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Zhang Y, Wu X, Liu G, Feng X, Jiang H, Zhang X. Association between overactive bladder and depression in American adults: A cross-sectional study from NHANES 2005-2018. J Affect Disord 2024; 356:545-553. [PMID: 38642902 DOI: 10.1016/j.jad.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/12/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND AIM Overactive bladder (OAB) and depression are both common disorders and there is research suggesting an association between the two, but there is a lack of studies with large samples. The aim of this study is to investigate the association between OAB and depressive symptoms. METHODS We used data from the National Health and Nutrition Examination Survey (NHANES) database for the period 2005 to 2018. OAB was characterized by the Overactive Bladder Symptom Score (OABSS, score > 3) and depression was diagnosed by the Patient Health Questionnaire (PHQ-9, score ≥ 10). There were three models employed in our analysis: (1) Crude model was unadjusted; (2) Model 1 was adjusted for age, sex, race/ethnicity, educational level, and marital status; (3) Model 2 was adjusted for factors in Model 1 plus the remained potential covariates. We used survey-weighted logistic regression models to assess the association between OAB and depression. Subsequently, subgroup analyses and smoothed curve analyses were used to evaluate the reliability of the findings. RESULTS Finally, a total of 6612 participants were included in our study, consisting of 1005 participants with diagnosis of OAB and 5607 participants without diagnosis of OAB. After adjusting for all covariates, there was a significant positive association between OAB and depression (OR: 2.89, 95 % CI: 1.91, 4.37). The severity of OAB was also positively associated with depression. Compared to participants without OAB, the fully adjusted ORs for depression were 2.76 (95 % CI: 1.64, 4.65) for those with mild OAB, 3.79 (95 % CI: 1.68, 8.55) for those with moderate OAB, and 5.21 (95 % CI: 1.39, 19.53) for those with severe OAB. CONCLUSIONS This study revealed a strong association between OAB and depression and a progressive increase in the risk of depression as the severity of OAB (mild, moderate, and severe) increased. Therefore, it is important for clinicians to recognize the assessment of OAB symptoms in patients who are at risk for or have developed depressive symptoms, as well as the mental health of patients with OAB.
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Affiliation(s)
- Yuyang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Xu Wu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Guodong Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Xingliang Feng
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| | - Hui Jiang
- Department of Urology, Peking University First Hospital Institute of Urology, Peking University Andrology Center, Beijing, China.
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China.
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Lin W, Li T, Xu Z, Chen P, Zheng Q, Hong YK, Liu WJ. Association of socioeconomic status and overactive bladder in US adults: a cross-sectional analysis of nationally representative data. Front Public Health 2024; 12:1345866. [PMID: 38596511 PMCID: PMC11003547 DOI: 10.3389/fpubh.2024.1345866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/29/2024] [Indexed: 04/11/2024] Open
Abstract
Background Socioeconomic status inequality is an important variable in the emergence of urological diseases in humans. This study set out to investigate the association between the prevalence of overactive bladder (OAB) and the poverty income ratio (PIR) that served as a more influential indicator of socioeconomic status compared to education and occupation. Method Data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2020 were used in this cross-sectional study. The association between the PIR and OAB was examined using weighted multivariate logistic regression and weighted restricted cubic splines (RCS). Additionally, interaction analysis was used for investigation to the connections between PIR and OAB in various covariate groups in order to confirm the stability of the results. Results We observed a noteworthy inverse association between PIR and OAB after adjusting for potential confounding variables (OR = 0.87, 95% CI, 0.84-0.90, p < 0.0001). PIR was transformed into categorical variables, and the association held steady after that (1.0 < PIR <4.0 vs. PIR ≤ 1.0, OR = 0.70, 95% CI =0.63-0.77, p < 0.0001; PIR ≥ 4.0 vs. PIR ≤ 1.0, OR = 0.56, 95% CI =0.48-0.65, p < 0.0001). Additionally, RCS analysis showed that PIR and OAB had a negative nonlinear response relationship. Subgroup analyses showed that the inverse association between PIR and prevalence of OAB was stronger in obese than in nonobese individuals (P for interaction < 0.05). Conclusion In our study, we observed a significant negative association between the PIR and the prevalence of OAB. In the future, PIR could be used as a reference standard to develop strategies to prevent and treat OAB.
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Affiliation(s)
- Weilong Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Taibiao Li
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Zhengyuan Xu
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Peixin Chen
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Qianqi Zheng
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Ying-kai Hong
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Wei-juan Liu
- Department of Medical Cosmetic Center, the First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
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Bowman M, Vélez CA, Jericevic D, Shapiro K, Mbassa R, Fang R, Brucker BM, Van Kuiken M. Factors Influencing Medication Selection for Management of Overactive Bladder: Trends and Insights From AUA Quality Registry. Urology 2024; 184:51-57. [PMID: 38081481 DOI: 10.1016/j.urology.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To determine how a patient's demographics, including insurance type, race/ethnicity, gender, and age, may impact the choice of medication prescribed for overactive bladder (OAB). METHODS We queried the AUA Quality Registry for adults between 2014 and 2020 with a diagnosis of OAB for >1year, excluding neurogenic causes. Variables included age, race/ethnicity, gender, insurance type, medication first prescribed, year of prescription, provider metropolitan status, and provider practice type. Primary outcome was which factors were associated with increased odds of beta-3 prescription as first medication choice. RESULTS We found 1,453,566 patients with OAB, 641,122 (44.1%) with complete data. Of these, 112,021 (17.5%) were prescribed medication. On multivariate analysis, patients with Medicaid, Medicare, and other/self-pay insurance were less likely to receive a beta-3 vs an anticholinergic compared to private or military insurance. Compared to white patients, Asian, Black, and other races were less likely to receive a beta-3, as were patients outside of metropolitan areas. Age >50, prescriptions after 2014, and nonacademic settings were associated with increased odds of beta-3 prescription. There was no difference between genders. CONCLUSION Many nonclinical factors, including insurance type and race, may affect which medication is first prescribed for OAB. This is useful for practicing urologists and may help lower barriers to beta-3 prescription through policy change and advocacy.
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Affiliation(s)
- Max Bowman
- University of California San Francisco, Department of Urology, San Francisco, CA.
| | - Camille A Vélez
- Universidad Central del Caribe, School of Medicine, Bayamon, PR
| | - Dora Jericevic
- New York University Langone, Department of Urology, New York, NY
| | | | | | | | | | - Michelle Van Kuiken
- University of California San Francisco, Department of Urology, San Francisco, CA
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Abushamma F, Abu Alwafa R, Shbaita S, Aghbar A, Zyoud SH, Hashim H. The correlation between academic stress, overactive bladder syndrome (OAB) and quality of life among healthy university students: A cross-sectional study. Urologia 2024:3915603231225632. [PMID: 38247131 DOI: 10.1177/03915603231225632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION This study aims to assess the presence of overactive bladder syndrome (OAB), academic stress, and their impact on quality of life (QoL) of healthy university students. METHODS A cross-sectional study recruited university students from different academic streams, between January 2021 to December 2021. Demographics, overactive bladder-validated 8 questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB) questionnaire, and Perception of Academic Stress (PAS) scale were collected. The correlation between the variables was assessed using the Social Sciences Statistical Package (SPSS) version 21. RESULTS Three hundred and 89 people met the inclusion criteria. There were 241 (62%) females, and 248 (63.8%) of the students were under the age of 22. Four academic streams were included: Engineering 96 (24.7%), Humanities 121 (31.1%), Medicine 85 (21.8%) and Nursing 87 (22.4%). OAB was found among 103 (26%) students. The mean OAB-V8 score was 5.8 ± 6.6. The mean PAS scale was 53.9 ± 9.4. The mean ICIQ-OAB score was 1.5 (0-9). Male gender 62 (60%), smoking 42 (40.8%), academic stream (Humanity 40 (38.8%)) and year (third and fourth-year students 34 (33%) and 33 (32%), respectively) have a statistically significant positive correlation with OAB (p < 0.001). Humanity stream (mean rank 169.2) and junior students (first and second years with mean rank of 174 and 177), respectively, had high level of academic stress and low PAS scale. There is a weak but statistically significant inverse correlation between OAB and the PAS scale (r = -0.211) (p < 0.001). CONCLUSION OAB is prevalent among healthy university students and is directly related to academic stress. Both OAB and academic stress have impact on quality of life. We hope this study will help to raise awareness of OAB among university students to early identify and treat such a condition, avoiding unnecessary bother among healthy university students.
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Affiliation(s)
- Faris Abushamma
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Department of Urology, An-Najah National University Hospital, Nablus, Palestine
| | - Rola Abu Alwafa
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sara Shbaita
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Amir Aghbar
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Department of Urology, An-Najah National University Hospital, Nablus, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, Palestine
| | - Hashim Hashim
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
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Zdroik A, El Haraki A, Smith W, Badlani G, Parker-Autry C, Matthews C. Injection site number and outcomes of intradetrusor onabotulinumtoxinA for refractory overactive bladder syndrome: a randomized clinical trial. Int Urogynecol J 2024; 35:119-126. [PMID: 37991564 DOI: 10.1007/s00192-023-05685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The optimal number of onabotulinumtoxinA injections for the treatment of refractory overactive bladder syndrome is unknown. Our primary objective was to determine whether 10-injections sites with 100 units of onabotulinumtoxinA each were associated with less pain than 20-injections sites. METHODS In a single-blinded randomized trial, 100 units of onabotulinumtoxinA was administered, either as 10 × 1 ml or as 20 × 0.5 ml injections following the instillation of 30 ml of bupivacaine and 5 ml of NaHCO3 solution for 15 min. The primary outcome was procedural pain, as measured on an 11-point Numerical Pain Rating Scale (NPRS) immediately following the procedure. A power calculation estimated that 16 subjects in each arm were needed to detect a mean difference of 1 with a standard deviation of 1, on the NPRS score between the two treatment groups, with α 0.05 and power 80%. To adjust for an estimated 20% dropout rate, the final sample size was planned for 20 patients per group. RESULTS From October 2020 to November 2022, a total of 56 patients were approached and 40 were enrolled and randomized to two groups (21 in the 10-injections group and 19 in 20-injections group). The difference in the median pain score between the group was not statistically significant (4 [1.5-5] for 10 injections vs 3 [1-4] for 20 injections, p=0.823). CONCLUSION Patients' perception of pain, efficacy, and adverse events did not significantly differ between patients receiving 10 and those receiving 20 injections of 100 units of onabotulinumtoxinA.
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Affiliation(s)
- Anna Zdroik
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA
| | - Amr El Haraki
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA
| | - Whitney Smith
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gopal Badlani
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA
| | - Candace Parker-Autry
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA
| | - Catherine Matthews
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA.
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Carr DN, Macharia A, Hacker MR, Winkelman WD. Despite Recommendations, Anticholinergics Account for the Majority of Prescriptions to Treat Overactive Bladder in the United States. Urogynecology (Phila) 2023; 29:497-503. [PMID: 36730660 PMCID: PMC10134866 DOI: 10.1097/spv.0000000000001301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE There are significant associations between anticholinergic medication use and an increased risk of cognitive impairment and dementia. Many experts now advocate minimizing the use of anticholinergic medications to treat overactive bladder (OAB) in elderly women. OBJECTIVE The aim of this study was to describe temporal and geographic trends in the pharmacologic treatment of OAB for patients 65 years or older across the United States. STUDY DESIGN The U.S. Centers for Medicare & Medicaid Services publishes annual Medicare Provider Utilization and Payment Data. The data set includes the number of unique Part D beneficiaries 65 years or older with at least 1 claim for a drug and the number of 30-day fills dispensed. The database also includes the U.S. state and rural-urban commuting area designation of the prescriber. RESULTS From 2013 to 2019, Medicare Part D beneficiaries 65 years or older received 47.7 million 30-day fills for the treatment of OAB. In 2013, anticholinergics represented 98% of the total 30-day fills (5.6 million) for OAB. The use of β3 agonists was nearly 24 times greater in 2019 than in 2013. Geographic variation in prescribing practices was evident. CONCLUSIONS The number of anticholinergics dispensed for the treatment of OAB remained relatively stable, and there was a substantial increase in the use of β3 agonists. Percentages of anticholinergics dispensed varied among states. More patients are being treated for OAB; however, anticholinergics comprised the majority of prescriptions for treatment in 2019.
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Affiliation(s)
| | - Annliz Macharia
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
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Abstract
Overactive bladder is a symptom complex consisting of bothersome storage urinary symptoms that is highly prevalent among both sexes and has a significant impact on quality of life. Various antimuscarinic agents and the beta-3 agonists mirabegron and vibegron are currently available for the treatment of OAB. Each drug has specific pharmacologic properties, dosing schedule and tolerability profile, making it essential to individualize the medical treatment for the patient's characteristics and expectations. In this manuscript, we review the most important factors involved in the contemporary pharmacological treatment of OAB.
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Affiliation(s)
- Evgenyi I. Kreydin
- University of Southern CaliforniaKeck School of MedicineDepartment of UrologyLos AngelesCAUSADepartment of Urology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Cristiano M. Gomes
- Faculdade de Medicina da Universidade de São PauloDepartamento de CirurgiaDivisão de UrologiaSão PauloSPBrasilDivisão de Urologia, Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Francisco Cruz
- Faculdade de Medicina do PortoHospital de S. JoãoDepartamento de UrologiaPortoPortugalDepartamento de Urologia, Hospital de S. João, Faculdade de Medicina do Porto, Porto, Portugal
- i3S Instituto para Investigação e Inovação em SaúdePortoPortugali3S Instituto para Investigação e Inovação em Saúde, Porto, Portugal
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Clinical Consensus Statement: Association of Anticholinergic Medication Use and Cognition in Women With Overactive Bladder. Female Pelvic Med Reconstr Surg 2021; 27:69-71. [PMID: 33497068 DOI: 10.1097/SPV.0000000000001008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
ABSTRACT Overactive bladder affects a significant portion of the overall population and has substantial impact on daily activities and quality of life. First-line treatment of overactive bladder includes behavioral therapies, which may be combined with pharmacologic management as indicated. Anticholinergic medications and β-3 agonists are often used as initial pharmacologic therapy, but caution should be taken in prescribing anticholinergic medications in frail or cognitively impaired patients. Recently, additional concerns have emerged regarding prolonged use of anticholinergic medications and the associated risk of cognitive impairment, dementia, and Alzheimer disease in the general population. Given the available evidence, which has shown significant associations between anticholinergic medication use and increased risk of cognitive impairment and dementia, providers should counsel on the associated risks, prescribe the lowest effective dose, and consider alternative medications in patients at risk.
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Varano S, Staskin D, Frankel J, Shortino D, Jankowich R, Mudd PN. Efficacy and Safety of Once-Daily Vibegron for Treatment of Overactive Bladder in Patients Aged ≥65 and ≥75 Years: Subpopulation Analysis from the EMPOWUR Randomized, International, Phase III Study. Drugs Aging 2021; 38:137-146. [PMID: 33469832 PMCID: PMC7882560 DOI: 10.1007/s40266-020-00829-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 02/03/2023]
Abstract
Background Overactive bladder (OAB) is common among older adults. The efficacy and safety of vibegron for the treatment of OAB were demonstrated in the international, phase III EMPOWUR trial. This subpopulation analysis from EMPOWUR assessed the efficacy and safety of vibegron in patients aged ≥ 65 and ≥ 75 years. Methods In EMPOWUR, patients with OAB were randomly assigned 5:5:4 to receive once-daily vibegron 75 mg, placebo, or tolterodine 4 mg extended release, respectively, once daily for 12 weeks. Coprimary efficacy endpoints were change from baseline at week 12 in average daily number of micturitions and urge urinary incontinence (UUI) episodes; a key secondary efficacy endpoint was change from baseline at week 12 in average daily number of urgency episodes. Safety was assessed through adverse events (AEs). Efficacy analyses compared vibegron with placebo; no efficacy comparisons were made between vibegron and tolterodine. Results Of the 1463 patients with evaluable efficacy data, 628 patients were aged ≥ 65 years, and 179 were aged ≥ 75 years. After 12 weeks, patients treated with once-daily vibegron 75 mg in both age subgroups showed significant improvements from baseline versus placebo in all three symptoms of OAB: daily micturitions (≥ 65 years, P < 0.0001; ≥75 years, P < 0.05), UUI episodes (≥ 65 years, P < 0.001; ≥ 75 years, P < 0.0001), and urgency episodes (≥ 65 years, P < 0.01; ≥ 75 years, P < 0.01). Significant reductions from baseline versus placebo in daily micturitions, UUI episodes, and urgency episodes were observed beginning at week 2 for patients aged ≥ 65 years treated with vibegron. In patients aged ≥ 65 years, 50.0% of those receiving vibegron versus 29.8% receiving placebo experienced a ≥ 75% reduction in UUI episodes at week 12 (P < 0.0001). Rates of cardiovascular-associated AEs were low for patients receiving vibegron (<2% of patients in either age subgroup) and similar to rates in patients receiving placebo. In patients aged ≥ 65 years, hypertension was reported by 1.2%, 3.1%, and 2.9% of patients receiving vibegron, placebo, and tolterodine, respectively; in patients aged ≥ 75 years, hypertension was reported by 1.3%, 3.3%, and 2.1%, respectively. Conclusions In this subpopulation analysis of patients with OAB aged ≥ 65 and ≥ 75 years from the EMPOWUR study, once-daily vibegron 75 mg showed rapid onset and robust efficacy versus placebo and was generally safe and well tolerated, consistent with results from the overall population. Trial Registration ClinicalTrials.gov identifier NCT03492281; registered April 10, 2018.
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Affiliation(s)
- Susann Varano
- Geriatric Medicine, Clinical Research Consulting, 2080 Bridgeport Avenue, Suite D, Milford, CT, 06460, USA.
| | - David Staskin
- Department of Surgery, Division of Urology, Tufts University School of Medicine, Boston, MA, USA
| | | | | | | | - Paul N Mudd
- Clinical Development, Urovant Sciences, Irvine, CA, USA
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Kim SK, Kim SH. The impact of overactive bladder on health-related quality of life in Korea: based on the results of a Korean Community Health Survey. Qual Life Res 2021; 30:1017-24. [PMID: 33216260 DOI: 10.1007/s11136-020-02710-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to assess the impact of overactive bladder on health-related quality of life (HRQoL) in a community-based sample of Korean population. METHODS The data of adults aged 19 and over that who participated in the 2012 Korean Community Health Survey were analyzed. Overactive bladder severity was classified as normal, mild, moderate, or severe using the Overactive Bladder Symptom scores, and HRQoL was evaluated using EQ-5D-3L. Relations between HRQoL and the severities and symptoms of OAB were investigated. Sampling weighted adjusted multiple regression analysis was performed to determine the effect of OAB symptom severity on HRQoL. RESULTS Of the 226,867 study subjects, 12,303 (5.4%) had OAB, and 552 (0.2%) had an OABSS of ≥ 12, indicating severe OAB. The problem -reporting rate significantly increased in all EQ-5D-3L dimensions as OAB severity increased. After adjusting for other variables, OAB severity had a significant effect on EQ-5D-3L index. Urge incontinence had greatest impact on quality of life. CONCLUSIONS As the severity of OAB increased from mild to severe, quality of life decreased significantly. OAB was found to negatively affect HRQoL.
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Araklitis G, Robinson D. The cognitive safety of antimuscarinics in the treatment of overactive bladder. Expert Opin Drug Saf 2020; 19:1303-1313. [PMID: 32857638 DOI: 10.1080/14740338.2020.1817377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Overactive bladder is a common problem women suffer from, with its incidence increasing with age. The mainstay of treatment is antimuscarinic medication. There is growing evidence that antimuscarinics may increase the risk of cognitive impairment, dementia, and even death. AREAS COVERED This review explores the evidence that antimuscarinics increase the risk of cognitive impairment, dementia, and death. It evaluates how best to treat overactive bladder the older woman. EXPERT OPINION The evidence suggests that antimuscarinics increase the risk of cognitive impairment and dementia in the older adult. Care should be taken to use an antimuscarinic that is less likely to cross the blood-brain barrier and thus reduce the risk of these significant adverse events. A patient's anticholinergic load also needs to be considered when treating this group. Other treatment options such as fluid management, bladder retraining, vaginal estrogens, mirabegron, Onabotulinum toxin A and neuromodulation can be used instead.
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Affiliation(s)
| | - Dudley Robinson
- Urogynaecology Department, King's College Hospital , London, UK
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Al-Azzawi IS, Al-Hindawi HT. A comparative study between sacral neuromodulation and intravesical botulinum toxin injection for patients with refractory overactive bladder. Arab J Urol 2020; 18:88-93. [PMID: 33029412 PMCID: PMC7473272 DOI: 10.1080/2090598x.2020.1740391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/10/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare the efficacy, safety, patient compliance and quality of life (QoL) (early and at 6 months after treatment), in a group of Iraqi female patients with refractory overactive bladder (OAB), treated with intradetrusor botulinum toxin A (BTX) injections vs sacral neuromodulation (SNM). PATIENTS AND METHODS A prospective, clinical interventional study of 37 female patients assessed by history, physical examination, voiding diary, ultrasonography (US), and urodynamics. The patients were assigned to one of two groups: Group 1, treated with cystoscopic BTX injections; and Group 2, treated with SNM. Response to treatment was assessed by voiding diary, the Treatment Benefit Scale, a modified Quality of Life scale, urine culture, and abdominal US. RESULTS The mean age of the patients in Group 1 (BTX) was 43.8 years and in Group 2 (SNM) was 37.2 years. OAB-wet was diagnosed in 11 patients in Group 1 and 10 in Group 2. At the 6-month follow-up there were 14/16 and 12/15 positive responders, in groups 1 and 2, respectively; with no major complications. All the responders had a significant improvement in their overall QoL after both types of treatment. CONCLUSIONS Both BTX and SNM, in our experience, were safe and effective in managing our patients with refractory OAB after 6 months of follow-up, which was also reflected by an improvement in their QoL. ABBREVIATIONS BTX: botulinum toxin A; IPG: implantable pulse generator; OAB: overactive bladder; PVR: post-void residual urine; QoL: quality of life; SNM: sacral neuromodulation; UDS, urodynamics; UI, urinary incontinence.
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Abstract
Age and body mass index are associated with increased risks of overactive bladder, whereas employment status is associated with a decreased risk of overactive bladder. Objective The purpose of this study was to investigate the risk factors of overactive bladder (OAB). Methods The PubMed, Embase, and Cochrane Library databases were retrieved through May 2016. Odds ratios (OR) or standard mean differences (SMDs) with 95% confidence intervals (CIs) were used to evaluate the associations between risk factors and OAB. Heterogeneity among studies was examined using χ2 test based on the Q and I2 tests. Results A total of 28 articles were analyzed in our study. The results suggested that age and body mass index were significantly higher in OAB patients than in non-OAB controls (SMDs [95% CIs], 0.30 [0.19–0.41] and 0.39 [0.24–0.53]). A significant negative association was found between employment status and OAB (OR [95% CIs], 0.64 [0.46–0.90]). However, sex, educational level, parity, vaginal delivery, race, menopause, marital status, smoking, and alcohol consumption were not significantly different in OAB and non-OAB control patients (ORs [95% CIs], 0.95 [0.59–1.55], 1.04 [0.82, 1.33], 0.98 [0.56–1.70], 1.66 [0.90–3.07], 0.98 [0.75–1.28], 1.84 [0.23–14.70], 0.97 [0.78–1.19], 0.91 [0.77–1.08], and 0.88 [0.71–1.09], respectively). In addition, the number of parities and vaginal deliveries in OAB patients also showed no significant differences compared with non-OAB control patients (SMDs [95% CI], 0.05 [−0.27 to 0.38] and −0.16 [0.40 to 0.09]). Conclusions This meta-analysis suggests that age and body mass index are associated with increased risks of OAB, whereas employment status is associated with a decreased risk of OAB. Further prospective studies with large sample sizes are needed to confirm this conclusion.
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Kim SK, Kim KH, Kim SH, Yoo SJ, Jeong YW. Health-related quality of life in adult males with lower urinary tract symptoms. Qual Life Res 2019; 28:2419-28. [PMID: 31087248 DOI: 10.1007/s11136-019-02205-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the status and impact of lower urinary tract symptoms (LUTS) on health-related quality of life (HRQoL) in a community-based sample of Korean adult males. METHODS We analyzed the data of 101,606 adult males aged ≥ 19 years of age obtained during the 2011 Korean Community Health Survey. Subject data were assessed for LUTS and HRQoL using international prostate symptom scores, and EuroQol-five-dimensions three-level version (EQ-5D-3L) and EuroQol-visual analogue scale (EQ-VAS) scores. RESULTS Of the 101,606 subjects, 53,323 (52.5%) reported having at least one LUTS and 3116 (3.1%) had an IPSS of ≥ 20, indicating severe LUTS. In those aged 19-39 years, 28.7% (8343/29,072) reported they had mild to severe LUTS. The prevalence of LUTS was high among those aged 40-59 years (47.7%), 60-79 years (80.5%), and ≥ 80 years (91.2%). In addition, EQ-5D-3L and EQ-VAS scores decreased as LUTS severity and frequency increased. CONCLUSIONS Adult men of all ages with mild to severe LUTS have poorer health statuses and quality of life. Even among young males, LUTS severity and was found to negatively affect HRQoL.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Mourad S, Shokeir A, Ayoub N, Ibrahim M, Reynolds N, Donde S, Hassan T. Prevalence and impact of lower urinary tract symptoms: Results of the epic survey in Egypt. Neurourol Urodyn 2018; 38:637-643. [PMID: 30575129 DOI: 10.1002/nau.23875] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/23/2018] [Indexed: 11/07/2022]
Abstract
AIMS To estimate the prevalence of lower urinary tract symptoms (LUTS), including overactive bladder (OAB), and urinary incontinence (UI), in Egypt and the impact on patients' quality of life. METHODS A population-based, cross-sectional survey (EPIC) was conducted with a random sample of adults aged ≥18 years. Prevalence estimates were based on 2002 International Continence Society definitions. RESULTS A total of 3600 adult men and women participated in the survey; 86% of them experienced ≥1 LUTS: storage symptoms were more frequently reported (75%) than voiding (52%) or postmicturition (42%) symptoms. The most prevalent storage symptom was nocturia (defined as ≥1 time per night) in 70% of the population. UI was reported by 21% (mixed UI [MUI]: 9%; stress UI [SUI]: 4%; urgency UI [UUI]: 5%; other UI: 3%), and 30% met criteria for OAB. Despite the high prevalence of LUTS, few individuals with UUI, MUI, SUI, or OAB took prescription medicine (12%) or consulted a healthcare professional about their symptoms (23%). CONCLUSION High prevalence rates of LUTS and OAB were found in adult men and women in Egypt, although low healthcare utilization and low prescription medication use for symptoms were observed.
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Affiliation(s)
| | | | | | | | | | | | - Tarek Hassan
- Pfizer Essential Health, New York, United States of America
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Kim TY, Shin JS, Lee J, Lee YJ, Kim MR, Choi A, Park KB, Kim EJ, Ha IH. Urinary incontinence in middle-aged and older Korean women and its impact on quality of life: a cross-sectional study. Eur Geriatr Med 2018; 9:871-80. [PMID: 34674475 DOI: 10.1007/s41999-018-0112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is a distinct lack of studies on the impact of urinary incontinence on quality of life in middle-aged and older Korean women, despite numerous clinical observations supporting its negative influence. The association between urinary incontinence and quality of life and subjective health state was investigated with various covariates to identify mediating variables. METHODS A nationally representative sample of Korean women aged ≥ 45 years (n = 4020) with data for urinary incontinence, quality of life, health-related items and covariates from the 4th Korean Longitudinal Study of Ageing (KLoSA, 2012) were analyzed in a cross-sectional study. Association between urinary incontinence and quality of life and subjective health state adjusted for using sociodemographic factors and health behavior, and regression analysis in adjusted complex sampling design to determine regression coefficients with 95% confidence intervals. RESULTS Prevalence of urinary incontinence in middle-aged and older Korean women was 27.5% (n = 1107). The negative relationship between urinary incontinence and quality of life was maintained in full adjustments (sociodemographic factors, health behavior, somatic health, and mental health) with mental health exerting greatest influence on the association between urinary incontinence and quality of life. Moreover, in presence of urinary incontinence symptoms, aggravation of urinary incontinence symptoms held a more negative relationship with quality of life compared to similarly maintained state. CONCLUSIONS Urinary incontinence has a negative association with quality of life and subjective health state, and psychological factors which are implicated in old age may be of importance in urinary incontinence patient management.
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Abstract
Overactive bladder (OAB) is a symptom-driven condition with economic burden estimated to be on the order of several hundred dollars or euros per patient in some North American and European countries. This work reviews recently published economic models to evaluate how health states are defined, what cost components are considered, and what utility values are used to estimate the cost effectiveness of OAB pharmacotherapies, botulinum toxin, or sacral neuromodulation. It was found that no clear standard exists for determining OAB health states, although most were defined by some measure of incontinence frequency. Costs of physician visits and incontinence pads were included in nearly all models; however, OAB-associated depression and nursing home costs were rarely included, despite being large cost drivers of global economic burden studies. Utility values used in the models ranged from 0.544 to 0.933, highlighting the uncertainty associated with how OAB patients value health-related quality of life. More research is warranted so that health states providing delineations among OAB symptom severity and quality of life are clinically and economically meaningful as well as meaningful to affected patients.
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Affiliation(s)
- Sonya J Snedecor
- Pharmerit International, 4350 East West Hwy, Suite 1110, Bethesda, MD, 20814, USA.
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Vouri SM, Schootman M, Strope SA, Birge SJ, Olsen MA. Differential Prescribing of Antimuscarinic Agents in Older Adults with Cognitive Impairment. Drugs Aging 2018; 35:321-31. [PMID: 29492862 DOI: 10.1007/s40266-018-0531-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Lee HY, Yun YJ, Choi JY, Hong JW, Lee I, Park SH, Kwon JN. Effectiveness and safety of moxibustion for alleviating symptoms of overactive bladder: A prospective, randomized controlled, crossover-design, pilot study. Medicine (Baltimore) 2018; 97:e12016. [PMID: 30142847 PMCID: PMC6113034 DOI: 10.1097/md.0000000000012016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to evaluate trial feasibility and explore the potential efficacy and safety of moxibustion in the treatment of overactive bladder (OAB). METHOD A randomized, controlled, cross-over, assessor blinded design was used. This study was conducted in an outpatient department of a university hospital in Republic of Korea. The overall study period was 8 weeks. Participants were randomly allotted to either Group A or Group B. Group A participants underwent 8 to 12 sessions of moxibustion with behavioral training during the first 4 weeks, while the Group B participants received behavioral training only. Over the next 4 weeks, the treatment offered to the 2 groups was reversed (Group A participants received behavioral training only, while Group B participants underwent the moxibustion session with behavioral training). The OAB-validated 8-question awareness tool (OAB-V8), OAB symptom scores (OABSS), visual analog scale (VAS) for lower urinary tract symptoms, and frequency voiding chart were used to assess outcomes. For analysis, we used effect size, measured as Hedge's g, to present descriptive results indicating the actual difference between the groups. RESULTS Compared to that in Group B, the Hedge's g of OAB-V8 for the former 4 weeks in Group A was -0.248, that of OABSS was -1.531, and that of VAS was -0.713. During the latter 4 weeks, Group B showed similar effect with g = 0.465, 1.207, and 0.427 for OAB-V8, OABSS, and VAS, respectively, compared to Group A. The portion of nocturnal voiding volume decreased (g = -0965), the mean voiding volume increased (g = 0.690), and the voiding frequency decreased (g = -0.498) with moxibustion. CONCLUSIONS Moxibustion might be considered as an alternative for OAB. A full-sized randomized controlled trial may be feasible with minimal modification in outcome measures and comparator population. OTHER INFORMATION This clinical trial has been registered on clinicaltrials.gov (NCT02271607).
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Affiliation(s)
- Hye-Yoon Lee
- Pusan National University Korean Medicine Hospital
| | - Young-Ju Yun
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - Jun-Yong Choi
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - Jin-Woo Hong
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - In Lee
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - Seong-Ha Park
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - Jung-Nam Kwon
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
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Rapariz M, Mora AM, Roset M. Impact of overactive bladder symptoms on work activity: The ACTIVHA study. Actas Urol Esp 2018; 42:176-84. [PMID: 29103735 DOI: 10.1016/j.acuro.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To analyse the impact of overactive bladder (OAB) symptoms on the work activity of patients in Spain. METHOD An observational, multicentre cross-sectional study was conducted with 149 urologists and 131 gynaecologists of Spain and included patients diagnosed with OAB, according to clinical judgment, who were of working age (18-65 years). We collected sociodemographic, clinical and work activity data. The patients filled out the Bladder Control Self-Assessment Questionnaire (B-SAQ) and the Work Productivity and Activity Impairment Questionnaire-General Health (WPAI-GH). The effect of each symptom on the daily and occupational activity was assessed. The results were stratified according to sex and the presence of emergency and urinary incontinence (UI) according to the B-SAQ. RESULTS We assessed 768 patients (89% women), with a mean (SD) age of 52.5 (9.3) years and 2.6 (2.6) years of OAB progression. The most common symptoms according to the patients were urgent urination (89.8%), nocturia (75.7%), urge incontinence (68.5%) and frequent urination (68.2%). Ninety-six percent of the patients adopted adaptive measures for their OAB. According to the B-SAQ, 543 patients (71%) presented urgent urination; of these, 294 (54%) showed UI. The symptom that most affected work activity was frequent urination (59.8%). According to the WPAI-GH, the patients reported an impact of 32% during the workday (41% in patients with urgent urination and UI) and a loss of work time of 6.5% (9.9% in patients with urgent urination and UI). CONCLUSIONS The symptoms of OAB negatively affect work activity, especially in patients who have urgent urination and UI.
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Kim JI, Choi TY, Jun JH, Kang H, Lee MS. Acupuncture for management of lower urinary tract symptoms in Parkinson's disease: A protocol for the systematic review of randomized controlled trials. Medicine (Baltimore) 2018; 97:e9821. [PMID: 29419682 PMCID: PMC5944678 DOI: 10.1097/md.0000000000009821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Acupuncture is claimed to improve the lower urinary tract symptoms (LUTS). Currently, no systematic reviews are performed for acupuncture on LUTS in patients with Parkinson's diseases (PD). This review aims to evaluate the current evidence on the efficacy of acupuncture for the management of LUTS in PD. METHODS AND ANALYSES Eleven databases will be searched from their inception. These include PubMed, AMED, EMBASE, the Cochrane Library, 6 Korean medical databases, and 1 Chinese medical database. Study selection, data extraction, and assessment will be performed independently by 2 researchers. Risk of bias will be assessed with the Cochrane risk of bias assessment tool. ETHICS AND DISSEMINATION Ethical approval will not be required, given that this protocol is for a systematic review. The systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. TRIAL REGISTRATION NUMBER PROSPERO 2018 CRD42018083857.
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Affiliation(s)
- Jong-In Kim
- Division of Acupuncture & Moxibustion Medicine, Kyung Hee Korean Medicine Hospital, Kyung Hee University, Seoul
| | - Tae-Young Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Ji Hee Jun
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Hee Kang
- Graduate School of East-West Medical Science, Kyung Hee University, Yongin, Republic of Korea
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
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Pyo H, Kim BR, Park M, Hong JH, Kim EJ. Effects of Overactive Bladder Symptoms in Stroke Patients' Health Related Quality of Life and Their Performance Scale. Ann Rehabil Med 2018; 41:935-943. [PMID: 29354569 PMCID: PMC5773436 DOI: 10.5535/arm.2017.41.6.935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
Objective To identify the effects of overactive bladder (OAB) symptoms on the health-related quality of life (HRQOL) in stroke patients since OAB symptoms are common in such patients, but their effects on stroke rehabilitation over time are unclear. Methods This study included 30 post-acute stroke patients who had been admitted for rehabilitation treatments. All participants completed a questionnaire evaluating urinary symptoms, including the Overactive Bladder Symptom Score (OABSS) and general HRQOL with a Short-Form 36 (SF-36) health survey. We assessed their performance in terms of the Function Ambulation Category, Modified Rankin Scale (MRS), Modified Barthel Index, and Mini-Mental State Examination (MMSE). All assessments were carried out twice at baseline and at 3 months. We divided patients into an OAB and non-OAB group with OABSS. A correlation analysis and multivariate regression were then performed. Results All performance scales showed an improvement over 3 months in the non-OAB group (n=18; p<0.02), but, MRS and MMSE scores did not improve significantly in the OAB group (n=12) (p=0.15 and p=0.20, respectively). In the OAB group, the vitality and mental health scores significantly decreased over 3 months (p=0.011 and p=0,041, respectively), and the mental component summary (MCS) score showed a marginal decrease over 3 months (p=0.05). A multivariate regression analysis revealed that OAB symptoms were negatively correlated with the 3 months MCS score (B=−8.15, p=0.034). Conclusion These results indicated that OAB symptoms could have negative effects on HRQOL and performance in patients suffering from a stroke.
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Affiliation(s)
- Hannah Pyo
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Bo Ra Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Mina Park
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Jeong Hee Hong
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Eun Joo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
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Schneider A, Tourlonias B, Cormier L, Mourey E, Koutlidis N, Delorme E, Pasquale J, Kermarec I, Foahom-Kamwa AD, Bonniaud V. [Botulinium toxin and idiopathic overactive bladder: Multicentric contempory management in Bourgogne]. Prog Urol 2018; 28:173-9. [PMID: 29329897 DOI: 10.1016/j.purol.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Since 2014, OnabotulinumtoxinA Botox® (Allergan, Inc., Irvine, USA) represents a new therapeutic option for second-line treatment of idiopathic overactive bladder. The purpose of the current study was to evaluate practices of surgeons using onabotulinium toxin (BoNTA) in this indication. MATERIAL AND METHODS All urogynecology centers of the country were asked in order to list all patients who were treated since marketing autorisation. Patient symptoms, previous treatments, paraclinic evaluations, data of surgery and the characteristics of the follow up were collected and analyzed. RESULTS Six centers used BoNTA and five have accepted to participate. Ninety-seven patients have been identified. Sixty-eight first injections (70 %) were carried out with the strict frameworf of the marketing autorisation (urinary frequency, urinary urgency, urinary incontinence). All patients had at least two symptoms. In 69 %, Botulinum toxin was a second-line treatment after the failure of tibial neuromodulation or sacral neuromodulation. Urodynamic evaluation was carried out for 91 % of patients. The search for a post-void residual volume was observed for 59 % of patients during the follow up. CONCLUSION In our country, BoNTA injections for idiopathic overactive bladder are mainly effected after tibial neuromodulation or sacral neuromodulation failure. Diagnostic, operating and outcome evaluation practices are still very heterogeneous pleading for a greater standardization of this new therapy in this indication. LEVEL OF EVIDENCE 3.
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Pillalamarri N, Shalom DF, Pilkinton ML, Winkler HA, Chatterjee PK, Solanki M, Metz CN. Inflammatory Urinary Cytokine Expression and Quality of Life in Patients With Overactive Bladder: . Female Pelvic Med Reconstr Surg 2018; 24:449-53. [DOI: 10.1097/spv.0000000000000492] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Geller EJ, Dumond JB, Bowling JM, Khandelwal CM, Wu JM, Busby-Whitehead J, Kaufer DI. Effect of Trospium Chloride on Cognitive Function in Women Aged 50 and Older: A Randomized Trial. Female Pelvic Med Reconstr Surg 2017; 23:118-23. [PMID: 28067745 DOI: 10.1097/SPV.0000000000000374] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study aimed to investigate the effect of trospium chloride on cognitive function in postmenopausal women treated for overactive bladder (OAB). METHODS Randomized double-blind placebo-controlled trial conducted from April 2013 to April 2015. Women aged 50 years or older seeking treatment for OAB were randomized to either trospium chloride XR 60 mg daily or placebo. Baseline cognitive function was assessed via Hopkins Verbal Learning Test-Revised (HVLT-R), Mini Mental Status Exam, Mini Mental Status X, Digit Span, Trails A, Trails B, and Epworth Sleepiness Scale. Cognitive function was reassessed at week 1 and week 4. A priori power analysis determined that 21 subjects were needed per group. RESULTS Although 59 women were enrolled and randomized (28 trospium and 31 placebo), 45 completed assessment (21 trospium and 24 placebo). Mean age was 68 years, 78% were white, and 44% had previously taken OAB medication. For the primary outcome, there was no difference in HVLT-R total score between trospium and placebo groups at week 4 (P = 0.29). There were also no differences based on the other cognitive tests. There was a correlation between age and the following week-4 tests: HVLT-R total score (r = -0.3, P = 0.02), HVLT-R total recall subscale (r = -0.4, P = 0.007), Trails A (r = 0.4, P = 0.002), and Trails B (r = 0.4, P = 0.004). A linear regression model found that HVLT-R total score decreased by 0.372 points for each increased year of age. CONCLUSIONS In women aged 50 years and older, there were no changes in cognitive function between those taking trospium and placebo. Cognitive function was correlated with age.
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Melotti IGR, Juliato CRT, Coelho SCA, Lima M, Riccetto CLZ. Is There Any Difference Between Depression and Anxiety in Overactive Bladder According to Sex? A Systematic Review and Meta-Analysis. Int Neurourol J 2017; 21:204-11. [PMID: 28954462 DOI: 10.5213/inj.1734890.445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/13/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Overactive bladder (OAB) is characterized by urinary urgency with or without urge incontinence, accompanied by frequency and nocturia. It affects individuals of all ages and can predispose affected individuals to depression and anxiety. However, few studies have been conducted on this topic. The objective of this study was to perform a systematic review and meta-analysis assessing the symptoms of depression, anxiety, and OAB using validated instruments. METHODS The search for articles was based on the following descriptors: overactive bladder, depression, and anxiety ("Urinary bladder, Overactive AND Depression and Anxiety") OR ("Urinary bladder, Overactive AND Depression" OR "Urinary bladder, Overactive AND Anxiety"). The databases searched included PubMed, MEDLINE, and SciELO. RESULTS Initially, 111 articles were identified, but only 11 articles, containing 11,784 participants with depression and 10,436 with anxiety, specifically addressed depression or anxiety and were included in this systematic review. Ten articles incorporated a quantitative analysis, with cohort, series, population-based, and cross-sectional designs. One qualitative study was also included. Three articles were included in the meta-analysis, resulting in a total of 7,468 participants in whom depression was evaluated and 8,030 participants in whom anxiety was analyzed. Depression and anxiety were positively correlated with OAB. Men with OAB were considerably more likely than women to have anxiety (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.40-1.73) but there was no sex-related difference in depression (OR, 0.96; 95% CI, 0.77-1.21). CONCLUSIONS This study showed a positive correlation between OAB and anxiety and depression. Men were considerably more likely than women to have anxiety related to OAB, but depression levels in OAB patients were not sex-related. This review highlights the need to investigate depression and anxiety in patients with OAB.
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Suh YS, Ko KJ, Kim TH, Lee HS, Sung HH, Cho WJ, Lee M, Lee KS. Potential Biomarkers for Diagnosis of Overactive Bladder Patients: Urinary Nerve Growth Factor, Prostaglandin E2, and Adenosine Triphosphate. Int Neurourol J 2017; 21:171-7. [PMID: 28954458 DOI: 10.5213/inj.1732728.364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022] Open
Abstract
Purpose This study aimed to investigate potential biomarkers for the diagnosis of overactive bladder (OAB). Methods A total of 219 subjects were enrolled and divided into 2 groups: OAB subjects (n=189) and controls without OAB symptoms (n=30). Three-day voiding diaries and questionnaires were collected, and urinary levels of nerve growth factor (NGF), prostaglandin E2, and adenosine triphosphate were measured and normalized to urine creatinine (Cr). Baseline characteristics and urinary levels of markers were analyzed. A receiver-operator characteristic (ROC) curve was used to analyze the diagnostic performance of urinary markers. Urinary levels of markers according to subgroup and pathogenesis of OAB were evaluated. Correlation analyses were used to analyze the relationship between urinary levels of markers and voiding diary parameters and questionnaires. Results There was no difference between the 2 groups with regards to age, sex ratio, or urine Cr (P>0.05). The urinary levels of NGF/Cr were higher in OAB subjects than in controls (P<0.001). Urinary NGF/Cr was a sensitive biomarker for discriminating OAB patients (area under the curve=0.741; 95% confidence interval, 0.62–0.79; P=0.001) in the ROC curve. The urinary levels of NGF/Cr were significantly higher in OAB subjects than in controls regardless of subgroup or pathogenesis. Correlation analysis demonstrated urinary urgency was significantly related to urinary NGF/Cr level (correlation coefficient, 0.156). Limitations include a relatively wide variation of urinary markers. Conclusions Urinary NGF is a potential biomarker that could serve as a basis for adjunct diagnosis of OAB.
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Xu D, Gao J, Wang X, Huang L, Wang K. Prevalence of overactive bladder and its impact on quality of life in 1025 patients with type 2 diabetes in mainland China. J Diabetes Complications 2017; 31:1254-1258. [PMID: 28533105 DOI: 10.1016/j.jdiacomp.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/26/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
AIMS This study examined the prevalence of overactive bladder (OAB) and investigated the impact of OAB on quality of life (QOL) in patients with type 2 diabetes in Mainland China. METHODS A total of 1025 patients with type 2 diabetes were surveyed. Patients were grouped into no OAB, dry OAB, and wet OAB groups according to the presence of OAB and urge incontinence. Descriptive analyses, one-way analysis of variance (ANOVA) and multivariable regression models were conducted to assess the prevalence of OAB and the effect of OAB on QOL. RESULTS The prevalence of OAB among patients with type 2 diabetes was 13.9% (with dry OAB, 6.1%; with wet OAB, 7.8%). Multivariable regression models showed that OAB symptoms caused significant deterioration of the physical and mental aspects of QOL. Compared with dry OAB, wet OAB further decreased the mental aspect of QOL. Moreover, the effect sizes of the impacts of dry and wet OAB on QOL were larger than those of diabetic neuropathy or retinopathy, diabetes duration, or urinary tract infection history. CONCLUSIONS OAB is more common in patients with type 2 diabetes than in the general population and substantially decreases patient QOL.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, IN, USA.
| | - Jie Gao
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
| | - Xiaojuan Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
| | - Liqun Huang
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
| | - Kefang Wang
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
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Arlandis Guzmán S, Martínez Cuenca E, Martínez García R, Bonillo García MA, Rejas J, Broseta-Rico E. Cultural adaptation to Spanish (Spain) of the "Overactive Bladder - Family Impact Measure (OAB-FIM)" questionnaire. Actas Urol Esp 2017; 41:324-332. [PMID: 28202287 DOI: 10.1016/j.acuro.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/07/2016] [Accepted: 12/23/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The OAB-FIM was developed as a measure of the impact of an overactive bladder (OAB) on relatives who live with the patient. The objective of this study was conduct a cultural adaptation to Spanish (Spain) of the OAB-FIM questionnaire. METHODS The adaptation included a conceptual and linguistic validation phase, as well as a phase for measuring the psychometric properties in 25 relatives [mean age, 63.0 years (SD, 14.3); 44% women] who regularly live with patients with OAB, who are of either sex and 18 years of age or older. We measured conceptual and linguistic equivalence, internal reliability, construct validity and content validity. We assessed the applicability and administration load. RESULTS The OAB-FIM was conceptually and linguistically equivalent to the original, maintaining its 6 domains: social, travel, worry, irritability, sleep and sex. The interagreement correctly placed all items in their domain, except for number 10, which was placed more in worry than in irritability, motivates its reformulation. Some 2.95% of the items were missing. The floor and ceiling effects of the items varied, respectively, between 20-28%, and 0-16%. The mean time for completing the questionnaire was 5.2minutes (SD, 2.8), and 24% of the participants required some type of assistance. The α-Cronbach coefficient varied between 0.948-0.839. The correlations with similar scales in the family were moderate-high (0.407-0.753) or small-moderate with those administered to the patient (0.004-0.423). CONCLUSION We obtained a Spanish (Spain) version of the OAB-FIM that was conceptually and linguistically equivalent to the original. The questionnaire showed good internal consistency, content and construct validity and applicability.
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Affiliation(s)
- S Arlandis Guzmán
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - E Martínez Cuenca
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - R Martínez García
- Servicio de Urología, Hospital Clínico Universitario, Valencia, España
| | - M A Bonillo García
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J Rejas
- Departamento de Investigación de Resultados en Salud y Farmacoeconomía, Pfizer, Alcobendas, Madrid, España
| | - E Broseta-Rico
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
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AUGS Consensus Statement: Association of Anticholinergic Medication Use and Cognition in Women With Overactive Bladder. Female Pelvic Med Reconstr Surg 2017; 23:177-8. [DOI: 10.1097/spv.0000000000000423] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Barsdorf AI, Carlsson M, Bushmakin AG, Quinn S, Cappelleri JC, Pleil A. Validation of overactive bladder questionnaire (1-week recall version) in medically complex elderly patients with overactive bladder. Int Urogynecol J 2017; 28:1857-63. [DOI: 10.1007/s00192-017-3305-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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Kim KS, Moon HS. Antimuscarinic Agent Treatment Affecting Patient-Reported Outcomes in Overactive Bladder Syndrome With Depressive Symptoms. Int Neurourol J 2016; 20:349-55. [PMID: 28043114 DOI: 10.5213/inj.1624678.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/12/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose We investigated improvements in overactive bladder symptoms and depressive symptoms after solifenacin treatment in overactive bladder patients with or without depressive symptoms. Methods We performed a prospective study of patients who had been diagnosed with overactive bladder from July 2013 to June 2014. Based on the Beck Depression Inventory questionnaire, the test subjects were divided into group 1, without depressive symptoms (0–9 points), and group 2, with depressive symptoms (10 or more points). The patients were administered 5 mg of solifenacin for 3 months. The following outcomes were analyzed at the first visit, 4 weeks, and 12 weeks: the overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), patients’ perceptions of their bladder condition, and the Beck Depression Inventory. Results A total of 72 patients participated, and 52 patients completed the study. Most outcome measures showed improvements in both groups at weeks 4 and 12. Especially in group 2, the questionnaires showed significant improvements from baseline to week 12, indicating that solifenacin was effective at treating overactive bladder symptoms (group 1 vs. group 2: OABSS, −2.67±0.80 vs. −3.00±0.77; P<0.01; IPSS-total, −2.14±2.15 vs. −4.94±1.70; P<0.01). Statistically significant decreases in the Beck Depression Inventory score from baseline to weeks 4 and 12 were observed in group 2 (group 1 vs. group 2: 1.43±0.74 vs. −2.68±4.05 at week 4, P<0.001; 0.10±3.37 vs. −5.52±5.82 at week 12, P<0.001). Conclusions In overactive bladder patients with depressive symptoms, solifenacin can help improve quality of life and depressive symptoms at the same time.
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Kim JI, Lee JA, Choi TY, Jun JH, Choi J, Shin BC, Lim HJ, Lee MS. Acupuncture for the treatment of overactive bladder: A protocol for systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.08.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Overactive bladder (OAB) is a common condition affecting millions of men and women worldwide. It is an embarrassing condition with far-reaching consequences. Although many treatment options exist, no single treatment has been proven to be most effective. Often a combination of therapy is required to successfully manage OAB symptoms. In this review, we provide an overview of OAB, including risk factors for development of OAB; keys to diagnosis; therapeutic options including conservative and medical management, as well as treatments for refractory OAB; when to consider referral to a specialist; and resources for clinicians and patients. The aim of this review is to inform clinicians regarding OAB management in order to improve patient counseling and care.
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Affiliation(s)
- Marcella G Willis-Gray
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis A Dieter
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth J Geller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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KIM A, LEE KS, JUNG R, NA S, KIM JC, KIM HG, CHOO MS. Health Related Quality of Life in Patients with Side-Effects after Antimuscarinic Treatment for Overactive Bladder. Low Urin Tract Symptoms 2016; 9:171-175. [DOI: 10.1111/luts.12132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/23/2015] [Accepted: 01/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Aram KIM
- Department of Urology, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Kyu-Sung LEE
- Department of Urology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | | | - Selee NA
- Department of Computer science and Information system; Hanyang Women's University; Seoul Korea
| | - Joon-chul KIM
- Department of Urology, Bucheon St. Mary's hospital; The Catholic University of Korea; Seoul Korea
| | - Hyeong Gon KIM
- Department of Urology, Konkuk University Hospital; Konkuk University School of Medicine; Seoul Korea
| | - Myung-Soo CHOO
- Department of Urology, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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Freemantle N, Ginsberg DA, McCool R, Fleetwood K, Arber M, Khalaf K, Loveman C, Ni Q, Glanville J. Comparative assessment of onabotulinumtoxinA and mirabegron for overactive bladder: an indirect treatment comparison. BMJ Open 2016; 6:e009122. [PMID: 26908514 PMCID: PMC4769403 DOI: 10.1136/bmjopen-2015-009122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT OnabotulinumtoxinA and mirabegron have recently gained marketing authorisation to treat symptoms of overactive bladder (OAB). OBJECTIVE To evaluate the relative efficacy of mirabegron and onabotulinumtoxinA in patients with idiopathic OAB. DESIGN Network meta-analysis. DATA SOURCES A search of 9 electronic databases, review documents, guidelines and websites. METHODS Randomised trials comparing any licensed dose of onabotulinumtoxinA or mirabegron with each other, anticholinergic drugs or placebo were eligible (19 randomised trials were identified). 1 reviewer extracted data from the studies and a second reviewer checked the data. Candidate trials were assessed for similarity and networks were developed for each outcome. Bayesian network meta-analysis was conducted using both fixed-effects and random-effects models. When there were differences in mean baseline values between mirabegron and onabotulinumtoxinA trials they were adjusted for using network meta-regression (NMR). RESULTS No studies directly comparing onabotulinumtoxinA to mirabegron were identified. A network was created for each of the 7 outcomes, with 3-9 studies included in each individual network. The trials included in the networks were broadly similar. Patients in the onabotulinumtoxinA trials had more urinary incontinence and urgency episodes at baseline than patients in the mirabegron trials and these differences were adjusted for using NMR. Both onabotulinumtoxinA and mirabegron were more efficacious than placebo at reducing the frequency of urinary incontinence, urgency, urination and nocturia. OnabotulinumtoxinA was more efficacious than mirabegron (50 and 25 mg) in completely resolving daily episodes of urinary incontinence and urgency and in reducing the frequency of urinary incontinence, urgency and urination. NMR supported the results of the network meta-analysis. CONCLUSIONS In the absence of head-to-head trials comparing onabotulinumtoxinA to mirabegron, this indirect comparison indicates that onabotulinumtoxinA may be superior to mirabegron in improving symptoms of urinary incontinence, urgency and urinary frequency in patients with idiopathic OAB.
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Affiliation(s)
- Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - David A Ginsberg
- USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Rachael McCool
- York Health Economics Consortium, University of York, York, UK
| | | | - Mick Arber
- York Health Economics Consortium, University of York, York, UK
| | - Kristin Khalaf
- Allergan, Inc., Irvine, California, USA
- Xcenda, Palm Harbor, Florida, USA
| | | | - Quanhong Ni
- Allergan, Inc., Bridgewater, New Jersey, USA
- Celgene, Summit, New Jersey, USA
| | - Julie Glanville
- York Health Economics Consortium, University of York, York, UK
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Abstract
INTRODUCTION Overactive bladder affects a significant portion of the population and results in prescribing of numerous medications for its treatment. Traditional drug delivery systems used in therapy are associated with multiple commonly reported side effects. Adherence rates with use of these medications are low. It is likely that low adherence rates with the use of these drugs are due in some part to drug side effects. It is therefore important that alternate methods for drug delivery be explored to reduce side effect profiles and improve patient compliance. AREAS COVERED This article addresses the various forms of drug delivery for overactive bladder medications, focusing on those currently in use. Newer systems of drug delivery are also discussed. Through thorough review of research data, randomized trials and meta analyses, drug delivery systems were evaluated. EXPERT OPINION EXPERT OPINION favors the use of the transdermal patch and recognizes the necessity for further research and development of other delivery methods. The patch delivery method offers the most effective means of treating symptoms and minimizing drug related adverse side effects leading to treatment discontinuation. Development of OAB medications aimed at alternate receptor targets has the potential to facilitate the creation of new treatment methods to compete with the current standard of care used in OAB treatment.
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Affiliation(s)
- Katie Scott
- a School of Medicine , The University of Kansas , Kansas City , KS , USA
| | | | - Priya Padmanabhan
- c Department of Urology , The University of Kansas , Kansas City , KS , USA
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Xu T, Sun Q, Huang X, Lyu B. A nurse-led long-term pelvic floor muscle training program in the management of female patients with overactive bladder – A study protocol for a randomized controlled trial. Int J Nurs Sci 2015; 2:158-166. [DOI: 10.1016/j.ijnss.2015.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nazir J, Posnett J, Walker A, Odeyemi IA, Hakimi Z, Garnham A. Economic evaluation of pharmacological treatments for overactive bladder from the perspective of the UK National Health Service. J Med Econ 2015; 18:390-7. [PMID: 25488631 DOI: 10.3111/13696998.2014.995300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the costs and outcomes associated with different sequences of oral anti-muscarinic agents and the selective β(3)-adrenoceptor agonist, mirabegron, for the treatment of overactive bladder (OAB). METHODS A Markov model with monthly cycle length and time horizon up to 3 years was designed to compare two different sequences of up to three lines of oral therapy for OAB. Patients who discontinued one oral medication could switch to another oral medication or could discontinue treatment. Patients whose symptoms were not controlled were considered for botulinum toxin or sacral nerve stimulation. Outcomes were measured by (a) number of patients with controlled symptoms (no incontinence episodes and <8 micturitions per 24 h); (b) patients with no incontinence episodes per 24 hours; and (c) patients with <8 micturitions per 24 h. RESULTS Including a third-line oral medication before considering other treatment options improved all patient outcomes, irrespective of the specific drugs used. A three-line sequence including two generic (oxybutynin first line and tolterodine extended-release second line) and one branded drug (solifenacin 5 mg third line) resulted in inferior patient outcomes at costs similar to a sequence of branded drugs (mirabegron first line, solifenacin 5 mg second line, solifenacin 10 mg third line): controlled patients (generic 29.6/1000 vs branded 38.7/1000); patients with no incontinence episodes (103.6/1000 vs 123.7/1000); patients with <8 micturitions (228.7/1000 vs 262.1/1000). Annual treatment costs per patient were similar (generic £1299 vs branded £1385). CONCLUSIONS In the treatment of OAB, low-cost generic treatments are not necessarily more cost-effective than branded drugs, primarily because a better efficacy and tolerability balance improves both symptom control and persistence.
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Castro-Diaz D, Chapple CR, Hakimi Z, Blauwet MB, Delgado-Herrera L, Lau W, Mujais S. The effect of mirabegron on patient-related outcomes in patients with overactive bladder: the results of post hoc correlation and responder analyses using pooled data from three randomized Phase III trials. Qual Life Res 2015; 24:1719-27. [PMID: 25688038 DOI: 10.1007/s11136-014-0904-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/03/2022]
Abstract
PURPOSE To understand how improvements in the symptoms of overactive bladder (OAB) seen with the β3-adrenoceptor agonist mirabegron 50 mg, correlate with patient experience as measured by validated and standard patient-reported outcomes (PROs), and to identify whether there is overall directional consistency in the responsiveness of PROs to treatment effect. METHODS In a post hoc analysis of pooled data from three randomized, double-blind, placebo-controlled, 12-week Phase III trials of mirabegron 50 mg once daily, responder rates for incontinence frequency (≥50 % reduction in incontinence episodes/24 h from baseline to final visit), micturition frequency (≤8 micturitions/24 h at final visit), and PROs [minimally important differences in patient perception of bladder condition (PPBC) and subsets of the overactive bladder questionnaire (OAB-q) measuring total health-related quality of life (HRQoL), and symptom bother] were evaluated individually and in combination. RESULTS Mirabegron 50 mg demonstrated greater improvement from baseline to final visit than placebo for each of the responder analyses, whether for individual objective and subjective outcomes or combinations thereof. These improvements versus placebo were statistically significant for all double and triple responder analyses and for all single responder analyses except PPBC. PRO measurements showed directional consistency and significant correlations, and there were also significant correlations between objective and subjective measures of efficacy. CONCLUSIONS The improvements in objective measures seen with mirabegron 50 mg translate into a meaningful clinical benefit as evident by the directional consistency seen in HRQoL measures of benefit.
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Song M, Kim JH, Lee KS, Lee JZ, Oh SJ, Seo JT, Choi JB, Kim SW, Rhee SJ, Choo MS. The efficacy and tolerability of tarafenacin, a new muscarinic acetylcholine receptor M3 antagonist in patients with overactive bladder; randomised, double-blind, placebo-controlled phase 2 study. Int J Clin Pract 2015; 69:242-50. [PMID: 25363415 DOI: 10.1111/ijcp.12540] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/10/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To evaluate the dose-response relationship of tarafenacin, an antimuscarinic agent in development phase, for efficacy and safety, at daily doses of 0.2 and 0.4 mg for the treatment of overactive bladder (OAB) PATIENTS AND METHODS: This multicentre, placebo-controlled, randomised, double-blind, phase 2b study was conducted. Patients were randomised to tarafenacin 0.2 mg, tarafenacin 0.4 mg or placebo daily for 12 weeks. Adult patients with OAB for at least 6 months, with an average of ≥ 8 micturitions per day and ≥ 3 incontinence episodes or a total of ≥ 6 urgency episodes per 3 days were enrolled. The primary objective was to compare the mean changes in the number of micturitions per 24 h of the two doses of tarafenacin compared with placebo from baseline to 12 weeks after treatment. RESULTS A total of 334 patients were screened, of whom 235 patients were randomised. The mean decrease in the number of micturitions per 24 h from baseline to 12 weeks was statistically higher in the tarafenacin 0.4 mg group (-2.43 ± 2.21 times per day, p = 0.033) and non-statistically significant in the tarafenacin 0.2 mg group (-1.92 ± 2.45 times per day, p = 0.393) when compared with the placebo group (-1.77 ± 2.95 times per day). There were no statistically significant differences in the mean change of urgency episodes per 24 h among three groups. The most common adverse event was dry mouth. There were no significant differences in blurred vision and constipation compared with placebo. CONCLUSIONS Tarafenacin 0.4 mg decreased the number of micturitions in patients with OAB after 12 weeks compared with placebo, and the dose-response relationship of tarafenacin 0.2 and 0.4 mg was confirmed. Both dose levels of tarafenacin were well tolerated.
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Affiliation(s)
- M Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Beauval JB, Guilloteau V, Cappellini M, Westfall TD, Rischmann P, Palea S, Gamé X, Lluel P. Comparison of the effects of β3 -adrenoceptor agonism on urinary bladder function in conscious, anesthetized, and spinal cord injured rats. Neurourol Urodyn 2014; 34:578-85. [PMID: 24938622 DOI: 10.1002/nau.22629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/14/2014] [Indexed: 02/05/2023]
Abstract
AIMS To compare the dose effect relationship of a selective β3 -adrenoceptor agonist (CL-316,243) on cystometric parameters in anesthetized and conscious rats and to evaluate its effect in a model of neurogenic bladder overactivity induced by spinal cord injury (SCI). METHODS Experiments were performed in anesthetized and conscious normal rats and in conscious rats after complete transection at the T8 level of the spinal cord. The jugular vein and urinary bladder were catheterized and the bladder infused with saline. CL-316,243 was tested intravenously at 0.01, 0.03, and 0.1 mg/kg in anesthetized and conscious rats and at 0.01 mg/kg in sham and SCI rats. Intravesical pressure was recorded for 1 hr following drug administration. Intercontraction interval (ICI), amplitude of micturition (AM), micturition frequency (MF) and non-voiding contractions (NVC) were analyzed. RESULTS In anesthetized and conscious normal rats, CL-316,243 significantly increased ICI in a dose-dependent manner. In anesthetized rats, AM was significantly decreased at all doses tested whereas in conscious rats, a significant decrease (-19 ± 6%) in AM was only observed at the highest dose (0.1 mg/kg). In conscious sham and SCI rats, CL-316,243 significantly increased ICI (42 ± 17% and 49 ± 17%, respectively) and decreased MF without affecting AM. In SCI rats, CL-316,243 reduced the frequency of NVC (-53 ± 14%) without significant effects on amplitude. CONCLUSIONS The current results suggest that anesthesia can alter the effects of β3 -adrenoceptor agonists in experimental models. In addition, this is the first demonstration that stimulation of β3 -adrenoceptors can produce decreases in micturition frequency and NVC in SCI rats without affecting AM.
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Affiliation(s)
- J B Beauval
- UROsphere, Faculty of Pharmaceutical Sciences, Toulouse, France.,Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, Toulouse, France
| | - V Guilloteau
- UROsphere, Faculty of Pharmaceutical Sciences, Toulouse, France
| | - M Cappellini
- UROsphere, Faculty of Pharmaceutical Sciences, Toulouse, France
| | - T D Westfall
- UROsphere, Faculty of Pharmaceutical Sciences, Toulouse, France
| | - P Rischmann
- UROsphere, Faculty of Pharmaceutical Sciences, Toulouse, France
| | - S Palea
- UROsphere, Faculty of Pharmaceutical Sciences, Toulouse, France
| | - X Gamé
- UROsphere, Faculty of Pharmaceutical Sciences, Toulouse, France.,Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, Toulouse, France.,INSERM I2MC, Rangueil University Hospital, Toulouse, France
| | - P Lluel
- UROsphere, Faculty of Pharmaceutical Sciences, Toulouse, France
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Fujimura M, Izumimoto N, Momen S, Yoshikawa S, Kobayashi R, Kanie S, Hirakata M, Komagata T, Okanishi S, Hashimoto T, Yoshimura N, Kawai K. Characteristics of TRK-130 (Naltalimide), a Novel Opioid Ligand, as a New Therapeutic Agent for Overactive Bladder. J Pharmacol Exp Ther 2014; 350:543-51. [DOI: 10.1124/jpet.114.214031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Chun JY, Song M, Han JY, Na S, Hong B, Choo MS. Clinical factors associated with dose escalation of solifenacin for the treatment of overactive bladder in real life practice. Int Neurourol J 2014; 18:23-30. [PMID: 24729924 DOI: 10.5213/inj.2014.18.1.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/04/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine the baseline clinical characteristics associated with dose escalation of solifenacin in patients with overactive bladder (OAB). METHODS We analyzed the data of patients with OAB (micturition frequency ≥8/day and urgency ≥1/day) who were treated with solifenacin and followed up for 24 weeks. According to our department protocol, all the patients kept voiding diaries, and OAB symptom scores (OABSS) were monitored at baseline and after 4, 12, and 24 weeks of solifenacin treatment. RESULTS In total, 68 patients (mean age, 60.8±10.0 years) were recruited. The dose escalation rate by the end of the study was 41.2%, from 23.5% at 4 weeks and 17.6% at 12 weeks. At baseline, the dose escalator group had significantly more OAB wet patients (53.6% vs. 20.0%) and higher total OABSS (10.2±2.4 vs. 7.9±3.5, P=0.032) than the nonescalator group. OAB wet (odds ratio [OR], 4.615; 95% confidence interval [CI], 1.578-13.499; P<0.05) and total OABSS (OR, 1.398; 95% CI, 1.046-1.869; P<0.05) were found to be independently associated with dose escalation. CONCLUSIONS Patients who have urgency urinary incontinence and high total OABSS have a tendency for dose escalation of solifenacin.
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Abstract
This review aimed to provide an overview of the current research on the psychological impact of overactive bladder. A systematic search yielded 32 papers. It was found that people with overactive bladder tended to have greater levels of depression, anxiety and embarrassment/shame; difficulties with social life; impact on sleep and sexual relationships; and a lower quality of life than people without overactive bladder. A psychological impact on family members was also found. Psychological health should be considered an important aspect of managing overactive bladder and further research is required to determine how best to provide psychological care and support in this area.
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Park C, Park J, Choo MS, Kim JC, Lee JG, Lee JZ, Lee KS, Kim DY, Lee SJ, Seo JT. A randomised, prospective double-blind, propiverine-controlled trial of imidafenacin in patients with overactive bladder. Int J Clin Pract 2014; 68:188-96. [PMID: 24373019 DOI: 10.1111/ijcp.12255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/16/2013] [Indexed: 01/04/2023] Open
Abstract
AIM To assess the efficacy and safety of imidafenacin compared with propiverine for treatment of overactive bladder (OAB) in Korean patients. MATERIALS AND METHODS Patients with OAB symptoms were randomised to double-blind treatment with 0.1 mg of imidafenacin twice daily (group A) or propiverine 20 mg once daily (group B) for 12-week regimen, and assessed for efficacy and safety. The primary efficacy outcome was per cent change of weekly urgency urinary incontinence (UUI) episodes at week 12. The secondary efficacy outcomes were changes in the micturitions per day, urine volume voided per micturition, urgency episodes per day, complete disappearance of incontinence episodes and severity of urgency from baseline to week 12. Quality of life and safety profiles were also compared. RESULTS Of 162 patients randomised, 140 completed the study protocol. The per cent change of weekly UUI episodes at week 12 was -69.1% in group A and -70.4% in group B (both p < 0.0001). The lower limit of 95% one-sided confidence interval of the difference between the groups was above the non-inferiority margin (-19.42%). Other voiding parameters and quality of life significantly improved at week 12 in both the groups. The discontinuation rates caused by adverse events were low in both the groups. While dry mouth was the most common adverse event (group A: 28.4% vs. B: 30.4%, p = 0.783), the severity of dry mouth was significantly less in the group A than B (p = 0.042) There were no significant differences in other safety profiles. CONCLUSIONS After the 12-week treatment of imidafenacin 0.1 mg twice daily, all OAB symptoms and quality of life improved. Imidafenacin was not inferior to propiverine for the reduction of UUI episodes, and was better tolerated than propiverine in the safety profile. Our results indicate that imidafenacin is a safe and effective drug in Korean patients with OAB.
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Affiliation(s)
- C Park
- Department of Urology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
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Laviana A, Jellison F, Kim J. Sacral Neuromodulation for Refractory Overactive Bladder, Interstitial Cystitis, and Painful Bladder Syndrome. Neurosurg Clin N Am 2014; 25:33-46. [DOI: 10.1016/j.nec.2013.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Comorbidities and personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract 2013; 67:1015-33. [PMID: 24073974 DOI: 10.1111/ijcp.12164] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 02/21/2013] [Indexed: 11/30/2022] Open
Abstract
AIMS Studies on the burden and comorbidities associated with urgency urinary incontinence (UUI) are difficult to compare, partly because of the evolution of definitions for lower urinary tract symptoms and the various instruments used to assess health-related quality of life (HRQL). This article summarises published evidence on comorbidities and the personal burden associated specifically with UUI to provide clinicians with a clear perspective on the impact of UUI on patients. METHODS A PubMed search was conducted using the terms: (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR quality of life OR well-being OR depression OR mental health OR sexual health OR comorbid), with limits for English-language articles published between 1991 and 2011. RESULTS Of 1364 identified articles, data from 70 retained articles indicate that UUI is a bothersome condition that has a marked negative impact on HRQL, with the severity of UUI a predictor of HRQL. UUI is significantly associated with falls in elderly individuals, depression, urinary tract infections, increased body mass index, diabetes and deaths. The burden of UUI appears to be greater than that of stress urinary incontinence or overactive bladder symptoms without UUI. UUI adversely impacts physical and mental health, sexual function and work productivity. CONCLUSIONS UUI is associated with numerous comorbid conditions and inflicts a substantial personal burden on many aspects of patients' lives. Healthcare providers should discuss UUI with patients and be aware of the impact of UUI and its associated comorbidities on patients' lives.
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Affiliation(s)
- K S Coyne
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD, USA
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