Daytime Frequency Research Articles

The Efficacy and Safety of Propiverine Hydrochloride in Patients with Overactive Bladder Symptoms Who Poorly Responded to Previous Anticholinergic Agents

Objectives. To prospectively examine the efficacy and safety of propiverine hydrochloride in patients with overactive bladder (OAB) symptoms who poorly responded to previous treatment with solifenacin, tolterodine or imidafenacin. Methods. Patients aged ≥20 with persisting OAB symptoms (≥6 in OAB symptom score (OABSS)) even after at least 4-week treatment using solifenacin, tolterodine or imidafenacin were enrolled. Propiverine 20 mg/day was administered for 12 weeks to 70 patients who desired the further improvement of OAB symptoms and 3 who had intolerable adverse events of previous drugs. The OABSS and postvoid residual urine volume (PVR) were determined before and at 4 and 12 weeks of treatment. Results. Of 73 patients enrolled (29 males and 44 females, median age 71 years), 52 completed the protocol treatment. The OABSS was significantly improved by propiverine treatment (9.0 at baseline, 6.2 at 4 weeks, 6.3 at 12 weeks (P < 0.001)). The scores of OAB symptoms (nighttime frequency, urgency and urge incontinence) except daytime frequency also improved significantly. No increase in PVR was observed. The most frequent adverse event was dry mouth (13.7%), followed by constipation (6.8%). Conclusions. Propiverine is useful to improve OAB for patients who poorly respond to solifenacin, tolterodine or imidafenacin.

Effect of Desmopressin with Anticholinergics in Female Patients with Overactive Bladder

PurposeThe aim of this study was to evaluate the effect of desmopressin combined with anticholinergics on daytime frequency and urgency in female patients with overactive bladder (OAB).Materials and MethodsWe included 68 female patients with OAB. Patients were randomly assigned to receive 5 mg of solifenacin (group I) or 5 mg of solifenacin and 0.2 mg of desmopressin (group II) for 2 weeks. A pre/post-treatment 3-day voiding diary and the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to assess changes in voiding symptoms and quality of life (QoL); results were compared between the two groups.ResultsGroups I and II included 31 and 37 patients, respectively. Time to first void was 12 min later in group II (105 min vs. 117 min), but this difference was not statistically significant. However, time to the second and third voids (203 min vs. 255 min, 312 min vs. 368 min) and the first urgency episode (212 min vs. 255 min) were significantly longer in group II. Compared with group I, patients in group II showed significant improvement in QoL scores. When improvement after treatment was defined as increase in time to first void of greater than 10% after 2 weeks of treatment, desmopressin with anticholinergics was more effective in patients over the age of 65 years and with more than 150 ml of voided volume.ConclusionsDesmopressin combined with anticholinergics was more effective than anticholinergics only in the treatment of female patients with OAB.

Botulinum A Toxin Intravesical Injections for Painful Bladder Syndrome: Impact Upon Pain, Psychological Functioning and Quality of Life

To assess the impact of intravesically injected botulinum A toxin (BoNT/A) upon bladder pain, urological complaints, symptoms of anxiety and depression, and Quality of Life (QoL) in patients with painful bladder symptoms (PBS) refractory to conventional treatment. In this prospective study 14 patients received one injection of BoNT/A (200 U diluted in 20 ml 0.9% NaCl), under cystoscopic guidance. At pre- and 3 months post- treatment all patients underwent an urological assessment (voiding diary, urodynamics), a pain quantification on a visual analog scale (VAS), an evaluation with the 14-item Hamilton Anxiety Rating Scale (HAM-A) to assess symptoms of psychic and somatic anxiety, an evaluation with the Hamilton Depression Rating Scale (HAM-D) to assess depression, and the 36-item Medical Outcomes Study Short Form (SF-36) to assess QoL. Results. At pre-treatment all 14 patients had increased daytime and nighttime urinary frequency and high VAS scores. Nine patients had pathological HAM-A scores and all had pathological HAM-D scores. At the 3-month follow-up 10/14 patients reported a subjective improvement in pain. Mean VAS score, mean daytime and nighttime urinary frequency decreased significantly (p <0.01, <0.01 and <0.01, respectively). All domains in SF-36 and HAM-A significantly improved (p<0.01). All domains, except weight and sleep disorders, significantly improved in HAM-D, particularly somatoform symptoms (p<0.01), cognitive performance (p<0.01), and circadian variations (p<0.01). In patients with refractory PBS with symptoms of anxiety, depression and poor QoL, BoNT/A intravesical treatment reduced bladder pain, improved psychological functioning, and well-being.

S117 4 h cough frequency monitoring with the Leicester Cough Monitor

IntroductionThe Leicester Cough Monitor (LCM) is a validated 24-h automated cough frequency monitor. Shorter recordings are more convenient for patients and take less time to analyse but their validity for...

Neuromodulative treatment with percutaneous tibial nerve stimulation for intractable detrusor instability: outcomes following a shortened 6‐week protocol

To describe our initial outcome data following a shortened 6-week treatment protocol with percutaneous tibial nerve stimulation (PTNS) in women with overactive bladder syndrome (OABS) unresponsive to bladder retraining and anticholinergic therapy. This was a prospective observational study over a 6-month period. In all, 43 women with OABS refractory to medical therapy were treated with a shortened PTNS protocol that consisted of 6 weekly 30 min sessions. Bladder symptom diaries and health-related quality of life (HRQL) assessed using the short-form seven-item self-report. Incontinence Impact Questionnaire (IIQ-7) were completed before and after treatment. A positive response was defined as: (i) OAB symptoms no longer being bothersome; (ii) reduction by half in frequency episodes and (iii) reduction by 25% in IIQ-7 outcomes. All 43 women (median age 55.3 years) completed six treatments with a positive response rate of 69.7%. In the positive responders, the median daytime and nocturnal frequency was reduced by half after 6 weeks of treatment (11.8 vs 6.9 and 3.5 vs 1.8, respectively, P < 0.05) and the patients reported fewer urge leak episodes per 24 h (median 3.5 vs 2.4, P < 0.05). The median IIQ-7 scores improved by 25% (30.4 vs 24.3, P < 0.05) in responders, while the median number of pads changed in 24 h also decreased by 34% (3.8 vs 2.5, P < 0.05). The median acceptability of the technique when scored by Visual Analogue Score was 9.6/10 and no side-effects were reported. A shortened 6-week treatment with PTNS appears to be successful, with a significant reduction in symptoms and improvement in HRQL. This early data suggest that the duration of treatment for peripheral neuromodulation can be halved compared with the conventional 12 weeks, which would make it more acceptable and cost effective for patients. A randomised controlled trial of 6 weeks vs 12 weeks of PTNS therapy would be useful in determining the optimal duration of treatment.

Fluid manipulation among individuals with lower urinary tract symptoms: a mixed methods study

To determine, qualitatively and quantitatively, how individuals use fluid manipulation to self-manage the urinary symptoms of daytime frequency, urgency and urine leakage and the underlying rationale for this behaviour. Lower urinary tract symptoms are prevalent and burdensome, and little is known about how individuals with lower urinary tract symptoms manipulate their fluid intake. A mixed methods design included statistical analysis of data from a population-based survey of urologic symptoms and qualitative analysis of in-depth interviews. Quantitative data came from 5503 participants of the baseline Boston Area Community Health Survey, a population-based, random sample epidemiologic survey of urologic symptoms. Qualitative data came from in-depth interviews with a random subsample from Boston Area Community Health of 152 black, white and Hispanic men and women with LUTS. Qualitative data showed that some respondents restricted fluid intake while others increased it, in both cases with the expectation of improved symptoms. Quantitative data showed that fluid intake was greater in men and women reporting frequency (p < 0·001). Women with frequency drank significantly more water (p < 0·001), while women with urgency drank significantly less water (p = 0·047). This study found divergent expectations of the role of fluids in alleviating symptoms, leading some individuals to restrict and others to increase fluid intake. Individuals with lower urinary tract symptoms may need guidance in fluid management. Nurses should be aware that patients may self-manage lower urinary tract symptoms by restricting fluid intake, putting them at risk for dehydration, constipation and urinary tract infection, but also that they may be increasing their fluid intake, which could worsen symptoms. This study pinpoints a specific area of need among patients with lower urinary tract symptoms and provides a practical opportunity for nurses to assist their patients with behavioural and fluid management by emphasising the clinical guidelines.

Validity and reliability of the patient’s perception of intensity of urgency scale in overactive bladder

• To assess the measurement characteristics of the Patient Perception of Intensity of Urgency Scale (PPIUS) in patients with overactive bladder (OAB). • Adult women with at least a 3-month history of OAB. The design was a 4-week, double-blind, randomized, placebo-controlled trial of transdermal oxybutynin, with a 2-week placebo run-in and 8-week, open-label extension. • Symptom improvement was assessed using 3-day bladder diaries incorporating the PPIUS, and disease-specific health-related quality of life was assessed using the King's Health Questionnaire (KHQ). Convergent validity was shown by correlation with the KHQ, and other bladder diary variables. Known groups validity was assessed by comparison of baseline mean urge ratings, and urgency episode frequency for continent and incontinent patients, and by comparison with the same measures from a historical control group of 40 asymptomatic female volunteers. • Between- and within-groups responsiveness was assessed using standardized effect sizes (Cohen's d and effect size r). Reliability was assessed for the two arms of the trial at different time points and intervals, using intraclass correlation (ICC) and a t-test for the difference between mean scores. • In total, 96 women were randomized. Urgency episode frequency showed moderate correlation with total KHQ score (r = 0.500, P < 0.001) and with daytime and night-time voiding frequency. • There were significant differences in continent and incontinent subgroups for mean urge ratings (difference in means, -0.61/void, P < 0.001), and urgency episodes (difference in means, -2.67 episodes/day, P < 0.001), as well as between OAB patients and normal controls (mean urge rating: difference in means 1.22 per void, P < 0.001; urgency episodes: difference in means 2.93 episodes/day, P < 0.001). • Between-groups analysis of effect size found that urgency episode frequency (d = 0.679, r = 0.321) was more responsive than mean urge rating (d = 0.480, r = 0.233). In both subgroups, urgency episode frequency (d = 0.421-0.454, r = 0.206-0.222) had better within-groups responsiveness than mean urge rating. • Urgency episodes (ICC, 0.65-0.81) were measured more reliably than urgency urinary incontinence episodes (ICC, 0.50-0.65). • Assessment of urgency episodes using the PPIUS shows good reliability, excellent known groups validity, high responsiveness and convergence with subjective measures of severity. • PPIUS is freely available, and should be useful in both clinical practice and research studies when assessing women with urgency, with or without urgency urinary incontinence.

Assessment of Overactive Bladder Symptoms: Comparison of 3-Day Bladder Diary and the Overactive Bladder Symptoms Score

To compare the Overactive Bladder Symptom Score (OABSS) and a bladder diary as a tool for assessing symptoms of overactive bladder (OAB). Treatment-naive OAB patients received an antimuscarinic agent, solifenacin. At baseline and 12 weeks after treatment, patients completed a 3-day bladder diary and the OABSS. Relationships between the 2 methods were evaluated by comparison of changes after treatment, agreement between variables and correlation between changes. In total, 79 patients (42 male and 37 female, mean age 71.1 years) were included in the analysis. Statistically significant improvements were noted for all the OABSS and the corresponding diary variables. The effect size (ES) was largest for the OABSS urgency score (2.00), followed by the OABSS total score (1.54), and then by the diary urgency score (0.92). All of the ESs for the OABSS, except daytime frequency, were larger than those of the corresponding diary variables. The standard response means followed a similar pattern to the ESs. A fairly good agreement between OABSS items and the corresponding diary variables was found at baseline and 12 weeks (kappa coefficient, 0.33-0.80). High correlations (Spearman's rho, ≥ 0.5) between changes in OABSS items and the corresponding diary variables were found for urgency incontinence and night-time frequency. The OABSS is highly sensitive to treatment-related changes of OAB symptoms. Because of its simplicity and dependability, the OABSS can be an alternative to a bladder diary for symptom and efficacy assessment in daily clinical practice.

Treatment of non-monosymptomatic nocturnal enuresis by transcutaneous parasacral electrical nerve stimulation

To evaluate the effectiveness of transcutaneous parasacral electrical stimulation (TCPSE) in the treatment of non-monosymptomatic nocturnal enuresis (NMNE). Also, we evaluated possible pretreatment predictors of TCPSE failure. Nineteen children diagnosed with NMNE who underwent TCPSE were studied prospectively. There were 6 boys and 13 girls with a mean age of 9.05 ± 3.153 years (range 5-17 years). The sessions were performed three times per week for a maximum of 20 sessions, for 20 min each and at a frequency of 10 Hz. For eight children (42%) the nocturnal enuresis resolved, four (21%) presented a reduction in nocturnal episodes to less than one a week, six (32%) presented no change and one (5%) had increased frequency of NMNE. Symptoms present before treatment, such as daytime incontinence, frequency, constipation and occurrence of urinary tract infection, were not predictors of failure after TCPSE. TCPSE can be an effective treatment for NMNE, but about a third of patients will need another kind of treatment. No pretreatment factor was determined that predicted TCPSE failure.

Ultrasound measurement of bladder wall thickness is associated with the overactive bladder syndrome

To assess the relationship between mean bladder wall thickness and components of the overactive bladder (OAB syndrome). Women attending urogynaecology clinic was categorized into overactive bladder syndrome, stress urinary incontinence (SUI), and mixed urinary continence (MUI) according to International Continence Society (ICS) definitions based on symptom history. Women completed a bladder diary, visual analog score (VAS) for urgency, and the mean bladder wall thickness (BWT) was determined. Comparison was made between the mean BWT and symptom history, daytime frequency, nocturia, VAS scores. Three hundred seventy-nine women were recruited to the study with a mean age of 56 years (range: 24-92 years). The mean bladder wall thickness did not show any age-related difference. Of these women 138/379 (36%) reported overactive bladder symptoms (mean BWT = 5.6 mm) 75/379 (20%) gave a history of stress urinary incontinence (mean BWT = 4.7 mm), and 166/379 (44%) had mixed urinary incontinence (mean BWT = 5.4). Women with nocturia >1 had mean BWT 5.6 mm, with nocturia <1 a mean BWT 4.9 mm. Women with daytime frequency >7 had mean BWT 5.7 mm and those <7 had mean BWT 5.1 (P < 0.001). Women with a mean BWT of ≤5 mm had a mean VAS score lower than women with a BWT >5 mm (P < 0.001). Mean BWT is associated with a symptom history of OAB and MUI, higher daytime and nightime frequency, and higher VAS scores.

Sleep Disorders and Occupational Accident in Shift Work Nurses

Objective: This study aimed to investigate the prevalence of symptoms of sleep related breathing disorders in shiftwork nurses and to evaluate relationship between occupational accident and the symptoms. Material and Method: Data of 410 nurses was evaluated. A questionnaire was administered to get information on their socio-demographic data, presence of witnessed apnea during sleep, the prevalence of snoring, excessive daytime sleepiness and frequency of other symptoms and having any occupational accident. Results: The prevalence of habitual snoring, witnessed apnea, excessive daytime sleepiness was 5.4%, 22.4%, 47.1% respectively. Snoring (p<0.001) and witnessed apnea (p<0.001) prevalence was higher in overweight nurses. Mean values of the body mass index (p<0.001), neck circumflex (p=0.03), co-morbid disease (p<0.001) and the prevalence of witnessed apnea (p<0.001) among the nurses with habitual snoring were statistically higher than the nurses without habitual snoring. 51 nurses (12.4%) had been involved in an occupational accident. The prevalence of snoring (p=0.008) and mean Epworth Sleepiness Score (ESS) were higher than the group without accidents. The ESS was higher than 10 points in 63 (15.4%) of the interviews. In this group occupational accident prevalence was 4.1 times higher than the group with less than 10 points ESS. Conclusion: We come to the conclusion that interrogating the sleep related disorders symptoms in adults and also performing diagnostic procedures and treatment in case of suspicion may decrease the morbidity of sleep related breathing disorders. (Tur Toraks Der 2010; 11: 105-8)

Clinical Efficacy of α1-Adrenargic Receptor Antagonist Naftopidil 75 mg/day in Patients with Benign Prostatic Hyperplasia.

The clinical efficacy and safety of 75 mg/day of naftopidil, an α1-adrenargic receptor antagonist, was assessed in patients with benign prostatic hyperplasia (BPH). A total of 28 patients (mean age, 71.1 years; range, 46-86 years) with BPH were studied. Inclusion criteria were: (i) International Prostate Symptom Score (IPSS) ≥8; and (ii) quality of life (QOL) index ≥3. IPSS, QOL index, Overactive Bladder Symptom Score (OABSS), and bladder diary (urinary frequency in daytime and nighttime, frequency of urinary incontinence and urgency) were evaluated before and 4 weeks after treatment with naftopidil at 75 mg/day. Total IPSS and QOL index were significantly decreased after treatment. Total OABSS tended to decrease after treatment, with significant improvements in the "urgency" parameter. From the bladder diary, urinary frequency in daytime and nighttime and frequency of urgency were significantly decreased after treatment. Total IPSS and QOL index in patients with previous treatment were significantly improved after treatment, with significant improvements in the "incomplete emptying,""poor flow" and "nocturia" parameters of IPSS. One case with a mild adverse effect of dizziness was encountered. These results suggest that administration of naftopidil at 75 mg/day was safe and effective for patients with BPH, regardless of the presence of previous treatment. This study indicates the feasibility of naftopidil at 75 mg/day as a first-line treatment for men with BPH, or a second-line treatment in cases with symptoms of incomplete emptying, poor flow and nocturia.

Self‐report of difficult defecation is associated with overactive bladder symptoms

The association of dysfunctional bowel elimination with lower urinary tract symptoms is well known in children, but not in adults. It was our objective to assess lower urinary tract symptoms (LUTS) in women who report difficult defecation (DD). This is a secondary analysis of 2,812 women, aged 35-64, who participated in a telephone interview. All subjects were asked "When you move your bowels, does the stool come out easily?" DD was considered present in those answering "no." All subjects were queried regarding LUTS, urinary infections in the past year, self-perceived health status, medical history, and demographics. Symptoms of stress incontinence (five items), urge incontinence (five items), and the impact of these symptoms on their quality of life were solicited from subjects reporting more than 12 episodes of incontinence in 1 year. DD was reported by 10.4% (290/2,790) of women. Women with DD had higher LUTS than those who did not: nocturia (mean 1.8 ± 0.1 vs. 1.3 ± 0.0), urgency (47.6% vs. 29.2%), increased daytime frequency (mean 8.2 ± 0.3 vs. 7.2 ± 0.1), dysuria (22.9% vs. 13.7%), and a sensation of incomplete bladder emptying (55.6% vs. 28.2%). DD women were more often menopausal, reported a fair or poor self-reported health status, and had a higher number of comorbidities, less formal education, and lower annual household income. Women with symptoms of DD have an increased rate of LUTS, consistent with the diagnosis of overactive bladder without incontinence. The pathophysiology underlying this association is worthy of future research.

Modeling dose-response relationships of the effects of fesoterodine in patients with overactive bladder

BackgroundFesoterodine is an antimuscarinic for the treatment of overactive bladder, a syndrome of urgency, with or without urgency urinary incontinence (UUI), usually with increased daytime frequency and nocturia. Our objective was to develop predictive models to describe the dose response of fesoterodine.MethodsData from subjects enrolled in double-blind, placebo-controlled phase II and III trials were used for developing longitudinal dose-response models.ResultsThe models predicted that clinically significant and near-maximum treatment effects would be seen within 3 to 4 weeks after treatment initiation. For a typical patient with 11 micturitions per 24 hours at baseline, predicted change was -1.2, -1.7, and -2.2 micturitions for placebo and fesoterodine 4 mg and 8 mg, respectively. For a typical patient with 2 UUI episodes per 24 hours at baseline, predicted change was -1.05, -1.26, and -1.43 UUI episodes for placebo and fesoterodine 4 mg and 8 mg, respectively. Increase in mean voided volume was estimated at 9.7 mL for placebo, with an additional 14.2 mL and 28.4 mL for fesoterodine 4 mg and 8 mg, respectively.ConclusionsA consistent dose response for fesoterodine was demonstrated for bladder diary endpoints in subjects with overactive bladder, a result that supports the greater efficacy seen with fesoterodine 8 mg in post hoc analyses of clinical trial data. The dose-response models can be used to predict outcomes for doses not studied or for patient subgroups underrepresented in clinical trials.Trial RegistrationThe phase III trials used in this analysis have been registered at ClinicalTrials.gov (NCT00220363 and NCT00138723).

Impacts of leuprolide acetate on quality of life in patients with prostate cancer: A prospective multicenter study

To investigate the impacts of leuprolide acetate on the quality of life (QoL) of patients with prostate cancer. A total of 104 patients was enrolled in this prospective multicenter study. All patients received subcutaneous injections of 3.75 mg leuprolide acetate at 4 week intervals for a total of 12 weeks. QoL was assessed before treatment and at 12 weeks using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and an accompanying prostate cancer-specific module (QLQ-PR25). Eighty-nine of 104 patients (85.6%) completed the 12 week study. Eighty-six of 89 patients (96.6%) achieved and maintained medical castration. The results of the EORTC QLQ-C30 indicated that patients experienced an improvement in global health status/QoL (p < 0.001), despite a deterioration in physical and role functioning (p = 0.012 and p = 0.007, respectively). The symptom scales indicated a statistically significant improvement in appetite (p = 0.003). The results of the QLQ-PR25 revealed that patients experienced an increase in hot flushes (p < 0.001) and erection problems and uncomfortable sexual intimacy among the sexual functioning items (p = 0.030 and p = 0.023, respectively), but day-time urinary frequency was improved (p = 0.004). The results of this prospective study indicate that leuprolide acetate treatment was accompanied by improvements in global health status/QoL, despite a deterioration in physical, role and sexual function.

Prevalence of Urinary Incontinence in Men: Results From the National Health and Nutrition Examination Survey

We estimated the prevalence of urinary incontinence in the United States adult male population and identified associated factors. Data were analyzed for 5,297 men 20 years old or older who participated in the 2005 to 2006 and 2007 to 2008 cycles of the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey of the United States noninstitutionalized population. Urinary incontinence (score of 3 or greater on a validated incontinence severity index, indicating moderate to severe leakage) was assessed. Potential associated factors included age, race/ethnicity, education, self-reported health status, prior diagnosis of prostate cancer and/or enlarged prostate (men 40 years old or older), chronic diseases and depression status. Prevalence ORs were estimated from a multivariable logistic regression analysis using appropriate sampling weights. The prevalence of moderate/severe urinary incontinence was 4.5% (95% CI 3.8, 5.4). Prevalence increased with age from 0.7% (95% CI 0.4, 1.6) in men 20 to 34 years old, to 16.0% (95% CI 13.0, 19.4) in men 75 years old or older (p <0.001). We found no difference in prevalence by racial/ethnic group (p = 0.38). Factors significantly associated (p <0.05) with urinary incontinence were age (per 10-year increase, OR 1.8; 95% CI 1.6, 2.0), major depression (OR 2.7; 95% CI 1.6, 4.0) and hypertension (OR 1.3; 95% CI 1.1, 1.5). Age and race adjusted prevalence estimates for urinary incontinence in men are consistent with other estimates using a similar definition. To our knowledge this is the first study that identifies factors associated with moderate to severe urinary incontinence in men.

The Effect of Botulinum Toxin Type A on Overactive Bladder Symptoms in Patients With Multiple Sclerosis: A Pilot Study

Patients with multiple sclerosis often experience overactive bladder symptoms. High dose intradetrusor botulinum toxin A treatment is effective but often results in urinary retention and urinary diversion via a catheter. In this pilot study we evaluated whether only 100 U botulinum toxin A would significantly decrease overactive bladder symptoms in patients with multiple sclerosis without impairing pretreatment voluntary voiding. Included in our study were 12 patients with multiple sclerosis who had overactive bladder symptoms such as urgency, frequency and/or urgency incontinence. The treatment effect was evaluated using data on 3 consecutive visits, that is before, and a mean +/- SD of 46.2 +/- 11.9 and 101 +/- 21 days after intradetrusor injection of 100 U Botox, including the results of cystometry and uroflowmetry at visits 1 and 2, and uroflowmetry alone at visit 3. Patients completed a 3-day voiding diary for all 3 visits. Maximum bladder capacity significantly increased and maximum detrusor pressure decreased. Daytime and nighttime frequency, urgency and pad use significantly decreased. Post-void residual volume significantly increased initially but decreased until 12 weeks. Median time to re-injection due to recurrent overactive bladder symptoms was 8 months. Overactive bladder treatment in patients with multiple sclerosis using 100 U Botox intradetrusor injections seems to be effective and safe. Despite slightly impaired detrusor contractility most patients still voided voluntarily without symptoms. Thus, 100 U Botox may be a reasonable treatment option for overactive bladder symptoms in patients with multiple sclerosis who still void voluntarily.

Review of cognitive impairment with antimuscarinic agents in elderly patients with overactive bladder

Overactive bladder (OAB) will become an increasingly prevalent problem as the proportion of older people in the population increases over the next 20 years. In addition to the urological symptoms (urinary urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia), OAB is associated with other problems in older patients, especially an increased risk of falls and fractures. The bother caused by OAB needs not be an inevitable consequence of ageing, because the symptoms can usually be alleviated, even in frail older people. Pharmacological treatment for OAB involves the use of antimuscarinic agents, whose efficacy and safety profiles depend on their interactions with muscarinic receptors that are widely distributed throughout the body. Interactions between antimuscarinics and M(1) receptors in the central nervous system may have the potential to cause cognitive impairment in older people, depending on muscarinic receptor binding profiles, lipophilicity and the ability to cross the blood brain barrier. Concerns over the possibility of cognitive impairment have contributed to an under-utilisation of antimuscarinics in the geriatric population, despite the high prevalence and severity of OAB in older subjects. Antimuscarinic agents should be actively considered for elderly patients with OAB, but it is desirable to establish the cognitive risk for every type of antimuscarinic, using robust cognition assessment methods.

Strong Correlation Between the Overactive Bladder Symptom Score and Urgency Severity Score in Assessment of Patients With Overactive Bladder Syndrome

Objective To correlate between the overactive bladder symptom score (OABSS) and urgency severity score (USS) in a group of patients with over-active bladder (OAB) syndrome and evaluate the changes in these two measures after antimuscarinic treatment. Materials and Methods A total of 170 patients with clinical symptoms of frequency urgency were prospectively enrolled in this study. The Chinese version of the OABSS questionnaire, which has been linguistically validated, and the USS based on a 3-day voiding diary were recorded at baseline. Patients with clinically diagnosed OAB were treated with solifenacin 5 mg daily for 1 month, and the OABSS and USS were repeated at 1 week and 1 month. The OABSS and USS were compared at baseline, 1 week and 1 month after treatment. Results The patients enrolled included 98 men and 72 women with a mean age of 64.1 years. A high OABSS total score was significantly associated with a high grade of USS. There was a significant correlation between the two sores ( R 2=0.5520, p<0.0001). The main contributions to the OABSS in patients with a low USS were daytime frequency and nighttime frequency. The contribution of urgency and urgency urinary incontinence became significant in patients with high urgency grades. The changes in the USS and OABSS were significant at 1 month. The change in frequency was significant in the daytime as well as at nighttime. Conclusion A strong correlation between the OABSS and USS based on a voiding diary was noted in patients with OAB. The changes in these two measures were similar after solifenacin treatment.

193 ONE YEAR FOLLOWUP FOR THE EFFECT OF BOTULINUM A TOXIN INTRAVESICAL INJECTION IN PATIENTS WITH PAINFUL BLADDER SYNDROME

You have accessJournal of UrologyBladder and Urethra: Anatomy, Physiology and Pharmacology I1 Apr 2010193 ONE YEAR FOLLOWUP FOR THE EFFECT OF BOTULINUM A TOXIN INTRAVESICAL INJECTION IN PATIENTS WITH PAINFUL BLADDER SYNDROME Mohamed Shafik and Ahmed Fahmy Mohamed ShafikMohamed Shafik More articles by this author and Ahmed FahmyAhmed Fahmy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.249AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate the effect of intravesical Botulinum toxin A (BTX-A) treatment in patients with painful bladder syndrome (PBS) refractory to conventional treatment with one year follow up METHODS A total of 20 patients with PBS were treated with 200 U of intravesical BTX-A injection under short general anesthesia. Injections were performed submucosally in the bladder trigone and lateral walls under cystoscopic guidance. A voiding chart and the visual analog scale for pain were used, and urodynamics were performed before treatment, and 1, 3, 6 and 12 months later. RESULTS Overall 17 patients (85%) reported subjective improvement at the 1 and 3-month follow-ups. The mean visual analog scale score, and daytime and nighttime urinary frequency were significantly decreased (p _0.05, _0.01 and _0.05, respectively). At the 6-month follow up the beneficial effects persisted in 30% of cases but increased daytime and nighttime urinary frequency, and an increased visual analog scale score were observed compared to baseline. At 12 months after treatment pain recurred in all patients. CONCLUSIONS Intravesical BTX-A injections reduce bladder pain in patients with PBS. PBS may be potentially helped with bladder BTX injection, however, the beneficial effects decreased progressively within a few months after treatment. Thus, repeat injections are required for maintaining efficacy in PBS patients. Alexandria, Egypt© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e76 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Shafik More articles by this author Ahmed Fahmy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...