currently in the public domain are included, including some in-press manuscripts. RESULTS In Phase III clinical trials in patients with overactive bladder (OAB), mirabegron at daily doses of 25, 50, and 100 mg demonstrated significant efficacy in treating the symptoms of OAB, including micturition frequency, urgency incontinence, and urgency. Significant improvements in micturition frequency, urgency incontinence, and mean volume voided/micturition were seen as early as the first assessment (week 4) for mirabegron 50 and 100 mg, and were maintained throughout treatment. Responder analyses showed a significant improvement with mirabegron 50 and 100 mg in terms of dry rates, ≥50% reduction in mean number of incontinence episodes/24 hr, and the proportion of patients with ≤8 micturitions/24 hr at final visit. The benefit of mirabegron 50 and 100 mg was also evident in patients ≥65 years of age, and in both treatment-naïve patients and those who previously discontinued antimuscarinic therapy. These data therefore demonstrate a clinically meaningful benefit with mirabegron in the objective endpoints of OAB. Assessment of measures of health-related quality of life and treatment satisfaction showed that patients perceived treatment with mirabegron as meaningful. In OAB clinical trials of up to 12 months mirabegron appeared to be well tolerated. The most common adverse events (AEs) observed with mirabegron in clinical trials of up to 12 months were hypertension, nasopharyngitis, and urinary tract infection. The incidence of dry mouth was similar to placebo, and was between three and fivefold less than for tolterodine extended release 4 mg. Since dry mouth is the most bothersome AE associated with antimuscarinic drugs and often a reason for treatment discontinuation, mirabegron may be a valuable treatment option for these patients. CONCLUSIONS In Phase III clinical trials, mirabegron at daily doses of 25, 50, and 100 mg demonstrated significant efficacy in treating symptoms of OAB and, at doses of 50 and 100 mg, demonstrated significant improvements versus placebo on key secondary endpoints, as early as the first assessment (week 4), and these were maintained throughout treatment. In OAB clinical trials of up to 12 months, mirabegron appeared to be well tolerated.
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Affiliation(s)
- Christopher R Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom
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Nitti VW, Khullar V, van Kerrebroeck P, Herschorn S, Cambronero J, Angulo JC, Blauwet MB, Dorrepaal C, Siddiqui E, Martin NE. Mirabegron for the treatment of overactive bladder: a prespecified pooled efficacy analysis and pooled safety analysis of three randomised, double-blind, placebo-controlled, phase III studies. Int J Clin Pract 2013; 67:619-32. [PMID: 23692526 PMCID: PMC3752932 DOI: 10.1111/ijcp.12194] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/20/2013] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION To examine pooled efficacy data from three, large phase III studies comparing mirabegron (50 and 100 mg) with placebo, and pooled safety data including additional mirabegron 25 mg and tolterodine extended release (ER) 4 mg results. METHODS This prespecified pooled analysis of three randomised, double-blind, placebo-controlled, 12-week studies, evaluated efficacy and safety of once-daily mirabegron 25 mg (safety analysis), 50 or 100 mg (efficacy and safety analyses) and tolterodine ER 4 mg (safety analysis) for the treatment of symptoms of overactive bladder (OAB). Co-primary efficacy measures were change from baseline to Final Visit in the mean number of incontinence episodes/24 h and mean number of micturitions/24 h. Key secondary efficacy end-points included mean number of urgency episodes/24 h and mean volume voided/micturitions, while other end-points included patient-reported outcomes according to the Treatment Satisfaction-Visual Analogue Scale (TS-VAS) and responder analyses [dry rate (posttreatment), ≥ 50% reduction in incontinence episodes/24 h, ≤ 8 micturitions/24 h (post hoc analysis)]. The safety analysis included adverse event (AE) reporting, laboratory assessments, ECG, postvoid residual volume and vital signs (blood pressure, pulse rate). RESULTS Mirabegron (50 and 100 mg once daily) demonstrated statistically significant improvements compared with placebo for the co-primary end-points, key secondary efficacy variables, TS-VAS and responder analyses (all comparisons p < 0.05). Mirabegron is well tolerated and demonstrates a good safety profile. The most common AEs (≥ 3%) included hypertension, nasopharyngitis and urinary tract infection (UTI); the incidence of hypertensive events and UTIs decreased with increasing dose. For mirabegron, the incidence of the bothersome antimuscarinic AE, dry mouth, was at placebo level and of a lesser magnitude than tolterodine. CONCLUSION The efficacy and safety of mirabegron are demonstrated in this large pooled clinical trial dataset in patients with OAB.
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Affiliation(s)
- V W Nitti
- Department of Urology, NYU Langone Medical Center, New York, NY, USA.
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Nitti VW, Rosenberg S, Mitcheson DH, He W, Fakhoury A, Martin NE. Urodynamics and safety of the β₃-adrenoceptor agonist mirabegron in males with lower urinary tract symptoms and bladder outlet obstruction. J Urol 2013; 190:1320-7. [PMID: 23727415 DOI: 10.1016/j.juro.2013.05.062] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE Bladder outlet obstruction often presents as storage and voiding symptoms. We investigated urodynamic parameters in men with lower urinary tract symptoms and bladder outlet obstruction treated with the β₃ agonist mirabegron, a new therapy for overactive bladder symptoms. MATERIALS AND METHODS A total of 200 men 45 years old or older with lower urinary tract symptoms and bladder outlet obstruction were randomized to receive once daily mirabegron 50 mg (70) or 100 mg (65), or placebo (65) for 12 weeks. The primary urodynamic parameters assessed were change from baseline to end of treatment in maximum urinary flow and detrusor pressure at maximum urinary flow (noninferiority margins -3 ml per second and 15 cm H2O, respectively). We evaluated adverse events and vital signs. RESULTS Treatment with mirabegron 50 and 100 mg was noninferior to placebo based on the lower and upper limits of the 95% CI, respectively, for maximum urinary flow and detrusor pressure at maximum urinary flow. The adjusted mean difference vs placebo was 0.40 (95% CI -0.63, 1.42) and 0.62 ml per second (95% CI -0.43, 1.68) for maximum urinary flow, and -5.94 (95% CI -13.98, 2.09) and -1.39 cm H2O (95% CI -9.73, 6.96), respectively, for detrusor pressure at maximum urinary flow. The incidence of adverse events was similar for mirabegron and placebo. CONCLUSIONS Mirabegron did not adversely affect voiding urodynamics (maximum urinary flow and detrusor pressure at maximum urinary flow) compared with placebo after 12 weeks of treatment.
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Affiliation(s)
- Victor W Nitti
- Department of Urology, New York University Langone Medical Center, New York, New York.
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Aponte MM, Shah SR, Hickling D, Brucker BM, Rosenblum N, Nitti VW. Urodynamics for clinically suspected obstruction after anti-incontinence surgery in women. J Urol 2013; 190:598-602. [PMID: 23567748 DOI: 10.1016/j.juro.2013.03.113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE We determined the usefulness of urodynamics in patients with obstruction secondary to anti-incontinence surgery. MATERIALS AND METHODS We retrospectively reviewed the records of all procedures performed from January 2001 to June 2011 to relieve obstruction due to anti-incontinence surgery. Patients were excluded from study if they underwent prior procedures to relieve obstruction, followup data were missing or a neurological disorder was present. Patients were grouped into categories before intervention, including urodynamics diagnostic of obstruction vs nondiagnostic urodynamics vs no urodynamics testing. We also separated patients with predominantly storage symptoms and those with incomplete emptying. RESULTS A total of 71 women were included in analysis. Of 54 women who presented with increased post-void residual urine volume 33 (61%) were diagnosed with obstruction on urodynamics, urodynamics was not diagnostic in 4 (7.4%) and 17 (32%) did not undergo urodynamics preoperatively. All 18 patients with predominantly storage symptoms underwent urodynamics. In patients with incomplete emptying there was no difference between the groups in storage or voiding symptom improvement, overall cure or success according to whether diagnostic urodynamics were or were not done. Of patients with storage symptoms who underwent urodynamics those without evidence of detrusor overactivity had significantly greater storage symptom improvement than those with detrusor overactivity (85.7% vs 53.8%, p = 0.02). CONCLUSIONS When voiding symptoms or urinary retention is the primary indication for intervention after anti-incontinence surgery, urodynamic findings are not predictive of outcomes after intervention to relieve obstruction. If storage symptoms are the main indication for intervention, urodynamics may be valuable for patient counseling.
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Affiliation(s)
- Margarita M Aponte
- Departments of Urology, New York University Langone Medical Center, New York, New York, and McIver Clinic (SRS), Jacksonville, Florida, USA.
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Hickling DR, Nitti VW. Management of recurrent urinary tract infections in healthy adult women. Rev Urol 2013; 15:41-48. [PMID: 24082842 PMCID: PMC3784967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Recurrence after urinary tract infection (rUTI) is common in adult women. The majority of recurrences are believed to be reinfection from extraurinary sources such as the rectum or vagina. However, uropathogenic Escherichia coli are now known to invade urothelial cells and form quiescent intracellular bacterial reservoirs. Management of women with frequent symptomatic rUTI can be particularly vexing for both patients and their treating physicians. This review addresses available and promising management strategies for rUTI in healthy adult women.
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Affiliation(s)
- Duane R Hickling
- Department of Urology, New York University Langone Medical Center, New York, NY
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Nitti VW, Dmochowski R, Herschorn S, Sand P, Thompson C, Nardo C, Yan X, Haag-Molkenteller C. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol 2012; 189:2186-93. [PMID: 23246476 DOI: 10.1016/j.juro.2012.12.022] [Citation(s) in RCA: 255] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 12/12/2022]
Abstract
PURPOSE Overactive bladder affects 12% to 17% of the general population and almost a third experience urinary incontinence, which may severely impact health related quality of life. Oral anticholinergics are the mainstay of pharmacological treatment but they are limited by inadequate efficacy or side effects, leading to a high discontinuation rate. We report the results of the first large (557 patients), phase 3, placebo controlled trial of onabotulinumtoxinA in patients with overactive bladder and urinary incontinence inadequately managed with anticholinergics. MATERIALS AND METHODS Eligible patients with overactive bladder, 3 or more urgency urinary incontinence episodes in 3 days and 8 or more micturitions per day were randomized 1:1 to receive intradetrusor injection of onabotulinumtoxinA 100 U or placebo. Co-primary end points were the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients with a positive response on the treatment benefit scale at posttreatment week 12. Secondary end points included other overactive bladder symptoms and health related quality of life. Adverse events were assessed. RESULTS OnabotulinumtoxinA significantly decreased the daily frequency of urinary incontinence episodes vs placebo (-2.65 vs -0.87, p <0.001) and 22.9% vs 6.5% of patients became completely continent. A larger proportion of onabotulinumtoxinA than placebo treated patients reported a positive response on the treatment benefit scale (60.8% vs 29.2%, p <0.001). All other overactive bladder symptoms improved vs placebo (p ≤ 0.05). OnabotulinumtoxinA improved patient health related quality of life across multiple measures (p <0.001). Uncomplicated urinary tract infection was the most common adverse event. A 5.4% rate of urinary retention was observed. CONCLUSIONS OnabotulinumtoxinA 100 U showed significant, clinically relevant improvement in all overactive bladder symptoms and health related quality of life in patients inadequately treated with anticholinergics and was well tolerated.
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Affiliation(s)
- Victor W Nitti
- New York University Urology Associates, New York, New York, USA.
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