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Evans CNB, Badenhorst A, Van Wijk FJ. The impact of pharmacotherapy on sexual function in female patients being treated for idiopathic overactive bladder: a systematic review. BMC Womens Health 2024; 24:290. [PMID: 38755593 PMCID: PMC11097459 DOI: 10.1186/s12905-024-03103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Overactive bladder (OAB) is a condition defined by urgency with or without incontinence which disproportionately affects female patients and has a negative impact on sexual enjoyment and avoidance behaviour. Pharmacotherapy can be considered one of the main options for treating OAB. This research set out to determine the impact of pharmacotherapy on sexual function in females with OAB. METHODS This research used the robust methodology of a systematic review. The clinical question was formulated using the PICO (population, intervention, control, and outcomes) format to include females being treated with pharmacotherapy (anticholinergics or beta-3 adrenergic agonists) for idiopathic OAB with the use of a validated questionnaire assessing self-reported sexual function at baseline and post-treatment. The review incorporated the MEDLINE, PubMed and EMBASE databases. The AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) appraisal tool was used to guide the review process. Two reviewers worked independently in screening abstracts, deciding on the inclusion of full-texts, data extraction and risk of bias assessment. RESULTS In female patients with OAB, pharmacotherapy does seem to offer at least partial improvement in self-reported sexual function outcomes after 12 weeks of therapy. Still, the value of this finding is limited by an overall poor quality of evidence. Patients with a higher degree of bother at baseline stand to benefit the most from treatment when an improvement within this health-related quality of life domain is sought. CONCLUSION This research should form the basis for a well-conducted randomized controlled study to accurately assess sexual function improvements in females being treated with pharmacotherapy for OAB.
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Affiliation(s)
- Christopher Neal Bruce Evans
- Surgery Masters in Urology, the University of Edinburgh (Edinburgh Surgery Online, Deanery of Clinical Sciences) and Life Groenkloof Hospital, Suite 209, Life Groenkloof Hospital, 50 George Storrar Drive, Groenkloof, Pretoria, 0181, South Africa.
| | - Anja Badenhorst
- General Practitioner, University of Pretoria, Pretoria, South Africa
| | - Frans Jacob Van Wijk
- Private Uro-Gynaecologist/Urologist, Pelvic Wellness Unit, The Urology Hospital, Pretoria, South Africa
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He W, Huang G, Cui W, Tian Y, Sun Q, Zhao X, Zhao Y, Li D, Liu X. Comparative assessment of efficacy and safety of approved oral therapies for overactive bladder: a systematic review and network meta-analysis. Int Braz J Urol 2023; 49:535-563. [PMID: 37506033 PMCID: PMC10482468 DOI: 10.1590/s1677-5538.ibju.2023.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
bladder based on a systematic review and network meta-analysis approach. METHODS Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022. Randomized controlled double-blind trials of oral medication for overactive bladder were screened against the protocol's entry criteria. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 software. RESULT A total of 60 randomized controlled double-blind clinical trials were included involving 50,333 subjects. Solifenacin 10mg was the most effective in mean daily micturitions and incontinence episodes, solifenacin 5/10mg in mean daily urinary urgency episodes and nocturia episodes, fesoterodine 8mg in urgency incontinence episodes/d and oxybutynin 5mg in voided volume/micturition. In terms of safety, solifenacin 5mg, ER-tolterodine 4mg, mirabegron, vibegron and ER-oxybutynin 10mg all showed a better incidence of dry mouth, fesoterodine 4mg, ER-oxybutynin 10mg, tolterodine 2mg, and vibegron in the incidence of constipation. Compared to placebo, imidafenacin 0.1mg showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and darifenacin 15mg in headache. CONCLUSION Solifenacin showed better efficacy. For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated. The choice of drugs should be tailored to the patient's specific situation to find the best balance between efficacy and safety.
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Affiliation(s)
- Wenjuan He
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Guangliang Huang
- HeBei Medical UniversityDepartment of Clinical PharmacyShijiazhuangHebeiChinaDepartment of Clinical Pharmacy, HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Wenyan Cui
- HeBei Medical UniversityDepartment of Clinical PharmacyShijiazhuangHebeiChinaDepartment of Clinical Pharmacy, HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Yunfei Tian
- University of Hong KongDepartment of psychologyHong KongChinaDepartment of psychology, the University of Hong Kong, Hong Kong, China
| | - Qian Sun
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Xiaojuan Zhao
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Yonghong Zhao
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Dan Li
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
| | - Xiuju Liu
- Second Hospital of HeBei Medical UniversityDepartment of PharmacyShijiazhuangHebeiChinaDepartment of Pharmacy, the Second Hospital of HeBei Medical University, Shijiazhuang (Hebei), China;
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Farag F, Sakalis VI, Arteaga SM, Sihra N, Karavitakis M, Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, Groen J, Peyronnet B, Phé V, van Poelgeest-Pomfret ML, van den Bos TWL, van der Vaart H, Harding CK, Carmela Lapitan M, Imran Omar M, Nambiar AK. What Are the Short-term Benefits and Potential Harms of Therapeutic Modalities for the Management of Overactive Bladder Syndrome in Women? A Review of Evidence Under the Auspices of the European Association of Urology, Female Non-neurogenic Lower Urinary Tract Symptoms Guidelines Panel. Eur Urol 2023; 84:302-312. [PMID: 37331921 DOI: 10.1016/j.eururo.2023.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023]
Abstract
CONTEXT Overactive bladder syndrome (OAB) is highly prevalent among women and has a negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities. OBJECTIVE To provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome. EVIDENCE ACQUISITION The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. The risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions, and quality of evidence was assessed using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A meta-analysis was performed where appropriate. EVIDENCE SYNTHESIS Antimuscarinics and beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists being more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events. Onabotulinumtoxin-A (Onabot-A) was more effective than placebo across most outcomes, but with significantly higher rates of acute urinary retention/clean intermittent self-catheterisation (six to eight times) and urinary tract infections (UTIs; two to three times). Onabot-A was also significantly better than antimuscarinics in the cure of urgency urinary incontinence (UUI) but not in the reduction of mean UUI episodes. Success rates of sacral nerve stimulation (SNS) were significantly higher than those of antimuscarinics (61% vs 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% vs 10%). SNS was associated with 9% removal rate and 3% revision rate. CONCLUSIONS Overactive bladder is a manageable condition, with first-line treatment options including antimuscarinics, beta-3 agonists, and posterior tibial nerve stimulation. Second-line options include Onabot-A bladder injections or SNS. The choice of therapies should be guided by individual patient factors. PATIENT SUMMARY Overactive bladder is a manageable condition. All patients should be informed and advised on conservative treatment measures in the first instance. The first-line treatment options for its management include antimuscarinics or beta-3 agonists medication, and posterior tibial nerve stimulation procedures. The second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation procedure. The therapy should be chosen based on individual patient factors.
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Affiliation(s)
- Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Néha Sihra
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | | | | | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Veronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | | | | | - Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - Christopher K Harding
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Carmela Lapitan
- College of Medicine/Philippine General Hospital/National institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Muhammad Imran Omar
- University of Aberdeen, Aberdeen, UK; European Association of Urology, Arnhem, The Netherlands
| | - Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Stoniute A, Madhuvrata P, Still M, Barron-Millar E, Nabi G, Omar MI. Oral anticholinergic drugs versus placebo or no treatment for managing overactive bladder syndrome in adults. Cochrane Database Syst Rev 2023; 5:CD003781. [PMID: 37160401 PMCID: PMC10167789 DOI: 10.1002/14651858.cd003781.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Around 16% of adults have symptoms of overactive bladder (OAB; urgency with frequency and/or urge incontinence), with prevalence increasing with age. Anticholinergic drugs are commonly used to treat this condition. This is an update of a Cochrane Review first published in 2002 and last updated in 2006. OBJECTIVES To assess the effects of anticholinergic drugs compared with placebo or no treatment for treating overactive bladder syndrome in adults. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 14 January 2020), and the reference lists of relevant articles. We updated this search on 3 May 2022, but these results have not yet been fully incorporated. SELECTION CRITERIA We included randomised or quasi-randomised trials in adults with overactive bladder syndrome that compared an anticholinergic drug alone with placebo treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility and extracted data from the included studies, including an assessment of the risk of bias. We assessed the certainty of the body of evidence using the GRADE approach. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 104 studies, 71 of which were new or updated for this version of the review. Although 12 studies did not report the number of participants, there were 47,106 people in the remainder of the included studies. The majority of the studies had insufficient information to allow judgement of risk of bias and we judged them to be unclear for all domains. Nine anticholinergic drugs were included in these studies: darifenacin; fesoterodine; imidafenacin; oxybutynin; propantheline; propiverine; solifenacin; tolterodine and trospium. No studies were found that compared anticholinergic drugs to no treatment. At the end of the treatment period, anticholinergics may slightly increase condition-specific quality of life (mean difference (MD) 4.41 lower, 95% confidence interval (CI) 5.28 lower to 3.54 lower (scale range -100 to 0); 12 studies, 6804 participants; low-certainty evidence). Anticholinergics are probably better than placebo in terms of patient perception of cure or improvement (risk ratio (RR) 1.38, 95% CI 1.15 to 1.66; 9 studies, 8457 participants; moderate-certainty evidence), and the mean number of urgency episodes per 24-hour period (MD 0.85 lower, 95% CI 1.03 lower to 0.67 lower; 23 studies, 16,875 participants; moderate-certainty evidence). Compared to placebo, anticholinergics may result in an increase in dry mouth adverse events (RR 3.50, 95% CI 3.26 to 3.75; 66 studies, 38,368 participants; low-certainty evidence), and may result in an increased risk of urinary retention (RR 3.52, 95% CI 2.04 to 6.08; 17 studies, 7862 participants; low-certainty evidence). Taking anticholinergics may be more likely to lead to participants withdrawing from the studies due to adverse events (RR 1.37, 95% CI 1.21 to 1.56; 61 studies, 36,943 participants; low-certainty evidence). However, taking anticholinergics probably reduces the mean number of micturitions per 24-hour period compared to placebo (MD 0.85 lower, 95% CI 0.98 lower to 0.73 lower; 30 studies, 19,395 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS The use of anticholinergic drugs by people with overactive bladder syndrome results in important but modest improvements in symptoms compared with placebo treatment. In addition, recent studies suggest that this is generally associated with only modest improvement in quality of life. Adverse effects were higher with all anticholinergics compared with placebo. Withdrawals due to adverse effects were also higher for all anticholinergics except tolterodine. It is not known whether any benefits of anticholinergics are sustained during long-term treatment or after treatment stops.
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Affiliation(s)
- Akvile Stoniute
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Priya Madhuvrata
- Obstetrics & Gynaecology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Madeleine Still
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Evelyn Barron-Millar
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ghulam Nabi
- Section of Academic Urology, Division of Cancer Research, University of Dundee, Dundee, UK
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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The effects of mirabegron used for overactive bladder treatment on female sexual function. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Background/Aim: Overactive bladder (OAB) is a common condition, especially in middle-aged women and can frequently have negative effects on female sexual function (FSD). The aim of the study was to assess the impact of mirabegron on female sexual dysfunction in women affected by OAB.
Methods: In this cross-sectional study, 42 women with OAB and FSD were retrospectively enrolled. Patients were evaluated based on a detailed history, physical examination, uroflowmetry and residual urine measurements, 3-day voiding diary, visual analog scale (VAS), and Female Sexual Function Index (FSFI) questionnaire before and 12 weeks after treatment with mirabegron (50 mg/day).
Results: At the 12-week follow-up, OAB symptoms improved significantly in all patients. The mean (standard deviation [SD]) FSFI total score significantly improved in 34/42 patients (80.9%) from 16.8 (1.3) to 26.9 (1.6); P<0.001. Mean (SD) scores significantly increased in domains of desire (from 2.1 [0.6] to 4.8 [0.2]), arousal (from 2.6 [0.3] to 4.3 [0.5]), lubrication (from 3.1 [0.6] to 4,1 [0.2]), orgasm (from 3.1 [0.2] to 4.3 [0.1]), and satisfaction (from 2.8 [0.4] to 4.1 [0.5]) after 12 weeks of treatment with mirabegron. Also, mean VAS scores significantly improved from 4.4 (1.4) to 8.8 (1.1); P<0.001.
Conclusion: Treatment of OAB with mirabegron yields positive effects on sexual function of OAB patients.
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Polland A, Hamner JJ, Arunachalam D, Dwarica DS, Gupta A, Pennycuff JF, Tran AD, Tefera E, Meriwether KV, Gutman RE. STOMp: sexual function trial of overactive bladder medication. Sex Med 2023; 11:qfac001. [PMID: 37007850 PMCID: PMC10065174 DOI: 10.1093/sexmed/qfac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 01/13/2023] Open
Abstract
Abstract
Background
Female sexual function has been shown to improve with overactive bladder (OAB) treatment.
Aim
The objective of this study was to evaluate the effects of anticholinergics (ACHs) or a beta-agonist (BAG) on female sexual function.
Methods
This was a prospective multicenter cohort study. Sexually active women with OAB completed the Overactive Bladder questionnaire (OAB-q) and Female Sexual Function Index (FSFI) prior to and after 12 weeks of therapy. Sample sizes of 63 per group were calculated to detect a clinically relevant difference in the FSFI.
Outcomes
The primary outcome was FSFI change from baseline at 12 weeks.
Results
A total of 157 patients were recruited, and 91 completed follow-up (58/108, ACH; 31/49, BAG). There were within-group FSFI differences from pre- to posttreatment: a worsening of arousal in the ACH group (P = .046) and an improvement in overall FSFI (P = .04) and pain (P = .04) in the BAG group. After treatment, postmenopausal women in the BAG group had significantly better overall FSFI (P = .01), desire (P = .003), arousal (P = .009), and orgasm (P = .01).
Clinical Implications
While further research is necessary, this study provides information about the comparative effects of OAB treatments on female sexual function, which may ultimately lead to better patient selection and outcomes.
Strengths and Limitations
While there was no difference between the subjects who completed the study and those who did not, the study remained underpowered after the loss to follow-up. The multicenter cohort design allows for generalizability of results.
Conclusion
Although this study was underpowered, an improvement in overall sexual function was seen with BAGs, while ACHs were associated with worsening aspects of sexual function.
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Affiliation(s)
- Allison Polland
- Department of Surgery/Urology, Maimonides Medical Center , Brooklyn, NY 11220 , USA
| | | | - Divya Arunachalam
- Department of Gynecology, Kaiser Permanente Fontana Medical Center , Fontana, CA 92553 , USA
| | | | - Ankita Gupta
- Department of Gynecology, University of Louisville , Louisville, KY 40215 , USA
| | - Jon F Pennycuff
- Department of Gynecology, University of Wisconsin , Madison, WI 53715 , USA
| | - Ann D Tran
- Department of Gynecology, Icahn School of Medicine at Mount Sinai , New York, NY 10029 , USA
| | - Eshetu Tefera
- Department of Biostatistics, Medstar Health Research Institute , Hyattsville, MD 20782 , USA
| | - Kate V Meriwether
- Department of Gynecology, University of New Mexico , Albuquerque, NM 87131 , USA
| | - Robert E Gutman
- Department of Gynecology, MedStar Georgetown University , Washington, DC 20010 , USA
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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] [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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Mostafaei H, Salehi-Pourmehr H, Jilch S, Carlin GL, Mori K, Quhal F, Pradere B, Grossmann NC, Laukhtina E, Schuettfort VM, Aydh A, Sari Motlagh R, König F, Roehrborn CG, Katayama S, Rajwa P, Hajebrahimi S, Shariat SF. Choosing the Most Efficacious and Safe Oral Treatment for Idiopathic Overactive Bladder: A Systematic Review and Network Meta-analysis. Eur Urol Focus 2021; 8:1072-1089. [PMID: 34563481 DOI: 10.1016/j.euf.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The choice of the most efficacious drug for patients with idiopathic overactive bladder (IOAB) remains challenging. OBJECTIVE The aim of this network meta-analysis was to determine the most efficacious oral antimuscarinic or β-adrenoceptor agonist accounting for adverse events for the management of IOAB. EVIDENCE ACQUISITION A comprehensive electronic search was done in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Ovid for studies in any language in February 2021 considering the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We included all randomized controlled trials assessing oral antimuscarinics or β-adrenoceptor agonists for the treatment of IOAB. We determined the effect of specific bothersome symptoms separately. EVIDENCE SYNTHESIS Fifty-four articles were included in our analysis. The most efficacious agents considering the evaluated outcomes were oxybutynin 15 mg/d in reducing incontinence episodes, imidafenacin 0.5 mg/d together with solifenacin 10 and 5 mg/d in reducing micturition episodes, fesoterodine 4 and 8 mg/d as well as solifenacin 10 mg/d in reducing urgency episodes, imidafenacin 0.5 mg/d and solifenacin 10 mg/d in reducing urgency urinary incontinence episodes, and solifenacin 10 mg/d, vibegron 50 mg/d, and fesoterodine 8 mg/d in improving the voided volume. Gastrointestinal problems, especially due to antimuscarinic agents, were the most prevalent adverse events. CONCLUSIONS Taken together, there is only minimal difference between the efficacy of oral antimuscarinics and that of β-adrenoceptor agonists. Although finding the best medication for all is impossible, finding the best treatment for every individual patient can be done by considering the efficacy of a medicine for the most bothersome symptom(s) in balance with drug-specific adverse events. PATIENT SUMMARY This study aimed to find the most efficient oral medication to treat overactive bladder, taking into consideration the adverse events. Based on our study, there is a minimal difference in the efficacy between the two major drug classes used to treat overactive bladder. Gastrointestinal problems were the most common adverse events in medical treatment of overactive bladder. Selection of the best treatment is possible through shared decision-making between the doctor and the patient based on the patient's most bothersome symptom. We provide a framework for physicians to facilitate shared decision-making with each individual patient.
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Affiliation(s)
- Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sandra Jilch
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Greta Lisa Carlin
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Nico C Grossmann
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Victor M Schuettfort
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Abdulmajeed Aydh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; King Faisal Medical City, Abha, Saudi Arabia
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; European Association of Urology research foundation, Arnhem, The Netherlands.
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Placebo Response in Patients with Oral Therapy for Overactive Bladder: A Systematic Review and Meta-analysis. Eur Urol Focus 2021; 8:239-252. [PMID: 33674256 DOI: 10.1016/j.euf.2021.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/10/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022]
Abstract
CONTEXT The role of a placebo response in the management of overactive bladder (OAB) remains unclear. OBJECTIVE The aim of this review is to methodically study the placebo response extracted from the control arms of randomized clinical trials assessing therapy in patients with OAB. EVIDENCE ACQUISITION Medline (PubMed), The Cochrane Library, EMBASE, and Scopus were searched to identify randomized controlled trials (RCTs) published until September 2019. Randomized placebo-controlled trials investigating oral drug therapy for OAB were included. The articles were critically appraised by two reviewers. The primary outcomes were the placebo response in the main patient-reported urinary outcomes together with assessing the impact of patient demographic factors on the placebo response. EVIDENCE SYNTHESIS The initial search resulted in 1982 records after reviewing the titles and abstracts, and reference lists of other systematic reviews; 57 studies with an overall estimated 12 901 patients were included in the meta-analysis. The included studies were of overall high/acceptable quality. The standardized mean difference was -0.45 (95% confidence interval [CI] -0.51 to -0.40; p<0.001) for daily micturition episodes, -0.33 (95% CI -0.42 to -0.24; p<0.001) for daily nocturia episodes, -0.46 (95% CI -0.55 to -0.37; p<0.001) for urgency urinary incontinence episodes, -0.50 (95% CI -0.61 to -0.39; p<0.001) for daily urgency episodes, -0.51 (95% CI -0.60 to -0.43; p<0.001) for daily incontinence episodes, and 0.25 (95% CI 0.211-0.290; p<0.001) for volume voided per micturition. The meta-regression of age-related impact of the placebo response on nocturia showed a slope of -0.02 (p<0.001). CONCLUSIONS Placebo has a statistically significant effect on improving symptoms and signs associated with OAB; this effect is age dependent. However, there is no consensus on what change of OAB symptoms and signs is clinically meaningful for the affected patient. Taken together, the placebo response seems to be non-negligible in OAB, supporting the need for placebo control in RCTs. PATIENT SUMMARY Placebo is an inert treatment method often used in clinical research for comparison with active treatment. However, studies show that placebo has an effect of its own. A placebo response means the total improvement resulting from receiving a placebo. In our study, placebo had a significant role in improving the symptoms of overactive bladder.
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Takahashi S, Takei M, Asakura H, Gotoh M, Ishizuka O, Kato K, Koyama M, Takeyama M, Tomoe H, Yamanishi T, Yokoyama O, Yoshida M, Yoshimura Y, Yoshizawa T. Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition). Int J Urol 2021; 28:474-492. [PMID: 33650242 DOI: 10.1111/iju.14492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Takeyama
- Urogynecology Center, First Towakai Hospital, Takatsuki, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasukuni Yoshimura
- Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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11
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Kinjo M, Masuda K, Nakamura Y, Taguchi S, Tambo M, Okegawa T, Fukuhara H. Effects on Depression and Anxiety After Mid-Urethral Sling Surgery for Female Stress Urinary Incontinence. Res Rep Urol 2020; 12:495-501. [PMID: 33117749 PMCID: PMC7585269 DOI: 10.2147/rru.s270915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Urinary incontinence (UI) is a common health-related problem in the female population and has a negative impact on many aspects of patients’ quality of life including mental problems. This study evaluated the mental effects of mid-urethral sling (MUS) surgery in female patients with stress UI or stress UI-dominant mixed UI. Patients and Methods Women with stress UI or stress UI-dominant mixed UI who underwent MUS surgery and were enrolled in this study and followed up for 12 months. The International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF) and the Hospital Anxiety and Depression Scale (HADS) at baseline and 12 months after the MUS to evaluate the efficacy of the surgery. Results At baseline, proportions of the patients with anxiety (HADS-Anxiety score of ≥8) and depression (HADS-Depression score of ≥8) were 21.6% (22/102) and 24.5% (25/102), respectively. At 12 months postoperatively, the median ICIQ-SF score, HADS-Anxiety score, and HADS-Depression score were significantly improved compared with their baseline values (p<0.001 for ICIQ-SF and HADS-Depression, p=0.011 for HADS-Anxiety). At 12 months postoperatively, changes in the ICIQ-SF and HADS-A scores showed a moderate correlation (r = 0.578, p < 0.001), and changes in the ICIQ-SF and HADS-D scores had a strong correlation (r = 0.838, p <0.001). Conclusion This study demonstrated that MUS surgery significantly improved UI, anxiety, and depression with significant correlations in their symptoms. This suggests that improvement of the patients’ UI helped to relieve their symptoms of anxiety and depression.
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Affiliation(s)
- Manami Kinjo
- Department of Urology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Kazuki Masuda
- Department of Urology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Yu Nakamura
- Department of Urology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Satoru Taguchi
- Department of Urology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Mitsuhiro Tambo
- Department of Urology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Takatsugu Okegawa
- Department of Urology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
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12
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Comparison of vascularization and overall perfusion of the bladder wall between women with and without overactive bladder syndrome. Sci Rep 2020; 10:7549. [PMID: 32371952 PMCID: PMC7200738 DOI: 10.1038/s41598-020-64532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/28/2020] [Indexed: 11/21/2022] Open
Abstract
The pathophysiology of female overactive bleeder syndrome (OAB) remains undetermined. Our aim is to elucidate the role of vacularization and overall perfusion of the bladder wall in women with OAB. Between 2010 and 2016, women with OAB and the asymptomatic controls were enrolled. Women with OAB were treated with tolterodine. Women with OAB (n = 40) had higher vascularization index (0.40 ± 0.57 versus 0.17 ± 0.22, p = 0.003), vascularization-flow index (0.15 ± 0.28 versus 0.05 ± 0.08, p = 0.003) and thicker trigone (0.56 ± 0.13 cm versus 0.47 ± 0.11 cm, p = 0.004), compared with the controls (n = 34). The following optimum cut-off values to predict OAB were determined: (1) vascularization index (%) ≥ 0.16, (2) vascularization-flow index ≥ 0.032, and (3) trigone bladder wall thickness ≥ 0.47 cm with an area under the curve of 0.71, 0.71 and 0.70, respectively. Correlation analysis showed that a significant correlation between urgency and vascularization index/vascularization-flow index (Spearman’s rho = 0.34 and 0.35, respectively, all p < 0.01). However, after 12 weeks of tolterodine treatment, the vascularization index, flow index and vascularization-flow index did not differ between baseline and after treatment. In conclusion, women with OAB have higher vascularization and overall perfusion of the bladder wall, compared women without OAB. However, vascularization and overall perfusion did not change after antimuscarinic treatment.
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Holschneider DP, Wang Z, Guo Y, Sanford MT, Yeh J, Mao JJ, Zhang R, Rodriguez LV. Exercise modulates neuronal activation in the micturition circuit of chronically stressed rats: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome (MAPP) research network study. Physiol Behav 2019; 215:112796. [PMID: 31884113 DOI: 10.1016/j.physbeh.2019.112796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rats exposed to water avoidance stress (WAS) show increased urinary frequency, increased somatosensory nociceptive reflex responses, as well as altered brain responses to bladder distension, analogous to similar observations made in patients with urologic chronic pelvic pain syndrome (UCPPS). Exercise has been proposed as a potential treatment option for patients with chronic urinary frequency and urgency. We examined the effects of exercise on urinary voiding parameters and functional brain activation during bladder distension in rats exposed to WAS. METHODS Adult, female Wistar Kyoto rats were exposed to 10 days of WAS and thereafter randomized to either voluntary exercise for 3 weeks or sedentary groups. Voiding parameters were assessed at baseline, post-WAS, and weekly for 3 weeks. Thereafter, cerebral blood flow (CBF) mapping was performed during isotonic bladder distension (20 cm H2O) after intravenous bolus injection of [14C]-iodoantipyrine. Regional CBF was quantified in autoradiographs of brain slices and analyzed in 3-D reconstructed brains by statistical parametric mapping. Functional connectivity was examined between regions of the micturition circuit through interregional correlation analysis. RESULTS WAS exposure in sedentary animals (WAS/no-EX) increased voiding frequency and decreased urinary volumes per void. Exercise exposure in WAS animals (WAS/EX) resulted in a progressive decline in voiding frequency back to the baseline, as well as increased urinary volumes per void. Within the micturition circuit, WAS/EX compared to WAS/no-EX demonstrated a significantly lower rCBF response to passive bladder distension in Barrington's nucleus that is part of the spinobulbospinal voiding reflex, as well as in the periaqueductal gray (PAG) which modulates this reflex. Greater rCBF was noted in WAS/EX animals broadly across corticolimbic structures, including the cingulate, medial prefrontal cortex (prelimbic, infralimbic areas), insula, amygdala, and hypothalamus, which provide a 'top-down' decision point where micturition could be inhibited or triggered. WAS/EX showed a significantly greater positive brain functional connectivities compared to WAS/no-EX animals within regions of the extended reflex loop (PAG, Barrington's nucleus, intermediodorsal thalamic nucleus, pons), as well as within regions of the corticolimbic decision-making loop of the micturition circuit, with a strikingly negative correlation between these pathways. Urinary frequency was positively correlated with rCBF in the pons, and negatively correlated with rCBF in the cingulate cortex. CONCLUSION Our results suggest that chronic voluntary exercise may decrease urinary frequency at two points of control in the micturition circuit. During the urine storage phase, it may diminish the influence of the reflex micturition circuit itself, and/or it may increase corticolimbic control of voiding. Exercise may be an effective adjunct therapeutic intervention for modifying the urinary symptoms in patients with UCPPS.
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Affiliation(s)
- Daniel P Holschneider
- Departments of Psychiatry and the Behavioral Sciences, Los Angeles, CA, United States.
| | - Zhuo Wang
- Departments of Psychiatry and the Behavioral Sciences, Los Angeles, CA, United States
| | - Yumei Guo
- Departments of Psychiatry and the Behavioral Sciences, Los Angeles, CA, United States
| | - Melissa T Sanford
- Urology at the University of Southern California, Los Angeles, CA, United States
| | - Jihchao Yeh
- Urology at the University of Southern California, Los Angeles, CA, United States
| | - Jackie J Mao
- Urology at the University of Southern California, Los Angeles, CA, United States
| | - Rong Zhang
- Urology at the University of Southern California, Los Angeles, CA, United States
| | - Larissa V Rodriguez
- Urology at the University of Southern California, Los Angeles, CA, United States.
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Levy G, Lowenstein L. Overactive Bladder Syndrome Treatments and Their Effect on Female Sexual Function: A Review. Sex Med 2019; 8:1-7. [PMID: 31604683 PMCID: PMC7042164 DOI: 10.1016/j.esxm.2019.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction Overactive bladder (OAB), the most common subtype of urinary incontinence, has a heavy price on quality of life, especially on sexual life. Unfortunately, most women rarely voice the worsening of sexual function, especially those who already suffer from OAB symptoms. It has been demonstrated that patients who suffer from OAB score lower on Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and Female Sexual Function Index scores, meaning that their sexual function is debilitated. Therapies for OAB begin with traditional pelvic floor physiotherapy, advance to anticholinergic drugs, and become more invasive with intravesical injections of onabotulinumtoxinA (commonly known as Botox). Last, for patients resistant to conservative therapies, sacral neuromodulation is the treatment of choice. Methods This article reviews the current literature that sheds light on the above 4 treatments and their effect on sexual function. This topic is of great importance because of the under-reporting of sexual dysfunction in women who suffer from OAB, in hopes of raising awareness of sexual function for clinicians treating patients with OAB. Results This review found that the aforementioned 4 treatments for OAB (physiotherapy, anticholinergic drugs, intravesical injections of onabotulinumtoxinA, and sacral neuromodulation) do not have a detrimental affect on sexual function. On the contrary, the little data that do exist show that sexual function increases after these therapies are completed in women with OAB. Conclusion This review concludes with a positive outlook: physicians are helping women with OAB syndrome to improve their sexual function. However, not enough data exist, partially due to under-reporting of diminished sexual function. Levy G, Lowenstein L. Overactive Bladder Syndrome Treatments and Their Effect on Female Sexual Function: A Review. Sex Med 2019;8:1–7.
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Affiliation(s)
- Gali Levy
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Tel Aviv, Israel.
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
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15
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Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review. J Gen Intern Med 2019; 34:1615-1625. [PMID: 31062225 PMCID: PMC6667523 DOI: 10.1007/s11606-019-05028-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/06/2019] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs). METHODS We systematically reviewed nonsurgical interventions for urgency, stress, or mixed UI in women, focusing on AEs. We searched MEDLINE®, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and Embase® through December 4, 2017. We included comparative studies and single-group studies with at least 50 women. Abstracts were screened independently in duplicate. One researcher extracted study characteristics and results with verification by another independent researcher. When at least four studies of a given intervention reported the same AE, we conducted random effects model meta-analyses of proportions. We also assessed the strength of evidence. RESULTS There is low strength of evidence that AEs are rare with behavioral therapies and neuromodulation, and that periurethral bulking agents may result in erosion and increase the risk of voiding dysfunction. High strength of evidence finds that anticholinergics and alpha agonists are associated with high rates of dry mouth and constitutional effects such as fatigue and gastrointestinal complaints. Onabotulinum toxin A (BTX) is also associated with increased risk of urinary tract infections (UTIs) and voiding dysfunction (moderate strength of evidence). DISCUSSION Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.
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16
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Balk EM, Rofeberg VN, Adam GP, Kimmel HJ, Trikalinos TA, Jeppson PC. Pharmacologic and Nonpharmacologic Treatments for Urinary Incontinence in Women: A Systematic Review and Network Meta-analysis of Clinical Outcomes. Ann Intern Med 2019; 170:465-479. [PMID: 30884526 DOI: 10.7326/m18-3227] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI), a common malady in women, most often is classified as stress, urgency, or mixed. PURPOSE To compare the effectiveness of pharmacologic and nonpharmacologic interventions to improve or cure stress, urgency, or mixed UI in nonpregnant women. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials (Wiley), Cochrane Database of Systematic Reviews (Wiley), EMBASE (Elsevier), CINAHL (EBSCO), and PsycINFO (American Psychological Association) from inception through 10 August 2018. STUDY SELECTION 84 randomized trials that evaluated 14 categories of interventions and reported categorical cure or improvement outcomes. DATA EXTRACTION 1 researcher extracted study characteristics, results, and study-level risk of bias, with verification by another independent researcher. The research team collaborated to assess strength of evidence (SoE) across studies. DATA SYNTHESIS 84 studies reported cure or improvement outcomes (32 in stress UI, 16 in urgency UI, 4 in mixed UI, and 32 in any or unspecified UI type). The most commonly evaluated active intervention types included behavioral therapies, anticholinergics, and neuromodulation. Network meta-analysis showed that all interventions, except hormones and periurethral bulking agents (variable SoE), were more effective than no treatment in achieving at least 1 favorable UI outcome. Among treatments used specifically for stress UI, behavioral therapy was more effective than either α-agonists or hormones in achieving cure or improvement (moderate SoE); α-agonists were more effective than hormones in achieving improvement (moderate SoE); and neuromodulation was more effective than no treatment for cure, improvement, and satisfaction (high SoE). Among treatments used specifically for urgency UI, behavioral therapy was statistically significantly more effective than anticholinergics in achieving cure or improvement (high SoE), both neuromodulation and onabotulinum toxin A (BTX) were more effective than no treatment (high SoE), and BTX may have been more effective than neuromodulation in achieving cure (low SoE). LIMITATION Scarce direct (head-to-head trial) evidence and population heterogeneity based on UI type, UI severity, and history of prior treatment. CONCLUSION Most nonpharmacologic and pharmacologic interventions are more likely than no treatment to improve UI outcomes. Behavioral therapy, alone or in combination with other interventions, is generally more effective than pharmacologic therapies alone in treating both stress and urgency UI. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42017069903).
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Affiliation(s)
- Ethan M Balk
- Brown University, Providence, Rhode Island (E.M.B., V.N.R., G.P.A., H.J.K., T.A.T.)
| | - Valerie N Rofeberg
- Brown University, Providence, Rhode Island (E.M.B., V.N.R., G.P.A., H.J.K., T.A.T.)
| | - Gaelen P Adam
- Brown University, Providence, Rhode Island (E.M.B., V.N.R., G.P.A., H.J.K., T.A.T.)
| | - Hannah J Kimmel
- Brown University, Providence, Rhode Island (E.M.B., V.N.R., G.P.A., H.J.K., T.A.T.)
| | - Thomas A Trikalinos
- Brown University, Providence, Rhode Island (E.M.B., V.N.R., G.P.A., H.J.K., T.A.T.)
| | - Peter C Jeppson
- University of New Mexico School of Medicine, Albuquerque, New Mexico (P.C.J.)
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Gubbiotti M, Giannantoni A, Cantaluppi S, Coluccia AC, Ghezzi F, Serati M. The impact of Mirabegron on sexual function in women with idiopathic overactive bladder. BMC Urol 2019; 19:7. [PMID: 30665388 PMCID: PMC6341751 DOI: 10.1186/s12894-019-0438-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/14/2019] [Indexed: 11/23/2022] Open
Abstract
Background Overactive bladder (OAB) can frequently exert a negative effect on female sexual function. Mirabegron, a β3 receptor agonist, improves OAB symptoms, but there are very few information about its role on female sexual dysfunction (FSD). Aim of the study was to assess the impact of Mirabegron on FSD in women affected by OAB. Methods Fifty sexually active women suffering from idiopathic OAB were included in the study. Patients were assessed by means of a urogynecologic physical examination and were asked to complete the 3-day voiding diary, the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF), the Female Sexual Function Index (FSFI) questionnaire and VAS, before and 12 weeks after treatment with Mirabegron. In addition, at the same time points, patients underwent uroflowmetry with the measurement of post- void residual volume (PVR). Results At baseline all patients were affected by OAB symptoms, with 49/50 patients (98%) presenting with FSD. At 12- weeks follow- up, OAB symptoms improved significantly in all patients, with 59.5% of subjects achieving a complete urinary continence. FSFI Total Score significantly improved in 42/50 patients (84%) from 18.9 ± 4.3 to 21.8 ± 4.5 (p < 0.0001). Sixteen cases (32%) presented with no FSD. Also mean ± SD scores of ICIQ-SF and VAS significantly improved (from 17.1 ± 5 to 7.9 ± 4.8 and from 3.9 ± 1.2 to 6.9 ± 1.2 respectively, p < 0.000). Conclusions Mirabegron not only is able to control urinary symptoms in women with OAB, but also induces a significant improvement in their sexual life.
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Affiliation(s)
- Marilena Gubbiotti
- Department of Surgical and Biomedical Sciences, Uro- Oncology Section, University of Perugia, S. Maria della Misericordia Hospital, 06132, Perugia, Italy. .,Istituto Serafico di Assisi, Centro di Ricerca "InVita", 06081, Assisi, Perugia, Italy.
| | - Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neuroscience, Urology Section, University of Siena, Siena, 53100, Italy
| | - Simona Cantaluppi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, 21100, Italy
| | - Anna Chiara Coluccia
- Department of Obstetrics and Gynecology, University of Insubria, Varese, 21100, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, 21100, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, 21100, Italy
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18
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The effect of overactive bladder treatment with anticholinergics on female sexual function in women: a prospective observational study. Int Urol Nephrol 2018; 51:27-32. [DOI: 10.1007/s11255-018-2030-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/10/2018] [Indexed: 01/23/2023]
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19
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Zachariou A, Mamoulakis C, Filiponi M, Dimitriadis F, Giannakis J, Skouros S, Tsounapi P, Takenaka A, Sofikitis N. The effect of mirabegron, used for overactive bladder treatment, on female sexual function: a prospective controlled study. BMC Urol 2018; 18:61. [PMID: 29940933 PMCID: PMC6020185 DOI: 10.1186/s12894-018-0377-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 06/20/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Αim of the study was to determine the effect of mirabegron, used for overactive bladder (OAB) treatment, on female sexual function. METHODS Eighty five sexually active women suffering from overactive bladder were prospectively enrolled in this study. Females were divided into two groups. In Group A (control), 48 patients received no treatment and in Group B, 37 patients received mirabegron 50 mg/daily for 3 months. Patients were evaluated with FSFI-Gr at the beginning of the study and again after a period of 3 months. RESULTS In Group B, there was a significant increase post-treatment compared to baseline (p < 0.001) in total FSFI (20.3 (3.8) to 26.6 (4.2)) and all domains (desire: 3.0 (1.2) to 4.8 (1.2)), arousal: 3.0 (0.8) to 4.8 (0.9), lubrication: 3.9 (1.1) to 4.8 (1.2), orgasm: 3.6 (0.8) to 4.8 (1.0), satisfaction: 3.2 (0.4) to 4.0 (0.8) and pain: 3.2 (0.8) to 4.4 (1.2)). In Group A, there were no statistically significant changes in pre- and post-observation values. CONCLUSIONS This study is one of the few demonstrating that management of OAB with mirabegron improves female sexual function. TRIAL REGISTRATION TRN ISRCTN17199301 , 20/10/2017, retrospectively registered.
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Affiliation(s)
- A. Zachariou
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
- 3 Spyridi Street, 38221 Volos, Greece
| | - C. Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
| | - M. Filiponi
- Department of Urology, ELPIS Hospital, Volos, Greece
| | - F. Dimitriadis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - J. Giannakis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - S. Skouros
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - P. Tsounapi
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - A. Takenaka
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - N. Sofikitis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
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20
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Iino S, Kaneko M, Narukawa M. Factors influencing efficacy endpoints in clinical trials for new oral medicinal treatments for overactive bladder: a systematic literature review and meta-analysis. Int Urol Nephrol 2018; 50:1021-1030. [PMID: 29651695 DOI: 10.1007/s11255-018-1869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Overactive bladder (OAB) is a symptom-based disease; therefore, clinical trials to evaluate treatments for OAB employ a range of efficacy endpoints. Since factors that influence efficacy endpoints can affect trial outcomes, their identification could aid in the design of future OAB clinical trials. We investigated factors influencing different efficacy endpoints used in clinical trials with OAB patients and examined their characteristics to determine future clinical trial strategies for new medicinal treatments for OAB. METHODS Data from placebo-controlled double-blind trials in patients with OAB were extracted via a systematic literature review. The integrated differences for efficacy endpoints were calculated. Heterogeneity was assessed using the Q statistic and I2 statistic. Factors influencing efficacy endpoints were identified through univariate and multivariate meta-regression analyses. RESULTS Forty-one controlled trials were analyzed. Substantial heterogeneity between studies was observed for each efficacy endpoint (P > 0.001, I2 > 70%). We found with multivariate meta-regression analysis that period of recording in a bladder diary and year of publication were significantly likely to influence the change from baseline in the mean number of urgency episodes in 24 h, year of publication and gender were significantly likely to influence the change from baseline in the mean number of micturitions in 24 h, and gender was significantly likely to influence the change from baseline in the mean volume voided per micturition. In contrast, there were no factors significantly associated with change from baseline in the mean number of incontinence episodes in 24 h. CONCLUSIONS We identified that change from baseline in the mean number of incontinence episodes in 24 h should serve as a relatively stable endpoint. In contrast, we identified factors influencing other endpoints, and the identified factors should be taken into account when planning and conducting future clinical trials.
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Affiliation(s)
- Shingo Iino
- Astellas Pharma Inc, 2-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan. .,Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University Graduate School of Pharmaceutical Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan.
| | - Masayuki Kaneko
- Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University Graduate School of Pharmaceutical Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University Graduate School of Pharmaceutical Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
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21
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Cybulski M, Cybulski L, Krajewska-Kulak E, Orzechowska M, Cwalina U, Jasinski M. Sexual Quality of Life, Sexual Knowledge, and Attitudes of Older Adults on the Example of Inhabitants Over 60s of Bialystok, Poland. Front Psychol 2018; 9:483. [PMID: 29695983 PMCID: PMC5904191 DOI: 10.3389/fpsyg.2018.00483] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/22/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction: Aging has a strong influence on the quality of relationships and sexual functioning, but in itself does not cause a lack of sexual desire. Objectives: The aim of this study was to assess the quality of sexual life and define sexual knowledge and attitudes of older people on the example of residents of Bialystok, Poland at the age of 60 and over. Methods: The study included 170 people, inhabitants of Bialystok, Poland aged over 60: 85 students of the University of Healthy Senior and the University of Psychogeriatric Prophylaxis and 85 students of the University of the Third Age. The study used three standardized psychometric scales: Sexual Quality of Life Questionnaire-Male (SQoL-M), Sexual Quality of Life Questionnaire-Female (SQoL-F), and Aging Sexual Knowledge and Attitudes Scale (ASKAS). Results: The overall mean score for the ASKAS scale for knowledge was 65.21 ± 12.32 and for attitudes −124.65 ± 22.00. The overall mean SQOL score was 62.92 ± 18.18. Taking into account the gender of the respondents, the knowledge of men on sexuality of seniors was at the level of 63.48 ± 12.63, while in the female group −65.74 ± 12.23. The attitudes of men on sexuality of seniors was at the level of 128.80 ± 21.56, while in the female group −123.38 ± 22.05. Satisfaction with sex life among men (72.36 ± 27.49) was significantly higher than among women (60.02 ± 12.88). Discussion: The seniors were characterized by moderate knowledge and attitudes to sexuality of older people and the average level of sexual satisfaction. There was no significant relationship between knowledge on sexuality and sexual satisfaction in the study groups, and there was a positive correlation between attitudes toward sexuality and the satisfaction of sex life outside the group of men. In addition, a significant positive relationship was found between attitudes toward sexuality and sexual satisfaction. In order to improve the knowledge of senior citizens about sexuality of old age and to overcome the taboos that are prevalent in this topic, a structured training should be provided in this field. Such training should be carried out by specialists in the field of sexology. It is desirable to conduct in-depth studies in the assessment of knowledge, attitudes, and quality of sexual life in a larger research group, in order to get results for the population of the whole country.
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Affiliation(s)
- Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Lukasz Cybulski
- National Security Student, Faculty of Social Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Elzbieta Krajewska-Kulak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Magda Orzechowska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Urszula Cwalina
- Department of Statistics and Medical Informatics, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Marek Jasinski
- Department of Psychology, Non-State Higher Pedagogical School in Bialystok, Bialystok, Poland
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Lee KS, Yoo TK, Liao L, Wang J, Chuang YC, Liu SP, Chu R, Sumarsono B. Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study. BMC Urol 2017; 17:108. [PMID: 29162085 PMCID: PMC5698954 DOI: 10.1186/s12894-017-0294-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022] Open
Abstract
Background Lower urinary tract symptoms (LUTS) and overactive bladder (OAB) symptoms have a substantial effect on quality of life (QoL). We report QoL and mental health results from a LUTS prevalence study in three Asian countries. Methods A cross-sectional, population-representative, internet-based study among individuals aged ≥40 years in China, Taiwan and South Korea. Instruments included: Overactive Bladder Symptom Score (OABSS); International Prostate Symptom Score (IPSS); other International Continence Society (ICS) symptom questions; health-related QoL 12-item short-form (HRQoL-SF12v2); Work Limitations Questionnaire (WLQ); Hospital Anxiety and Depression Scale (HADS). Presence of LUTS was determined according to ICS criteria, with three symptom groups (storage, voiding and post-micturition). Post-stratification weighting matched the age and sex population distribution per country. Initial data analyses were based on descriptive statistics. Significance testing undertaken post hoc included: independent-samples t-test (differences in HRQoL between sexes and between individuals with/without LUTS; relationship between HRQoL score and OABSS; differences in HADS anxiety and depression scores between individuals with/without LUTS; association between HADS anxiety/depression scores and OABSS), chi-square test (association between LUTS prevalence and workplace productivity) and analysis of variance (differences in HRQoL score and in HADS anxiety/depression scores between individuals with different symptom groups, association between HADS anxiety/depression scores and IPSS). Results In total, 8284 participants were included. HRQoL scores were significantly worse (p < 0.001) among individuals with versus without LUTS (ICS criteria): mean physical health domain scores were 61.1 (standard deviation [SD], 20.1) and 76.7 (17.0), respectively; corresponding mental health domain scores were 34.8 (12.7) and 43.7 (10.7). Workplace productivity was best among individuals without LUTS (difficulties reported by 2–3% of individuals), and worst in those with all three ICS symptom groups (difficulties reported by 29–38% of individuals; p = 0.001). Mean HADS scores showed significantly worse (p < 0.001) levels of anxiety and depression among individuals with versus without LUTS: anxiety, 6.5 (SD, 3.7) and 4.0 (3.3); corresponding mean depression scores were 6.8 (4.3) and 4.2 (3.6). Increasing OAB severity was also associated with decreasing HRQoL physical and mental health scores. Conclusion LUTS and increasing OAB severity are both associated with impaired QoL, reduced workplace productivity, and increased tendency towards anxiety and depression. These results highlight the need to ensure that individuals with LUTS receive appropriate, effective treatment. Trial registration ClinicalTrials.gov identifier: NCT02618421, registered 26 November 2015 (retrospectively registered).
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Affiliation(s)
- Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, Korea.
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, Beijing, China
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Romeo Chu
- Astellas Pharma Singapore Pte. Ltd., Singapore, Singapore.,, Present address: 5 Pemimpin Drive, #19-03 Seasons View, Singapore, Singapore
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Zachariou A, Filiponi M. The effect of extended release tolterodine used for overactive bladder treatment on female sexual function. Int Braz J Urol 2017; 43:713-720. [PMID: 28199076 PMCID: PMC5557448 DOI: 10.1590/s1677-5538.ibju.2016.0303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/11/2016] [Indexed: 01/16/2023] Open
Abstract
Introduction Overactive bladder (OAB) is a common condition, especially in middle aged women, requiring long term therapy with anticholinergics to maintain symptoms relief. The aim of the study was to determine the effect of tolterodine extended release (ER) used for OAB treatment on the sexual function of women. Materials and Methods Between August 2010 and August 2014, 220 women with confirmed OAB, attended Urogynecology Outpatient Clinic and were prospectively enrolled in this study. 158 women were evaluated, with a comprehensive history, physical examination, urodynamic studies and Female Sexual Function Index (FSFI) questionnaire. 73 patients of group A (control group) received no treatment and 85 patients of group B received an anticholinergic regimen – tolterodine ER 4mg once daily. Data were evaluated again in accordance with FSFI after three months, using SPSS software. Results A statistically significant increase was noted in group B in domains of desire (pre-treatment 2.5±0.2 to 4.5±0.2 post-treatment), arousal (3.1±0.2 to 3.1±0.2 respectively), lubrication (3.4±0.3 to 4.3±0.3 respectively), orgasm (3.5±0.3 to 4.5±0.3 respectively), satisfaction (2.6±0.2 to 4.2±0.3 respectively) and pain (2.4±0.2 to 4.6±0.4 respectively) after three months treatment with tolterodine ER. In group A there were no statistically significant changes in pre and post treatment values (p>0.05). Total FSFI score for group B was significantly higher after tolterodine treatment (26.5±1.5) compared to pre-treatment values (17.4±1.4, p<0.01) and to control group A (17.7±1.2 and 17.9±1.5, p>0,05) respectively. Conclusions This preliminary study demonstrates that treatment of OAB with tolterodine ER was found to have positive effect on sexual function of patients with OAB.
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Affiliation(s)
| | - Maria Filiponi
- Laboratory of Endocrinology and Metabolic Disorders, Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Effects of water avoidance stress on peripheral and central responses during bladder filling in the rat: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome (MAPP) research network study. PLoS One 2017; 12:e0182976. [PMID: 28886046 PMCID: PMC5590813 DOI: 10.1371/journal.pone.0182976] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 07/27/2017] [Indexed: 12/30/2022] Open
Abstract
Stress plays a role in the exacerbation and possibly the development of functional lower urinary tract disorders. Chronic water avoidance stress (WAS) in rodents is a model with high construct and face validity to bladder hypersensitive syndromes, such as interstitial cystitis/bladder pain syndrome (IC/BPS), characterized by urinary frequency and bladder hyperalgesia and heightened stress responsiveness. Given the overlap of the brain circuits involved in stress, anxiety, and micturition, we evaluated the effects chronic stress has on bladder function, as well as its effects on regional brain activation during bladder filling. Female Wistar-Kyoto rats were exposed to WAS (10 days) or sham paradigms. One day thereafter, cystometrograms were obtained during titrated bladder dilation, with visceromotor responses (VMR) recorded simultaneously. Cerebral perfusion was assessed during passive bladder distension (20-cmH2O) following intravenous administration of [14C]-iodoantipyrine. Regional cerebral blood flow was quantified by autoradiography and analyzed in 3-dimensionally reconstructed brains with statistical parametric mapping. WAS animals compared to controls demonstrated a decreased pressure threshold and visceromotor threshold triggering the voiding phase. At 20-cmH2O, VMR was significantly greater in WAS animals compared to controls. WAS animals showed greater activation in cortical regions of the central micturition circuit, including the posterior cingulate, anterior retrosplenial, somatosensory, posterior insula, orbital, and anterior secondary (“supplementary”) motor cortices, as well as in the thalamus, anterior hypothalamus, parabrachial and Barrington nuclei, and striatum. Seed analysis showed increased functional connectivity of WAS compared to control animals of the posterior cingulate cortex to the pontine parabrachial nucleus; of the Barrington nucleus to the anterior dorsal midline and ventrobasilar thalamus and somatosensory and retrosplenial cortices; and of the posterior insula to anterior secondary motor cortex. Our findings show a visceral hypersensitivity during bladder filling in WAS animals, as well as increased engagement of portions of the micturition circuit responsive to urgency, viscerosensory perception and its relay to motor regions coordinating imminent bladder contraction. Results are consistent with recent findings in patients with interstitial cystitis, suggesting that WAS may serve as an animal model to elucidate the mechanisms leading to viscerosensitive brain phenotypes in humans with IC/BPS.
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Rantell A, Apostolidis A, Anding R, Kirschner-Hermanns R, Cardozo L. How does lower urinary tract dysfunction affect sexual function in men and women? ICI-RS 2015-Part 1. Neurourol Urodyn 2017; 36:949-952. [DOI: 10.1002/nau.23040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/18/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Angie Rantell
- Department of Urogynaecology; King's College Hospital; London United Kingdom
| | - Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | | | - Linda Cardozo
- Department of Urogynaecology; King's College Hospital; London United Kingdom
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Iino S, Kaneko M, Narukawa M. Potential Primary Endpoint for Exploratory Clinical Trial in Patients with Overactive Bladder: A Systematic Literature Review. Low Urin Tract Symptoms 2016; 10:64-75. [PMID: 27792298 DOI: 10.1111/luts.12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/25/2016] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify a potential primary endpoint in an early-phase exploratory trial among key overactive bladder (OAB) symptoms. METHODS Placebo-controlled double-blinding trials in patients with OAB were extracted for systematic literature review. The correlation between key OAB symptoms recorded in bladder diaries and coefficient of variation (CV) in each study were assessed. RESULTS Forty-one controlled trials were extracted for the present review. Mean number of urgency episodes in 24 h was substantially associated with mean number of urgency incontinence episodes in 24 h, mean volume voided per micturition, and mean number of micturitions in 24 h (Spearman's r = 0.725, -0.661, and 0.657, respectively). Mean number of micturitions in 24 h was also substantially associated with mean volume voided per micturition (Spearman's r = -0.674). Mean number of incontinence episodes in 24 h was substantially associated with mean number of urgency incontinence episodes in 24 h and mean volume voided per micturition (Spearman's r = 0.840 and -0.628, respectively). The median CV of mean volume voided per micturition in each trial was the smallest among all endpoints. CONCLUSIONS Our findings suggest that volume voided per micturition is a useful symptom for evaluating OAB candidate compounds in a small sample size and represents an effective primary endpoint, especially in exploratory clinical trials.
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Affiliation(s)
- Shingo Iino
- Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University Graduate School of Pharmaceutical Sciences, Tokyo, Japan
| | - Masayuki Kaneko
- Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University Graduate School of Pharmaceutical Sciences, Tokyo, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University Graduate School of Pharmaceutical Sciences, Tokyo, Japan
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27
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The Relationship Between Anxiety and Overactive Bladder or Urinary Incontinence Symptoms in the Clinical Population. Urology 2016; 98:50-57. [PMID: 27450939 DOI: 10.1016/j.urology.2016.07.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the relationship between anxiety and overactive bladder (OAB) or urinary incontinence symptoms among clinical population. MATERIALS AND METHODS Patients who were diagnosed with OAB and age-matched control subjects without OAB were enrolled. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS-A). OAB or incontinence symptoms were assessed using the International Consultation on Incontinence-Urinary Incontinence Short Form (ICIQ-UI), ICIQ-OAB, Urogenital Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7), and OAB-q. Other psychosocial factors were also assessed. RESULTS About half of the OAB subjects (48%) had anxiety symptoms, and one quarter of OAB subjects (24%) had moderate to severe anxiety. OAB subjects reported significantly higher anxiety symptoms compared to age-matched controls (HADS-A: 7.5 ± 4.5 vs 3.3 ± 3.6, P < .001). OAB subjects with anxiety reported more severe OAB or incontinence symptoms, and greater bother and impact on quality of life compared to OAB subjects without anxiety (ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, OAB-q, P values all <.05). OAB subjects with anxiety also have more psychosocial difficulties (eg, more depression, higher stress levels). Among OAB subjects, there were positive correlations between the severity of anxiety symptoms and the severity of OAB/incontinence symptoms (Spearman's correlation coefficients 0.29 to 0.47, P < .05). OAB subjects with both anxiety and depression reported higher ICIQ-UI and IIQ-7 scores than those who had anxiety but no depression (P = .014, .025 respectively). CONCLUSION OAB patients reported higher anxiety symptoms compared to controls. OAB patients with anxiety reported more severe OAB or incontinence symptoms, worse quality of life, and more psychosocial difficulties compared to OAB patients without anxiety. There are positive correlations between the severity of anxiety symptoms and OAB or incontinence symptoms.
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28
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Kim TH, Lee KS. Persistence and compliance with medication management in the treatment of overactive bladder. Investig Clin Urol 2016; 57:84-93. [PMID: 26981589 PMCID: PMC4791665 DOI: 10.4111/icu.2016.57.2.84] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 03/04/2016] [Indexed: 01/31/2023] Open
Abstract
Overactive bladder (OAB) is a common and chronic condition that impacts patients' daily activities and quality of life. Pharmaco-therapy for OAB is a mainstay of treatment. Antimuscarinics and β3-adrenoceptor agonists are the two major classes of oral pharmacotherapy and have similar efficacy for treating the symptoms of OAB. Owing to the chronic nature of OAB, long-term use of medication is essential for OAB symptom control and positive health outcomes. However, many patients elect to stop their medications during the treatment period. Unmet expectations of treatment and side effects seem to be the major factors for discontinuing OAB pharmacotherapy. Furthermore, the short- and long-term persistence and compliance with medication management are markedly worse in OAB than in other chronic medical conditions. Improvement in persistence and compliance with OAB pharmacotherapy is a hot topic in OAB treatment and should be an important goal in the treatment of OAB. Effective strategies should be identified to improve persistence and compliance. In this review, we outline what is known about persistence and compliance and the factors affecting persistence with pharmacotherapy in patients with OAB.
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Affiliation(s)
- Tae Heon Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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Chughtai B, Forde JC, Buck J, Asfaw T, Lee R, Te AE, Kaplan SA. The concomitant use of fesoterodine and topical vaginal estrogen in the management of overactive bladder and sexual dysfunction in postmenopausal women. Post Reprod Health 2016; 22:34-40. [PMID: 26883688 DOI: 10.1177/2053369116633017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The objective of this study is to investigate the combination effect of anti-muscarinic medication and topical vaginal estrogen in the treatment of overactive bladder (OAB) and female sexual dysfunction in postmenopausal women. STUDY DESIGN After IRB approval, 23 female subjects who met the entry criteria were randomized into two groups: (1) fesoterodine (Toviaz®, Pfizer, NY) with topical vaginal estrogen (Premarin®, Pfizer, NY) once daily or (2) fesoterodine once daily alone. If 4 mg fesoterodine was tolerated at 1-week, the dose was increased to 8 mg. MAIN OUTCOME MEASURES Primary endpoints were improvement in OAB symptom severity (Overactive Bladder Questionnaire, OAB-Q SF), improvement in OAB health-related quality of life (HRQL) (OAB-Q SF), and sexual function (Sexual Quality of Life-Female, SQOL-F) after 12 weeks. Secondary endpoint was change in total number of micturitions. RESULTS After 12-weeks, the combination group had a significant improvement in OAB symptom severity (p = 0.006), HRQL (p = 0.029), and SQOL-F (0.0003). The fesoterodine alone group also had significant improvement in OAB symptom severity (p < 0.0001), HRQL (p = 0.0002), and SQOL-F (p = 0.02). When compared directly to the fesoterodine alone group, the combination group after 12-weeks had a reduced OAB symptom severity (10 versus 23.3; p = 0.35), higher HRQL (96.9 versus 84.6; p = 0.75), and higher SQOL-F (99 versus 81; p = 0.098). The total number of micturitions over 3 d was significantly reduced in the combination group (45-26, p = 0.03) between baseline and 12-weeks. CONCLUSIONS The combined effect of fesoterodine and topical vaginal estrogen improved OAB symptoms and sexual function in postmenopausal women.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA
| | - James C Forde
- Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA
| | - Jessica Buck
- Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA
| | - Tirsit Asfaw
- Department of Obstetrics and Gynecology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA
| | - Richard Lee
- Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA
| | - Alexis E Te
- Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA
| | - Steven A Kaplan
- Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA
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Truzzi JC, Gomes CM, Bezerra CA, Plata IM, Campos J, Garrido GL, Almeida FG, Averbeck MA, Fornari A, Salazar A, Dell’Oro A, Cintra C, Sacomani CAR, Tapia JP, Brambila E, Longo EM, Rocha FT, Coutinho F, Favre G, Garcia JA, Castaño J, Reyes M, Leyton RE, Ferreira RS, Duran S, López V, Reges R. Overactive bladder - 18 years - Part II. Int Braz J Urol 2016; 42:199-214. [PMID: 27176185 PMCID: PMC4871379 DOI: 10.1590/s1677-5538.ibju.2015.0367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/09/2015] [Indexed: 12/25/2022] Open
Abstract
Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.
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Affiliation(s)
- Jose Carlos Truzzi
- Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo, SP, Brasil
| | | | | | | | - Jose Campos
- Departamento de Urología, Escuela Médico Militar, Cidade do México, Mexico
| | - Gustavo Luis Garrido
- Cátedra de Urologia, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Fernando G. Almeida
- Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo, SP, Brasil
| | | | - Alexandre Fornari
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - Anibal Salazar
- Departamento de Urologia, AC Camargo Hospital, SP, Brasil
| | - Arturo Dell’Oro
- Hospital Clinico de la Fuerza Area de Chile, Santiago, Chile
| | - Caio Cintra
- Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasi
| | | | | | | | - Emilio Miguel Longo
- Servicio de Urología, del Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina
| | | | | | - Gabriel Favre
- Centro Policlínico Valencia “La Viña”, Valencia, Venezuela
| | | | | | - Miguel Reyes
- Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil
| | | | | | - Sergio Duran
- Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil
| | - Vanda López
- Servicio de Urología, del Hospital Universitario de Caracas, Caracas, Venezuela
| | - Ricardo Reges
- Divisão de Urologia, Universidade Federal do Ceará, CE, Brasil
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Amano T, Earle C, Imao T, Takemae K. Are urge incontinence and aging risk factors of erectile dysfunction in patients with male lower urinary tract symptoms? Aging Male 2016; 19:54-7. [PMID: 26550919 DOI: 10.3109/13685538.2015.1103219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Several studies have indicated that erectile dysfunction (ED) patients also suffer from lower urinary tract symptoms (LUTS). We investigated a group of men with LUTS and assessed their sexual function with the aim of being able to predict ED risk factors and introduce ED treatments earlier for this patient group. METHODS International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS) and Sexual Health Inventory for Men (SHIM) score were obtained from 236 men with LUTS at their first out-patients visit. Clinical parameters such as body mass index, prostate volume, residual urine volume and prostate specific antigen were also evaluated. The relationship between the SHIM score and other clinical data was analyzed. RESULTS According to the SHIM score, ED in men with LUTS was severe 15%, moderate 19%, moderate to mild 28%, mild 17%, normal 7% and data was incomplete in 14%. Based on the results of a multivariate analysis, aging (p < 0.001) and OAB severity (p = 0.024) were significantly correlated to severe and moderate ED. Furthermore, among OAB symptoms score items, urge urinary incontinence was a risk factor for severe and moderate ED (p = 0.005). CONCLUSION Aging and OAB (notably urinary urge incontinence) are risk factors for severe and moderate ED in men with LUTS.
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Affiliation(s)
- Toshiyasu Amano
- a Department of Urology , Nagano Red Cross Hospital , Nagano , Japan and
| | - Carolyn Earle
- b Private Practice , Nedlands, Western Australia , Australia
| | - Tetsuya Imao
- a Department of Urology , Nagano Red Cross Hospital , Nagano , Japan and
| | - Katsuro Takemae
- a Department of Urology , Nagano Red Cross Hospital , Nagano , Japan and
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Comparative Effectiveness of Anticholinergic Therapy for Overactive Bladder in Women. Obstet Gynecol 2015; 125:1423-1432. [DOI: 10.1097/aog.0000000000000851] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mestre M, Lleberia J, Pubill J, Espuña-Pons M. Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acuroe.2015.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse. Actas Urol Esp 2015; 39:175-82. [PMID: 25174768 DOI: 10.1016/j.acuro.2014.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 11/20/2022]
Abstract
CONTEXT Integrating sexual health in clinical practice is important. In women with pelvic floor disorders, the evaluation of the anatomical defects, lower urinary tract function and the anorectal function often receives more attention than the sexual function. METHODS Review of Medline using defined search terms to identify articles related to sexual health assessment in urogynecology and manual analyses was performed. Only articles published in English or Spanish were included. RESULTS Only 50% of women attending urogynecological clinics are sexually active. Of those, 60% present with some sort of sexual sexual dysfunction (FSD). Questionnaires and sexuality scales would facilitate discussion of sexual matters between the Health Care professionals and the women, and may increase the likelihood of FSD being diagnosed. The Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ) and the PISQ-IR (IUGA-Revised) are the only female sexual function specific questionnaires currently validated and developed specifically to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse. Furthermore, the PISQ-IR also allows evaluation of the outcomes of women who are not sexually active when requiring urogynecologic care. PISQ-IR is also designed for international validation. In order to use the PISQ-IR in Spain, a proper interpretation and validation of the questionnaire is needed. CONCLUSIONS The evaluation of sexual function through specific questionnaires facilitates the identification of the sexual dysfunctions associated to the pelvic floor disorders. The inclusion of sexuality questionnaires as an outcome measure allows to analyze the impact in the sexual life of women treated for an urogynecological problem.
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Vrijens D, Drossaerts J, van Koeveringe G, Van Kerrebroeck P, van Os J, Leue C. Affective symptoms and the overactive bladder - a systematic review. J Psychosom Res 2015; 78:95-108. [PMID: 25499886 DOI: 10.1016/j.jpsychores.2014.11.019] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Overactive bladder syndrome (OAB) is characterised by urgency symptoms, with or without urgency incontinence, usually with frequency and nocturia. Although literature suggest an association between OAB, depression and anxiety, no systematic review has been presented. OBJECTIVE Systematically review the literature on the association of affective conditions with OAB. METHODS Systematic review according to the PRISMA guidelines. This review is registered in the PROSPERO register (CRD4201400664). RESULTS Forty-three articles were included, describing more than 80,000 subjects. Depression and OAB were positively associated in 26 studies, anxiety and OAB in 6 studies. Longitudinal studies reported: a) OAB subjects who developed depression/anxiety or b) depressed/anxious subjects developing OAB, or c) both. The quality of evidence in studies reporting an association between the co-occurrence of OAB and depression was rated level 3 in accordance with the GRADE framework. Evidence reporting on the co-occurrence of anxiety and OAB was rated GRADE level 2. Longitudinal associations between new onset of OAB in depressive subjects was GRADE level 2. Evidence reporting association of OAB with anxiety in longitudinal studies was of GRADE level 1. CONCLUSION To our knowledge, this systematic review is the first to give a comprehensive qualitative overview on the association between OAB and affective symptoms. Many evaluated studies failed to note longitudinal changes and lacked evidence of causality. Still, results revealed an association between OAB and affective symptoms and there is evidence for new onset of OAB in depressive subjects, but further research is necessary to examine the strength of the effect.
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Affiliation(s)
- Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; King's College London, King's Health Partners, London, Institute of Psychiatry, United Kingdom.
| | - Carsten Leue
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Lee UJ, Ackerman AL, Wu A, Zhang R, Leung J, Bradesi S, Mayer EA, Rodríguez LV. Chronic psychological stress in high-anxiety rats induces sustained bladder hyperalgesia. Physiol Behav 2014; 139:541-8. [PMID: 25449389 DOI: 10.1016/j.physbeh.2014.11.045] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate whether anxiety-prone rats exposed to chronic water avoidance stress (WAS) develop visceral bladder hyperalgesia in addition to increased voiding frequency and anxiety-related behaviors. MATERIALS AND METHODS Female Wistar-Kyoto (WKY) rats were exposed to chronic (10-day) WAS or sham paradigms. Referred hyperalgesia and tactile allodynia were tested using von Frey filaments applied to the suprapubic region and plantar region of the hindpaw, respectively. To confirm that suprapubic nociception represented referred visceral bladder hyperalgesia, we recorded abdominal visceromotor responses (VMR) to slow (100 μl/min) and fast (1 cc/sec) bladder filling with room temperature or ice-cold saline. We assessed the development of hyperalgesia over the 10-day WAS protocol and the durability of increased pain sensations over time. RESULTS Animals exposed to chronic WAS had significantly lower hindpaw withdrawal thresholds post-stress and significant differences in referred hyperalgesia. Rats exposed to chronic WAS demonstrated an increased pain response to suprapubic stimulation and decreased response threshold to mechanical hindpaw stimulation by day 8 of the stress protocol, which persisted for more than one month. Animals exposed to chronic WAS showed increased VMR to fast filling and ice water testing in comparison to sham animals. Cystometry under anesthesia did not show increases in the frequency of non-voiding contractions. CONCLUSION Chronic WAS induces sustained bladder hyperalgesia, lasting over a month after exposure to stress. The urinary frequency demonstrated previously in anxiety-prone rats exposed to chronic WAS seems to be associated with bladder hyperalgesia, suggesting that this is a potential model for future studies of bladder hypersensitivity syndromes such as interstitial cystitis/painful bladder syndrome (IC/PBS).
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Affiliation(s)
- Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason, Seattle, WA.
| | - A Lenore Ackerman
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Ais Wu
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Rong Zhang
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Joanne Leung
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Sylvie Bradesi
- Center for the Neurobiology of Stress, The David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Emeran A Mayer
- Center for the Neurobiology of Stress, The David Geffen School of Medicine at UCLA, Los Angeles, CA
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Ko K, Yang DY, Lee WK, Kim SW, Moon DG, Moon KH, Park NC, Park JK, Son HC, Lee SW, Hyun JS, Park K. Effect of improvement in lower urinary tract symptoms on sexual function in men: tamsulosin monotherapy vs. combination therapy of tamsulosin and solifenacin. Korean J Urol 2014; 55:608-14. [PMID: 25237463 PMCID: PMC4165924 DOI: 10.4111/kju.2014.55.9.608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/29/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate how much the improvement of lower urinary tract symptoms (LUTS) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function. MATERIALS AND METHODS A total of 187 patients were enrolled in this study. Patients were randomly assigned to receive either tamsulosin 0.2 mg (group A) or tamsulosin 0.2 mg and solifenacin 5 mg (group B). At 4 weeks and 12 weeks, the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 (IIEF5), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) questionnaire, uroflowmetry, and bladder scan. RESULTS Both groups A and B showed statistically significant improvements in IPSS, OABSS, and quality of life (QoL). Group A showed improved maximum flow rate, mean flow rate, and residual urine volume by time. Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time. The IIEF5 score was not improved in either group. In group A, the IIEF5 score dropped from 13.66 ± 4.97 to 11.93 ± 6.14 after 12 weeks (p=0.072). Group B showed a decline in the IIEF5 score from 13.19 ± 5.91 to 12.45 ± 6.38 (p=0.299). Although group B showed a relatively smaller decrease in the IIEF5 score, the difference between the two groups was not significant (p=0.696). CONCLUSIONS Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function.
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Affiliation(s)
- Kyungtae Ko
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Dae Yul Yang
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Won Ki Lee
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sae Woong Kim
- Department of Urology, The Catholic University College of Medicine, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Ki Hak Moon
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Nam Cheol Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Hwan Cheol Son
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Won Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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[Linguistic validation of Japanese version of Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)]. Nihon Hinyokika Gakkai Zasshi 2014; 105:102-11. [PMID: 25158552 DOI: 10.5980/jpnjurol.105.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To translate the Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) into Japanese and evaluate the linguistic validation of the translated PISQ-IR. METHODS The translation and evaluation of PISQ-IR were performed through 3 steps: forward translation based on 2 urologists and discussed by another 4 urologists, 1 pharmacoeconomist and 1 nurse; the community review process consists of conducting one-on-one cognitive interviews with 20 patients by a professional interviewer; backward translation by a native English speaker, which was negotiated with the PISQ-IR Working Group comprised original authors in International Urogynecological Association (IUGA). RESULTS The PISQ-IR Working Group generally approved our translation and had 2 major concerns in the Japanese version; 1) "disagree" in every sentence of English version was not translated into Japanese, and 2) the Japanese expression in "sexual desire" should be more emotional. The former concern was approved by explaining that Japanese does not have the word which is the equivalent of "disagree", and "don't agree" is always used instead of "disagree". The latter concern was compromised by switching to a translation using emotional words. CONCLUSION The Japanese version of PISQ-IR was translated in a linguistically valid manner. It would be equivalent to the original English questionnaire. It may provide a tool to assess sexual function for Japanese women with prolapse, urinary incontinence and/or fecal incontinence in an internationally harmonized fashion.
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Orri M, Lipset CH, Jacobs BP, Costello AJ, Cummings SR. Web-based trial to evaluate the efficacy and safety of tolterodine ER 4 mg in participants with overactive bladder: REMOTE trial. Contemp Clin Trials 2014; 38:190-7. [PMID: 24792229 DOI: 10.1016/j.cct.2014.04.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/21/2014] [Accepted: 04/24/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Participatory patient-centered, web-based methods could streamline and improve the convenience of clinical trial participation. We used an entirely web-based approach to conduct a randomized, placebo-controlled, Phase 4 (REMOTE) trial under an Investigational New Drug (IND) application to evaluate tolterodine extended release (ER) 4 mg for overactive bladder. METHODS The trial was designed to replicate previous clinic-based trials of tolterodine ER but was conducted via the web from one clinical site overseen by physicians. Participants were recruited via the web, screened for eligibility using web-based questionnaires, had laboratory testing in their community, and entered a run-in phase requiring bladder e-diaries. Informed consent was obtained using an interactive web-based method with physician countersignature. Study medication was shipped directly to participants. RESULTS With a goal of 283 randomized participants, 5157 registered on the trial website. Of 456 who passed initial screening, identification verification, and signed consent, 237 passed additional medical screening and were countersigned by the investigator. After laboratory testing, 118 entered the placebo run-in; only 18 passed e-diary assessments and were randomized to treatment. At week 12, the mean change from the baseline in micturitions/24 hours (primary endpoint) was -2.4 for tolterodine ER versus -0.8 for placebo [treatment difference (95% CI): -1.6 (-3.9, 0.6)]. CONCLUSION The REMOTE trial is the first entirely web-based trial conducted under an IND application. The efficacy observed was consistent with results from conventional trials. With simplification of multi-step screening and testing, web-based trials or their component parts should provide a participant-friendly approach to many clinical trials.
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Affiliation(s)
| | | | - Bradly P Jacobs
- University of California-San Francisco, San Francisco, CA, USA; Mytrus, San Francisco, CA, USA
| | | | - Steven R Cummings
- University of California-San Francisco, San Francisco, CA, USA; Mytrus, San Francisco, CA, USA; California Pacific Medical Center Research Institute, San Francisco, CA, USA
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The minimum important difference for the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire. Int Urogynecol J 2014; 25:1321-6. [DOI: 10.1007/s00192-014-2342-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
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Maman K, Aballea S, Nazir J, Desroziers K, Neine ME, Siddiqui E, Odeyemi I, Hakimi Z. Comparative efficacy and safety of medical treatments for the management of overactive bladder: a systematic literature review and mixed treatment comparison. Eur Urol 2013; 65:755-65. [PMID: 24275310 DOI: 10.1016/j.eururo.2013.11.010] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/07/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Overactive bladder (OAB) treatment guidelines recommend antimuscarinics as first-line pharmacologic therapy. Mirabegron is a first-in-class β3-adrenoceptor agonist licensed for the treatment of OAB and has shown to be well tolerated and effective in the treatment of OAB symptoms. OBJECTIVE To assess the relative efficacy and tolerability of OAB medications, specifically mirabegron 50 mg versus antimuscarinics in patients with OAB. EVIDENCE ACQUISITION A systematic literature search was performed on published peer-reviewed articles from 2000 to 2013. This review included randomised controlled trials (RCTs) studying changes in symptoms (micturition frequency, incontinence, and urgency urinary incontinence [UUI] episodes) and incidence of the most frequently reported adverse events (dry mouth, constipation) associated with current OAB medications. The following drugs were considered in addition to mirabegron: darifenacin, tolterodine immediate release (IR) and extended release (ER), oxybutynin IR/ER, trospium, solifenacin, and fesoterodine. Bayesian mixed treatment comparisons (MTCs) were performed for efficacy (micturition, incontinence, UUI) and tolerability (dry mouth, constipation, blurred vision). EVIDENCE SYNTHESIS Overall, 44 RCTs involving 27,309 patients were included. The MTCs showed that mirabegron 50 mg was as efficacious as antimuscarinics in reducing the frequency of micturition incontinence and UUI episodes, with the exception of solifenacin 10 mg that was more efficacious than mirabegron 50 mg in improving micturition frequency and frequency of UUI. Mirabegron 50 mg had an incidence of dry mouth similar to placebo and significantly lower than all included antimuscarinics. CONCLUSIONS Mirabegron 50 mg had similar efficacy to most antimuscarinics and lower incidence of dry mouth, the most common adverse event reported with antimuscarinics and one of the main causes of discontinuation of treatment. Despite being a powerful tool for evidence-based health care evaluation, the Bayesian MTC method has limitations. Further head-to-head comparisons between mirabegron and antimuscarinics should be conducted to confirm our results.
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Affiliation(s)
| | | | | | | | | | - Emad Siddiqui
- Astellas Pharma Europe, Chertsey, UK; Department of Urology, Ealing Hospital, London, UK
| | | | - Zalmai Hakimi
- Astellas Pharma Global Development, Leiden, The Netherlands
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Ellsworth P, Marschall-Kehrel D, King S, Lukacz E. Bladder health across the life course. Int J Clin Pract 2013; 67:397-406. [PMID: 23574100 DOI: 10.1111/ijcp.12127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/07/2013] [Indexed: 12/22/2022] Open
Abstract
Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bladder habits and dysfunctions at one stage of life may affect bladder health in subsequent stages. However, bladder problems are neither a normal part of aging nor inevitable at any stage of life. Many of the factors that negatively impact bladder health at all ages may be modifiable, and healthy bladder habits may prevent or reverse bladder dysfunctions that can occur naturally or in response to life events. There are opportunities to further define and promote healthy bladder habits through focused research and heightened public awareness of the importance of bladder health, which may lead to improvements in overall health and quality of life. It is our hope that this paper will inform and encourage public health initiatives and research programs aimed at this goal.
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Affiliation(s)
- P Ellsworth
- University Urological Associates Inc., Brown University, Providence, RI 02905, USA.
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Tannenbaum C, Gray M, Hoffstetter S, Cardozo L. Comorbidities associated with bladder dysfunction. Int J Clin Pract 2013; 67:105-13. [PMID: 23305472 DOI: 10.1111/ijcp.12085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- C Tannenbaum
- Faculties of Pharmacy and Medicine, University of Montreal, Montreal, QC, Canada
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Buser N, Ivic S, Kessler TM, Kessels AGH, Bachmann LM. Efficacy and adverse events of antimuscarinics for treating overactive bladder: network meta-analyses. Eur Urol 2012; 62:1040-60. [PMID: 22999811 DOI: 10.1016/j.eururo.2012.08.060] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/28/2012] [Indexed: 11/25/2022]
Abstract
CONTEXT Millions of people worldwide experience overactive bladder (OAB), and antimuscarinics are the pharmacologic treatment of choice. Several conventional meta-analyses have been published, but they fail to quantify efficacy and adverse events across drugs, dosages, formulations, and pharmaceutical forms. OBJECTIVE To perform two network meta-analyses summarizing the efficacy and adverse events of antimuscarinics in the treatment of OAB. EVIDENCE ACQUISITION Medline and Scopus searches, previous systematic reviews, conference abstracts, book chapters, and the reference lists of relevant articles were searched. Trialists were contacted. Eligible studies were randomized trials that compared at least one antimuscarinic for treating OAB with placebo or with another antimuscarinic, and that reported efficacy and/or adverse event outcomes. Efficacy was assessed for six outcomes (perception of cure or improvement, urgency episodes per 24h, leakage episodes per 24h, urgency incontinence episodes per 24h, micturitions per 24h, and nocturia episodes per 24h). Adverse events were assessed in seven categories according to the Common Terminology Criteria for Adverse Events. Across all outcomes, a summary efficacy and an adverse event score were computed. Two authors independently extracted data. EVIDENCE SYNTHESIS For the comparison of the efficacy, 76 trials enrolling 38 662 patients were included; for adverse events, 90 trials enrolling 39 919 patients were included. In the subset of studies reporting on treatments and dosages as used in clinical practice, 40 mg/d trospium chloride, 100mg/g per day oxybutynin topical gel, and 4 mg/d fesoterodine had the best efficacy, while higher dosages of orally administered oxybutynin and propiverine had the least favorable relationship of efficacy and adverse events. CONCLUSIONS This is the first study allowing trade-offs between efficacy and adverse events of various drugs and dosages in the treatment of patients with OAB. Differences among the various antimuscarinics call for careful, patient-centered management in which regimen changes should be considered.
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Affiliation(s)
- Nora Buser
- Horten Center, University of Zurich, Switzerland
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Apostolidis A, de Nunzio C, Tubaro A. What determines whether a patient with LUTS seeks treatment?: ICI-RS 2011. Neurourol Urodyn 2012; 31:365-9. [DOI: 10.1002/nau.22212] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 01/12/2012] [Indexed: 11/10/2022]
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Lee YS, Choo MS, Lee JY, Oh SJ, Lee KS. Symptom change after discontinuation of successful antimuscarinic treatment in patients with overactive bladder symptoms: a randomised, multicentre trial. Int J Clin Pract 2011; 65:997-1004. [PMID: 21849011 DOI: 10.1111/j.1742-1241.2011.02728.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Efficacy of antimuscarinic therapy for overactive bladder (OAB) has been demonstrated; however, the durability of its effects is unknown. The study was conducted to evaluate symptom change and retreatment rate after discontinuation of antimuscarinic therapy. Also, we tried to find risk factors for retreatment. METHODS This was a prospective, randomised, open-label, multicentre trial at four university hospitals. Women who had OAB symptoms for ≥ 6 months and who showed successful response to 1 month of Tolterodine 4 mg medication were randomly assigned to one of three groups: (A) discontinue medication, (B) 2-month additional medication and (C) 5-month additional medication. After completion of the 1-, 3- or 6-month treatment, patients stopped the medication and were followed up for additional 3 months to assess symptom relapse and retreatment rates. Risk factors for retreatment were evaluated. RESULTS Of a total of 558 patients who took the study medication, 173 were randomised and 108 (A: 40, B: 40, C: 28) were included in the analysis. At the end of the treatment, the mean micturition frequency was decreased to 8.3/24 h from 11.7/24 h, and the mean urgency episode was decreased to 2.2/24 h from 8.0/24 h. Three months after discontinuation, the micturition frequency and the urgency episode were increased to 9.1/24 and 4.4/24 h respectively. Sixty five per cent of patients requested retreatment, and 62% experienced symptom relapse. Baseline health-related quality of life was the only independent risk factor for retreatment. DISCUSSION AND CONCLUSION Discontinuation of antimuscarinic therapy resulted in high symptom relapse and retreatment rates regardless of treatment duration. The results provide new information on the durability of the efficacy of antimuscarinics, and may improve treatment efficacy by promoting the medication persistence of antimuscarinics in OAB patients.
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Affiliation(s)
- Y-S Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Samsung Changwon Hospital, Changwon, Korea
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Coyne KS, Sexton CC, Thompson C, Kopp ZS, Milsom I, Kaplan SA. The Impact of OAB on Sexual Health in Men and Women: Results from EpiLUTS. J Sex Med 2011; 8:1603-15. [DOI: 10.1111/j.1743-6109.2011.02250.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sexton CC, Notte SM, Maroulis C, Dmochowski RR, Cardozo L, Subramanian D, Coyne KS. Persistence and adherence in the treatment of overactive bladder syndrome with anticholinergic therapy: a systematic review of the literature. Int J Clin Pract 2011; 65:567-85. [PMID: 21489081 DOI: 10.1111/j.1742-1241.2010.02626.x] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Overactive bladder syndrome (OAB) is a chronic condition that has an impact on patients' daily activities and health-related quality of life (HRQL). Anticholinergic therapy is often prescribed following insufficient results with behaviour modification alone; however, rates of treatment discontinuation are consistently high. This study systematically reviewed persistence and adherence data in patients with OAB treated with anticholinergic therapy. A search focused on the intersection of OAB, persistence/adherence, and anticholinergic therapy was conducted in MEDLINE and EMBASE. Articles published after 1998 were reviewed and selected for inclusion based on prespecified criteria. A total of 147 articles and two abstracts were included in the review. Results from 12-week clinical trials showed high rates of discontinuation, ranging from 4% to 31% and 5% to 20% in treatment and placebo groups, respectively. Unsurprisingly, rates of discontinuation found in medical claims studies were substantially higher, with 43% to 83% of patients discontinuing medication within the first 30 days and rates continuing to rise over time. Findings from medical claims studies also suggest that over half of patients never refill their initial prescription and that adherence levels tend to be low, with mean/median medication possession ratio (MPR) values ranging from 0.30 to 0.83. The low levels of persistence and adherence documented in this review reveal cause for concern about the balance between the efficacy and tolerability of anticholinergic agents. Strategies should be identified to increase persistence and adherence. New agents and non-pharmacologic alternatives with good efficacy and minimal side effects should be explored.
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Affiliation(s)
- C C Sexton
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD 20814, USA.
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Omotosho T, Chen CCG. Update on tolterodine extended-release for treatment of overactive bladder. Open Access J Urol 2010; 2:185-91. [PMID: 24198627 PMCID: PMC3818890 DOI: 10.2147/oaju.s7232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Overactive bladder is a prevalent condition which negatively impacts quality of life and puts a significant economical burden on society. First-line therapy often includes pharmacotherapy with antimuscarinic medications, and numerous research studies have demonstrated that tolterodine extended-release (ER) is an efficacious and tolerable formulation of this class of medication. This review provides an update on the clinical use of tolterodine ER, detailing the current literature on its efficacy, tolerability, adverse effects, and comparability with other commonly prescribed medications for the treatment of overactive bladder.
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Affiliation(s)
- Tola Omotosho
- Women’s Center for Pelvic Health, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chi Chiung Grace Chen
- Women’s Center for Pelvic Health, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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