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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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Fernandez Moncaleano G, Gibbons CM, Holt S, Braffett B, Pop-Busui R, Jacobson A, Wessells H, Sarma A. Urinary symptoms and female sexual dysfunction in women with type 1 diabetes: the role of depression. J Sex Med 2023; 20:1391-1398. [PMID: 37933193 PMCID: PMC10689960 DOI: 10.1093/jsxmed/qdad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Some reports suggest that women with type 1 diabetes (T1D) have a greater burden of female sexual dysfunction (FSD) than women without T1D, but the etiology of this elevated risk is poorly understood. AIM To examine the associations between FSD and urinary incontinence/lower urinary tract symptoms (UI/LUTS) in women with T1D and to evaluate how depression may mediate these relationships. METHODS LUTS and UI symptoms were assessed in women with T1D who participated in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Multivariable logistic regression models estimated associations between FSD and UI/LUTS (overall and specific domains) and the impact of depression on these associations. OUTCOMES FSD was measured with the Female Sexual Function Index-Reduced. RESULTS In total, 499 self-reported sexually active women completed validated assessments of sexual and urinary function (mean ± SD age, 47.7 ± 7.6 years; T1D duration, 23.4 ± 5.15 years). FSD was reported in 232 (46%) responders. The frequency of UI and LUTS was 125 (25.1%) and 96 (19.2%), respectively. Neither UI nor its subcategories (urge, stress) were associated with FSD. Although LUTS (odds ratio [OR], 1.75; 95% CI, 1.09-2.77) and its symptoms of urgency (OR, 1.99; 95% CI, 1.09-3.61) and incomplete emptying (OR, 2.44; 95% CI, 1.23-4.85) were associated with FSD, these associations were attenuated following adjustment for depression and antidepressant medication use. Depression indicators were independently associated with FSD overall and across domains. CLINICAL IMPLICATIONS The complex interplay of voiding dysfunction, mental health, and sexual function warrants further investigation to understand the potential implications for patient assessment, goal setting, treatment, and care planning. STRENGTHS AND LIMITATIONS Data are from a prospective study of individuals with T1D. These results are unable to explore cause-and-effect relationships among LUTS, UI, depression, and FSD. The sample may not be representative of the general population of women with T1D. Because participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study are mostly White, generalizing the findings to other races and to type 2 diabetes may not be appropriate. While exclusion of sexually inactive women likely biases our findings toward the null, this design element permitted study of LUTS and UI in relation to aspects of FSD, the primary objective of this study. CONCLUSIONS The significant associations between LUTS/UI and FSD among middle-aged women with T1D were greatly attenuated when depression was considered a mediating factor.
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Affiliation(s)
| | - Cody M Gibbons
- Department of Urology, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - Sarah Holt
- Department of Urology and Diabetes Endocrinology Research Center, University of Washington, Seattle, WA 98195, United States
| | - Barbara Braffett
- Biostatistics Center, George Washington University, Rockville, MD 20852, United States
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48105, United States
| | - Alan Jacobson
- Long Island School of Medicine, New York University, Mineola, NY 11501, United States
| | - Hunter Wessells
- Department of Urology and Diabetes Endocrinology Research Center, University of Washington, Seattle, WA 98195, United States
| | - Aruna Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI 48109-2800, United States
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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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Kocjancic E, Chung E, Garzon JA, Haylen B, Iacovelli V, Jaunarena J, Locke J, Millman A, Nahon I, Ohlander S, Pang R, Plata M, Acar O. International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction. Neurourol Urodyn 2022; 41:140-165. [PMID: 34989425 DOI: 10.1002/nau.24846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research. METHODS This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent. RESULTS A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated. CONCLUSION A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.
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Affiliation(s)
- Ervin Kocjancic
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Eric Chung
- Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Bernard Haylen
- Department of Gynaecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Valerio Iacovelli
- Department of Urology, San Carlo di Nancy General Hospital-GVM Care and Research, Tor Vergata University of Rome, Rome, Italy
| | - Jorge Jaunarena
- Division of Urology, Centro de Urologia CDU, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Jennifer Locke
- Department of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Alexandra Millman
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Irmina Nahon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Samuel Ohlander
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ran Pang
- Department of Urology, Guang An Men Hospital, Beijing, China
| | - Mauricio Plata
- Department of Urology, Universidad de los Andes School of Medicine, Fundación Santa fe de Bogotá University, Bogotá, Colombia
| | - Omer Acar
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Lin XD, Lin N, Ke ZB, Xu N, Jiang P, Li H. Effects of overactive bladder syndrome on female sexual function. Medicine (Baltimore) 2021; 100:e25761. [PMID: 34011037 PMCID: PMC8137100 DOI: 10.1097/md.0000000000025761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 04/10/2021] [Indexed: 01/05/2023] Open
Abstract
This study was to evaluate the impact of the symptoms of overactive bladder (OAB) syndrome on female sexual function. Seventy nine patients with OAB (OAB group) and 79 healthy women (control group) underwent physical examination at our center, and had their sexual function evaluated using the female sexual function index (FSFI). In accordance with the presence or absence of urge incontinence, the OAB group was further divided into the wet and dry groups. The sexual function was evaluated again after 3 months of pharmacotherapy. We investigate the difference of sexual function between OAB and control group. The effect of OAB severity and OAB pharmacotherapy on sexual function was also explored. There were no significant differences between OAB group and control group, including age, body mass index (BMI), education, occupation, fertility, parity, childbirth, and menopause. Compared with the control group, the OAB group had significantly lower FSFI scores. The respective mean ± standard error FSFI scores in the control group and the OAB group were 2.98 ± 1.07 and 2.27 ± 0.96 for desire, 3.48 ± 1.16 and 2.32 ± 1.44 for arousal, 4.60 ± 1.13 and 3.10 ± 1.95 for lubrication, 3.37 ± 0.87 and 2.63 ± 1.04 for orgasm, 3.58 ± 1.02 and 2.41 ± 1.35 for sexual satisfaction, 3.58 ± 1.02 and 2.41 ± 1.35 for sexual pain, and 22.24 ± 5.29 and 15.59 ± 7.47 for the total score (P < .05 for all comparisons). The scores for desire, lubrication, orgasm, sexual satisfaction, pain, and total FSFI between the OAB-dry and OAB-wet subgroup were similar while score of arousal in OAB-wet subgroup was significantly increased compared with that of OAB-dry. OABSS score was commonly used in the assessment of OAB severity. The difference of the FSFI scores among mild OAB group, moderate OAB group, and severe OAB group was statistically significant (P < .05). Female FSFI sexual function scores were significantly improved after OAB pharmacotherapy (P < .05). Women with OAB syndrome have poorer sexual function than healthy women. Patients with more serious OAB experience more disturbing sexual dysfunction. Female sexual function scores were significantly improved after OAB pharmacotherapy.
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Affiliation(s)
- Xiao-Dan Lin
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Ning Lin
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Zhi-Bin Ke
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Ning Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Ping Jiang
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
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6
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Nitti VW, Patel A, Karram M. Diagnosis and management of overactive bladder: A review. J Obstet Gynaecol Res 2021; 47:1654-1665. [PMID: 33592680 DOI: 10.1111/jog.14708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/27/2022]
Abstract
AIM Overactive bladder (OAB) is a common and troublesome condition that can significantly impair quality of life. This review aims to educate providers of obstetrics and gynecology services about available therapies for OAB and what to expect following treatment. METHODS Here, we review published data from studies that have evaluated available treatments for OAB. Relevant articles published over the past 2 decades, including large multicenter trials, were identified through a literature search using PubMed.gov, and the references in those articles were also manually searched to find additional articles. Treatment guidelines and product labels were also reviewed. RESULTS Behavioral therapy is recommended as a first choice for OAB management; pharmacologic treatment (anticholinergics, β3 -adrenoceptor agonists) as second-line treatment; and onabotulinumtoxinA, peripheral tibial nerve stimulation, and sacral nerve stimulation as third-line therapy for patients refractory or intolerant to first- and second-line treatments. A stepwise approach to treatment through first-, second-, and third-line therapies is recommended, recognizing this may not be appropriate for all patients. CONCLUSIONS To optimize symptom control and set realistic expectations, patients should be carefully monitored and counseled appropriately on available treatment options.
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Affiliation(s)
- Victor W Nitti
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Vozmediano-Chicharro R, Blasco Hernández P, Madurga-Patuel B. Insights into the Management of Overactive Bladder with Transdermal Oxybutynin: A Practical Review. Res Rep Urol 2020; 12:321-330. [PMID: 32884926 PMCID: PMC7434563 DOI: 10.2147/rru.s266400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/19/2020] [Indexed: 11/24/2022] Open
Abstract
Overactive bladder (OAB), clinically defined as urinary urgency, with or without incontinence, generally accompanied by an increase in urinary frequency and nocturia, after any local disease or metabolic disorder that would explain these symptoms have been ruled out, is a highly prevalent condition that affects millions of men and women worldwide. Not only can the symptoms of OAB be very bothersome, but OAB can have significant detrimental effects on many aspects of individuals' lives, representing a particularly impactful health burden to quality of life and productivity. Besides a wide range of conservative treatments, the clinical efficacy of which remains an open issue, antimuscarinics are the mainstay of pharmacotherapy for this condition but anticholinergic troublesome side effects like dry mouth, and the patient's perception of lack of efficacy and poor adherence, are common reasons of abandonment of treatment. An alternative to oral administration treatment, with a lower incidence of dry mouth and other anticholinergic adverse effects, might be attractive to patients and a real treatment option for physicians. Delivery of oxybutynin directly through the skin with oxybutynin transdermal (OXY-TDS) avoids the first-pass hepatic metabolism that occurs with orally administered oxybutynin and prevents the appearance of anticholinergic adverse events. OXY-TDS being equally effective than oral treatment improves adherence, persistence, and patient satisfaction. The aim of this review is to focus on evidence available of the use of OXY-TDS in the management of patients with OAB, and to help clinicians in the challenges involved in the treatment options for patients with this condition.
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8
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Is overactive bladder a risk factor for erectile dysfunction? A cross-sectional study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.767471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Toprak Celenay S, Korkut Z, Oskay K, Aydin A. The effects of pelvic floor muscle training combined with Kinesio taping on bladder symptoms, pelvic floor muscle strength, and quality of life in women with overactive bladder syndrome: A randomized sham-controlled trial. Physiother Theory Pract 2020; 38:266-275. [DOI: 10.1080/09593985.2020.1750079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Zehra Korkut
- Department of Therapy and Rehabilitation, KTO Karatay University, Konya, Turkey
| | - Kemal Oskay
- Department of Urology, Gazi Mustafa Kemal Hospital, Ankara, Turkey
| | - Arif Aydin
- Department of Urology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
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Badour CL, Cox KS, Goodnight JR, Flores J, Tuerk PW, Rauch SA. Sexual Desire among Veterans Receiving Prolonged Exposure Therapy for PTSD: Does Successful PTSD Treatment Also Yield Improvements in Sexual Desire? Psychiatry 2020; 83:70-83. [PMID: 31577915 PMCID: PMC7083685 DOI: 10.1080/00332747.2019.1672439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: People with posttraumatic stress disorder (PTSD) commonly report difficulties with sexual desire and other aspects of sexual functioning, but it is currently unknown if people who respond to psychotherapy for PTSD also report improvements in sexual desire. Method: One hundred and eighty-seven veterans with PTSD received prolonged exposure (PE) therapy at two outpatient PTSD specialty clinics and completed measures of PTSD symptoms (the PTSD Checklist - Military Version) and sexual desire (item 21 of the Beck Depression Inventory - Second Edition) repeatedly throughout the course of treatment. Results: The results of a conditional generalized mixed ordinal regression model showed a significant interaction between weeks in treatment and PTSD treatment response in predicting change in sexual desire across the course of treatment. Specifically, PTSD treatment responders reported improvement in sexual desire over the course of treatment, whereas nonresponders did not show changes in sexual desire over time. However, the effect of PTSD treatment response was no longer significant when accounting for severity of depression at the start of treatment. Participants reporting more severe depression at the start of treatment reported less improvement in sexual desire, regardless of PTSD symptom response. Conclusions: People with PTSD who respond to PE also report improvements in sexual desire over time, indicating that response to PE is associated with improved sexual desire, but the effect is complicated by the presence of co-occurring depression symptomatology.
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Affiliation(s)
| | - Keith S. Cox
- University of North Carolina, Asheville, Department of Psychology
| | | | | | | | - Sheila A.M. Rauch
- Emory University, Department of Psychiatry and Behavioral Sciences,VA Atlanta Healthcare System, Mental Health Service Line
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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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12
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Vouri SM, Schootman M, Strope SA, Xian H, Olsen MA. Antimuscarinic use and discontinuation in an older adult population. Arch Gerontol Geriatr 2019; 80:1-11. [PMID: 30268971 PMCID: PMC6497475 DOI: 10.1016/j.archger.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/28/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Although antimuscarinics are typically the first-line pharmacological treatment option for overactive bladder, patients often discontinue therapy. The aim of this research project is to identify the rate of antimuscarinic discontinuation, switching, and continuation and differences in discontinuation among different antimuscarinics. METHODS Using the 5% random sample of Medicare Claims Data, we identified a cohort of patients aged ≥ 66 years old who newly initiated antimuscarinics between January 1, 2007 and December 31, 2012. Treatment discontinuation was defined as no subsequent fills of the initial antimuscarinic in the days' supply plus a 30 day grace period. We ascertained percentages of patients who discontinued antimuscarinics, switched antimuscarinics, or died within 12 months of antimuscarinic initiation. Cox proportional hazards models were used to determine time to discontinuation of individual antimuscarinics relative to oxybutynin immediate-release (IR). RESULTS Among the 42,886 new-users of antimuscarinics, 71.8% discontinued, 10.8% switched, and 3.2% died prior to antimuscarinic discontinuation or switching while only 14.2% continually filled an antimuscarinic for one year. In the multivariable analysis, patients who were initiated on oxybutynin extended-released (ER), tolterodine, trospium, darifenacin, solifenacin, and fesoterodine were significantly less likely to be discontinued therapy compared to oxybutynin IR (p < 0.001). CONCLUSION After one year of antimuscarinic initiation, only 14% of older adult patients continuously utilized their initial antimuscarinic therapy suggesting a need for clinical interventions to improve continual use of antimuscarinics.
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Affiliation(s)
- Scott Martin Vouri
- University of Florida College of Pharmacy, Department of Pharmaceutical Outcomes & Policy, PO Box 100496, Gainesville, FL 32610-0496, United States; University of Florida Health Physicians, PO BOX 100354, Gainesville, FL 32610-0354, United States.
| | - Mario Schootman
- SSM Health, Department of Clinical Analytics and Insights, 10101 Woodfield Lane, St. Louis, MO 63132, United States
| | - Seth A Strope
- Baptist MD Anderson Cancer Center, Department of Urologic Surgery, 1235 San Marco Blvd., Jacksonville, FL 32207, United States
| | - Hong Xian
- Saint Louis University, College of Public Health and Social Justice, 3545 Lafayette Ave., St. Louis, MO 63104, United States
| | - Margaret A Olsen
- Washington University in St. Louis School of Medicine, Department of Medicine, 4523 Clayton Ave., Campus Box 8051, St. Louis, MO 63110, United States
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Khunda A, McCormick C, Ballard P. Sacral neuromodulation and sexual function: a systematic review and meta-analysis of the literature. Int Urogynecol J 2018; 30:339-352. [PMID: 30535791 DOI: 10.1007/s00192-018-3841-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/28/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sexual function is being increasingly recognized as an important patient-reported outcome. Sacral neuromodulation (SNM) is a treatment with an expanding list of indications. The effect of sacral neuromodulation on sexual function has been examined in a number of studies with variable results. In this review, we aim to systematically review the literature and pool the data if appropriate. METHODS The literature search was conducted primarily on the Healthcare Databases Advanced Search (HDAS) platform using the Medline, EMBASE and CINHAL search engines. Of 196 initial citations, 17 articles met our predefined inclusion criteria. Thirteen studies reported enough information to be included in our meta-analysis. RevMan5 software was used for analysis. RESULTS Eight of 17 studies reported a positive effect of SNM on sexual function. Pooled analysis of data from 11 studies involving 573 patients before SNM and 438 patients after SNM showed significant improvement in sexual function (SMD = -0.39; 95% CI: -0.58 to -0.19; p = 0.0001). The results remained significant in most subgroup analyses except in patients suffering from fecal incontinence. CONCLUSIONS SNM in women with pelvic floor disorders, especially bladder dysfunction, seems to have a positive effect on sexual function. This needs to be verified in adequately powered primary research using sexual function as the primary outcome.
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Affiliation(s)
- Aethele Khunda
- James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
| | | | - Paul Ballard
- James Cook University Hospital, Middlesbrough, TS4 3BW, UK
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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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Differential Prescribing of Antimuscarinic Agents in Older Adults with Cognitive Impairment. Drugs Aging 2018; 35:321-331. [PMID: 29492862 DOI: 10.1007/s40266-018-0531-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Oral oxybutynin has been associated with the development of cognitive impairment. OBJECTIVE The objective of this study was to describe the use of oral oxybutynin versus other antimuscarinics (e.g., tolterodine, darifenacin, solifenacin, trospium, fesoterodine, transdermal oxybutynin) in older adults with documented cognitive impairment. METHODS This is a population-based retrospective analysis of antimuscarinic new users aged ≥ 66 years from January 2008 to December 2011 (n = 42,886) using a 5% random sample of Medicare claims linked with Part D data. Cognitive impairment was defined as a diagnosis of mild cognitive impairment, dementia, use of antidementia medication, and memory loss/drug-induced cognitive conditions in the year prior to the initial antimuscarinic claim. We used multivariable generalized linear models to assess indicators of cognitive impairment associated with initiation of oral oxybutynin versus other antimuscarinics after adjusting for comorbid conditions. RESULTS In total, 33% received oral oxybutynin as initial therapy. Cognitive impairment was documented in 10,259 (23.9%) patients prior to antimuscarinic therapy. Patients with cognitive impairment were 5% more likely to initiate another antimuscarinic versus oral oxybutynin (relative risk [RR] 1.05; 95% confidence interval [CI] 1.03-1.06). The proportion of patients with cognitive impairment initiated on oral oxybutynin increased from 24.1% in 2008 to 41.1% in 2011. The total cost of oral oxybutynin, in $US, year 2011 values, decreased by 10.5%, whereas the total cost of other antimuscarinics increased by 50.3% from 2008 to 2011. CONCLUSION Our findings suggest opportunities for quality improvement of antimuscarinic prescribing in older adults, but this may be hampered by cost and formulary restrictions.
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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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Moutounaïck M, Miget G, Teng M, Kervinio F, Chesnel C, Charlanes A, Le Breton F, Amarenco G. [Coital incontinence]. Prog Urol 2018; 28:515-522. [PMID: 29866492 DOI: 10.1016/j.purol.2018.05.001] [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: 02/20/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Urinary incontinence may seriously impact quality of life, self-image and subsequently the sexual life. Beside this fact, urinary leakage can specifically occur during sexual intercourse, formally named coital incontinence, and thus lead to specific alteration of the sexual life. AIM To analyse the prevalence, pathophysiological mechanisms and possible therapeutic options for coital urinary incontinence. METHODS Related terms to urinary incontinence and sexual dysfunction were search on PubMed database. RESULTS Whereas at least a quarter of incontinent women have a coital incontinence, this symptom was rarely spontaneously reported. Some women had only coital incontinence (7.6 to 20% of cases). In men, urinary incontinence during sexual intercourse was mainly observed after prostatectomy in 20 to 64% of cases. Coital incontinence requires precise assessment. Indeed, it can occur whatever the phase of coitus: local stimulation (20-30%), excitement (13-18%), penetration (62.9-68%), movements back and forth, orgasm (27-37.1%). Cervico-urethral hypermobility, sphincter incompetence, urethral instability, detrusor overactivity could be the principal physiopathological mechanisms. In men, the main cause was a stress incontinence secondary to sphincter deficiency. Specific therapeutic strategies have proved their effectiveness. The rehabilitative approach (RR=0.25, CI [0.06-1.01]), medicinal (anticholinergic were effective in 59% of cases) or surgical therapeutic (slings with an efficiency of 87%) was proposed to patients. CONCLUSION Coital incontinence is a common and troublesome symptom. Its precise assessment may suggest a specific mechanism and thus a specific treatment.
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Affiliation(s)
- M Moutounaïck
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - G Miget
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Teng
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Kervinio
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Chesnel
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - A Charlanes
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Le Breton
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - G Amarenco
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
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Balzarro M, Rubilotta E, Braga A, Bassi S, Processali T, Artibani W, Serati M. OnabotulinumtoxinA detrusor injection improves female sexual function in women with overactive bladder wet syndrome. Eur J Obstet Gynecol Reprod Biol 2018; 225:228-231. [PMID: 29753213 DOI: 10.1016/j.ejogrb.2018.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/11/2018] [Accepted: 05/02/2018] [Indexed: 01/23/2023]
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Efficacy of pelvic floor muscle training in women with overactive bladder syndrome: a systematic review. Int Urogynecol J 2018; 29:1565-1573. [PMID: 29644384 DOI: 10.1007/s00192-018-3602-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our objective was to evaluate the effectiveness of pelvic floor muscle training (PFMT) in reducing overactive bladder (OAB) symptoms in women. METHODS Searches were performed at MEDLINE, PubMed, Physiotherapy Evidence Database (PEDro), Scielo, and Central Cochrane Library PubMed until January 2017. Controlled trials were researched by two independent reviewers. Eligible studies were restricted to random and controlled clinical trials that investigated the effectiveness of PFMT in decreasing OAB symptoms. Qualitative methodology was evaluated using the PEDro scale. Data was analyzed and interpreted qualitatively. RESULTS The final search retrieved eight studies (n = 1161 women with urgency symptoms), which were published between 2002 and 2016. The methodological scores varied between 4 and 7 in the PEDro scale. PFMT, with the objective of controlling urgent micturition, demonstrated improvements in quality of life in women with OAB. Most data in this revision came from small- to moderate-sized trials, with different and inconsistent outcome measures, which could have impacted the end results. CONCLUSIONS The literature regarding the effectiveness of PFMT in OAB remains heterogeneous and inconclusive.
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Minaldi G, Ventimiglia B, Finocchiaro M, Fanzone I, Tsirgiotis A, Spitaleri F, Di Marco G, Ranno S. Sexual Activity and Urinary Incontinence in Women. Urologia 2018. [DOI: 10.1177/039156030907600306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Urinary incontinence during sexual intercourse refers to overactive bladder (OAB) syndrome and it is divided in incontinence during penetration and during orgasm. 480 women with low urinary tract symptoms (LUTS) were divided in a) affected by probable genuine stress incontinence, b) probable Urge-stress incontinence, c) probable Urge Incontinence, to specify incidence. Materials and Methods In Group C (186 women) 36 women, age range 24 to 56 years, with urinary incontinence only during sexual intercourse, were selected: 16 during orgasm (group I), 20 during penetration (group II). These patients filled in specific validated questionnaires (ICI-9), urinary recordings and, after urine exam, they underwent US study of urinary tract with post-micturition evaluation. The patients with other urological diseases or pelvic prolapse in stage II of POP-Q or higher were excluded. Patients were referred to physiatric evaluation and urodynamic exam with cystomanometry and perineal EMG, with provocative tests and after pressure-flow study. Results Cystocele was found in 4 out of 16 women in Group I, and in 6 out of 20 in Group II. No patients showed basic detrusor hyperactivity during cystomanometry. In Group I: 50% had detrusor hyperactivity and 18.75% had prolonged perineal relaxation. In Group II 30% had detrusor hyperactivity and 35% had prolonged perineal deficit. Results suggest parasympathetic deficiency in Group I and sympathetic deficiency in Group II.
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Affiliation(s)
- G. Minaldi
- Dipartimento di Scienze della Senescenza, Urologiche e Neurourologiche, Università di Catania
- UOC di Urologia PO S. Marta e S. Venera di Acireale, AUSL 3 Catania
| | - B. Ventimiglia
- Dipartimento di Scienze della Senescenza, Urologiche e Neurourologiche, Università di Catania
- UOC di Urologia PO S. Marta e S. Venera di Acireale, AUSL 3 Catania
| | - M. Finocchiaro
- Dipartimento di Scienze della Senescenza, Urologiche e Neurourologiche, Università di Catania
- UOC di Urologia PO S. Marta e S. Venera di Acireale, AUSL 3 Catania
| | - I. Fanzone
- Dipartimento di Scienze della Senescenza, Urologiche e Neurourologiche, Università di Catania
- UOC di Urologia PO S. Marta e S. Venera di Acireale, AUSL 3 Catania
| | - A. Tsirgiotis
- Dipartimento di Scienze della Senescenza, Urologiche e Neurourologiche, Università di Catania
- UOC di Urologia PO S. Marta e S. Venera di Acireale, AUSL 3 Catania
| | - F. Spitaleri
- Dipartimento di Scienze della Senescenza, Urologiche e Neurourologiche, Università di Catania
- UOC di Urologia PO S. Marta e S. Venera di Acireale, AUSL 3 Catania
| | - G. Di Marco
- Dipartimento di Scienze della Senescenza, Urologiche e Neurourologiche, Università di Catania
- UOC di Urologia PO S. Marta e S. Venera di Acireale, AUSL 3 Catania
| | - S. Ranno
- Dipartimento di Scienze della Senescenza, Urologiche e Neurourologiche, Università di Catania
- UOC di Urologia PO S. Marta e S. Venera di Acireale, AUSL 3 Catania
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Does the Severity of Overactive Bladder Symptoms Correlate With Risk for Female Sexual Dysfunction? J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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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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Zilberlicht A, Haya N, Feferkorn I, Goldschmidt E, Kaldawy A, Abramov Y. Somatic, psychological, and sexual triggers for overactive bladder syndrome in women. Neurourol Urodyn 2017; 37:163-168. [PMID: 28220549 DOI: 10.1002/nau.23236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/01/2017] [Accepted: 01/07/2017] [Indexed: 11/06/2022]
Abstract
AIMS Patients with overactive bladder (OAB) often describe somatic, psychological, and sexual triggers for their symptoms. The aim of this study was to characterize these triggers and assess their impact on patients' symptoms and quality of life (QoL). METHODS Patients who visited our urogynecologic clinic between August 2015 and March 2016 and diagnosed with OAB syndrome were asked to fill a questionnaire comprising 34 statements regarding SOmatic, Psychological, and Sexual Triggers for OAB (SOPSETO). Patients additionaly completed the UDI-6 and IIQ-7 questionnaires. Statistical analysis was performed to determine the prevalence of each trigger and its correlation with the UDI-6 and IIQ-7 scores. RESULTS Sixty four women enrolled in this study. The SOPSETO questionnaire was found to be relaiable with Cronbach's alpha of 0.73-0.88. Construct validity was high with good correlation between the SOPSETO and the UDI-6 and IIQ-7 questionnaires. The triggers which had the highest correlation with the total UDI-6 scores were: Being far from toilets (r = 0.32, P = 0.004), swimming (r = 0.44, P = 0.02), taking a shower/bath (r = 0.36, P = 0.004), touching water (r = 0.35, P = 0.004), stepping out of a car (r = 0.32, P = 0.014), and experiencing an orgasm (r = 0.59, P = 0.001). The triggers: Experiencing an orgasm (r = 0.4, P = 0.033), having intercourse (r = 0.53, P = 0.002), stepping out of a car (r = 0.45, P = 0.001), and touching water (r = 0.28, P = 0.03) most significantly correlated with the total IIQ-7 scores. CONCLUSIONS Certain somatic, psychological, and sexual factors may trigger OAB symptoms and are therefore potential targets for behavioral therapy of this disorder, and for further research regarding its pathophysiological mechanisms.
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Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Nir Haya
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Ido Feferkorn
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Eyal Goldschmidt
- Department of Obstetrics and Gynecology, Bnei-Zion Medical Center, Haifa, Israel
| | - Anis Kaldawy
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
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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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What Is the Impact of Overactive Bladder Symptoms on Female Sexual Function? CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Salinas-Casado J, Esteban-Fuertes M, Serrano O, Galván J. The value of oxybutynin in transdermal patches for treating overactive bladder. Actas Urol Esp 2015; 39:599-604. [PMID: 26321038 DOI: 10.1016/j.acuro.2015.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/13/2015] [Indexed: 11/15/2022]
Abstract
CONTEXT There is currently a broad therapeutic arsenal of drugs for treating overactive bladder syndrome (OAB). However, there is still a need for new compounds and for improving known drugs in terms of efficacy, compliance and tolerability. OBJECTIVE To report the scientific evidence on the safety and efficacy of transdermal oxybutynin (OXY-TDS) for treating OAB. MATERIAL AND METHODS A systematic review without time restrictions was conducted until May 2015 in the MEDLINE/PubMed database. We also performed a manual review of abstracts published in international urogynaecology congresses. RESULTS The evaluated studies show that patients treated with OXY-TDS experience a significant reduction in urinary incontinence episodes compared with placebo, which is comparable to that observed in patients treated with oral oxybutynin or with tolterodine. In all of the studies, we observed improvements in symptoms from the second or third week of treatment and in a sustained manner until the end of treatment (6, 12 or 24 weeks). The clinical practice study also showed improved quality of life, achieving benefits in numerous patient profiles, with an efficacy independent of previous treatments. The safety of the drug was demonstrated in the various patient profiles. CONCLUSIONS OXY-TDS represents an effective alternative for the symptomatic treatment of adult patients with OAB, which, thanks to its pharmacokinetic profile, better tolerability, different administration method and dosage, could represent an added value in treating special populations.
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Affiliation(s)
- J Salinas-Casado
- Servicio de Urología, Hospital Clínico San Carlos, Madrid, España.
| | - M Esteban-Fuertes
- Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, España
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Chu CM, Arya LA, Andy UU. Impact of urinary incontinence on female sexual health in women during midlife. Womens Midlife Health 2015; 1:6. [PMID: 30766693 PMCID: PMC6214215 DOI: 10.1186/s40695-015-0007-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
Sexual health is important to the self worth, emotional well being, and overall quality of life of women in midlife. However, urinary incontinence, which is prevalent in this population, has a negative impact on sexual function. The purpose of this article is to review the impact of urinary incontinence on female sexual dysfunction and discuss the impact of urinary incontinence treatment on sexual function. We carried out a literature review on the effect of stress urinary incontinence and urgency urinary incontinence on sexual health and physiological response, including coital incontinence, satisfaction, desire, orgasm, frequency, and partner relationships. We examined the literature regarding changes in sexual function related to non-surgical and surgical interventions for incontinence. Overall, though studies are lacking and of poor quality, treatment of incontinence has been shown to improve sexual function. Both pelvic muscle training and midurethral slings have been shown to improve sexual function in those with stress urinary incontinence. In urgency urinary incontinence, evidence indicates improvement in sexual function after treatment with anti-muscarinic medications. Coital incontinence commonly improves with treatment of the underlying incontinence subtype. Although problems related to sexual health are complex and involve both psychological and physical factors, it is important to consider treatment of urinary incontinence as part of management of sexual dysfunction.
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Affiliation(s)
- Christine M Chu
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
| | - Uduak U Andy
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
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OnabotulinumtoxinA intradetrusorial injections improve sexual function in female patients affected by multiple sclerosis: preliminary results. World J Urol 2015; 33:2095-101. [PMID: 25966660 DOI: 10.1007/s00345-015-1578-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/26/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the effects of onabotulinum toxin type A (Onabot/A) intravesical injections on urinary and sexual function in a group of patients affected by multiple sclerosis (MS). METHODS We enrolled 31 MS female patients with symptoms of overactive bladder and detrusor overactivity. All patients underwent urodynamics and were administered 3-day voiding diary, Incontinence Quality of Life (I-QoL) questionnaire, Female Sexual Function Index (FSFI) questionnaire, Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) before and 3 months after Onabot/A intravesical injection. RESULTS Onabot/A injection significantly improved urinary symptoms as shown by the 3-day voiding diary, I-QoL questionnaire and the urodynamic variables. In addition, it also significantly improved sexual functioning in continent patients and psychological status as demonstrated by the increase in FSFI, HAM-A and HAM-D scores. CONCLUSIONS The Onabot/A-induced positive effect on sexual dysfunction in our MS patients is likely due to an indirect effect exerted by the overall urological clinical improvement on sexual function at both the psychological and emotional levels. The positive effect exerted by Onabot/A on the anxiety and depression scale also suggests that urinary symptoms have a negative impact on the psychological status of the patients.
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Castagna G, Montorsi F, Salonia A. Sexual and bladder comorbidity in women. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:165-76. [PMID: 26003244 DOI: 10.1016/b978-0-444-63247-0.00010-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual dysfunction in women is defined as disorders of sexual desire, arousal, orgasm, and/or sexual pain, which result in significant personal distress and may have a negative effect on a woman's health and an impact on her quality of life. A comprehensive understanding of the anatomic, neurobiologic, and psychologic mechanisms behind women's sexual function and dysfunction is of paramount importance. This chapter reviews the most frequent comorbid conditions related to urinary tract symptoms (thus including symptoms related to overactive bladder syndrome and urinary incontinence) and sexual dysfunction in women. Likewise, it considers the different disorders from the point of view of daily clinical practice.
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Affiliation(s)
- Giulia Castagna
- Universitá Vita-Salute San Raffaele, Milan, Italy; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Universitá Vita-Salute San Raffaele, Milan, Italy; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
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Filipetto FA, Fulda KG, Holthusen AE, McKeithen TM, McFadden P. The patient perspective on overactive bladder: a mixed-methods needs assessment. BMC FAMILY PRACTICE 2014; 15:96. [PMID: 24885491 PMCID: PMC4030445 DOI: 10.1186/1471-2296-15-96] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 04/22/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND While overactive bladder is often managed in the primary care setting, a number of barriers including embarrassment, poor communication, and low patient adherence contribute to the under-treatment of patients with burdensome urinary symptoms. In order to address these challenges, it is crucial to have a fundamental understanding of patient perspectives toward OAB and urinary symptoms. To meet this aim, researchers designed and conducted a study to identify patients' knowledge, experiences and attitudes, barriers to treatment adherence, and desires and tendencies regarding patient/clinician communications. METHODS A mixed-methods qualitative/quantitative needs assessment of patients with overactive bladder and/or urinary symptoms. Researchers conducted in-depth qualitative interviews via telephone with 40 patients. Interview results informed the design and dissemination of a quantitative survey, which was completed by 200 self-selected respondents who had previously identified themselves as having overactive bladder or bladder problems. Statistical and qualitative analysis of results were conducted. RESULTS Among survey respondents, an average of 3.5 years elapsed between symptom onset and seeking diagnosis by a physician. In the long term most patients do not experience improvement in symptoms. Medication non-adherence is common and is related to therapy effectiveness and adverse effects. Patients clearly indicate that communication and patient/physician relationships are important to them and they would prefer the clinician initiate the conversation on overactive bladder. Patient experiences, perspectives, and attitudes toward their bladder symptoms differ in many ways from clinicians' assumptions. CONCLUSIONS The significant time gap between symptom onset and diagnosis indicates ongoing need for screening and diagnosis of overactive bladder. Contrary to guideline recommendations, urinalysis and physical examination are not widely used in clinical practice. Many patients experience no improvement in symptoms over time. Patients indicate that clinician/patient relationships and communication regarding their condition are important.
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Affiliation(s)
| | | | - Amy E Holthusen
- Interstate Postgraduate Medical Association, P,O, Box 5474 Madison 53705, USA.
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Goren A, Zou KH, Gupta S, Chen C. Direct and indirect cost of urge urinary incontinence with and without pharmacotherapy. Int J Clin Pract 2014; 68:336-48. [PMID: 24372892 DOI: 10.1111/ijcp.12301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the impact of treating urge urinary incontinence (UUI), including mixed urinary incontinence (MUI), on healthcare resource utilisation, productivity, activity impairment and associated costs. METHODS The study used data from the 2011 U.S. National Health and Wellness Survey, an Internet-based questionnaire of a nationwide sample of adults. UUI or MUI respondents were identified via three Incontinence Questions. Respondents with stress urinary incontinence only, prostate cancer or (medication for) benign prostatic hyperplasia were excluded. UUI/MUI respondents were categorised as Rx users for overactive bladder (OAB) and non-Rx users (who never used Rx and whose condition reportedly interfered with life activities or was difficult to manage). Outcome measures included healthcare utilisation and Work Productivity and Activity Impairment questionnaire-based scores. Direct and indirect costs were estimated using 2010 labour and 2008 medical expenditure data sources. Generalised linear models predicted resource use and productivity as a function of treatment status, adjusting for covariates (e.g. sociodemographics, OAB severity, comorbid status) that may also predict impairment. RESULTS Rx (vs. non-Rx) users were more likely to be female (80.7% vs. 70.0%), older (mean = 62.7 vs. 53.1) and reporting more moderate-to-severe OAB (70.9% vs. 52.6%; all p < 0.05). Adjusting for covariates, Rx (vs. non-Rx) users had significantly lower activity impairment (41.1% vs. 46.8%), more provider visits (7.42 vs. 5.60) and costs ($18,175 vs. $13,679), and higher total direct costs ($27,291 vs. $21,493), all p < 0.01. CONCLUSIONS Urge urinary incontinence patients using, vs. never using, prescription medication reported lower activity impairment but higher direct costs. These findings may inform the degree to which UUI pharmacotherapy affects health outcomes.
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Affiliation(s)
- A Goren
- Kantar Health, New York, NY, USA
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Proietti S, Giannantoni A, Sahai A, Khan MS, Dasgupta P. Overactive bladder and sexual function: a nightmare couple. BJU Int 2012; 110:921-4. [DOI: 10.1111/j.1464-410x.2012.11411.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leone Roberti Maggiore U, Salvatore S, Alessandri F, Remorgida V, Origoni M, Candiani M, Venturini PL, Ferrero S. Pharmacokinetics and toxicity of antimuscarinic drugs for overactive bladder treatment in females. Expert Opin Drug Metab Toxicol 2012; 8:1387-408. [PMID: 22871042 DOI: 10.1517/17425255.2012.714365] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Antimuscarinics (AMs) are the mainstay of pharmacological treatment of overactive bladder (OAB), a symptom complex defined by the presence of urinary urgency, usually associated with frequency and nocturia, with or without urgency urinary incontinence. The AMs used to treat OAB differ in their pharmacological profiles, which may affect their potential for causing adverse effects (AEs). AREAS COVERED The present article aims to review the literature about pharmacokinetics (PK) of the different AMs used in the treatment of OAB. Furthermore, the AEs related to the use of these drugs and their incidence are presented. This systematic review is based on material searched and obtained via Medline, Pubmed and EMBASE up to March 2012 using the search terms "adverse events, pharmacokinetics, tolerability" in combination with "darifenacin, fesoterodine, imidafenacin, oxybutynin, propiverine, solifenacin, tolterodine, and trospium." EXPERT OPINION Antimuscarinics are the first-line pharmacological treatment for OAB. Despite the development of new molecules that improve their efficacy/safety profile, there are some drugs that are pharmacokinetically more appropriate to be prescribed in specific populations such as patients with neurological disease or the elderly. Moreover, research should be encouraged in evaluating antimuscarinics in conjunction with other drugs such as estrogens or beta-agonists. The identification of prognostic criteria for pharmacological therapy would be helpful.
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Affiliation(s)
- Umberto Leone Roberti Maggiore
- University of Genoa, San Martino Hospital and National Institute for Cancer Research, Department of Obstetrics and Gynaecology, Genoa, Italy
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Efficacy and safety of oxybutynin chloride topical gel for women with overactive bladder syndrome. Am J Obstet Gynecol 2012; 206:168.e1-6. [PMID: 21963104 DOI: 10.1016/j.ajog.2011.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 07/06/2011] [Accepted: 08/04/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This subgroup analysis of a phase-3 study evaluated the efficacy and safety of oxybutynin chloride topical gel (OTG) in women with overactive bladder syndrome (OAB). STUDY DESIGN Women (n = 704) with urgency-predominant urinary incontinence received OTG or placebo for 12 weeks. The primary endpoint was change from baseline to last observation in number of daily incontinence episodes. Treatments were compared with the use of analysis of covariance. RESULTS OTG significantly reduced the number (mean ± standard deviation) of daily incontinence episodes (OTG, -3.0 ± 2.8 episodes; placebo, -2.5 ± 3.0 episodes; P < .0001), reduced urinary frequency (P = .0013), increased voided volume (P = .0006), and improved select health-related quality-of-life domains (P ≤ .0161) vs placebo. Dry mouth was the only drug-related adverse event significantly more common with OTG (7.4%) than with placebo (2.8%; P = .0062). CONCLUSION OTG was well tolerated and provided significant improvement in urinary symptoms and health-related quality of life in women with OAB.
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Margolis MK, Vats V, Coyne KS, Kelleher C. Establishing the content validity of the King's Health Questionnaire in men and women with overactive bladder in the US. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2011; 4:177-87. [PMID: 21766913 DOI: 10.2165/11586480-000000000-00000] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Overactive bladder (OAB) consists of the symptoms of urinary urgency (with or without urgency incontinence) and increased urinary frequency and nocturia. As OAB is defined by symptoms, the patient is the best source of information for assessing the impact of the condition on health-related quality of life (HR-QOL). This assessment can be conducted through the use of valid patient-reported questionnaires, meaning the questionnaire has demonstrated content validity, among other acceptable psychometric properties. The aim of this study was to evaluate the content validity of the King's Health Questionnaire (KHQ) in patients with OAB in the US. METHODS Men and women with continent or incontinent OAB were recruited from a clinical research site in the US. Participants completed the KHQ and were then asked about the instructions, items, and response options. Data were analyzed descriptively and qualitatively. RESULTS A total of 24 participants (18 women, 6 men; mean [± SD] age 59.0 ± 11.1 years) with OAB were interviewed and provided feedback on the KHQ. Participants reported that overall, the KHQ covers the key aspects in which OAB impacts patients' daily lives. Most KHQ items and response options were acceptable and understandable to the participants; however, a few minor issues were noted. In item 3, shopping was not considered by some participants to be a household task, while shopping and cleaning were not relevant to some of the men. Two sets of items ('limit social life' and 'limit ability to see/visit friends' and 'bladder problem affect sleep' and 'feel worn out or tired') were perceived as redundant, while 'depressed' (item 12) and 'anxious or nervous' (item 13) were perceived by some participants as too intense. Some participants were unsure if the intended meaning of 'change your underclothes when they get wet' was about changing wet underwear or frequency of incontinence episodes. CONCLUSION The KHQ demonstrated content validity and can be considered a relevant and appropriate tool to assess the impact of OAB on HR-QOL in men and women in the US.
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Affiliation(s)
- Mary Kay Margolis
- United BioSource Corporation, Center for Health Outcomes Research, Bethesda, MD 20814, USA.
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Dmochowski RR, Rosenberg MT, Zinner NR, Staskin DR, Sand PK. Extended-release trospium chloride improves quality of life in overactive bladder. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:251-257. [PMID: 19818062 DOI: 10.1111/j.1524-4733.2009.00652.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Overactive bladder syndrome (OAB) is a urinary condition that often exerts detrimental effects on an individual's quality of life (QoL). A once-daily, extended-release (ER) formulation of the quaternary amine trospium chloride has recently been developed for the treatment of OAB. The pooled health-related QoL (HRQoL) data from two multicenter, parallel-group, double-blind Phase III studies with trospium chloride ER 60 mg were analyzed. METHODS Subjects aged>or=18 years with urinary urgency, frequency, and an average of >or=1 urge urinary incontinence episode per day on a 3-day bladder diary were randomized (1:1) to receive once-daily trospium 60 mg ER or placebo for 12 weeks. HRQoL was assessed at baseline and at Week 12 using the King's Health Questionnaire (KHQ) and the OAB questionnaire (OAB-q). RESULTS Overall, 1165 subjects were randomized (trospium ER, n=578; placebo, n=587). Trospium ER produced significantly greater improvements from baseline than placebo in seven of the nine KHQ domains. At Week 12, the improvement in mean OAB-q HRQoL total score (from approximately 52 at baseline) was significantly greater with trospium ER than with placebo (+25.8 vs. +20.7; P=0.0003). Improvements from baseline were seen with trospium ER on all eight of the OAB-q symptom bother scales. CONCLUSIONS Once-daily trospium 60 mg ER improved the QoL of subjects with OAB, as assessed using the KHQ and the OAB-q, in two large Phase III clinical trials.
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Affiliation(s)
- Roger R Dmochowski
- Department of Urology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Abstract
Oxybutynin chloride has been effectively used for treating overactive bladder syndrome for more than three decades. The evolution of different delivery systems led first to intravesical administration, anal suppositories, and then to the commercial development of an extended-release oral formulation of oxybutynin chloride to improve its tolerability while maintaining efficacy. These modes of delivery were associated with decreased antimuscarinic side effects and N-desethyloxybutynin serum levels by avoiding first-pass metabolism in the upper gut and liver. The development of transdermal delivery has carried this evolution even further, with serum levels of desethyloxybutynin < or = oxybutynin and dry mouth rates of 7%, with little constipation. The new development of a transdermal oxybutynin gel has decreased these application site reactions to low levels while maintaining good efficacy.
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Espuña-Pons M, Puig-Clota M. [Coital urinary incontinence. Associated symptoms and severity of incontinence]. Actas Urol Esp 2009; 33:801-5. [PMID: 19757666 DOI: 10.1016/s0210-4806(09)74233-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The objective of present study was to analyze the relationship between coital urinary incontinence (UI) and the symptoms of Stress UI (SUI), Urge UI (UUI) and the extent to which they impair the patient's life, measured through the ICIQ-UI SF questionnaire in a sample of sexually active women with UI symptoms. METHODS Epidemiologic, observational, cross-sectional and multicentric study of 1,735 women with diagnostic of urinary incontinence (UI). Patients who were not sexually active were excluded, remaining 1,292 patients for the analysis. All women filled in the ICIQ-UI SF questionnaire and the King's Health Questionnaire (KHQ). RESULTS According to KHQ, the prevalence of coital incontinence was 29.4%. Women with coital incontinence compared to those who did not suffer from it, had similar mean age and body mass index, were more likely to have symptoms of SUI (37.6% vs. 27.7%) and less likely to have UUI (16.6% vs. 27.4%) (p < 0.001). 36.1% of women with SUI had coital UI; this percentage was lower for women with UUI (20.1%). ICIQ-UI global score was higher in women with coital incontinence, 14.1 vs. 12.1 (p < 0.001), difference that was mainly due to the dimension "affectation" rather than "frequency" and "amount" dimension scores. DISCUSSION Coital IU seem to be associated to SUI and to a higher severity of the urinary incontinence measured by the ICIQ-UI SF. Probably this association is due to the fact that ICIQ-UI-SF includes in its score the impact of patients' UI symptoms on their life and coital incontinence has an important effect on the quality of life of sexually active women.
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Abstract
*Oxybutynin inhibits contraction of the detrusor muscle in the overactive bladder by binding to muscarinic M(3) receptors and blocking acetylcholinergic activation. *The transdermal oxybutynin system, applied twice weekly, delivers continuous oxybutynin over a 96-hour patch wear period. The transdermal route of administration avoids the extensive first-pass metabolism of oxybutynin to its active metabolite, N-desethyloxybutynin. *In two well designed trials in patients with overactive bladder, transdermal oxybutynin 3.9 mg/day decreased the number of incontinence episodes and increased average voided volume to a significantly greater extent than placebo. Urinary frequency was improved to a significantly greater extent with transdermal oxybutynin than with placebo in one trial but not the other. *There was no significant difference between transdermal oxybutynin and extended-release oral tolterodine for any of these endpoints. *Health-related quality-of-life improvements with transdermal oxybutynin were shown in patients with overactive bladder in the open-label MATRIX trial, as demonstrated by significant improvements in all domains of the King's Health Questionnaire. *Transdermal oxybutynin is generally well tolerated in patients with overactive bladder. The majority of patients who discontinued transdermal oxybutynin treatment in two pivotal trials did so because of application-site reactions. However, none discontinued treatment because of dry mouth.
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Thakar R. Review of current status of female sexual dysfunction evaluation in urogynecology. Int Urogynecol J 2009; 20 Suppl 1:S27-31. [DOI: 10.1007/s00192-009-0830-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Serati M, Salvatore S, Uccella S, Nappi RE, Bolis P. Female Urinary Incontinence During Intercourse: A Review on an Understudied Problem for Women's Sexuality. J Sex Med 2009; 6:40-8. [PMID: 19170835 DOI: 10.1111/j.1743-6109.2008.01055.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Pizzi LT, Talati A, Gemmen E, Dahl NV, Bunz TJ, Sand PK. Impact of transdermal oxybutynin on work productivity in patients with overactive bladder: results from the MATRIX study. PHARMACOECONOMICS 2009; 27:329-339. [PMID: 19485428 DOI: 10.2165/00019053-200927040-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Overactive bladder syndrome (OAB) is a common condition affecting a significant number of working adults, resulting in increased healthcare utilization, reduced quality of life and decreased work productivity. The MATRIX study was a large, prospective, community-based, observational US study aimed at evaluating the impact of oxybutynin transdermal system (OXY-TDS). In this paper, we report on productivity findings among working adults in MATRIX. METHODS This study enrolled 2878 adults (aged > or =18 years) with symptoms of OAB from 327 practice sites throughout the US. All subjects received OXY-TDS (3.9 mg/day up to 6 months). Baseline versus end-of-study productivity was measured using the Work Productivity Questionnaire (WPQ). The WPQ includes a subset of questions from the Work Limitations Questionnaire (WLQ) and consists of four scales: (i) physical; (ii) time management; (iii) mental; and (iv) output demands. Overall productivity was measured by the work productivity index score (WPQ Index; a summary score based on scales) and work productivity loss score (WPLS; a measure of reduced output compared with healthy workers). Psychometric performance of the WPQ instrument is also reported, since this study represents the first use of the tool. RESULTS Of the participants, 52% were of working age (18-65 years) and 38.6% were employed. A total of 1112 working adults participated in MATRIX and were included in this analysis. They had a mean age of 52.4 years; 92.2% were female and 80.9% were Caucasian. Subjects who reported that they were most affected by OAB were also most impaired at work. After OXY-TDS treatment, participants experienced significant improvements in mean scores for all four WPQ scales (p < or = 0.0002) and the mean WPQ Index decreased from 8.2 to 5.5 (p < 0.0001). In addition, the WPLS decreased from 7.7% to 5.2% (p < 0.0001), indicating improvement in work function with OXY-TDS treatment. CONCLUSION OAB contributes to decreased work productivity due to job interruptions as well as fatigue. OXY-TDS may result in productivity improvement when patients receive 3.9 mg/day via twice weekly patch application for up to 6 months.
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Affiliation(s)
- Laura T Pizzi
- Doris N. Grandon Center for Health Economics and Outcomes Research, Jefferson School of Population Health, Philadelphia, Pennsylvania 19107, USA.
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Serati M, Salvatore S, Uccella S, Cromi A, Khullar V, Cardozo L, Bolis P. Urinary Incontinence at Orgasm: Relation to Detrusor Overactivity and Treatment Efficacy. Eur Urol 2008; 54:911-5. [PMID: 18036728 DOI: 10.1016/j.eururo.2007.11.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Accepted: 11/05/2007] [Indexed: 11/17/2022]
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Lombardi G, Mondaini N, Giubilei G, Macchiarella A, Lecconi F, Del Popolo G. Sacral Neuromodulation for Lower Urinary Tract Dysfunction and Impact on Erectile Function. J Sex Med 2008; 5:2135-40. [DOI: 10.1111/j.1743-6109.2008.00948.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rogers R, Bachmann G, Jumadilova Z, Sun F, Morrow JD, Guan Z, Bavendam T. Efficacy of tolterodine on overactive bladder symptoms and sexual and emotional quality of life in sexually active women. Int Urogynecol J 2008; 19:1551-7. [PMID: 18685795 DOI: 10.1007/s00192-008-0688-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 06/29/2008] [Indexed: 11/28/2022]
Abstract
We evaluated overactive bladder (OAB) symptoms and sexual and emotional health in sexually active women with OAB/urgency urinary incontinence (UUI) treated with tolterodine extended release (ER). Sexually active women with OAB symptoms were randomized to placebo or tolterodine ER. Five-day bladder diaries, Sexual Quality of Life Questionnaire-Female (SQOL-F), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), and Hospital Anxiety and Depression Scale (HAD) were completed at baseline and week 12. Tolterodine ER (n = 201; mean +/- SD age, 49 +/- 12 years) reduced UUI episodes (P = 0.0029), total (P = 0.0006) and OAB (P < 0.0001) micturitions, and pad use per 24 h (P = 0.0024), and was associated with improvements in SQOL-F (P = 0.004), PISQ total (P = 0.009), and HAD Anxiety (P = 0.03) scores versus placebo (n = 210; mean +/- SD age, 47 +/- 12 years). OAB symptoms improved with tolterodine ER as did the scores of sexual health and anxiety measures in sexually active women with OAB.
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Affiliation(s)
- Rebecca Rogers
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, MSC10-5580 Albuquerque, NM, 87131, USA.
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