Does local vaginal estrogen after tension-free transobturator vaginal tape reduce overactive bladder symptoms in postmenopausal women? A prospective randomized, controlled study

Objective:We aimed to evaluate the efficacy of topical estrogen after transvaginal tension-free vaginal tape-obturator(TVT-O)in the treatment of de novo overactive bladder symptoms that appear after surgery.Methods:This is a prospective randomized controlled study performed in the Urology and Gynecology Departments,Kasr Al Ainy Hospital,Cairo University,Cairo,Egypt.Two hundred and ten postmenopausal females presenting during the period between January 2017 and November 2020 with stress urinary incontinence were included in the study.Patients were divided into two groups,105 patients in Group A(treatment group)and 105 patients in Group B(control group).Patients in Group A underwent transvaginal TVT-O followed by local vaginal estrogen treatment for 6 months,while patients in Group B underwent transvaginal TVT-O only.The study included any postmenopausal female with urodynamic stress urinary incontinence.All patients had to fulfill a 3-day bladder diary,overactive bladder symptoms score,urine analysis,urodynamic study,and post-voiding residual urine measurement by abdominal ultrasound preoperatively and at 3-month and 6-month follow-ups.Results:At 6-month follow-up,daytime frequency was reduced to 8%in Group A(increased to 21%in Group B)with a statistically significant difference between both groups(p=0.009).At 6-month follow-up,nocturia was 8%in Group A(11%in Group B)with no statistically significant difference between both groups(p=0.469).There was a statistically significant difference between both groups as regards to urinary urgency at 6-month follow-up(p=0.024).There was a statistically significant difference in postoperative wound healing events as regards to cure,hyperemia,gapping,and wound infection 1 week after intervention between both groups(p=0.008).No local or systemic side-effects were reported from local estrogen use.Conclusion:Local vaginal estrogen treatment given to postmenopausal patients after midurethral sling procedures can reduce the symptoms of daytime frequency and urinary urgency.Long-term follow-up is needed.

Does an “Overactive to Underactive Bladder Transition” Phenomenon Exist in a Rat Lumbar Spinal Canal Stenosis Model?

Purpose: To investigate the association between the maximum cystometric capacity (MCC) and other cystometric parameters in lumbar canal stenosis (LCS) rats. Material and Methods: One small hole was drilled at the fifth lumbar vertebral arch (Sham), and a rectangular piece of silicone rubber was then placed in the epidural space (LCS) of Wister rats. Two weeks after surgery, awake cystometry was performed. LCS rats were divided into three groups: Group A (n = 5, MCC < 0.87 mL), Group B (n = 13, MCC 0.87 - 1.81 mL), and Group C (n = 14, MCC > 1.81 mL). Cystometric parameters were investigated in sham and LCS groups. Results: MCC did not significantly correlate to the frequency of non-voiding contractions (NVCs), voided volume (VV), or maximum intravesical pressure during voiding (Pmax), but significantly positively correlated to postvoid residual urine volume (PVR) and residual urine rate (RUR) (Spearman’s correlation coefficients (ρ) = 0.8973 (p < 0.0001) and 0.4915 (p = 0.0068), respectively). Compared with the sham rats, LCS rats in each group revealed significantly smaller VV, larger RUR, and lower Pmax. On the other hand, among LCS rats, VV, RUR, and Pmax were not significantly different. The frequency of NVCs in each LCS group was not significantly different from that in sham-operated rats (Tukey-Kramer’s HSD test). However, a Jonckheere-Terpstra trend test revealed a significant trend toward higher NVCs in the order of sham, Groups C, B, and A (p = 0.036). Conclusions: LCS rats showed the same degree of detrusor underactivity regardless of MCC. NVCs did not significantly increase in LCS rats with decreased MCC, but the trend toward higher NVCs with smaller MCC was significant.

A nurse-led long-term pelvic floor muscle training program in the management of female patients with overactive bladder e A study protocol for a randomized controlled trial

Background:Previous research has suggested that pelvic floor muscle training(PFMT)offers a therapeutic benefit in patients with overactive bladder.Methods:Weconducted a single-blind,randomized trial of pelvic floor muscle training(PFMT)as compared with usual care.The intervention group(n=54)received a 6-month a nurse-led long-term pelvic floor muscle training program(three sessions a day,15e20 times per session)and the control group(n?53)received usual care.All patients received 3-month solifenacin succinate tablets(5 mg e once daily).The treatment outcomes were measured by the Modified Oxford Scale(MOS),Overactive Bladder SymptomScore(OABSS)and the King's Health Questionnaire(KHQ)at baseline,3 months and 6 months respectively.Results:Of the 91 randomly assigned patients,46 patients in the PFMT group and 45 patients in the control group completed the trial.The trial revealed statistically significant differences between groups in pelvic muscle strength at 3 months following the intervention(p<0.05),but no significant difference was found between two groups in OABSS scores(p>0.05).In regards to quality of life,the experimental group showed significant improvements compared to the control group on 6 of 10 domains(p<0.05).At 6 months,there were significant improvements in OABSS scores and quality of life in the experimental group compared to the control group(p<0.05).No adverse events were observed.Conclusion:A nurse-led long-term(6 months)pelvic floor muscle training program may alleviate OAB symptoms effectively and improve the quality of life more than a short term(3 months)pelvic floor muscle training program combined with solifenacin succinate tablets.

Non-invasive transcutaneous electrical stimulation in the treatment of overactive bladder

We reviewed the literature on transcutaneous electrical nerve stimulation(TENS)used as a therapy for overactive bladder(OAB)symptoms,with a particular focus on:stimulation site,stimuli parameters,neural structures thought to be targeted,and the clinical and urodynamic outcomes achieved.The majority of studies used sacral or tibial nerve stimulation.The literature suggests that,whilst TENS therapy may have neuromodulation effects,patient are unlikely to benefit to a significant extent from a single application of TENS and indeed clear benefits from acute studies have not been reported.In long-term studies there were differences in the descriptions of stimulation intensity,strategy of the therapy,and positioning of the electrodes,as well as in the various symptoms and pathology of the patients.Additionally,most studies were uncontrolled and hence did not evaluate the placebo effect.Little is known about the underlying mechanism by which these therapies work and therefore exactly which structures need to be stimulated,and with what parameters.There is promising evidence for the efficacy of a transcutaneous stimulation approach,but adequate standardisation of stimulation criteria and outcome measures will be necessary to define the best way to administer this therapy and document its efficacy.

Efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder and nocturia, current clinical features and outcomes: A systematic review

Objective To evaluate the efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder(OAB)and nocturia.Methods A selective database search was conducted to validate the effectiveness of desmopressin in patients with OAB and nocturia.Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilised.The meta-analysis included 378 women(five studies)with OAB.The clinical outcomes and adverse events were analysed.Results The treatment strategy of all the studies included can be divided into three categories:(1)The effect of desmopressin compared with baseline,(2)desmopressin compared with placebo,and(3)desmopressin and anticholinergic combination versus desmopressin monotherapy.There was a significant(50%)reduction in nocturia and urgency episodes after using desmopressin alone.Combined desmopressin and anticholinergic led to a decrease in the frequency of nocturia voids when only using anticholinergic(65%vs.33.2%).The time increased in the middle to the first nightly voids in the combination arm(65.11 min;p=0.045).The mean incidence(standard deviation)of leak-free episodes was higher under desmopressin than under placebo in the first 4 h(62%[35%]vs.48%[40%])and in the first 8 h(55%[37%]vs.40%[41%]).The safety profile was comparable between treatments.Conclusion Available data indicate that desmopressin is efficacious in significantly reducing nighttime urine production,episodes of nocturia,and urgency episodes.The affectivity of the combination therapy was very high with least side effects for the treatment of OAB/nocturnal polyuria.

Association of advanced glycation endproduct accumulation with overactive bladder in community-dwelling elderly: A cross-sectional Sukagawa study

Objective:This study aimed to evaluate the influence of advanced glycation end-product(AGE)accumulation on the prevalence and severity of overactive bladder(OAB)in community-dwelling elderly adults.Methods:We conducted a cross-sectional study involving 269 Japanese community dwellers aged≥75 years in 2015.AGE accumulation was non-invasively measured via skin autofluorescence(SAF)values using AGE Reader.The primary and secondary outcomes were the presence and severity of OAB evaluated using the Overactive Bladder Symptom Score(OABSS).Individuals with an urgency score of≥2 and sum score of≥3 were considered to have OAB.The associations of SAF with the prevalence and severity of OAB were assessed using logistic and linear regression models,respectively,adjusted for clinically important confounders.Results:The median age of participants was 78 years.Of 269 participants,110(40.9%)were men and 75(27.9%)had OAB.The median SAF was 2.2 arbitrary units(AUs).Increasing median SAF was observed with increasing age.Multivariable analysis revealed that SAF was not associated with either the likelihood of having OAB(odds ratio per AU=0.77,95%confidence interval:0.37-1.62)or the natural log-transformed OABSS(0 per AU=-0.07,95%confidence interval:-0.26-0.12).Conclusions:In this study,AGE accumulation,as assessed by SAF,was not associated with the prevalence and severity of OAB in Japanese community-dwelling elderly people aged≥75 years.

Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis

Objective:To compare these managements focusing on the efficacy and safety to treat overactive bladder(OAB)in children through network meta-analysis(NMA).Methods:We searched PubMed,Embase,the Cochrane Library Central Register of Controlled Trials(CENTRAL)and the reference lists up to May 1st,2017.Data from eligible randomized controlled trails(RCT)studies including three different treatment options were extracted.The primary outcome was maximal voiding volume(MVV).We performed pairwise metaanalyses by random effects model and NMA by Bayesian model.We used the Grading of Recommendations,Assessment,Development and Evaluations(GRADE)framework to assess the quality of evidence contributing to each network estimate.Results:Six RCTs(462 patients)comparing three different interventions fulfilled the inclusion criteria.A low risk of bias was shown for the majority of the study items.The results of NMA showed that compared with antimuscarinic drugs,Parasacral transcutaneous electrical nerve stimulation was associated with significant improvement in the MVV(mean difference[MD]=58.50,95% confidential interval[CI]:45.95-69.52),followed by urotherapy group(MD=21.03,95%CI:11.85-29.97).When it comes to the constipation,antimuscarinic drugs exerted significant benefit than PTENS(odds ratio[OR]:0.22,95%CI:0.01-0.46).No significant difference was found between other treatments.Conclusion:Compared with antimuscarinic drugs,PTENS was associated with significant better efficacy considering MVV,but more constipation events in de novo OAB children.Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy.Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy.

Very Low, Real-Time Rate of Urinary Retention after Intradetrusor Botox^&regfor Non-Neurogenic Overactive Bladder

Introduction: According to the most recent AUA/SUFU guidelines, intradetrusor onabotulinumtoxinA (BTN/A) is a standard, evidence strength grade B, third line treatment option for refractory non-neurogenic overactive bladder (OAB). Urinary retention is the most common clinically significant reported side effect ranging from 5.4% to 43% in previous studies. The aim of this study was to investigate the real-time rate of urinary retention in patients treated with BTN/A for refractory non-neurogenic OAB in a multi-institutional study. Methods: Retrospective chart review identified 71 patients who were treated with 100U BTN/A for refractory non-neurogenic OAB from August 2011 to July 2015 at two institutions. Using a flexible cystoscope, 100U Botox&reg reconstituted with 10 ml normal saline was administered. Injections of 1 ml (10 units/ mL) were administered in 10 evenly distributed sites sparing the trigone. Pre and post BTN/A post-void residuals (PVR) were reviewed. Urinary retention was defined as PVR > 200 mL requiring clean intermittent catheterization (CIC). Results: After exclusion, the study group consisted of 66 patients with a mean age of 67 years and 30% were men. Mean pre and post-procedural PVR were 14.06 mL and 69.21 mL. Eight patients (12.12%) were noted to have elevated PVR > 200 mL post injection however only one patient (female) required initiation of CIC. The rate of urinary retention was 1.5% (N = 1). There was no correlation with age, history of previous radiation, diabetes or prior use of a neuromodulator device. Conclusions: To the best of our knowledge, this is the first study to demonstrate a very low risk of real-time urinary retention rates in appropriately selected patients treated with BTN/A for refractory non-neurogenic OAB outside of a clinical trial setting.

Efficacy and safety of onabotulinum toxin A for overactive bladder

Overactive bladder(OAB) syndrome is a condition which affects 16.9% of women and 16.2% of men with a significant negative impact on quality of life. It is a condition characterized by urgency, with or without urge incontinence, frequency and nocturia. Behavioral modifications and oral anti-muscurinic medications are first and second-line therapies for OAB but are frequently ineffective or poorly tolerated. For refractory cases of OAB, onabotulinum toxin can be offered and this therapy was approved by the Food and Drug Administration in January of 2013. In this editorial, we will review the indications, usage, efficacy and safety data for intradetrusor injection of onabotulinum toxin A.

Effects of solifenacin on overactive bladder patients

Objective To investigate the effects of solifenacin on the detrusor instability of patients with overactive bladder ( OAB ) . Methods A total of 20

Clinical study of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia with overactive bladder

Objective To evaluate the efficacy and safety of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia ( BPH) with overactive bladder ( OAB) . Methods 82 patients with OAB and coexisting BPH were randomly divided into tamsulosin group ( n

Efficacy of solifenacin with or without tamsulosin in patients with overactive bladder

Objective To evaluate the efficacy of sollfenacin with or without tamsulosin in patients with overactive bladder ( OAB ) . Methods Fifty-three patients with OAB were randomly divided into two groups ( group

Pioneering drugs for overactive bladder and detrusor overactivity: Ongoing research and future directions

The ongoing research on pioneering drug candidates for the overactive bladder(OAB) aimed to overcome the limitations of currently licensed pharmacotherapies, such as antimuscarinics, β3-adrenergic agents, and botulinum neurotoxin, has been reviewed performing a systematic literature review and web search. The review covers the exploratory agents alternative to available medications for OAB and that may ultimately prove to be therapeutically useful in the future management of OAB patients based on preclinical and early clinical data. It emerges that many alternative pharmacological strategies have been discovered or are under investigation in disease-oriented studies. Several potential therapeutics are known for years but still find obstacles to pass the clinical stages of development, while other completely novel compounds, targeting new pharmacological targets, have been recently discovered and show potential to translate into clinical therapeutic agents for idiopathic and neurogenic OAB syndrome. The global scenario of investigational drugs for OAB gives promise for the development of innovative therapeutics that may ultimately prove effective as first, combined or second-line treatments within a realistic timescale of ten years.

The role of botulinum toxin in the management of nonneurogenic overactive bladder in children:Highlights for clinical practice.A systematic review

Overactive bladder(OAB)is the most common voiding dysfunction in children;however,nonneurogenic or idiopathic OAB remains poorly studied.First-line treatment includes conservative measures;however,as many patients are refractory,have adverse effects,or are contraindicated for anticholinergics,new options must be explored.This review covers the use of intravesical botulinum toxin(BoNT)for idiopathic OAB treatment in children,emphasizing its efficacy,safety,differences between toxins,doses,and injection tech-niques.Clinical results were promising,with all 8 studies reporting good results.All authors used BoNT type A(BoNT-A),either onabotulinum or abobotulinum toxin A.Response rates were variable,with full-response percentages of 32%-60%.As proven by the full-response rates of 50%,repeated injections are as safe and effective as first injections.Only a few cases of urinary tract infection,transient urinary retention,and hematuria have been reported,with no major local or systemic adverse effects.Despite these limitations,evidence encourages and supports BoNT-A use as a safe and effective treatment modality for refractory idiopathic OAB in pediatric set-tings,regardless of dosage and target toxin.To the best of our knowledge,this is the first systematic review of the use of intravesical BoNT-A for idiopathic OAB treatment in children.

Mirabegron, a novel, non-antimuscarinic drug for the overactive bladder: An up-to-dated review

Mirabegron opened a new era in the treatment of overactive bladder(OAB). For the fi rst time physicians dealing with OAB have an effective alternative to the pharmacological mainstay of the therapy for this disorder, the antimuscarinic drugs. This fi rst-in-class, potent β3-adrenoceptors agonist has recently received approval by regulatory authorities in Japan, United States and Europe, based on the favourable efficacy-tolerability profile demonstrated in multiple randomized, multinational, controlled trials, both short and long-term. There is substantial consistency through the studies in reporting the cardiovascular safety of treatment with mirabegron. The main advantage of mirabegron is the placebo-like incidence of classic adverse effects caused by antimuscarinics, dry mouth and constipation, that is expected to improve long-term adherence of patients to treatment. Mirabegron can be used in patients with contraindications to antimuscarinics and in those who discontinued previous antimuscarinic therapy. Herein, we reviewed the published literature on mirabegron, focusing on the rationale of β3-agonism for OAB treatment and on the preclinical and clinical evidence of effi cacy and safety available on this new pharmacological principle.

A comparative study of electroacupuncture at Zhongliao （BL33） and other acupoints for overactive bladder symptoms

Electroacupuncture （EA） at Zhongliao （BL33） can improve the symptoms of overactive bladder （OAB）, such as urinary frequency, urgency, and incontinence. However, its performance compared with other acupoints remains unclear. This study investigated the effects of EA at BL33 with deep needling on rats with OAB by detecting urodynamics in eight groups： no intervention group, D-BL33 group （deep needling at BL33）, S-BL33 group （shallow needling at BL33）, non-acupoint group （needling at the non-acupoint next to BL33）, Weizhong （BL40） group, Sanyinjiao （SP6） group, Tongtian （BL7） group, and Hegu （LI4） group. Results revealed that EA at BL33 with deep needling, BL40, and SP6 prolonged the intercontraction interval （ICI） of rats with OAB （P= 0.001, P = 0.005, P = 0.046, respectively, post-treatment vs. post-modeling）. Furthermore, the change in ICI from post-modeling in the D-BL33 group was significantly greater than those of the no intervention and other EA groups （all P 〈 0.01）. Significantly shortened vesical micturition time （VMT） and elevated maximum detrusor pressure （MDP） were also observed in the D-BL33 group （P = 0.017 and P = 0.024, respectively, post-treatment vs. post-modeling）. However, no statistically significant differences in the changes of VMT and MDP from post- modeling were observed between D-BL33 and the other EA groups. In conclusion, EA at BL33 with deep needling may inhibit acetic-acid-induced OAB more effectively.

Urodynamic investigation of cyclophosphamide-induced overactive bladder in conscious rats

Background Overactive bladder （OAB） can be caused by many factors such as inflammation,bladder outlet obstruction,neurogenic factors.We performed an intraperitoneal （ip） injection of cyclophosphamide to induce cystitis in rats,which causes their detrusors to overact,to provide a valuable disease model for discussing OAB pathogenesis and to study effective curing methods.Methods Female Sprague-Dawley rats were induced to form cystitis by cyclophosphamide （200 mg/kg,ip）.The day after the injection,two catheters were inserted into each rat＇s bladder to study its urodynamics.The BL-410 model bio-function experimental system was used to monitor bladder pressure while the rats were conscious.Unstable detrusor contractions appear in the urine storage period as a standard to determine OAB,and the positive rate was calculated.Urodynamic parameters such as bladder basal pressure （BP）,maximum voiding pressure （MVP）,intercontraction interval （ICI）,spontaneous activity （SA）,maximum cystometric capacity （MCC）,and bladder compliance （BC） were recorded in each group,and a light microscope was used to observe the pathological changes in the rat bladder tissue.Results The detrusor instability rate of the model group was 83.33%.The MVP,MCC and BC of rats in the model group were lower than the control group （P 〈0.01）,and the BP,ICI and SA of the model group rats were higher than the control group （P 〈0.01）.The difference between the control group and the model group is statistically significant.The model group rats＇ bladder walls swelled and bled,the submucosa thickened and leukocyte infiltration became serious.Conclusions Acute cystitis and OAB symptoms can be induced by ip injections of cyclophosphamide in rats.This can provide a valuable animal model to study OAB in human beings.

Overactive bladder symptom score to evaluate efficacy of solifenacin for the treatment of overactive bladder symptoms

Background Overactive bladder （OAB） is a series of symptoms with high prevalence in elderly people.This study was conducted using the overactive bladder symptom score （OABSS） to evaluate the efficacy of solifenacin succinate for the treatment of OAB.Methods This was a prospective,multicenter,single-arm,12-week study that enrolled 241 OAB patients.The patients received 5-10 mg/day solifenacin.Changes in OABSS,symptoms from voiding diary,perception of bladder condition （PPBC） score,international prostate symptom score （IPSS） and quality of life （QOL） were evaluated at weeks 0,4,and 12.The relationship between OABSS and PPBC score or parameters of voiding diary was also evaluated.Results At baseline,the mean OABSS for all patients was 9.41±2.40,and was reduced significantly at week 12 （-3.76 points; 61.21％,P ＜0.0001）.The OABSS subscore,PPBC score,IPSS,and QOL were also significantly reduced during the study （P ＜0.0001）.The overall incidence of adverse events was 19.91％ （44 cases）.The gastrointestinal system was the most commonly affected （11.31％）.Around 5.88％ of the cases had adverse events related to the genitourinary system.There was a strong correlation between OABSS and urinary symptoms that was recorded in the 3-day voiding dairy.Conclusions We showed that solifenacin was clinically effective for relieving OAB symptoms,considering the balance between efficacy,patients＇ well-being,and tolerability.OABSS integrates four OAB symptoms into a single score and can be a useful tool for research and clinical practice.

Overactive bladder

Overactive bladder(OAB)is known to affect millions of people worldwide,with a subsequent deleterious impact on the quality of life.The clinical diagnosis of OAB requires,at a minimum,a meticulous history,physical examination,and urinalysis.The American Urological Association views OAB as a symptom complex,not a life-threatening disease,and recommends conservative measures and behavioral therapies as first-line treatment,including bladder training,bladder control strategies,pelvic floor muscle training,and fluid management.Current medical management approved by the US FDA include anti-muscarinics and beta3-agonists.Anti-muscarincs should be avoided in patients with narrow-angle glaucoma,and used with extreme caution in patients with impaired gastric emptying or a history of urinary retention.Surgical interventions may be offered,if second-line therapy using medications is not successful in obtaining adequate symptom control of OAB,and the patient is motivated and healthy.In uncomplicated patients,OAB may be clinically diagnosed and treated with conservative measures;however,the armamentarium for the diagnosis and treatment continues to expand for more complicated patients.

前列腺癌根治术后远期膀胱过度活动症的危险因素

目的:分析前列腺癌根治术后膀胱过度活动症(overactive bladder, OAB)的发生及转归情况,并探讨其相关危险因素。方法:选择北京大学第三医院2013年1月至2017年5月住院接受根治性前列腺切除术的263例患者进行回顾性研究,分析并收集患者临床基线信息、计算影像特征、围术期参数、术前患者尿控情况、病理学诊断与术后1年内OAB发生情况的相关性。在影像特征中,定义膀胱壁厚度(bladder wall thickness, BWT)和膀胱黏膜光滑程度(bladder mucosal smoothness, BMS)两个参数,用于预测OAB的发生情况。结果:263例前列腺癌根治术后患者中,术后1年存在OAB状态者共52例,占所有患者的19.8%。术前既往存在OAB症状者40例,术后缓解者17例(42.5%),症状持续者23例(57.5%);术后新发OAB者29例,占术后所有OAB患者的55.77%。单因素分析显示膀胱壁厚度、膀胱黏膜光滑程度、膀胱过度活动症状评分和国际前列腺症状评分均与术后OAB的发生相关。进一步多因素分析发现,BMS是远期OAB的独立危险因素(P<0.001)。结论:根治性前列腺切除术后远期膀胱过度活动症是临床常见的并发症,通过术前磁共振成像测量充盈状态下膀胱壁厚度或膀胱黏膜光滑程度,可以预测根治术后OAB的发生风险。