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Andersson KE. Promising therapeutic targets for the treatment of urine storage dysfunction: what's the status? Expert Opin Ther Targets 2024:1-8. [PMID: 38629152 DOI: 10.1080/14728222.2024.2344698] [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: 11/19/2023] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Opinions differ on what drugs have both a rationale and a development potential for the treatment of bladder storage dysfunction. AREAS COVERED In the present review, the focus is given to small molecule blockers of TRP channels (TRPV1, TRPV4, TRPA1, and TRPM8), P2 × 3receptor antagonists, drugs against oxidative stress, antifibrosis agents, cyclic nucleotide - dependent pathways, and MaxiK±channel - gene therapy. EXPERT OPINION TRPV1 channel blockers produce hypothermia which seems to be a problem even with the most efficacious second-generation TRPV1 antagonists. This has so far precluded their application to urine storage disorders. Other TRP channel blockers with promising rationale have yet to be tested on the human lower urinary tract. The P2 × 3receptor antagonist, eliapixant, was tested in a randomized controlled clinical trial, was well tolerated but did not meet clinical efficacy endpoints. Antifibrosis agent still await application to the human lower urinary tract. New drug principles for oxidative stress, purine nucleoside phosphorylase inhibition, and NOX inhibition are still at an experimental stage, and so are soluble guanylate cyclase stimulators. Gene therapy with MaxiK±channels is still an interesting approach but no new trials seem to be in pipeline.
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Affiliation(s)
- Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Laboratory Medicine, Lund University, Lund, Sweden
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Kim JS, Kim J, Lim JW, Kim DJ, Lee JI, Choi H, Kweon H, Lee J, Yee H, Kim JH, Kim B, Kang MS, Jeong JH, Park SM, Kim DH. Implantable Multi-Cross-Linked Membrane-Ionogel Assembly for Reversible Non-Faradaic Neurostimulation. ACS Nano 2023; 17:14706-14717. [PMID: 37498185 DOI: 10.1021/acsnano.3c02637] [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] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Neural interfaces play a major role in modulating neural signals for therapeutic purposes. To meet the demand of conformable neural interfaces for developing bioelectronic medicine, recent studies have focused on the performance of electrical neurostimulators employing soft conductors such as conducting polymers and electronic or ionic conductive hydrogels. However, faradaic charge injection at the interface of the electrode and nerve tissue causes irreversible gas evolution, oxidation of electrodes, and reduction of biological ions, thus causing undesired tissue damage and electrode degradation. Here we report a conformable neural interface engineering based on multicross-linked membrane-ionogel assembly (termed McMiA), which enables nonfaradaic neurostimulation without irreversible charge transfer reaction. The McMiA consists of a genipin-cross-linked biopolymeric ionogel coupled with a dopamine-cross-linked graphene oxide membrane to prevent ion exchange between biological and synthetic McMiA ions and to function as a bioadhesive forming covalent bonds with the target tissues. In addition, the demonstration of bioelectronic medicine via the McMiA-based neurostimulation of sciatic nerves shows the enhanced clinical utility in treating the overactive bladder syndrome. As the McMiA-based neural interface is soft, robust for bioadhesion, and stable in a physiological environment, it can offer significant advancement in biocompatibility and long-term operability for neural interface engineering.
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Affiliation(s)
- Joo Sung Kim
- Department of Chemical Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Junho Kim
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Jun Woo Lim
- Department of Chemical Engineering, Soongsil University, Seoul 06978, Republic of Korea
| | - Dong Jun Kim
- Department of Chemical Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Jong Ik Lee
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Hanbin Choi
- Department of Chemical Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyukmin Kweon
- Department of Chemical Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Jiho Lee
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Hyeono Yee
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Ji Hong Kim
- Department of Chemical Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Bokyung Kim
- Department of Chemical Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Moon Sung Kang
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul 04107, Republic of Korea
- Institute of Emergent Materials, Sogang University, Seoul 04107, Republic of Korea
| | - Jae Hyun Jeong
- Department of Chemical Engineering, Soongsil University, Seoul 06978, Republic of Korea
| | - Sung-Min Park
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Do Hwan Kim
- Department of Chemical Engineering, Hanyang University, Seoul 04763, Republic of Korea
- Institute of Nano Science and Technology, Hanyang University, Seoul 04763, Republic of Korea
- Clean-Energy Research Institute, Hanyang University, Seoul 04763, Republic of Korea
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Michel MC. Progress in Functional Urology Reflected in Recent Papers in the Journal of Clinical Medicine. J Clin Med 2023; 12:4482. [PMID: 37445516 DOI: 10.3390/jcm12134482] [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: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Benign conditions of the lower urinary tract, including benign prostatic hyperplasia, overactive bladder syndrome, and stress urinary incontinence, are frequent in the general population. Despite their benign nature, they have major adverse effects on the quality of life of the afflicted patients and their partners. Despite major progress in the diagnosis and treatment of these conditions, improved understanding and management of these patients remain substantial medical needs. This editorial discusses some recent high-quality articles published in the Journal of Clinical Medicine on the understanding of the epidemiology, pathophysiology, diagnostic, and treatment of benign diseases of the lower urinary tract tissues such as the bladder and prostate.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
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Javan Balegh Marand A, Baars C, Heesakkers J, van den Munckhof E, Ghojazadeh M, Rahnama'i MS, Janssen D. Differences in the Urinary Microbiome of Patients with Overactive Bladder Syndrome with and without Detrusor Overactivity on Urodynamic Measurements. Life (Basel) 2023; 13:life13051199. [PMID: 37240844 DOI: 10.3390/life13051199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION It has been hypothesized that the urinary microbiome might play an important role in OAB. Studies have been conducted on the association between OAB symptoms and the microbiome, although a possible causality still has to be determined. MATERIAL AND METHODS In this study, 12 female patients, ≥18 years of age, with 'OAB DO+' and 9 female patients with 'OAB DO-' were included. Patients were excluded if they met one of the following exclusion criteria: bladder tumors and previous bladder operations; sacral neuromodulation; injection of Botox in the bladder; and TOT or TVT operations. Urine samples were collected and stored with patient informed consent and with the approval of the Hospital Ethical Review Board (Arnhem-Nijmegen). All OAB patients underwent urodynamics before collecting urine samples, and the diagnosis of detrusor overactivity was confirmed by two individual urologists. In addition, samples from 12 healthy controls who did not undergo urodynamic evaluation were analyzed. The 16S rRNA V1-V2 region amplification and gel electrophoresis were used to determine the microbiota. RESULTS 12 of the OAB patients had DO shown on their urodynamic studies; the remaining 9 patients had a normoactive detrusor on their urodynamic measurements. Overall, there were no substantial differences among the demographic characteristics of the subjects. The samples were classified as the following: 180 phyla, 180 classes, 179 orders, 178 families, 175 genera, and 138 species. The least commonly observed phyla were Proteobacteria, with an average presence of 10%, followed by Bacteroidetes with 15%, Actinobacteria with 16%, and Firmicutes with 41%. Most of the sequences could be classified according to the genus level for each sample. DISCUSSION Significant differences were observed in the urinary microbiome of patients with overactive bladder syndrome who have detrusor overactivity on urodynamics compared to OAB patients without detrusor overactivity and matched controls. OAB patients with detrusor overactivity have a significantly less diverse microbiome and show a higher proportion of Lactobacillus, particularly Lactobacillus iners. The results imply that the urinary microbiome could be involved in the pathogenesis of a specific phenotype of OAB. The urinary microbiome could be a new starting point to study the causes and treatments of OAB.
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Affiliation(s)
- Aida Javan Balegh Marand
- Department of Urology, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Cléo Baars
- Department of Urology, Radboud University, 6525 GA Nijmegen, The Netherlands
| | - John Heesakkers
- Department of Urology, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Ellen van den Munckhof
- Research Center for Evidence-Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran
| | - Morteza Ghojazadeh
- Viroclinics-DDL Diagnostic Laboratory, 2288 ER Rijswijk, The Netherlands
| | | | - Dick Janssen
- Department of Urology, Radboud University, 6525 GA Nijmegen, The Netherlands
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Fernández Chadily S, de Rijk MM, Janssen JMW, van den Hurk J, van Koeveringe GA. Assessment of Brainstem Functional Organization in Healthy Adults and Overactive Bladder Patients Using Ultra-High Field fMRI. Biomedicines 2023; 11:biomedicines11020403. [PMID: 36830937 PMCID: PMC9952946 DOI: 10.3390/biomedicines11020403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
The pathophysiological mechanisms of overactive bladder syndrome (OAB) remain largely unknown, with major involvement of the central nervous system (CNS). The periaqueductal gray (PAG) is a brainstem area which is indicated to play an essential role in bidirectional communication between the bladder and the CNS. We aimed to assess consistency of PAG functional organization across different bladder sensory states in OAB patients. We propose, that PAG functional organization patterns across sensory states will differ between controls and OAB patients. We analyzed fMRI scans at 7 Tesla from six controls and two OAB patients. The Louvain module detection algorithm was applied to parcellate the PAG in empty and full bladder states. We assessed within-subject consistency and investigated differences in this consistency between both groups. High within-subject agreement of PAG parcellations between empty and full bladder states was demonstrated in both groups. Additionally, we showed that the correlations between PAG clusters in both bladder states were significantly different in patients compared to controls (p = 0.039). The methods introduced here offer a promising tool to assess functional organization of the PAG and understand the underlying pathology and the role of this region in OAB syndrome.
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Affiliation(s)
- Susana Fernández Chadily
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Mathijs M. de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center+ (MUMC+), 6229 HX Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-043-388-1839
| | - Janine M. W. Janssen
- Department of Urology, Maastricht University Medical Center+ (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Job van den Hurk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Scannexus Ultra High-Field MRI Center, 6229 EV Maastricht, The Netherlands
| | - Gommert A. van Koeveringe
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center+ (MUMC+), 6229 HX Maastricht, The Netherlands
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Li W, Lin Y, Xie H, Fu Q, Chen R, Hu X, Huang J, Wang J, Yang R. Efficacy and safety of mirabegron in the treatment of overactive bladder syndrome after radical prostatectomy: a prospective randomized controlled study. Front Oncol 2023; 13:1188619. [PMID: 37205190 PMCID: PMC10185830 DOI: 10.3389/fonc.2023.1188619] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives To evaluate the effects of mirabegron in the treatment of overactive bladder syndrome (OAB) after radical prostatectomy (RP). Patients and methods A total of 108 post-operative RP patients were randomly assigned to either the mirabegron (study) or the placebo (control) group. The Overactive Bladder Syndrome Self-Assessment Scale (OABSS) was selected as the primary endpoint, and the International Prostate Symptom Score (IPSS) and Quality of Life (QOL) score were selected as secondary endpoints. Statistical analysis was performed using IBM SPSS Statistics 26, and the treatment effects were compared between the two groups using independent samples t-test. Results In total, 55 patients were included in the study group and 53 patients in the control group. The mean age was(70.08 ± 7.54)years. There was no statistical difference in the baseline data between the two groups. OABSS scores decreased significantly in the study group compared to the control group during drug treatment (6.67 ± 1.06 vs. 9.14 ± 1.83, p < 0.01) and were better than the control group during the follow-up at week 8 and week 12. In addition, the decrease in IPSS scores (11.29 ± 3.89 and 15.34 ± 3.54, p<0.01) and the increase in QOL scores (2.40 ± 0.81 vs. 3.20 ± 1.00) were statistically significant in the study group. And the patients in the study group had better improvement in voiding symptoms and quality of life than the control group during the follow-up period. Conclusion Daily administration of 50 mg mirabegron after RP surgery significantly improved the symptoms of OAB after surgery with fewer side effects. Additional randomized controlled trials should be conducted in the future to further evaluate the efficacy and safety of mirabegron.
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Affiliation(s)
- Wang Li
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanduo Lin
- Department of Urology, Hainan Hospital, General Hospital of the Chinese People's Liberation Army, Hainan, China
| | - Hong Xie
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Fu
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Chen
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyong Hu
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianwen Huang
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jihong Wang
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ranxing Yang
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Ranxing Yang,
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Michel MC. Are β 3 -adrenoceptor gene polymorphisms relevant for urology? Neurourol Urodyn 2023; 42:33-39. [PMID: 36321795 DOI: 10.1002/nau.25082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/14/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
AIMS β3 -adrenoceptors (ARs) are an important drug target for the treatment of overactive bladder syndrome (OAB) and are under investigation for other indications. The human β3 -AR gene is polymorphic; an exchange of amino acid tryptophan (Trp) for arginine (Arg) in position 64 of the receptor protein is the most frequent and best-studied polymorphism. A narrative review on the impact of β3 -AR polymorphisms on urological disease and its treatment is presented. RESULTS Two out of four studies have reported that the 64Arg allele was found more frequently in subjects with OAB than in healthy controls. A large study in a highly selective population (men undergoing prostatectomy for cancer treatment) did not confirm this. On the other hand, studies examining symptom severity typically found little difference between 64Arg and 64Trp carriers. In vitro studies with endogenously expressed β3 -AR reported a decreased lipolytic response in human adipose tissue. Studies with heterologously expressed receptors sometimes found a decreased responsiveness to agonists including β3 -AR agonists, but others did not confirm that. CONCLUSIONS The overall evidence points to carriers of the 64Arg genotype expressing fewer and/or hypofunctional β3 -ARs and being associated with the presence of OAB but such findings were only detected inconsistently. If this hypofunctionality exists, the consequences may be of insufficient magnitude to allow a robust detection. Only adequately powered studies comparing responses with a β3 -AR agonist in 64Arg carriers versus wild-type patients can address this.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Michel MC, Heemann U, de la Rosette JJMCH. Weak association between arterial hypertension and overactive bladder baseline symptoms and treatment responses. Front Pharmacol 2022; 13:1081074. [PMID: 36582525 PMCID: PMC9792767 DOI: 10.3389/fphar.2022.1081074] [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: 10/26/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
While animal studies have suggested an association between the presence of hypertension and the presence and/or severity of overactive bladder syndrome (OAB) symptoms, little clinical data is available. We have conducted a pre-specified secondary analysis of a non-interventional study involving 4450 OAB patients being treated with solifenacin to explore the existence of an association between OAB and hypertension using three parallel and overlapping definitions of hypertension to enhance robustness of analysis. Regardless of definition, patients with hypertension were older and had greater OAB symptom severity in univariate analyses. In multiple regression models including age as explanatory covariate, most relationships held up but effect sizes of concomitant hypertension on OAB severity were small (odds ratios <1.35 in all cases) and were deemed to be unlikely of clinical relevance. % Changes in symptom severity were somewhat smaller in univariate analysis, but effect sizes were small. We conclude that OAB and arterial hypertension are associated but effect sizes are too small to justify adaptation of clinical practice for OAB patients with concomitant hypertension.
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Affiliation(s)
- Martin C. Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany,*Correspondence: Martin C. Michel,
| | - Uwe Heemann
- Department of Medicine, University Medical Center, Munich, Germany
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Kalata U, Jarkiewicz MM, Barcz EM. Depression and anxiety in patients with pelvic floor disorders. Ginekol Pol 2022:VM/OJS/J/90219. [PMID: 36448346 DOI: 10.5603/gp.a2022.0130] [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: 05/23/2022] [Revised: 06/26/2022] [Accepted: 09/11/2022] [Indexed: 12/05/2022] Open
Abstract
Pelvic floor disorders are very common health problems in adult women affecting their quality of life in many aspects. One of them, still poorly recognised, is depression as well as anxiety. As the main goal of treatment is achievement of improvement of life quality we have to be aware of the incidence and severity of mood disorders in urogynecological patients. It is very important to be sure whether treatment of main disease is enough to solve depression and anxiety or we have to cope with them separately. The review sums up current knowledge on that very important topic.
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Affiliation(s)
- Urszula Kalata
- Multidisciplinary Hospital Warsaw Miedzylesie, Warsaw, Poland, Poland
| | - Michal M Jarkiewicz
- 3rd Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland, Poland
| | - Ewa M Barcz
- Chair of Gynecology and Obstetrics Faculty of Medicine, University of Cardinal Stefan Wyszynski, Warsaw, Poland, Poland.
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Schönburg S, Murgas S, Fornara P, Michel MC. Associations between the Patient Perception of Bladder Condition score and overactive bladder syndrome symptoms at baseline and upon treatment. Neurourol Urodyn 2022; 41:1399-1405. [PMID: 35593001 DOI: 10.1002/nau.24960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patient-reported outcomes such as the Patient Perception of Bladder Condition (PPBC) score are frequently used to characterize overactive bladder syndrome (OAB) patients and their treatment outcomes. However, little information is available on the relationship of such scores to OAB symptoms at the individual patient level. METHODS We have performed a post hoc analysis of two large noninterventional studies (n = 1345 and 745) in which patients received propiverine extended release (30 or 45 mg/day) for 12 weeks to determine the strength of nonparametric correlations between PPBC and OAB symptoms at baseline, after treatment and with treatment-associated changes thereof. RESULTS PPBC was not correlated with age but with episode frequencies of urgency, incontinence, micturitions, and nocturia, but the strength of correlations was only moderate (Spearman rank correlation coefficient 0.2045-0.3553). Similarly moderate correlations were observed after treatment and when changes in PPBC were compared to those of OAB symptoms, although these correlations were somewhat stronger. CONCLUSIONS PPBC is only moderately correlated to OAB symptoms indicating that it characterizes patients beyond what is captured by their symptoms.
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Affiliation(s)
- Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | | | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
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Bassi A, Pur DR, Chifor A, Malvankar-Mehta MS. Ocular adverse effects of bladder medication: a systematic review. Cutan Ocul Toxicol 2022; 41:129-136. [PMID: 35546446 DOI: 10.1080/15569527.2022.2052889] [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] [Indexed: 11/03/2022]
Abstract
BACKGROUND With the ageing population, lower urinary tract symptoms are becoming more prevalent with an estimate that by 2025, 52 million adults in the USA will be affected. After lifestyle modifications fail to resolve symptoms, second-line therapy with medications is often recommended by both the European Association of Urology and the American Urological Association. Considering the vulnerability of older patients to co-morbidities, physicians must be more aware of adverse side effects. This study aims to identify a linkage between common overactive bladder and interstitial cystitis medication and adverse ocular symptoms. METHODS A comprehensive literature search was conducted in MEDLINE, EMBASE, CINAHL, PsycInfo, and HealthSTAR alongside a grey literature search in clinicaltrials.gov to include all articles relating to bladder medication and vision-threatening loss. Covidence review software was utilised to conduct the systematic review. RESULTS In total, 222 articles were screened, and 23 articles met the inclusion criteria. Comprehensive coverage of 10 available medications was analysed. All medications reported adverse vision effects stratified over 15 categories. The most common adverse effect was reported to be blurred vision (n = 12 studies). Mirabegron had the most number of adverse types of ocular symptoms that covered 6 categories. Cizolirthine Citrate and Elocatitol had the least amount of ocular side effects reported. From the total of 8459 patients that were treated for either overactive bladder syndrome or interstitial cystitis with oral medications, 422 reported adverse vision effects. CONCLUSIONS This review suggests that ocular safety should be assessed in patients requiring systematic drug therapy in order to guide future research, focussing on long-term tolerability.
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Affiliation(s)
- Arshpreet Bassi
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Daiana Roxana Pur
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Anthony Chifor
- Wayne State School of Medicine, Wayne State University, Detroit, USA
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
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Abstract
PURPOSE The primary aim of this study was to identify high prescribing specialties of overactive bladder (OAB) medications for Medicare Part D beneficiaries, and describe prescribing trends by specialty from 2013 to 2017. The secondary aim was to compare the proportion of medication claims by medication class in each specialty. METHODS We used the Medicare Part D Provider Public Use File to identify the four highest prescribing specialties from 2013 to 2017. We then compared patterns of OAB medication prescription for beneficiaries over 65 years of age between specialties. The number of medication claims, cost, and region were considered. OAB medications were classified as anticholinergic or mirabegron for additional comparison. The primary outcome was the number of OAB medication claims, and the secondary outcome was the proportion of mirabegron claims of all medication claims. RESULTS Primary care providers (PCPs), urology, obstetrics and gynecology (OB/GYNs), and other specialties prescribed the most OAB medications. Total claims increased from 4.06 million in 2013 to 4.51 million in 2017. Mirabegron increased from 65,520 to 892,996 claims. PCPs prescribed the most OAB medications. Urologists had the highest proportion of mirabegron prescribing (19.6%), with an increased odds of mirabegron prescribing compared to OBGYNs (aOR 1.18, 95% CI 1.16-1.19). Compared to OBGYNs, PCPs, and other specialties demonstrated decreased odds of prescribing mirabegron (aOR 0.92 with 95% CI 0.91-0.93, and aOR 0.90 with 95% CI 0.88-0.91, respectively). CONCLUSION In Medicare Part D beneficiaries, PCPs prescribed the most OAB medications between 2013 and 2017. Urologists were most likely to prescribe mirabegron.
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Affiliation(s)
- Abhishek A Sripad
- Division of Urogynecology, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christina A Raker
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Vivian W Sung
- Division of Urogynecology, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
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Sripad A, Raker C, Shireman T, Sung V. Overactive bladder medication prescription trends from 2014 to 2018. Neurourol Urodyn 2022; 41:806-812. [PMID: 35132687 DOI: 10.1002/nau.24880] [Citation(s) in RCA: 2] [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: 05/26/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE A growing literature points to an association between overactive bladder (OAB) medications and dementia. Given differences in side effects for extended-release (ER) and immediate-release (IR) anticholinergic formulations and beta-3 agonists, we examined prescription utilization patterns in a national dataset of older adults from 2014 to 2018. METHODS We performed a retrospective study using the Medicare Part D Drug Spending Dashboard, a publicly available database that includes data from outpatient pharmacy claims from 2014 to 2018 in the United States. We identified total claims and total spending on common OAB medications, and further assessed trends by anticholinergic burden by medication, and immediate and ER formulations. RESULTS There were 54.1 million claims for OAB medications, accounting for $10.1 billion (2018 United States dollars) in spending from 2014 to 2018. When considering beta-agonist, mirabegron accounted for 13.1% of total claims and 29.0% of total spending. Mirabegron accounted for a greater proportion of OAB medication claims and spending during the 5 years from 5.7% to 20.1% and 11.3% to 44%, respectively. IR anticholinergics accounted for fewer total claims over this period, from 58.5% to 42.6%. ER formulations increased in proportion of all OAB medication total claims from 35.8% to 37.5% from 2014 to 2016, and decreased to 37.3% by 2018. CONCLUSION OAB medications and expenditures increased from 2014 to 2018. Mirabegron accounted for higher proportions and IR-formulations for decreased proportions of each from 2014 to 2018. The impact on clinical outcomes is a key area for future investigation considering our findings.
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Affiliation(s)
- Abhishek Sripad
- Division of Urogynecology, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christina Raker
- Division of Research, Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Theresa Shireman
- Department of Health Services Policy & Practice, Center for Gerontology & Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Vivian Sung
- Division of Urogynecology, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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14
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Xia L, Yan H, Sun Y, Zhu Y, Wu Y, Chen Z, Su S. Pooled analysis of the efficacy and safety of tibial nerve stimulation versus antimuscarinic agents in the management of overactive bladder syndrome. Medicine (Baltimore) 2021; 100:e27745. [PMID: 34766587 PMCID: PMC10545354 DOI: 10.1097/md.0000000000027745] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The purpose of this meta-analysis was to evaluate the efficacy and safety of tibial nerve stimulation (TNS) versus antimuscarinic agents in the management of overactive bladder (OAB) syndrome. METHODS The databases MEDLINE, EMBASE, the Cochrane Controlled Trial Register of Controlled Trials from 2000 to May 2021 were searched to identify randomized controlled trials that referred to the use of TNS and antimuscarinic agents for the treatment of OAB syndrome. A systematic review and meta-analysis was conducted. RESULTS Eight publications involving 420 patients were included in the meta-analysis. In the analysis, we found TNS had a comparable effect with antimuscarinic agents on micturition per day, nocturia, urge incontinence, and voided volume (P = .9; .4; .78; .44, respectively). Scores measured by questionnaires Overactive Bladder Symptom Score and Overactive Bladder questionnaire Short Form items also indicated no statistical difference between 2 groups. TNS group had a significantly less discontinuation rate and adverse events (P = .003; .0001). CONCLUSIONS TNS is as effective as antimuscarinic agents for the treatment of OAB. Moreover, TNS appears to be more tolerable and safer than antimuscarinic agents.
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Affiliation(s)
- Liping Xia
- Department of Neurology, Weifang Traditional Chinese Medicine Hospital, China
| | - Huilei Yan
- Department of Urology, Liaocheng People's Hospital, China
| | - Yalei Sun
- Department of Ultrasound, Weifang People's Hospital, China
| | - Yan Zhu
- Department of Urology, Weifang People's Hospital, China
| | - Yudong Wu
- Department of Urology, Weifang People's Hospital, China
| | - Zhipeng Chen
- Department of Urology, Weifang People's Hospital, China
| | - Shunye Su
- Department of Urology, Weifang People's Hospital, China
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15
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Khan Z, Healey GD, Paravati R, Berry N, Rees E, Margarit L, Gonzalez D, Emery S, Conlan RS. Chronic Urinary Infection in Overactive Bladder Syndrome: A Prospective, Blinded Case Control Study. Front Cell Infect Microbiol 2021; 11:752275. [PMID: 34660348 PMCID: PMC8515879 DOI: 10.3389/fcimb.2021.752275] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives To investigate whether women with overactive bladder (OAB) symptoms and no evidence of clinical infection by conventional clean-catch midstream urine cultures have alternative indicators of sub-clinical infection. Patients/Subjects Materials & Methods The study was a prospective, blinded case-control study with 147 participants recruited, including 73 OAB patients and 74 controls. The OAB group comprised female patients of at least 18 years of age who presented with OAB symptoms for more than 3 months. Clean-catch midstream urine samples were examined for pyuria by microscopy; subjected to routine and enhanced microbiological cultures and examined for the presence of 10 different cytokines, chemokines, and prostaglandins by ELISA. Results The mean age and BMI of participants in both groups were similar. No significant difference in the number of women with pyuria was observed between OAB and control groups (p = 0.651). Routine laboratory cultures were positive in three (4%) of women in the OAB group, whereas the enhanced cultures isolated bacteria in 17 (23.2%) of the OAB patients. In the control group, no positive cultures were observed using routine laboratory cultures, whereas enhanced culture isolated bacteria in 8 (10.8%) patients. No significant differences were observed in the concentrations of PGE2, PGF2α, MCP-1, sCD40L, MIP-1β, IL12p70/p40, IL12/IL-23p40, IL-5, EGF and GRO-α between the OAB and control groups. Conclusions Patients with OAB symptoms have significant bacterial growth on enhanced culture of the urine, which is often not detectable through routine culture, suggesting a subclinical infection. Enhanced culture techniques should therefore be used routinely for the effective diagnosis and management of OAB.
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Affiliation(s)
- Zainab Khan
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom
| | - Gareth D Healey
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Roberta Paravati
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Nidhika Berry
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom
| | - Eugene Rees
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom
| | - Lavinia Margarit
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom.,Cwm Taf Morgannwg University Health Board, Obstetrics Gynecology Department, Princess of Wales Hospital, Bridgend, United Kingdom
| | - Deyarina Gonzalez
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Simon Emery
- Swansea Bay University Health Board, Singleton Hospital, Swansea, United Kingdom
| | - Robert Steven Conlan
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
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16
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Shabir H, Hashemi S, Al-Rufayie M, Adelowo T, Riaz U, Ullah U, Alam B, Anwar M, de Preux L. Cost-Utility Analysis of Oxybutynin vs. OnabotulinumtoxinA (Botox) in the Treatment of Overactive Bladder Syndrome. Int J Environ Res Public Health 2021; 18:ijerph18168743. [PMID: 34444493 PMCID: PMC8394450 DOI: 10.3390/ijerph18168743] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/31/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022]
Abstract
Background: The UK National Health Service (NHS) propose the use of oxybutynin prior to onabotulinumtoxinA (Botox) in the management of overactive bladder syndrome (OAB). Oxybutynin is costly and associated with poor adherence, which may not occur with Botox. We conducted a cost-utility analysis (CUA) to compare the medications. Methods: we compared the two treatments in quality-adjusted life years (QALYS), through the NHS’s perspective. Costs were obtained from UK-based sources and were discounted. Total costs were determined by adding the treatment cost and management cost for complications on each branch. A 12-month time frame was used to model the data into a decision tree. Results: Our results found that using Botox first-line had greater cost utility than oxybutynin. The health net benefit calculation showed an increase in 0.22 QALYs when Botox was used first-line. Botox also had greater cost-effectiveness, with the exception of pediatric patients with an ICER of £42,272.14, which is above the NICE threshold of £30,000. Conclusion: Botox was found to be more cost-effective than antimuscarinics in the management of OAB in adults, however less cost-effective in younger patients. This predicates the need for further research to ascertain the age at which Botox becomes cost-effective in the management of OAB.
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Affiliation(s)
- Habiba Shabir
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
- Correspondence: ; Tel.: +44-7506808519
| | - Sana Hashemi
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Moussa Al-Rufayie
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Tayo Adelowo
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Umar Riaz
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Umayair Ullah
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Benyamin Alam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Mehreen Anwar
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Laure de Preux
- Department of Economics and Public Policy, Business School, Imperial College London, London SW7 2BX, UK;
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17
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Koch M, Lyatoshinsky P, Mitulovic G, Bodner-Adler B, Lange S, Hanzal E, Umek W. Characteristics of the Urinary Proteome in Women with Overactive Bladder Syndrome: A Case-Control Study. J Clin Med 2021; 10:jcm10112446. [PMID: 34072980 PMCID: PMC8198757 DOI: 10.3390/jcm10112446] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/16/2022] Open
Abstract
Despite an estimated prevalence of 13% in women, the exact etiology of non-neurogenic overactive bladder syndrome is unclear. The aim of our study was to gain a better understanding of the pathophysiology of female overactive bladder syndrome by mapping the urinary proteomic profile. We collected urine samples of 20 patients with overactive bladder syndrome and of 20 controls. We used mass spectrometric analysis for label-free quantitation, Swissprot human database for data search, Scaffold for data allocation and the Reactome Knowledgebase for final pathway enrichment analysis. We identified 1897 proteins at a false discovery rate of 1% and significance level p < 0.001. Thirty-seven significant proteins of the case group and 53 of the control group met the criteria for further pathway analysis (p < 0.0003 and Log2 (fold change) >2). Significant proteins of the overactive bladder group were, according to the 25 most relevant pathways, mainly involved in cellular response to stress and apoptosis. In the control group, significant pathways mainly concerned immunological, microbial-protective processes and tissue- elasticity processes. These findings may suggest a loss of protective factors as well as increased cellular response to stress and apoptosis in overactive bladder syndrome.
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Affiliation(s)
- Marianne Koch
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (B.B.-A.); (S.L.); (E.H.); (W.U.)
- Correspondence: ; Tel.: +43-1-404-002-9150
| | - Pavel Lyatoshinsky
- Department of Urology, Cantonal Hospital St Gallen, 9007 St Gallen, Switzerland;
| | - Goran Mitulovic
- Clinical Institute of Laboratory Medicine and Proteomics Core Facility, Medical University of Vienna, 1090 Vienna, Austria;
| | - Barbara Bodner-Adler
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (B.B.-A.); (S.L.); (E.H.); (W.U.)
| | - Sören Lange
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (B.B.-A.); (S.L.); (E.H.); (W.U.)
| | - Engelbert Hanzal
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (B.B.-A.); (S.L.); (E.H.); (W.U.)
| | - Wolfgang Umek
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (B.B.-A.); (S.L.); (E.H.); (W.U.)
- Karl Landsteiner Society, Institute for Special Gynecology and Obstetrics, 3100 St. Pölten, Austria
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18
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Santis-Moya F, Calvo CI, Rojas T, Dell'Oro A, Baquedano P, Saavedra A. Urodynamic and clinical features in women with overactive bladder: When to suspect concomitant voiding dysfunction? Neurourol Urodyn 2021; 40:1509-1514. [PMID: 34036625 DOI: 10.1002/nau.24688] [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: 01/28/2021] [Revised: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms. METHODS This is a cross-sectional study of female adult patients with OAB syndrome who underwent UDS in a University Hospital in Chile between January 2015 and April 2020. FVD was defined either as bladder outlet obstruction (BOO) or detrusor underactivity (DU). BOO was established if the Solomon-Greenwell BOO index was higher than 18. DU was diagnosed when the invasive maximum flow rate (Qmax) was ≤15 ml/sec, detrusor pressure at Qmax (Pdet@Qmax) was ≤20 cmH2 O and postvoid residual (PVR) was greater than 10%. Urodynamic data and clinical features were compared between groups. RESULTS Two hundred and ninety-nine UDS were selected and analyzed. Bladder outlet obstruction was diagnosed in 59 patients (19.7%), whereas DU was found in 10 patients (3.3%). In the multivariate analysis, the logistic regression to predict BOO demonstrated that night-time frequency, the presence of detrusor overactivity and a higher PVR were independent predictors of BOO. Instead, for DU, the only independent predictor was a smaller voided volume in the pressure-flow study. CONCLUSION Female voiding dysfunction was found in 23% of patients with overactive bladder. BOO is more frequent than DU, and should be suspected in patients with higher night-time frequency, presence of detrusor overactivity and a high PVR. Instead, DU should be suspected in patients with a smaller voided volume.
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Affiliation(s)
- Fernanda Santis-Moya
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Ignacio Calvo
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tania Rojas
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arturo Dell'Oro
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Baquedano
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alvaro Saavedra
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Urología, Clínica Alemana/Universidad del Desarrollo, Santiago, Chile
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19
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Amiri M, Schneider T, Oelke M, Murgas S, Michel MC. Factors Associated with Decisions for Initial Dosing, Up-Titration of Propiverine and Treatment Outcomes in Overactive Bladder Syndrome Patients in a Non-Interventional Setting. J Clin Med 2021; 10:311. [PMID: 33467690 DOI: 10.3390/jcm10020311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/16/2022] Open
Abstract
Two doses of propiverine ER (30 and 45 mg/d) are available for the treatment of overactive bladder (OAB) syndrome. We have explored factors associated with the initial dosing choice (allocation bias), the decision to adapt dosing (escalation bias) and how dosing relative to other factors affects treatment outcomes. Data from two non-interventional studies of 1335 and 745 OAB patients, respectively, receiving treatment with propiverine, were analyzed post-hoc. Multivariate analysis was applied to identify factors associated with dosing decisions and treatment outcomes. Several parameters were associated with dose choice, escalation to higher dose or treatment outcomes, but only few exhibited a consistent association across both studies. These were younger age for initial dose choice and basal number of urgency and change in incontinence episodes for up-titration. Treatment outcome (difference between values at 12 weeks vs. baseline) for each OAB system was strongly driven by the respective baseline value, whereas no other parameter exhibited a consistent association. Patients starting on the 30 mg dose and escalating to 45 mg after 4 weeks had outcomes comparable with those staying on a starting dose of 30 or 45 mg. We conclude that dose escalation after 4 weeks brings OAB patients with an initially limited improvement to a level seen in initially good responders. Analysis of underlying factors yielded surprisingly little consistent insight.
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20
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Yin L, Zhang Z, Zheng Y, Hou L, Zhao CG, Wang XL, Jiang KL, Du Y. Clinical Correlation Between Overactive Bladder and Allergy in Children. Front Pediatr 2021; 9:813161. [PMID: 35096719 PMCID: PMC8795948 DOI: 10.3389/fped.2021.813161] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The International Children's Continence Society defines overactive bladder (OAB) as a clinical syndrome characterized by urgency of urination usually accompanied by frequent urination and nocturia symptoms. This study aims to explore the correlation between overactive bladder (OAB) and allergy in children. METHOD The clinical characteristics of 918 patients diagnosed with OAB from January 2020 to March 2021 were retrospectively analyzed. Risk factors for OAB were analyzed using logistic regression analysis, and the effect of desloratadine in the treatment of OAB was evaluated. RESULTS The incidence of allergic cough or allergic rhinitis in the mild OAB group was higher than the moderate-severe group. Urodynamics demonstrated that the proportion of patients with a sensitive bladder in the overactive detrusor group was significantly higher than the non-overactive detrusor group. The effective rate of treatment of OAB in patients complicated with allergies and taking desloratadine was 90.14%, which was significantly higher than in patients who were not taking desloratadine, and blood IgE level was a risk factor of ineffective treatment with desloratadine. CONCLUSION OAB is correlated with allergies in children, and desloratadine can effectively improve OAB symptoms.
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Affiliation(s)
- Lu Yin
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhou Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Zheng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Hou
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Cheng-Guang Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiu-Li Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kai-Lei Jiang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Du
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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21
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Elia D, Gambiacciani M, Ayoubi JM, Berreni N, Bohbot JM, Descamps P, Druckmann R, Geoffrion H, Haab F, Heiss N, Rygaloff N, Russo E. Female urine incontinence: vaginal erbium laser (VEL) effectiveness and safety. Horm Mol Biol Clin Investig 2020; 41:/j/hmbci.ahead-of-print/hmbci-2020-0012/hmbci-2020-0012.xml. [PMID: 33119542 DOI: 10.1515/hmbci-2020-0012] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/06/2020] [Indexed: 11/15/2022]
Abstract
Urinary incontinence is a common health problem that impacts the quality of life of women at different ages. Its physiopathology is not unequivocal, and it is necessary to consider the stress urinary incontinence (SUI), the overactive bladder syndrome and the mixed incontinence (MUI). According to the type of incontinence, its impact on the quality of life and age of the patients, therapeutic strategies are currently summarized in physiotherapy, surgery and drug treatments. We already know the benefit/risk ratio of each of these strategies. Our objective is to evaluate the potential effectiveness and safety of the VEL, an innovative vaginal laser technique (VEL - Vaginal Erbium Laser, erbium yttrium-aluminum-garnet -Er: YAG) a non-invasive laser proposed as a treatment for SUI, overactive bladder syndrome and MUI. The mechanisms of action of lasers are discussed in general and those of VEL in particular with the description of the Smooth® mode. To do this, we have collected the 21 published studies including the first randomized vs. placebo and two pilot studies of intra-urethral VEL. In conclusion: VEL procedures already have their place between the rehabilitation of the perineal floor and surgery. Further properly sized, randomized studies are needed to evaluate the laser treatments in comparison with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications.
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Affiliation(s)
- David Elia
- Vaginal Erbium Laser Academy France, Paris, France
| | | | | | | | | | | | | | | | | | - Niko Heiss
- Vaginal Erbium Laser Academy France, Paris, France
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22
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Xiong C, Tang Y, Shi R, Zhou Y, Sun S, Xiang Y, Liu Q, Xiang J, Yang S, Li X. Therapeutic effect of myofascial trigger point electroacupuncture technology on the treatment of overactive bladder syndrome in female. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2020; 45:155-159. [PMID: 32386040 DOI: 10.11817/j.issn.1672-7347.2020.180790] [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] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the therapeutic effect of myofascial trigger point electroacupuncture technology on treating female overactive bladder syndrome. METHODS Forty female patients with overactive bladder were randomly divided into 2 groups: an experimental group and a control group. The experimental group was treated with myofascial trigger point electroacupuncture therapy combined with solifenacin succinate while the control group was only treated with solifenacin succinate. Patients in both groups were treated for 12 weeks. The overactive bladder symptom score (OABSS), urinary urgency score and urination frequency of 24 h in the 2 groups were compared to analyze the therapeutic effect. RESULTS Before the comprehensive treatment, there was no significant difference between the experimental group and the control group (P>0.05). After 2 and 12 weeks of continuous treatment, the OABSS, urinary urgency symptoms score and 24 h urination frequency in the experimental group and the control group were lower than those before the treatment, and the degree of decline in the experimental group was more obvious, with significant difference (P<0.05). CONCLUSIONS Treating overactive bladder syndrome in women with myofascial trigger point electroacupuncture combined with solifenacin succinate can significantly improve the OABSS and improve the life quality of the patients.
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Affiliation(s)
- Chao Xiong
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yuan Tang
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ruting Shi
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yanhua Zhou
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Shaodan Sun
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yali Xiang
- Department of Health Management, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Qianyu Liu
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Juan Xiang
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Shuo Yang
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xuhong Li
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
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23
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Amiri M, Murgas S, Stang A, Michel MC. Do overactive bladder symptoms and their treatment-associated changes exhibit a normal distribution? Implications for analysis and reporting. Neurourol Urodyn 2020; 39:754-761. [PMID: 31945207 DOI: 10.1002/nau.24275] [Citation(s) in RCA: 9] [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: 10/15/2019] [Accepted: 12/30/2019] [Indexed: 12/18/2022]
Abstract
AIMS To explore the use of means vs medians (assuming or not the presence of normal distribution) in studies reporting overactive bladder syndrome symptoms and to test for normal distribution of basal values and treatment-associated changes thereof in two large noninterventional studies. METHODS Systematic review of all original studies reporting on at least one overactive bladder syndrome symptom published in four leading urology journals in 2016 to 2017. Testing of the normal distribution of urgency, incontinence, frequency, and nocturia in two large noninterventional studies (n = 1335 and 745). RESULTS Among 48 eligible articles, 86% reported means (assuming a normal distribution), 6% medians (not making this assumption), and 8% a combination thereof. Baseline values for all four symptoms and treatment-associated alterations thereof deviated from a normal distribution (P < .0001 in all cases). Means overestimated basal value and absolute changes thereof as compared with medians, for example, basal number of incontinence episodes in study 1 5.1 vs 4. Differences between means and medians for percentage changes of symptoms were small and did not consistently favor means over medians. CONCLUSIONS Dominant reporting of means implies the assumption of a normal distribution of overactive bladder syndrome symptoms but our data from two noninterventional studies do not support this assumption. We recommend that basal values and absolute symptom changes should be reported as medians and subjected to nonparametric analysis; means may be appropriate for the reporting of percentage changes of symptoms.
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Affiliation(s)
- Marjan Amiri
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany.,Center for Clinical Trials Essen (ZKSE), University Hospital Essen, Essen, Germany
| | | | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany.,Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
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Tateno F, Sakakibara R, Aiba Y, Takahashi O, Shimizu A, Oki T. Increased bladder sensation without detrusor overactivity revisited: Use of a five-grade sensory measure. Low Urin Tract Symptoms 2019; 12:162-166. [PMID: 31833660 DOI: 10.1111/luts.12298] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/13/2019] [Accepted: 11/06/2019] [Indexed: 01/23/2023]
Abstract
AIMS Increased bladder sensation (IBS) without detrusor overactivity (DO) is still a matter of debate, regarding its clinical relevance, urodynamic nature, underlying pathology, and management. Among these, we present our data focusing on the urodynamic nature of IBS without DO, by applying our five-grade sensory measure during urodynamics. METHODS We enrolled 400 individuals who visited our laboratory for screening of lower urinary tract function, mostly with neurogenic etiologies. They included 74 control, 87 DO (irrespective of IBS), and 239 IBS (defined as first sensation <100 mL) without DO. During slow bladder filling, we instructed individuals to indicate their sensation in five grades: 1, first sensation to 5, strong desire to void. We also instructed individuals to report other sensations such as pain. RESULTS The five-grade measure could be performed in all participants without difficulty. None of the participants reported pain or any qualitatively different sensations. Although we defined DO irrespective of IBS, the sensation interval 0 (start) to 1 (first sensation) of subjects with IBS but without DO was significantly less than that of subjects with DO (P < 0.05). CONCLUSIONS The present study results showed that first sensation of subjects with IBS without DO was significantly less than that of subjects with DO (P < 0.05), while the bladder capacities of the two groups were the same. An extremely low-volume first sensation may suggest the possibility of IBS without DO.
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Affiliation(s)
- Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Yosuke Aiba
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Osamu Takahashi
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ayami Shimizu
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, Japan
| | - Takeshi Oki
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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La Rosa VL, Platania A, Ciebiera M, Garzon S, Jędra R, Ponta M, Butticè S. A comparison of sacral neuromodulation vs. transvaginal electrical stimulation for the treatment of refractory overactive bladder: the impact on quality of life, body image, sexual function, and emotional well-being. Prz Menopauzalny 2019; 18:89-93. [PMID: 31485205 DOI: 10.5114/pm.2019.86834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/17/2019] [Indexed: 02/04/2023]
Abstract
Overactive bladder syndrome (OAB) is defined by the presence of urinary urgency, with or without urge incontinence, usually accompanied by an increase in urinary frequency and nocturia in the absence of urinary tract infections (UTI) or other diseases. The overall prevalence of OAB symptoms in the female population is reported to be 16.6% and increases with advancing age and menopause. The aetiology of OAB is not fully understood and is likely to affect a heterogeneous population of patients due to changes to their central and peripheral nervous systems. Although OAB is frequently associated with female sexual dysfunction (FSD), its real impact on sexual function in women has been evaluated only in a few studies. The first line of treatment for OAB includes behavioural modification and physical therapy, either as monotherapies or in combination. Many patients who have not had success in managing their symptoms with more conservative therapies may decide to resort to third-line treatments for refractory OAB. These treatments include neuromodulation therapies, particularly transvaginal electrical stimulation (TES) and sacral neuromodulation (SN). The aim of this short commentary is to provide an overview of the effectiveness of these treatments and of their impact on quality of life, body image, sexual function, and emotional well-being.
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Mateu Arrom L, Peri Cusi L, López-Fando L, Franco de Castro A, Jiménez Cidre MÁ, Alcaraz A. Validation of a 3 day electronic bladder diary as an app for smart-phone. Neurourol Urodyn 2019; 38:764-769. [PMID: 30620092 DOI: 10.1002/nau.23914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/29/2018] [Accepted: 11/12/2018] [Indexed: 11/11/2022]
Abstract
AIM To validate an electronic 3-day bladder diary (BD) as an easy-to-use app for smart-phone (eDM3d). METHODS Descriptive and cross-sectional prospective study. One hundred and thirty-six patients with overactive bladder syndrome (OABs) or nocturia who had a smart-phone and attended the urology clinics of a tertiary hospital from June to November 2017 were included. Patients filled the eDM3d (test) and the Spanish validated paper BD (DM3d) and questionnaires ICIQ-UISF and BASQ during the first week. Two weeks later, they repeated the eDM3d (retest). We assessed feasibility of the eDM3d (percentage of variables completed), test-retest reliability (qualitative variables: McNemar test; quantitative variables: ICC), paper-app correlation (qualitative variables: Kappa index; quantitative variables: ICC) and convergent validity (correlation between eDM3d and questionnaires, Spearman's rank test). Patients answered a question about satisfaction: "If you had to repeat a BD again, would you choose paper or the app version?" RESULTS One hundred and twenty-three (90.4%) participants completed all the variables of the first eDM3d. There were no significant differences in the proportion of patients classified as positive for each symptom between test and retest. ICC ranged from 0.73 to 0.94 for all variables (P < 0.001) in the test-retest assessment. Paper-app correlation was good to excellent for all variables (ICC 0.76-0.95, P < 0.001; Kappa index 0.56-0.84, P < 0.001). Correlation between the eDM3d and the questionnaires ranged from 0.23 to 0.6 (P < 0.01). 120 (88.2%) patients would choose the eDM3d if they had to repeat a BD. CONCLUSION The eDM3d presents suitable feasibility, reliability, and validity to assess patients with OABs or nocturia who have a smart-phone.
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Affiliation(s)
- Laura Mateu Arrom
- Functional Urology and Urodynamics Department, Fundació Puigvert, Barcelona, Spain
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Kozma B, Majoros A, Pytel Á, Póka R, Takács P. [Efficacy of the percutaneous tibial nerve stimulation in the treatment of lower urinary tract symptoms]. Orv Hetil 2018; 159:1735-1740. [PMID: 30346235 DOI: 10.1556/650.2018.31228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive, safe and well-tolerated neuromodulation technique for the lower urinary tract dysfunctions. PTNS delivers neuromodulation to the pelvic floor through the S2-4 junction of the sacral nerve plexus via the route of the posterior tibial nerve. Using the fine needle electrode insertion above the ankle, the tibial nerve is accessed, which connected to the stimulator. To date despite of its excessive clinical use, PTNS mechanism of action still remains unclear. The technique seems to be an efficacious and safe treatment for overactive bladder syndrome (OAB). It could be recommended according to the Urinary Incontinence Guideline of the European Association of Urology in women who did not have adequate improvement or could not tolerate anti-muscarinic therapy. The success rate is comparable to sacral nerve stimulation in OAB patients. PTNS has been used for fecal incontinence since 2003, however, many of the published studies are of poor quality. PTNS has also been shown to have positive effects on chronic pelvic pain, when the usual therapeutic steps did not result in satisfactory improvement. No major complications are reported in the literature, following PTNS treatment. Orv Hetil. 2018; 159(43): 1735-1740.
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Affiliation(s)
- Bence Kozma
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Attila Majoros
- Urológiai Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Ákos Pytel
- Urológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Róbert Póka
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Péter Takács
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032.,Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School Norfolk, VA, Amerikai Egyesült Államok
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Tzeng NS, Chang HA, Chung CH, Kao YC, Yeh HW, Yeh CB, Chiang WS, Huang SY, Lu RB, Chien WC. Risk of psychiatric disorders in overactive bladder syndrome: a nationwide cohort study in Taiwan. J Investig Med 2018; 67:312-318. [PMID: 30275006 DOI: 10.1136/jim-2018-000835] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 01/03/2023]
Abstract
Population-based cohort study investigating the risk of depression and other psychiatric disorders for patients with overactive bladder (OAB) syndrome is unavailable. This study investigated the subsequent risk of psychiatric disorders among patients with OAB in an Asian population. Using data from the National Health Insurance Research Database of Taiwan, we established a cohort with 811 patients in an exposed group with OAB between January 1, 2000 and December 31, 2000, and a non-exposed group, without OAB, of 2433 patients without OAB matched by age and year of diagnosis. The occurrence of psychiatric disorders and Cox regression model measured adjusted HRs (aHR) were monitored until the end of 2013. The overall incidence of psychiatric disorders was 41.7% higher in the exposed group with OAB than in the non-exposed group without OAB (14.2% vs 10.1%, p<0.001), with an aHR of 1.34 (95% CI 1.12 to 1.80, p<0.001) for the OAB cohort. OAB was associated with the increased risk of dementia, anxiety, depressive, sleep, and psychotic disorders, with aHRs as 1.53 (p=0.040), 1.61 (p<0.001), 2.10 (p<0.001), 1.43 (p<0.001), and 2.49 (p=0.002), respectively. The risk of psychiatric disorders, including depression and anxiety, is significantly higher in patients with OAB than in those without OAB. Evaluation of psychiatric status in patients with OAB is strongly recommended.
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Affiliation(s)
- Nian-Sheng Tzeng
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.,Student Counseling Center, National Defense Medical Center, Taipei, Republic of China
| | - Hsin-An Chang
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.,Student Counseling Center, National Defense Medical Center, Taipei, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.,School of Public Health, National Defense Medical Center, Taipei, Republic of China.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Republic of China
| | - Yu-Chen Kao
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Republic of China
| | - Hui-Wen Yeh
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.,Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsinchu, Republic of China.,Department of Nursing, School of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.,Department of Nursing, Kang-Ning University (Taipei Campus), Taipei, Republic of China
| | - Chin-Bin Yeh
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Wei-Shan Chiang
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - San-Yuan Huang
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Ru-Band Lu
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.,Department of Psychiatry, College of Medicine and Hospital, National Cheng-Kung University, Tainan, Republic of China
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.,School of Public Health, National Defense Medical Center, Taipei, Republic of China.,Institute of Life Sciences, National Defense Medical Center, Taipei, Republic of China
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Schiavi MC, Sciuga V, Giannini A, Vena F, D'oria O, Prata G, Di Tucci C, Savone D, Aleksa N, Capone C, Di Mascio D, Meggiorini ML, Monti M, Zullo MA, Muzii L, Benedetti Panici P. Overactive bladder syndrome treatment with ospemifene in menopausal patients with vulvovaginal atrophy: improvement of sexuality? Gynecol Endocrinol 2018; 34:666-669. [PMID: 29463148 DOI: 10.1080/09513590.2018.1441398] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 01/16/2023] Open
Abstract
The aim of this study was to assess the effectiveness of ospemifene in the improvement of sexual function in postmenopausal women with vulvovaginal atrophy (VVA) affected by overactive bladder syndrome (OAB) or urge urinary incontinence (UUI). One hundred five postmenopausal patients with VVA affected by OAB and/or UUI were enrolled for the study. All patients received ospemifene 60 mg for 12 weeks. Clinical examination, 3-d voiding diary and the vaginal health index (VHI) were performed at baseline and at 12 weeks. Patients completed the OAB-Q SF, FSFI, FSDS, and SF-36 questionnaires. The patient's satisfaction was also calculated. After 12 weeks, the reduction of urinary symptoms was observed. The OAB-Q symptoms, OAB-Q (HRQL) score were (55.34 ± 13.54 vs. 23.22 ± 9.76; p < .0001) and (22.45 ± 9.78 vs. 70.56 ± 15.49; p < .0001), before and after treatment. SF-36 questionnaire showed a significant improvement (p < .0001). VHI score increased and the women who regularly practice sexual activity increased after treatment. The total FSFI score increased significantly and the FSDS score changed after 12 weeks (p < .0001). The PGI-I after 12 weeks showed a total success rate of 90.5%. Ospemifene is an effective potential therapy for postmenopausal women with VVA affected by OAB or UUI improving sexual function and quality of life.
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Affiliation(s)
- Michele Carlo Schiavi
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Valentina Sciuga
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Andrea Giannini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Flaminia Vena
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Ottavia D'oria
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Giovanni Prata
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Chiara Di Tucci
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Delia Savone
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Natalia Aleksa
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Carmela Capone
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Daniele Di Mascio
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Maria Letizia Meggiorini
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Marco Monti
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Marzio Angelo Zullo
- b Department of Surgery-Week Surgery, Campus Biomedico , University of Rome , Rome , Italy
| | - Ludovico Muzii
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
| | - Pierluigi Benedetti Panici
- a Department of Gynecological and Obstetric Sciences, and Urological Sciences , Umberto I Hospital, University of Rome "Sapienza" , Rome , Italy
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30
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Mateu Arrom L, Peri Cusi L, Franco de Castro A, López-Fando L, Jiménez Cidre MÁ, Alcaraz Asensio A. Development and feasibility assessment of a 3 day electronic bladder diary as an app for smart-phone. Neurourol Urodyn 2018; 37:1717-1723. [PMID: 29356063 DOI: 10.1002/nau.23494] [Citation(s) in RCA: 14] [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: 08/17/2017] [Accepted: 12/25/2017] [Indexed: 12/21/2022]
Abstract
AIMS To develop a 3 day bladder diary (BD) as an easy-to-use application for smart-phone (eDM3d). To test its feasibility and acceptance in a reduced number of patients. METHODS An external agency developed the eDM3d following the structure of the Spanish validated 3 day BD (DM3d©), which includes a frequency-volume chart, the assessment of the grade of urgency, the incontinence events and fluid intake. The eDM3d consisted in a main interface of four buttons ("wake up," "go to bed," "urinate," "drink") which had to be clicked to create an event. Results were automatically transferred to an internet server to obtain an electronic report. We recruited 25 patients with overactive bladder syndrome or nocturia and previous experience on paper BD. They were asked to complete the eDM3d. Finally, a direct question about satisfaction was answered: "If you had to complete a BD again, would you choose the paper or the app version?" RESULTS Three patients (12%) did not complete the eDM3d, 1 patient (4%) completed 2 days of the eDM3d and did not register volumes of micturition nor fluid intake, 1 patient (4%) completed all 2 days variables and 20 patients (80%) completed all 3 day variables. Regarding satisfaction, 19 patients (86.4%) would choose the app version, 2 patients (9.1%) would choose a paper version and 1 patient (4.5%) would choose either indistinctly. CONCLUSIONS The eDM3d is a useful tool easily filled in by patients with a high satisfaction rate. Adequate validation of the eDM3d is required.
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Affiliation(s)
- Laura Mateu Arrom
- Functional Urology & Urodynamics Department, Fundació Puigvert, Barcelona, Spain
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Deckmann K, Rafiq A, Erdmann C, Illig C, Durschnabel M, Wess J, Weidner W, Bschleipfer T, Kummer W. Muscarinic receptors 2 and 5 regulate bitter response of urethral brush cells via negative feedback. FASEB J 2018; 32:2903-2910. [PMID: 29401598 DOI: 10.1096/fj.201700582r] [Citation(s) in RCA: 6] [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] [Indexed: 01/14/2023]
Abstract
We have recently identified a cholinergic chemosensory cell in the urethral epithelium, urethral brush cell (UBC), that, upon stimulation with bitter or bacterial substances, initiates a reflex detrusor activation. Here, we elucidated cholinergic mechanisms that modulate UBC responsiveness. We analyzed muscarinic acetylcholine receptor (M1-5 mAChR) expression by using RT-PCR in UBCs, recorded [Ca2+]i responses to a bitter stimulus in isolated UBCs of wild-type and mAChR-deficient mice, and performed cystometry in all involved strains. The bitter response of UBCs was enhanced by global cholinergic and selective M2 inhibition, diminished by positive allosteric modulation of M5, and unaffected by M1, M3, and M4 mAChR inhibitors. This effect was not observed in M2 and M5 mAChR-deficient mice. In cystometry, M5 mAChR-deficient mice demonstrated signs of detrusor overactivity. In conclusion, M2 and M5 mAChRs attenuate the bitter response of UBC via a cholinergic negative autocrine feedback mechanism. Cystometry suggests that dysfunction, particularly of the M5 receptor, may lead to such symptoms as bladder overactivity.-Deckmann, K., Rafiq, A., Erdmann, C., Illig, C., Durschnabel, M., Wess, J., Weidner, W., Bschleipfer, T., Kummer, W. Muscarinic receptors 2 and 5 regulate bitter response of urethral brush cells via negative feedback.
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Affiliation(s)
- Klaus Deckmann
- Institute for Anatomy and Cell Biology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Amir Rafiq
- Institute for Anatomy and Cell Biology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Christian Erdmann
- Department of Urology, Pediatric Urology, and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Christian Illig
- Department of Urology, Pediatric Urology, and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Melanie Durschnabel
- Department of Urology, Pediatric Urology, and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Jürgen Wess
- Molecular Signaling Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology, and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Thomas Bschleipfer
- Clinic of Urology, Andrology, and Pediatric Urology, Weiden Hospital/Clinics of Nordoberpfalz AG, Weiden, Germany
| | - Wolfgang Kummer
- Institute for Anatomy and Cell Biology, Justus-Liebig-University Giessen, Giessen, Germany
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Wróbel A, Kluz T, Surkont G, Wlaźlak E, Miotła P, Skorupska K, Rechberger T. Perspectives for the pharmacological treatment of overactive bladder syndrome. Ginekol Pol 2017; 88:504-508. [PMID: 29057437 DOI: 10.5603/gp.a2017.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022] Open
Abstract
It has been found that antimuscarinic drugs, viewed as the "gold standard" in overactive bladder syndrome (OAB) treatment, have an unsatisfactory tolerance profile and limited clinical effectiveness. This fact has given a clear impetus to search for new options in OAB pharmacotherapy. The conducted pre-clinical trials have led to the development of new solutions for the treatment of OAB, which stand a good chance of being applied in clinical practice. The said compounds are characterised by higher receptor and organ specificity than currently used medications.
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Affiliation(s)
- Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin,, Jaczewskiego 8, PL 20-090 Lublin, Poland, 20-090, Lublin, Poland.
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Gralén K, Elmér C, Broström E, Althin R, Malmberg L. Clinical practice of BOTOX ® treatment for overactive bladder syndrome in Sweden: an assessment of resource use and external validity. Scand J Urol 2017; 51:397-401. [PMID: 28678587 DOI: 10.1080/21681805.2017.1334697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to assess the resource use of treating overactive bladder (OAB) patients in real-world clinical practice and to evaluate whether there is external validity in the treatment of OAB in clinical practice. MATERIALS AND METHODS The study included 55 patients suffering from OAB and treated with BOTOX® at two Swedish clinics. The study was conducted as an anonymized retrospective chart review study. RESULTS The estimated yearly direct cost of BOTOX treatment was €902. The mean age of patients in the study was 60 years, and 85% were women. The severity of OAB before BOTOX treatment, given by the mean number of daily leakages, equalled 4.8. The median interval between treatments was 210 days. CONCLUSIONS Patient characteristics in the real world were similar to those in the clinical trials, showing a high degree of external validity. Treatment intervals were longer in the real world than in clinical trials, indicating that treatment cost could be lower when patients are treated as observed in real-world clinical practice.
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Affiliation(s)
- Katarina Gralén
- a IHE , The Swedish Institute for Health Economics , Lund , Sweden
| | - Caroline Elmér
- b Stockholm Urogynecological Clinic , Stockholm , Sweden
| | - Eva Broström
- c Department of Urology , Skåne University Hospital , Malmö , Sweden
| | - Rikard Althin
- a IHE , The Swedish Institute for Health Economics , Lund , Sweden
| | - Lars Malmberg
- c Department of Urology , Skåne University Hospital , Malmö , Sweden
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Dahlinger D, Aslan S, Pietsch M, Frechen S, Fuhr U. Assessment of inhibitory effects on major human cytochrome P450 enzymes by spasmolytics used in the treatment of overactive bladder syndrome. Ther Adv Urol 2017; 9:163-177. [PMID: 28747995 PMCID: PMC5510770 DOI: 10.1177/1756287217708951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/19/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The objective of this study was to examine the inhibitory potential of darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine and trospium chloride on the seven major human cytochrome P450 enzymes (CYP) by using a standardized and validated seven-in-one cytochrome P450 cocktail inhibition assay. METHODS An in vitro cocktail of seven highly selective probe substrates was incubated with human liver microsomes and varying concentrations of the seven test compounds. The major metabolites of the probe substrates were simultaneously analysed using a validated liquid chromatography tandem mass spectrometry (LC-MS/MS) method. Enzyme kinetics were estimated by determining IC50 and Ki values via nonlinear regression. Obtained Ki values were used for predictions of potential clinical impact of the inhibition using a static mechanistic prediction model. RESULTS In this study, 49 IC50 experiments were conducted. In six cases, IC50 values lower than the calculated threshold for drug-drug interactions (DDIs) in the gut wall were observed. In these cases, no increase in inhibition was determined after a 30 min preincubation. Considering a typical dosing regimen and applying the obtained Ki values of 0.72 µM (darifenacin, 15 mg daily) and 7.2 µM [propiverine, 30 mg daily, immediate release (IR)] for the inhibition of CYP2D6 yielded a predicted 1.9-fold and 1.4-fold increase in the area under the curve (AUC) of debrisoquine (CYP2D6 substrate), respectively. Due to the inhibition of the particular intestinal CYP3A4, the obtained Ki values of 14 µM of propiverine (30 mg daily, IR) resulted in a predicted doubling of the AUC for midazolam (CYP3A4 substrate). CONCLUSIONS In vitro/in vivo extrapolation based on pharmacokinetic data and the conducted screening experiments yielded similar effects of darifenacin on CYP2D6 and propiverine on CYP3A4 as obtained in separately conducted in vivo DDI studies. As a novel finding, propiverine was identified to potentially inhibit CYP2D6 at clinically occurring concentrations.
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Affiliation(s)
- Dominik Dahlinger
- Department I of Pharmacology, University Hospital Cologne, Köln, Germany
| | - Sevinc Aslan
- Department I of Pharmacology, University Hospital Cologne, Köln, Germany
| | - Markus Pietsch
- Department II of Pharmacology, University Hospital Cologne, Köln, Germany
| | - Sebastian Frechen
- Department I of Pharmacology, University Hospital Cologne, Köln, Germany
| | - Uwe Fuhr
- Department I of Pharmacology, Center for Pharmacology, Clinical Pharmacology Unit, University Hospital Cologne (AöR), Gleueler Straße 24, 50931 Köln, Germany
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Janssen DA, Martens FM, de Wall LL, van Breda HM, Heesakkers JP. Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives. Med Devices (Auckl) 2017; 10:109-122. [PMID: 28615976 PMCID: PMC5460621 DOI: 10.2147/mder.s115678] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 12/21/2022] Open
Abstract
Objectives This review describes the evidence from established and experimental therapies that use electrical nerve stimulation to treat lower urinary tract dysfunction. Methods Clinical studies on established treatments such as percutaneous posterior tibial nerve stimulation (P-PTNS), transcutaneous electrical nerve stimulation (TENS), sacral nerve stimulation (SNS) and sacral anterior root stimulation (SARS) are evaluated. In addition, clinical evidence from experimental therapies such as dorsal genital nerve (DGN) stimulation, pudendal nerve stimulation, magnetic nerve stimulation and ankle implants for tibial nerve stimulation are evaluated. Results SNS and P-PTNS have been investigated with high-quality studies that have shown proven efficacy for the treatment for overactive bladder (OAB). SARS has proven evidence-based efficacy in spinal cord patients and increases the quality of life. TENS seems inferior to other OAB treatments such as SNS and P-PTNS but is noninvasive and applicable for ambulant therapy. Results from studies on experimental therapies such as pudendal nerve stimulation seem promising but need larger study cohorts to prove efficacy. Conclusion Neurostimulation therapies have proven efficacy for bladder dysfunction in patients who are refractory to other therapies. Significance Refinement of neurostimulation therapies is possible. The aim should be to make the treatments less invasive, more durable and more effective for the treatment of lower urinary tract dysfunction.
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Affiliation(s)
- Dick Aw Janssen
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
| | - Frank Mj Martens
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
| | - Liesbeth L de Wall
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
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Zilberlicht A, Haya N, Feferkorn I, Goldschmidt E, Kaldawy A, Abramov Y. Somatic, psychological, and sexual triggers for overactive bladder syndrome in women. Neurourol Urodyn 2017; 37:163-168. [PMID: 28220549 DOI: 10.1002/nau.23236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/01/2017] [Accepted: 01/07/2017] [Indexed: 11/06/2022]
Abstract
AIMS Patients with overactive bladder (OAB) often describe somatic, psychological, and sexual triggers for their symptoms. The aim of this study was to characterize these triggers and assess their impact on patients' symptoms and quality of life (QoL). METHODS Patients who visited our urogynecologic clinic between August 2015 and March 2016 and diagnosed with OAB syndrome were asked to fill a questionnaire comprising 34 statements regarding SOmatic, Psychological, and Sexual Triggers for OAB (SOPSETO). Patients additionaly completed the UDI-6 and IIQ-7 questionnaires. Statistical analysis was performed to determine the prevalence of each trigger and its correlation with the UDI-6 and IIQ-7 scores. RESULTS Sixty four women enrolled in this study. The SOPSETO questionnaire was found to be relaiable with Cronbach's alpha of 0.73-0.88. Construct validity was high with good correlation between the SOPSETO and the UDI-6 and IIQ-7 questionnaires. The triggers which had the highest correlation with the total UDI-6 scores were: Being far from toilets (r = 0.32, P = 0.004), swimming (r = 0.44, P = 0.02), taking a shower/bath (r = 0.36, P = 0.004), touching water (r = 0.35, P = 0.004), stepping out of a car (r = 0.32, P = 0.014), and experiencing an orgasm (r = 0.59, P = 0.001). The triggers: Experiencing an orgasm (r = 0.4, P = 0.033), having intercourse (r = 0.53, P = 0.002), stepping out of a car (r = 0.45, P = 0.001), and touching water (r = 0.28, P = 0.03) most significantly correlated with the total IIQ-7 scores. CONCLUSIONS Certain somatic, psychological, and sexual factors may trigger OAB symptoms and are therefore potential targets for behavioral therapy of this disorder, and for further research regarding its pathophysiological mechanisms.
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Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Nir Haya
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Ido Feferkorn
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Eyal Goldschmidt
- Department of Obstetrics and Gynecology, Bnei-Zion Medical Center, Haifa, Israel
| | - Anis Kaldawy
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
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Kirschner-Hermanns R, Anding R, Rosier P, Birder L, Andersson KE, Djurhuus JC. Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction--ICI-RS 2014. Neurourol Urodyn 2016; 35:318-23. [PMID: 26872575 PMCID: PMC4760427 DOI: 10.1002/nau.22815] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Received: 01/15/2015] [Accepted: 06/08/2015] [Indexed: 01/02/2023]
Abstract
Aims Urethral pathophysiology is often neglected in discussions of bladder dysfunction. It has been debated whether “urethral sphincter instability,” referred to based on observed “urethral pressure variations,” is an important aspect of overactive bladder syndrome (OAB). The purpose of this report is to summarize current urethral pathophysiology evidence and outline directions for future research based on a literature review and discussions during the ICI‐RS meeting in Bristol in 2014. Methods Urethral pathophysiology with a focus on urethral pressure variation (UPV) was presented and discussed in a multidisciplinary think tank session at the ICI_R meeting in Bristol 2014. This think tank session was based on collaboration between physicians and basic science researchers. Results Experimental animal studies or studies performed in clinical series (predominantly symptomatic women) provided insights into UPV, but the findings were inconsistent and incomplete. However, UPV is certainly associated with lower urinary tract symptoms (likely OAB), and thus, future research on this topic is relevant. Conclusions Future research based on adequately defined clinical (and urodynamic) parameters with precisely defined patient groups might shed better light on the cause of OAB symptoms. Further fundamental investigation of urethral epithelial–neural interactions via the release of mediators should enhance our knowledge and improve the management of patients with OAB. Neurourol. Urodynam. 35:318–323, 2016. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.
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Affiliation(s)
- Ruth Kirschner-Hermanns
- Neuro-Urologie, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Germany
| | - Ralf Anding
- Neuro-Urologie, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Germany
| | - Peter Rosier
- Department of Urology, University Medical Centre Utrecht, the Netherlands
| | - Lori Birder
- Departments of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Karl Erik Andersson
- Faculty of Health Sciences, Institut for Klinisk Medicin, Aarhus Universitet, Denmark.,AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Denmark
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Reynolds WS, Brown ET, Danford J, Kaufman M, Wein A, Dmochowski R, Bruehl S. Temporal summation to thermal stimuli is elevated in women with overactive bladder syndrome. Neurourol Urodyn 2016; 36:1108-1112. [PMID: 27434229 DOI: 10.1002/nau.23059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/04/2016] [Accepted: 06/13/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION This study sought to provide a preliminary assessment of whether spinally mediated afferent hyperactivity (i.e., central sensitization) might contribute to manifestations of overactive bladder syndrome (OAB) in women as indexed by elevated temporal summation of evoked heat pain stimuli. METHODS We recruited 20 adult women with OAB who were planning to undergo interventional therapy for OAB with either onabotulinumtoxinA injection or sacral neuromodulation and 23 healthy controls without OAB symptoms to undergo quantitative sensory testing with cutaneous thermal pain temporal summation. The primary study outcome was the degree of temporal summation, as reflected in the magnitude of positive slope of the line fitted to the series of 10 stimuli at the 49°C target temperatures. Linear regression and analysis of covariance were utilized to compare the degree of temporal summation between study groups. RESULTS The standardized slope of temporal summation trials for women with OAB was significantly higher than for controls (β = 3.43, 95% confidence interval = 0.6-6.2, P = 0.017). The adjusted means ±SE of the standardized temporal summation slopes for the full OAB and control groups were 3.0 ± 0.5 (95% confidence interval = 2.0, 4.1) and 1.7 ± 0.5 (95% confidence interval = 0.7, 2.7), respectively. CONCLUSION In this preliminary study, we demonstrated that women with OAB refractory to primary and secondary therapies exhibited greater thermal cutaneous temporal summation than women without OAB symptoms. This suggests that central sensitization, indexed by temporal summation, may be an underlying factor contributing to OAB in some women. Neurourol. Urodynam. 36:1108-1112, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Jill Danford
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan Wein
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
Male lower urinary tract symptoms (LUTS) are prevalent in the general population, especially in those of advanced age, and are characterized by notable diversity in etiology and presentation, and have been proven to cause various degrees of impairment on quality of life. The prostate has traditionally been regarded as the core cause of male LUTS. As a result, medical treatment aims to provide symptomatic relief and effective management of progression of male LUTS due to benign prostatic enlargement. In this context, α1-blockers, phosphodiesterase-5 inhibitors, and 5α-reductase inhibitors have long been used as monotherapies or in combination treatment to control voiding LUTS. There is accumulating evidence, however, that highlights the role of the bladder in the pathogenesis of male LUTS. Current research interests have shifted to bladder disorders, and medical management is aimed at the bladder. Muscarinic receptor antagonists and the newly approved β3-adrenergic agonist mirabegron aim to alleviate the most bothersome storage LUTS and thus improve quality of life. As voiding and storage LUTS frequently coexist, combination therapeutic strategies with α1-blockers and antimuscarinics or β3-agonists have been introduced to manage symptoms effectively. Anti-inflammatory agents, vitamin D3-receptor analogs, and cannabinoids represent treatment modalities currently under investigation for use in LUTS patients. Furthermore, luteinizing hormone-releasing hormone antagonists, transient receptor-potential channel blockers, purinergic neurotransmission antagonists, Rho-kinase inhibitors, and inhibitors of endothelin-converting enzymes could have therapeutic potential in LUTS management, but still remain in the experimental setting. This article reviews new strategies for the medical treatment of male LUTS, which are dictated by the potential role of the bladder and the risk of benign prostatic hyperplasia progression. Moreover, combination treatments and therapies currently under investigation are also presented.
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Affiliation(s)
- Konstantinos Dimitropoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Zhou F, Li H, Zhou C, Lv H, Ma Y, Wang Y, Song BO. Structural and functional changes in gap junctional intercellular communication in a rat model of overactive bladder syndrome induced by partial bladder outlet obstruction. Exp Ther Med 2016; 11:2139-2146. [PMID: 27284295 PMCID: PMC4887945 DOI: 10.3892/etm.2016.3246] [Citation(s) in RCA: 5] [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] [Received: 11/21/2014] [Accepted: 12/22/2015] [Indexed: 01/04/2023] Open
Abstract
The aim of the present study was to investigate the association between connexin (Cx)43 levels and alterations in gap junctional mediation of intercellular communication in overactive bladder syndrome (OAB), and to examine the effects of connexin inhibitor on this condition. Adult female Wistar rats with OAB following partial bladder outlet obstruction (PBBO) (OAB group, n=37) and sham-operated rats (control group, n=17) were studied. The ultrastructure of the rat detrusor was observed by transmission electron microscopy and the protein expression levels of Cx43 were analyzed using western blot analysis. Furthermore, bladder detrusor cells in both groups were cultured and cells in the OAB group were randomly divided into ten groups. In nine of these groups, 18-β glycyrrhetinic acid (18β-GA) was administered at various doses and durations. All groups were compared using fluorescence redistribution after photobleaching and a laser scanning confocal microscope. Cystometry demonstrated that gap junctions were an abundant mechanism among adjacent cells, and Cx43 protein expression levels were increased in the OAB group following 6 weeks of obstruction, as compared with the control group. Mean fluorescence recovery rates in the OAB group were significantly increased, as compared with the control group (P<0.01). Mean fluorescence recovery rates were noted following 18β-GA administration. These results suggested that upregulation of Cx43 induces structural and functional alterations in gap junctional intercellular communication following PBOO, and connexin inhibitors may be a novel therapeutic strategy for the clinical treatment of OAB.
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Affiliation(s)
- Fenghai Zhou
- Department of Urology, Lanzhou General Hospital, Lanzhou Command, PLA, Lanzhou, Gansu 730050, P.R. China
| | - Haiyuan Li
- Department of Urology, The Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730030, P.R. China
| | - Chuan Zhou
- Department of Urology, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Haidi Lv
- Department of Urology, Lanzhou General Hospital, Lanzhou Command, PLA, Lanzhou, Gansu 730050, P.R. China
| | - Yulei Ma
- Department of Urology, The Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730030, P.R. China
| | - Yangmin Wang
- Department of Urology, Lanzhou General Hospital, Lanzhou Command, PLA, Lanzhou, Gansu 730050, P.R. China
| | - B O Song
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
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van Breda HMK, Farag FF, Martens FMJ, Heesakkers JPFA, Rijkhoff NJM. Subject-Controlled, On-demand, Dorsal Genital Nerve Stimulation to Treat Urgency Urinary Incontinence; a Pilot. Front Neurosci 2016; 10:24. [PMID: 26903792 PMCID: PMC4746345 DOI: 10.3389/fnins.2016.00024] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/19/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the effect of subject-controlled, on-demand, dorsal genital nerve (DGN) stimulation on non-neurogenic urgency urinary incontinence (UUI) in a domestic setting. MATERIALS AND METHODS Non-neurogenic patients >18 years with overactive bladder symptoms and UUI were included. Exclusion criteria were mainly stress urinary incontinence. Patients underwent 1 week of subject-controlled, on-demand, DGN stimulation, delivered by a percutaneously placed electrode near the DGN connected to an external stimulator (pulse-rate 20 Hz, pulse-width 300 μs). Patients activated the stimulator when feeling the urge to void and stimulated for 30 s. The amplitude was set at the highest tolerable level. A bladder diary including a severity score of the UUI episodes/void (scores: 0 = none, 1 = drops, 2 = dashes, 3 = soaks) and a padtest was kept 3 days prior to, during, and 3 days after the test period. The subjective improvement was also scored. RESULTS Seven patients (4 males/3 females) were enrolled, the mean age was 55 years (range 23-73). Six completed the test week. In the remaining patient the electrode migrated and was removed. 5/6 finalized the complete bladder diary, 1/6 recorded only the heavy incontinence episodes (score = 3). 4/6 completed the padtest. In all patients who finalized the bladder diary the number of UUI episodes decreased, in 3/5 with ≥60%. The heavy incontinence episodes (score = 3) were resolved in 2/6 patients, and improved ≥80% in the other 4. The severity score of the UUI episodes/void was improved with ≥ 60% in 3/5 patients. The mean subjective improvement was 73%. CONCLUSION This feasibility study indicates that subject-controlled, on-demand DGN stimulation using a percutaneously placed electrode is possible over a longer time period, in a home setting, with a positive effect on non-neurogenic overactive bladder symptoms with UUI. Although the placement is an easy procedure, it is difficult to fixate the electrode to keep it in the correct position. Improvements in hardware, like a better fixated electrode and an easy to control stimulator, are necessary to make SODGNS a treatment possibility in the future.
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Affiliation(s)
| | - Fawzy F Farag
- Department of Urology, Radboud University Nijmegen Medical CentreNijmegen, Netherlands; Department of Urology, Sohag University HospitalSohag, Egypt
| | - Frank M J Martens
- Department of Urology, Radboud University Nijmegen Medical Centre Nijmegen, Netherlands
| | - John P F A Heesakkers
- Department of Urology, Radboud University Nijmegen Medical Centre Nijmegen, Netherlands
| | - Nico J M Rijkhoff
- Center for Sensory-Motor Interaction, Aalborg University Aalborg, Denmark
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Wróbel A. Overactive bladder syndrome pharmacotherapy: future treatment options. Prz Menopauzalny 2015; 14:211-7. [PMID: 26848291 DOI: 10.5114/pm.2015.56403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/18/2015] [Indexed: 12/02/2022]
Abstract
Overactive bladder syndrome (OAB) is a lifestyle disease and its incidence increases with age. Although it is not a life-threatening disease, it is known to have a significant impact on the quality of life. The first-choice pharmacological treatment of OAB is antimuscarinics. However, their limited clinical effectiveness and unsatisfactory tolerance profile, combined with the advancement of knowledge on the aetiopathogenesis of the disease, have inspired research on new pharmacotherapy options for OAB. Basic research has provided foundations for the development of new OAB treatments, which seem very promising and can be applied in clinical practice. The mechanisms of the studied compounds are based on their effect on certain receptors and neurotransmitters that contribute to regulating the micturition reflex. These compounds are not only more receptor-specific as compared to currently used drugs, but also some of them are organ-specific. Some of such compounds have already passed the proof-of-concept stage of development and have the therapeutic potential to determine the future of OAB pharmacotherapy. This review focuses on the mechanisms of substances that are now undergoing pre-clinical and clinical tests and their effects on the micturition cycle, while also identifying opportunities for using them with specific groups of patients. Due to the fact that OAB is a disease of symptoms and its aetiopathogenesis is complex, it seems that modern treatment methods should be tailor-made and based on the pathophysiological mechanisms that induce disease symptoms, rather than only treating the symptoms by inhibiting the contractility of the urinary bladder.
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Veeratterapillay R, Coates J, Leonard A, Pickard R, Drinnan M, Harding C. Detrusor after-contraction on ambulatory urodynamics in symptomatic women. Int J Urol 2015; 22:1058-62. [PMID: 26300214 DOI: 10.1111/iju.12887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/23/2015] [Accepted: 06/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the association between detrusor after-contraction and urodynamic parameters in a cohort of patients undergoing urodynamic studies by ambulatory monitoring. METHODS All symptomatic adult female patients with non-neurogenic lower urinary tract dysfunction having ambulatory monitoring over the period January 1998 to January 2014 were included. Urodynamic traces were reviewed to identify detrusor after-contraction. Measured urodynamic variables were Qmax (mL/s), V(void) (mL) and P(det.Qmax) (cmH(2)O). Student's unpaired t-test was used to compare the mean of the variable in the detrusor after-contraction and non-detrusor after-contraction groups. RESULTS We identified 331 women with a median age of 50 years (range 16-82). Detrusor after-contraction was seen after at least one void in 122 patients giving a prevalence of 37%. A total of 167 (51%) patients had detrusor overactivity. Diagnosis of detrusor overactivity was associated with the presence of detrusor after-contraction (P < 0.05). Overall, patients with detrusor after-contraction had a statistically higher mean P(det.Qmax) (32 vs 28 cmH(2)O, P = 0.04) and lower mean voided volume (300 vs 378 mL, P < 0.001). CONCLUSION These findings suggest a relatively high prevalence of detrusor after-contraction during ambulatory monitoring, and an association between detrusor overactivity, V(void), P(det.Qmax) and detrusor after-contraction recorded during ambulatory monitoring. Therefore, a link between detrusor after-contractions and the syndrome of overactive bladder can be postulated.
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Affiliation(s)
- Rajan Veeratterapillay
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James Coates
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Leonard
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Pickard
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Drinnan
- Department of Medical Physics, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris Harding
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Hsiao SM, Lin HH, Kuo HC. Factors associated with a better therapeutic effect of solifenacin in patients with overactive bladder syndrome. Neurourol Urodyn 2013; 33:331-4. [PMID: 23494586 DOI: 10.1002/nau.22394] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 11/11/2012] [Accepted: 02/13/2013] [Indexed: 11/09/2022]
Abstract
AIMS To analyze the predictors of therapeutic success after solifenacin treatment. METHODS Between January 2008 and December 2011, all patients with overactive bladder syndrome (OAB) who consecutively visited the urologic outpatient clinics of a medical center were prospectively enrolled. All enrolled patients received 5 mg solifenacin once a day for 12 weeks. RESULTS Overall, 648 patients, 332 men, and 316 women, completed the 12-week study. The overall success rate was 48.8%. The success rate for female patients was superior to that for male patients (55.4% vs. 42.5%, P < .001). The urgency severity scale (USS) score, daytime frequency, nocturia, voided volume, and bladder capacity were all improved after 12 weeks' treatment. Multivariate logistic regression analysis revealed that female gender, high USS score, high maximum flow rate (Qmax ), and low postvoid residual volume (PVR) were all significant predictive factors for success after antimuscarinic treatment. USS score = 4 and Qmax ≥ 12 ml/sec were the most strongly predictive cutoff values for success, with receiver operating characteristic curve (ROC) areas of 0.70 (sensitivity = 66.8%, specificity = 66.0%) and 0.63 (sensitivity = 80.7%, specificity = 43.1%), respectively. PVR ≥ 70 ml was the most predictive cutoff value for failure, with a ROC area of 0.58 (sensitivity = 18.2%, specificity = 93.7%). CONCLUSIONS Female gender, high USS score, high Qmax , and low PVR were associated with better therapeutic efficacy. These findings could serve as an initial guide or assist in consultation regarding the treatment of OAB patients with antimuscarinics.
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Affiliation(s)
- Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan
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Abstract
Overactive bladder syndrome (OAB) is a constellation of distressing symptoms that significantly impair quality of life, sexual function, and work productivity, and imposes a significant economic burden to society. Pharmacological treatment with antimuscarinic agents, behavioral modification, bladder retraining, and/or pelvic floor exercises are often used alone or in combination as the mainstay treatment in the management of OAB. Oxybutynin has been used in the treatment of OAB for over 20 years with proven efficacy and is often the comparator in drug treatment trials. Oral formulations of oxybutynin have proven efficacy, but not without significant antimuscarinic effects, which reduce patient persistence with medical treatment. Low levels of patient persistence with oral formulations of oxybutynin provided an impetus for the development of a transdermal oxybutynin delivery system. The oxybutynin transdermal formulation has been found to have side effects similar to that of a placebo in randomized controlled trials while providing excellent efficacy. Patient persistence with therapy, improved quality of life, sexual function and interpersonal relationships have been observed with use of the transdermal oxybutynin delivery system. Its twice weekly dosing, low side effect profile, and high efficacy have made it a good choice for initial treatment of overactive bladder syndrome.
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