Improvement In Overactive Bladder Symptoms Research Articles

Comparison of Therapeutic Efficacy and Urodynamic Findings of Solifenacin Succinate versus Mirabegron in Women with Overactive Bladder Syndrome: Results of a Randomized Controlled Study

Introduction: We assessed clinical and urodynamic effects of solifenacin versus mirabegron in women with overactive bladder (OAB) syndrome. Material and Methods: Eighty women with OAB were randomized into 2 groups. In group A, the patients received solifenacin 5 mg once a day for 12 weeks; in group B, the patients received mirabegron 50 mg once a day for 12 weeks. Symptoms were assessed with OAB Symptom Score (OABSS). Patients underwent urodynamic investigation with pressure flow study. OABSS and urodynamic study were performed before and after treatment. Results: Both solifenacin and mirabegron were effective in improving OAB symptoms. Mirabegron showed greater tolerability with fewer patients discontinuing therapy because of side effects. Both solifenacin and mirabegron were effective in improving the storage function in the pressure flow study, but solifenacin showed a significant reduction of the detrusor pressure in the voiding phase with an increase in the postvoid residual urine volume. Conclusions: Mirabegron has shown to be a drug with the better balance between efficacy and tolerability in women with OAB.

The Effect of Pelvic Organ Prolapse Surgery on Pre-existing Overactive Bladder

Overactive bladder (OAB) and pelvic organ prolapse (POP) are both significant and debilitating conditions for many women. They often coexist but a causal relationship is not known. Surgical repair of POP has been found to improve OAB symptoms to varying degrees. Some studies have examined possible factors associated with OAB improvement after surgery for POP such as exam findings, symptoms, and urodynamic parameters, but none have been robustly shown to predict outcomes. When counseling patients regarding expectations after prolapse correction surgery, it is important to appreciate that it cannot be predicted which OAB symptoms would improve, to what degree, and in which patient.

PD36-04 PERCUTANEOUS NERVE STIMULATION FOR OVERACTIVE BLADDER: COST-EFFECTIVENESS COMPARED TO MONO AND DUAL PHARMACOTHERAPY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2016PD36-04 PERCUTANEOUS NERVE STIMULATION FOR OVERACTIVE BLADDER: COST-EFFECTIVENESS COMPARED TO MONO AND DUAL PHARMACOTHERAPY Julie Jenks, Eskinder Solomon, Mahreen Pakzad, Rizwan Hamid, Tamsin Greenwell, and Jeremy Ockrim Julie JenksJulie Jenks More articles by this author , Eskinder SolomonEskinder Solomon More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1109AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pharmacological treatments of overactive bladder (OAB) with anticholinergics and/or beta-3-adrenergic receptor agonists are standard treatment, but persistence with medical therapy is poor. Posterior tibial nerve stimulation (PTNS) is a minimally invasive alternative with few reported side effects but its cost effectiveness is unknown. We compared the cost effectiveness of PTNS with mono (anticholinergic) pharmacotherapy, dual (anticholinergics and beta-3-adrenergic) therapy within an NHS setting. METHODS Pharmacotherapy consisted of monotherapy with the anticholinergic Solifennacin 10mgs OD, and dual therapy with the beta-3-adrenergic receptor agonist Mirabegron 50mgs OD. PTNS was based on twelve weekly sessions, then top ups monthly. Treatment success was defined as >50% improvement in OAB symptoms. A Spanish Markov model was adapted to UK practice based on published efficacy data and expert opinion. Persistence for treatment was taken to be 24% for both mono and dual pharmacotherapy (published data) and 60% for PTNS (hospital data). Health resource use included pre-/peri-/and post-procedure assessments; adverse events and procedure (PTNS) costs. Incremental-cost-effectiveness-ratios (ICER; costs per quality-adjusted-life-year) were calculated for PTNS monotherapy versus monotherapy and PTNS versus dual therapy at 5yrs; with univariate sensitivity analyses. RESULTS At 5 years, the cumulative costs of monotherapy, dual therapy and PTNS therapy were £3,451, £5,222 and £8,011 respectively. The QALYs for monotherapy, dual therapy and PTNS therapy were 2.92, 3.11, and 3.45. ICERs for PTNS versus monotherapy were £10,604, and PTNS versus dual pharmacotherapy were £11,620 at 5 years. CONCLUSIONS PTNS for OAB patients provides quality of life improvement and ICERs that are below the threshold for UK cost-effectiveness. PTNS represents value for money but at incremental cost (more effective/more costly) compared to mono and dual pharmacotherapy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e850 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Julie Jenks More articles by this author Eskinder Solomon More articles by this author Mahreen Pakzad More articles by this author Rizwan Hamid More articles by this author Tamsin Greenwell More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP68-15 ELECTRICAL STIMULATION OF AFFERENT NERVES IN THE FOOT WITH TRANSCUTANEOUS ADHESIVE PAD ELECTRODES IMPROVES OVERACTIVE BLADDER SYMPTOMS IN WOMEN

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Basic Research & Pathophysiology II1 Apr 2016MP68-15 ELECTRICAL STIMULATION OF AFFERENT NERVES IN THE FOOT WITH TRANSCUTANEOUS ADHESIVE PAD ELECTRODES IMPROVES OVERACTIVE BLADDER SYMPTOMS IN WOMEN Christopher Chermansky, Bing Shen, Jon Shepherd, Shachi Tyagi, Jeremy Reese, William de Groat, and Changfeng Tai Christopher ChermanskyChristopher Chermansky More articles by this author , Bing ShenBing Shen More articles by this author , Jon ShepherdJon Shepherd More articles by this author , Shachi TyagiShachi Tyagi More articles by this author , Jeremy ReeseJeremy Reese More articles by this author , William de GroatWilliam de Groat More articles by this author , and Changfeng TaiChangfeng Tai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1352AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatments for refractory overactive bladder (OAB) include onabotulinumtoxinA, sacral neuromodulation, and tibial neuromodulation. Yet, a non-invasive and convenient OAB treatment with no major adverse events would be ideal. We previously showed that stimulation of foot afferents in normal humans without OAB increased bladder capacity by more than 50% (an average of 200 cc) without any adverse events. We sought to determine if electrical stimulation of afferent nerves in the foot with transcutaneous adhesive pad electrodes (FootStim) improves OAB symptoms. METHODS Women with UUI from OAB underwent FootStim for 3 hours every evening for 7 days. All patients stopped OAB drug therapy 2 weeks prior. A 3-week voiding diary was obtained, and FootStim was applied during week 2 (see Figure). Transcutaneous adhesive pad electrodes were attached to the bottom of the foot to activate the lateral and medial plantar nerves. These electrodes were connected to a transcutaneous electrical nerve stimulator. Stimulation parameters included a pulse frequency of 5 Hz, a pulse width of 0.2 ms, and an intensity of 2-4 times the minimal stimulation necessary to induce a toe twitch. Responder was defined as having a statistically significant improvement in 1 or more of the measured voiding parameters. RESULTS Nineteen women completed the study, of which 16/19 (84%) responded. Incontinence frequency in all 19 women decreased from 3.7 leaks/day at baseline to 2.8 leaks/day at baseline (p=0.04), and urgency frequency decreased from 7.6 episodes/day to 6.6 episodes/day (p=0.03). Statistically significant decreases were seen in daytime voiding frequency and nocturia in 8 and 7 subjects respectively, although these differences were not significant when analyzing the entire sample size. The FootStim effect persisted for 4 days after treatment was discontinued. There were no adverse events. CONCLUSIONS FootStim in women with UUI from OAB decreased incontinence frequency and urgency frequency, and these results are comparable with pharmacotherapy. Our results support further testing of FootStim to determine ideal stimulation schedule and to test against placebo. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e894-e895 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Christopher Chermansky More articles by this author Bing Shen More articles by this author Jon Shepherd More articles by this author Shachi Tyagi More articles by this author Jeremy Reese More articles by this author William de Groat More articles by this author Changfeng Tai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy and Safety of Mirabegron Add-on Therapy to Solifenacin in Incontinent Overactive Bladder Patients with an Inadequate Response to Initial 4-Week Solifenacin Monotherapy: A Randomised Double-blind Multicentre Phase 3B Study (BESIDE)

BackgroundIncontinence has a greater detrimental effect on quality of life than other symptoms of overactive bladder (OAB) and is often difficult to treat with antimuscarinic monotherapy. ObjectiveTo evaluate the efficacy and the safety and tolerability of combination (solifenacin 5mg and mirabegron 50mg) versus solifenacin 5 or 10mg in OAB patients remaining incontinent after 4 wk of solifenacin 5mg. Design, setting, and participantsOAB patients remaining incontinent despite daily solifenacin 5mg during 4-wk single-blind run-in were randomised 1:1:1 to double-blind daily combination or solifenacin 5 or 10mg for 12 wk. Patients receiving the combination were initiated on mirabegron 25mg increasing to 50mg after week 4. Outcome measurements and statistical analysisThe primary end point was a change from baseline to end of treatment (EOT) in the mean number of incontinence episodes per 24h (stratified rank analysis of covariance [ANCOVA]). Key secondary end points were a change from baseline to EOT in the mean number of micturitions per 24h (ANCOVA) and number of incontinence episodes noted in a 3-d diary at EOT (mixed-effects Poisson regression). A trial (BESIDE) comparing combination treatment (solifenacin plus mirabegron) with one treatment alone (solifenacin) tested the superiority of combination versus solifenacin 5mg, noninferiority (and potential superiority) of combination versus solifenacin 10mg (key secondary end points), and the safety and tolerability of combination therapy versus solifenacin monotherapy. Results and limitationsA total of 2174 patients were randomised to combination (n=727), solifenacin 5mg (n=728), or solifenacin 10mg (n=719). At EOT, combination was superior to solifenacin 5mg, with significant improvements in daily incontinence (p=0.001), daily micturitions (p<0.001), and incontinence noted in a 3-d diary (p=0.014). Combination was noninferior to solifenacin 10mg for key secondary end points and superior to solifenacin 10mg for improving daily micturitions. All treatments were well tolerated. ConclusionsAdding mirabegron 50mg to solifenacin 5mg further improved OAB symptoms versus solifenacin 5 or 10mg, and it was well tolerated in OAB patients remaining incontinent after initial solifenacin 5mg. Patient summaryIn this 12-wk study, overactive bladder patients who remained incontinent despite initial solifenacin 5mg treatment received additional treatment with mirabegron 50mg. Combining mirabegron 50mg with solifenacin 5mg was superior to solifenacin 5mg alone in improving symptoms of incontinence and frequent urination, and it was well tolerated. Trial registrationClinicalTrials.gov NCT01908829.

The concomitant use of fesoterodine and topical vaginal estrogen in the management of overactive bladder and sexual dysfunction in postmenopausal women.

The objective of this study is to investigate the combination effect of anti-muscarinic medication and topical vaginal estrogen in the treatment of overactive bladder (OAB) and female sexual dysfunction in postmenopausal women. After IRB approval, 23 female subjects who met the entry criteria were randomized into two groups: (1) fesoterodine (Toviaz®, Pfizer, NY) with topical vaginal estrogen (Premarin®, Pfizer, NY) once daily or (2) fesoterodine once daily alone. If 4 mg fesoterodine was tolerated at 1-week, the dose was increased to 8 mg. Primary endpoints were improvement in OAB symptom severity (Overactive Bladder Questionnaire, OAB-Q SF), improvement in OAB health-related quality of life (HRQL) (OAB-Q SF), and sexual function (Sexual Quality of Life-Female, SQOL-F) after 12 weeks. Secondary endpoint was change in total number of micturitions. After 12-weeks, the combination group had a significant improvement in OAB symptom severity (p = 0.006), HRQL (p = 0.029), and SQOL-F (0.0003). The fesoterodine alone group also had significant improvement in OAB symptom severity (p < 0.0001), HRQL (p = 0.0002), and SQOL-F (p = 0.02). When compared directly to the fesoterodine alone group, the combination group after 12-weeks had a reduced OAB symptom severity (10 versus 23.3; p = 0.35), higher HRQL (96.9 versus 84.6; p = 0.75), and higher SQOL-F (99 versus 81; p = 0.098). The total number of micturitions over 3 d was significantly reduced in the combination group (45-26, p = 0.03) between baseline and 12-weeks. The combined effect of fesoterodine and topical vaginal estrogen improved OAB symptoms and sexual function in postmenopausal women.

Treatment of fecal retention is important in the management of overactive bladder in children.

The investigation of fecal retention using objective and patient-friendly tools, rather than the diagnosis of constipation, might be important in the management of overactive bladder (OAB) in children. The present study aimed to evaluate the incidence and grade of fecal retention in children with OAB and to determine the effectiveness of laxative treatment for fecal retention in the management of OAB in children. This study included 88 children with OAB aged 5-15 years. Fecal retention was defined as type 1/2 feces (Bristol stool form scale) or a Leech score above eight points, and constipation was determined according to the ROME III criteria. Among the 88 children, 71 with fecal retention or constipation were treated with oral laxatives (polyethylene glycol 3,350/4,000 or lactulose) for 2 weeks, and the responses to the treatment were assessed. Among the 88 children, 63 (71.6%) had a Leech score above eight points as assessed by plain abdominal radiography, 52 (59.1%) had type 1/2 feces (Bristol stool form scale), 24 (27.3%) had functional constipation and only 6 (6.8%) had none of either. Among the 71 children who received laxative treatment for 2 weeks, 58 (81.7%) reported an improvement in OAB symptoms. Additionally, the number of children with a Leech score above eight points was significantly higher in the good response group than in the poor response group (P = 0.014). Investigation of fecal retention with the Leech scoring system and laxative treatment might be helpful in the management of OAB in children. Neurourol. Urodynam. 36:490-494, 2017. © 2016 Wiley Periodicals, Inc.

Botulinum toxin as a treatment for refractory overactive bladder.

Detrusor overactivity is the most common cause of overactive bladder (OAB) and refers to demonstrable involuntary detrusor contractions during urodynamic studies. The number of adults age 40 years or older suffering from idiopathic urge incontinence ranges from 13% in men to 30% in women. For patients whose symptoms are refractory to conventional therapy, intradetrusor botulinum toxin injection offers a safe and effective outpatient treatment with high rates of improvement of OAB symptoms.

The role of acupuncture in managing overactive bladder; a review of the literature.

Overactive bladder (OAB) affects a considerable proportion of men and women in the United States and is associated with significant costs and quality of life (QoL) reduction. While medication remains a mainstay of treatment, there is increasing interest in the use of alternative medicine in the form of acupuncture. We reviewed the literature on the role of acupuncture in managing OAB. A narrative review was compiled after searching electronic databases (PubMed, MEDLINE, Scopus, and EMBASE) for clinical studies involving acupuncture in treating OAB. Databases were searched from the time of inception through September 2015 by a clinician for articles reporting the results related to the use of acupuncture in OAB. Key search terms were acupuncture, overactive bladder, bladder instability, urgency, urinary incontinence. Articles in English or translated into English were included. Initial animal studies suggest several biochemical mechanisms of action underlying the effect of acupuncture on OAB suppression. The experience in humans includes two case series and six comparative trials. All studies demonstrated subjective improvement in OAB symptoms, and some reported objective improvement in urodynamic studies. Notably, some comparative trials showed the benefit of acupuncture to be comparable with antimuscarinic treatment. Despite their limitations, existing studies serve as a promising foundation for suggesting a role for acupuncture as an alternative therapy for OAB. Further well-designed studies are required to investigate optimal technique and their outcomes.

Continuous positive airway pressure therapy is associated with improvement in overactive bladder symptoms in women with obstructive sleep apnea syndrome.

IntroductionTo evaluate the impact of continuous positive airway pressure (CPAP) therapy on overactive bladder (OAB) symptoms in women with obstructive sleep apnea syndrome (OSAS).Material and methodsOne-hundred and fifty women underwent an overnight polysomnography study between May 2014 and September 2014. Their voiding symptoms were evaluated using the OAB symptom score (OABSS) and International Consultation on Incontinence Questionnaire Short-Form at OSAS diagnosis and approximately 3-months after CPAP therapy. OSAS severity was assessed according to the apnea-hypopnea-index.ResultsWe evaluated 140 women and 111 of them (79.3%) reported symptoms consistent with OAB. There were no statistically significant differences between OSAS severity with a prevalence of OAB (p = 0.92). The prevalence of urinary incontinence (UI) was 35.7% (n = 50) and 39.6% (n = 44) in all patients and patients with OAB, respectively. There were no statistically significant differences between UI with OAB (p = 0.58). Baseline OABSS is comparable between OSAS severity (p = 0.143). After 3-months CPAP therapy, OABSS and ICIQ-SF sum scores were significantly decreased in patients with severe and moderate OSAS (p <0.01), however, change of OABSS sum score was insignificant in patients with mild OSAS (p = 0.44).ConclusionsCPAP therapy improves the OAB, OABSS and ICIQ-SF scores in women with severe and moderate OSAS. OSAS-induced OAB may be alleviated following CPAP therapy.

The association of pelvic organ prolapse severity and improvement in overactive bladder symptoms after surgery for pelvic organ prolapse.

ObjectiveThe purpose of this study was to evaluate the impact of pelvic organ prolapse (POP) repair on overactive bladder (OAB) symptoms in women with POP and the effect of baseline POP severity on improvement in OAB after surgical repair of POP. And we also tried to identify any preoperative factors for persistent postoperative OAB symptoms.MethodsA total of 87 patients with coexisting POP and OAB who underwent surgical correction of POP were included and retrospectively analyzed and postoperative data was obtained by telephone interview. OAB was defined as an affirmative response to item no. 15 (urinary frequency) and item no. 16 (urge incontinence) of the Pelvic Floor Distress Inventory. POP severity was dichotomized by Pelvic Organ Prolapse Quantification stage 1 to 2 (n=22) versus stage 3 to 4 (n=65).ResultsOAB symptoms were significantly improved after surgical treatment (P<0.001). But there was no significant differences in postoperative improvement of frequency and urge incontinence between stage 1 to 2 group versus stage 3 to 4 group. Preoperative demographic factors (age, parity, and POP stage) were not significantly related to persistent postoperative OAB symptoms.ConclusionWomen with coexisting POP and OAB who undergo surgical repair experience significant improvement in OAB symptoms after surgery, but severity of POP had no significant difference in improvement of OAB symptoms. Postoperative persistent OAB symptoms were not related to age, parity, body mass index, and POP stage.

Daily Enema Regimen Is Superior to Traditional Therapies for Nonneurogenic Pediatric Overactive Bladder.

Our objective was to evaluate the efficacy of daily enemas for the treatment of overactive bladder (OAB) in children. This study was a prospective, controlled trial of 60 children with nonneurogenic OAB. The control patients (40) were treated with standard therapies, including timed voiding, constipation treatment with osmotic laxatives, anticholinergics, and biofeedback physical therapy, whereas the treatment patients (20) received only daily enemas and osmotic laxatives. On assessment of improvement of OAB symptoms, only 30% of the traditionally treated patients’ parents reported resolution of symptoms at 3 months, whereas 85% of enema patients did. At the onset of the study, the average pediatric voiding dysfunction score of all patients was 14, whereas on follow-up, the average scores for traditionally treated patients and enema-treated patients were 12 and 4, respectively. This study demonstrated that daily enema therapy is superior to traditional methods for the treatment of OAB.

Reduction of urgency severity is the most important factor in the subjective therapeutic outcome of intravesical onabotulinumtoxinA injection for overactive bladder.

This study investigated the relationship between the subjective outcome assessment and objective parameters after intravesical onabotulinumtoxinA injection in patients with overactive bladder (OAB). A total of 77 consecutive patients with urodynamically confirmed detrusor overactivity were treated with intravesical 100 U of onabotulinumtoxinA in 20 divided injections (5 U in 0.5 ml normal saline each) at different sites sparing the trigone. The primary end-point was the change in the Global Response Assessment (GRA) 3 months after treatment. All patients were monitored monthly after treatment for up to 6 months. Patients were divided into successful and failed treatment groups according to change in their GRA (≥2 and ≤1, respectively) at 3 months. The changes in voiding diary variables, Urgency Severity Score (USS), Overactive Bladder Symptom Score (OABSS), maximal bladder capacity (MBC), post-void residual (PVR) volume, and voiding efficiency (VE) were compared between groups at each time point. Overall, USS, OABSS, and MBC improved after treatment. Three months after BoNT-A injection, 49 (64%) patients reported an improvement in the GRA of 2 (n = 30) or 3 (n = 19). Patients with GRA ≥ 2 had significant improvements in OABSS at 3 months, and USS, OABSS, urgency urinary incontinence (UUI), and urgency episodes at 6 months compared with patients with GRA ≤ 1. No significant difference in MBC, PVR, or VE was noted between groups at 3 or 6 months. Subjectively successful treatment outcomes of intravesical onabotulinumtoxinA injection for OAB patients were associated with improvement in OAB symptoms but not increased bladder capacity. Neurourol. Urodynam. 36:338-343, 2017. © 2015 Wiley Periodicals, Inc.

Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women

Surgery for stress urinary incontinence (SUI) has high success rates and high levels of patient satisfaction as well as durability. However, a high proportion of patients seeking surgery for incontinence have mixed urinary incontinence (MUI) with symptoms of overactive bladder (OAB). The urgency component of OAB is a risk factor for treatment failure and reduced satisfaction. The primary aim of this study was to assess changes in OAB symptoms following incontinence surgery from 1 to 5 years postoperatively and to identify associated predictors of change from baseline. The investigators conducted a secondary analysis of previously unreported data from 3 multicenter SUI surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The main study outcome was a 70% or greater improvement in OAB symptoms from baseline measured by the Urinary Distress Inventory–Irritative subscale. The treatment effect of each surgical type over time was assessed with generalized linear models fit using 1-year and up to 5-year data. None of the trials had a control group. One year after surgery, each SUI procedure group reported significant improvement in Urinary Distress Inventory–Irritative scores (P < 0.001). Improvement in OAB symptoms were reported by most women (50%-71%). Similar improvements occurred among patients in the retropubic midurethral sling groups and those in midurethral transobturator sling groups at 1 year (65.5% vs 70.7%, respectively; odds ratio, 0.83; 95% confidence interval, 0.57–1.20; P = 0.32) and throughout the 5-year follow-up period. More women in the Burch group reported improvement in OAB symptoms at 1 year than in the fascial sling group (67.9% vs 56.6%); the odds ratio was 1.59, with a 95% confidence interval of 1.10 to 2.31, P = 0.01. This group difference at 1 year was maintained throughout the 5-year follow-up (P = 0.02). At 1 year, the proportion of patients in all groups achieving 70% or greater improvement in UI ranged from 50.0% to 64.3%. Over the 5-year study period, this proportion declined gradually to 36.5% to 54.1%, which was still a statistically significant level of improvement (P < 0.001). Potentially relevant clinical factors such as preoperative use of anticholinergics and urodynamic parameters were not predictive of postoperative improvement of OAB symptoms. Obese women were 43% less likely to experience relief from their OAB symptoms than overweight or normal-weight women. These data show that most women with stress-predominant mixed UI experience significant improvement in OAB symptoms 1 year after incontinence surgery. Although this initial improvement diminishes over time, the level of improvement at 5 years is still significant. Overactive bladder symptom improvement is blunted in obese women.

Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women.

To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline. This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data. Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71%) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5% compared with 70.7%, P=.32; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9% compared with 56.6%, P=.01; OR 1.59, 95% CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3% of patients reported 70% greater improvement in UI. This proportion declined to 36.5-54.1% at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery. Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement. II.

Transcutaneous posterior tibial nerve stimulation in pediatric overactive bladder: A preliminary report

Non-neurogenic overactive bladder (OAB) is a common problem in children that may affect their quality of life. Various methods of neuromodulation have been reported to treat refractory lower urinary tract dysfunction. Since most of these techniques are invasive, they are less applicable in children. To evaluate the efficacy of transcutaneous PTNS in treatment of OAB in children, in a randomized clinical setting. This study was single-blinded, prospective, sham controlled randomized trial. 40 children with non-neurogenic OAB refractory to behavioural and anticholinergic therapy were randomized either to test group or sham group. Neuromodulation was performed using two self-adhesive electrodes cephalad to medial malleolus. In test group the stimulation was given with voltage pulse intensity of 0 to 10 mA, pulse width of 200 μs and frequency of 20 Hz. In sham group patch electrodes were applied to simulate the test group but no stimulation was given. In both groups, weekly session of 30 min was given for a period of 12 weeks. The OAB symptoms, severity of incontinence, number of voids daily (NV), average voided volume (AVV) and maximum voided volume (MVV) were evaluated before and after treatment. On assessment of subjective improvement of OAB symptoms, 66.66% patients reported cure and 23.81% patients reported significant improvement of symptoms in test group whereas in sham group only 6.25% patients reported significant improvement. In test group 71.42% patients reported complete improvement in incontinence whereas in sham group only 12.5% patient reported complete improvement. The AVV, MVV and NV improved significantly in test group (p <0.001) as compared to sham group (Table). The present study is unique as none of the earlier studies in children were sham controlled. It is also first PTNS study in which patch electrodes were used; therefore it is completely noninvasive. This technique provides better patient acceptability and compliance. This study proved that, there is a definite effect of PTNS as compared to placebo because when patients from sham group were treated actively, they responded well. The present study has few limitations as it has relatively short follow-up period of 12 weeks. Relapse of OAB symptoms and maintenance schedule of PTNS need to be assessed further. Transcutaneous PTNS is superior to placebo in treatment of non-neurogenic overactive bladder in children. In view of its effectiveness and acceptability we believe that transcutaneous PTNS should be part of pediatric urology armamentarium for treatment of OAB.

1088 What is the pre-treatment factor contributing to failure in improvement of over-active bladder symptoms following alpha-1 blocker administration in patients with benign prostatic hyperplasia accompanied by overactive bladder?

1088 What is the pre-treatment factor contributing to failure in improvement of over-active bladder symptoms following alpha-1 blocker administration in patients with benign prostatic hyperplasia accompanied by overactive bladder?

Laparoscopic sleeve gastrectomy effects on overactive bladder symptoms

BackgroundMorbidly obese patients may experience lower urinary tract symptoms. However, most studies focus only on urinary incontinence, with little regard to other symptoms as those suggestive for overactive bladder (OAB) syndrome. Laparoscopic sleeve gastrectomy (LSG) is commonly used to treat obesity; this procedure is effective, safe, and capable of reducing the impact of comorbidities associated with severe increase in body weight. Therefore, we investigated if LSG improves OAB symptoms in morbidly obese patients. MethodsWe prospectively recruited 120 morbidly obese patients (60 men and 60 women), evaluated by history taking, comorbidity assessment, physical examination, urinalysis and urine culture, renal and pelvic ultrasound, a 3-d voiding diary, and the OAB questionnaire short form. Outcomes of these investigations were assessed 7 d before and 180 d after LSG was performed. Controls were obese individuals (60 men and 60 women) from an LSG waiting list. ResultsSymptoms of OAB were common in the morbidly obese cohort, affecting more women than men. Compared with untreated patients, patients treated with LSG had significantly reduced body mass index 180 d postoperatively; this outcome was associated with improvement in OAB symptoms, whereas no change occurred in untreated controls. ConclusionsOAB symptoms improve in morbidly obese patients successfully treated by LSG.

Improvement of overactive bladder symptoms after tension-free vaginal mesh operation in women with pelvic organ prolapse: Correlation with preoperative urodynamic findings.

To further elucidate the mechanisms of overactive bladder coexisting with pelvic organ prolapse. A total of 100 consecutive women with stage 2 or greater pelvic organ prolapse associated with cystocele were enrolled in the present prospective study. They underwent urodynamic studies and then received tension-free vaginal mesh operation. Urodynamic studies were carried out before and after the correction of pelvic organ prolapse using a single gauze pack in the vagina in the sitting position. The overactive bladder symptom score and International Prostate Symptom Score were collected before and 3 months after surgery. In 53 of 100 cases, pelvic organ prolapse was accompanied with overactive bladder, and detrusor overactivity was observed in 28 out of 53 pelvic organ prolapse with overactive bladder cases (52.8%). Detrusor overactivity was resolved in 18 and reduced in four out of 28 cases after the correction of pelvic organ prolapse by the gauze packing method. Of 53 patients who had overactive bladder preoperatively, overactive bladder symptoms disappeared in 35 cases (66.0%) and improved in six additional cases (11.3%) after tension-free vaginal mesh operation. A total of 20 of 25 cases whose overactive bladder symptoms disappeared or improved after surgery coincided with those who had shown either disappearance (n = 16) or improvement (n = 4) of detrusor overactivity after intravaginal gauze pack insertion in preoperative urodynamic studies. All scores in the overactive bladder symptom score decreased significantly after tension-free vaginal mesh, as well as the International Prostate Symptom Score, except for night-time frequency. Pelvic organ prolapse-associated overactive bladder or detrusor overactivity conditions can be reversed in most cases within a short period of time after surgical correction of pelvic organ prolapse.

Review of the Efficacy and Safety of Fesoterodine for Treating Overactive Bladder and Urgency Urinary Incontinence in Elderly Patients

Overactive bladder (OAB) is a common condition, with prevalence rates increasing with advancing age. Symptoms of OAB, including urgency urinary incontinence (UUI), are associated with various co-morbidities in elderly individuals (e.g., falls and fractures, functional impairment, and depression). The current mainstay of pharmacological therapy for OAB is antimuscarinic agents. Until recently, few studies had specifically evaluated the efficacy and safety of antimuscarinics in the treatment of OAB symptoms in elderly patients. This review summarises available evidence from the medical literature on the efficacy and safety of fesoterodine in elderly patients with OAB symptoms, including UUI. The data from unique placebo-controlled fesoterodine trials of elderly and vulnerable elderly patients, together with age-stratified data from post hoc analyses of fesoterodine trials, demonstrate that treatment with fesoterodine 4 or 8 mg results in statistically and clinically significant improvements in OAB symptoms and patient-reported outcomes in many elderly patients. The data indicate that the efficacy of fesoterodine in elderly patients is comparable with that in younger patients. Fesoterodine is generally well tolerated in elderly and vulnerable elderly patients, with low rates of urinary retention and little evidence of central nervous system events or impaired cognition. The data support a favourable benefit-to-risk ratio for fesoterodine in elderly and medically complex vulnerable elderly patients with OAB.