Non-neurogenic Detrusor Overactivity Research Articles

β3-Adrenoceptor Agonist for the Treatment of Bladder Dysfunction in Children: A Systematic Review and Meta-Analysis.

ß3-adrenergic receptor agonists (ß3 agonists) have been used in treatment of overactive bladder (OAB) and neurogenic detrusor overactivity (NDO) in adults. However, their use in children has only recently been approved by the U.S. Food and Drug Administration for patients with NDO. As in adults, the role of ß3 agonists in children may include conditions such as OAB. This systematic review and meta-analysis aims to understand the intended use, efficacy and safety of ß3 agonists in the pediatric population. A literature search was performed in February 2021 across MEDLINE®, Embase®, Scopus®, the Cochrane Library and ClinicalTrials.gov. No language restrictions were placed. All records describing the clinical use of ß3 agonists in pediatric patients (<18 years of age) were included, regardless of the methodological design or outcomes assessed. The identified records were screened by 2 independent authors. The reporting was compliant with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Data extraction was performed by 2 independent reviewers, blinded to each other's extractions. The data were pooled using the fixed effects model. Of 367 records identified, 8 studies were included in the review (3 prospective and 5 retrospective). ß3 agonists led to improvements in both urodynamics parameters and self-reported outcomes such as incontinence. Commonly reported side effects were headaches (3%‒5.9%), constipation (3.5%‒5.7%), rhinitis/nasopharyngitis (1.7%‒5.8%) and blurred vision (1.7%‒2.9%). Clinically meaningful changes in safety outcomes (blood pressure, heart rate, electrocardiogram-related changes, liver function) were rare. Before and after ß3 agonist use, pooled effect estimates for maximum cystometric capacity for 171 patients were mean difference of +98.84 ml (95% CI 74.72, 122.96); for complete dryness, assessment of 235 patients showed a Peto odds ratio of 8.68 (95% CI 5.22, 14.45). ß3 agonists appear to be a promising, effective and safe alternative/adjunctive therapy in management of pediatric NDO or OAB, with improvements in both objective urodynamics parameters and subjective patient-reported outcomes following their use.

The treatment of overactive bladder syndrome with onabotulinumtoxinA therapy

Introduction: Overactive bladder syndrome is an endemic phenomenon, which has a significant impact on the quality of life. In cases where conservative treatment fails, intradetrusor onabotulinumtoxinA injection can be used as second-line therapy. Objective: To assess the safety and efficacy of onabotulinumtoxinA treatment in the management of non-neurogenic detrusor overactivity among our patients. Also, to examine the influence of perioperative factors on the effects of the efficacy. Method: We have retrospectively collected the perioperative data of 33 patients treated with intradetrusor BOTOX®. The assessment of the efficacy and complications was done by the examination of patient files and questionnaires. The results obtained during the statistical analysis were considered significant for p<0.05. Results: We have not experienced notable complications after the procedures. Only 6 patients had residual urine (p = 0.024), none of them needed to be catheterized. We have observed significant decrease in the incidence of frequency, nocturia, urgency and incontinence, just as in the number of pads needed daily (p<0.01). Quality of life and general health were significantly improved (p<0.001). We have not found any significant connection between preoperative factors and efficacy (72.7%). Discussion: Our results considering the relief of symptoms are well in line with international data. The fact that our rate of complications is - in international comparison - outstanding can be explained by a more careful patient selection and thorough preoperative assessment. Conclusion: OnabotulinumtoxinA therapy is a safe and effective solution of therapy-refractory overactive bladder. We could not identify any perioperative factor to predict postoperative efficacy of therapy. Orv Hetil. 2021; 162(36): 1459-1465.

Clinical effectiveness of intradetrusor injections of botulinum toxin type a in dose 100 units in multiple sclerosis patients with neurogenic detrusor overactivity

Intravesical injections of botunulinum toxin type A (BTA) demonstrate good results in treatment of detrusor overactivity symptoms in patients with neurogenic low urinary tract dysfunction (NLUTD) when use in recommended doses of 200 and 300 Units. In clinical practice a government insurance dose not cover the price for the 200 BTA Units and only 100 Units may be injected in patients with neurogenic and nonneurogenic detrusor overactivity.&#x0D; The aim was to evaluate the efficiency of intradetrusor injections of BTA in patients with NLUTD.&#x0D; Materials and methods. The study included 28 MS patients with resistant to medical treatment neurogenic detrusor overactivity. All patients received intradetrusor injections of 100 BTA Units. The results were assessed after 1, 3 and 6 months after procedure.&#x0D; Results. Clinical improvement had been achieved in all 28 patients. According to the urodynamic studies three months after BTA injections maximal cystometric capacity increased by 119.9 37.6% (p 0,05), volume at first detrusor involuntary contraction increased by 74.8 21.4% (p 0,05), maximal detrusor pressure at involuntary contraction decreased by 53.5 29.7% (p 0,05). The NBSS total score decreased from 38.04 14.27 to 29.06 14.46 (p = 0,000), mainly because of questions about incontinence and urgency. SF-Qualiveen total score turned from 2.32 0.70 to 1.61 0.85 (p = 0.000). Before procedure 2 patients performed intermittent catheterization, 4 patients catheterized after BTA injections.&#x0D; Conclusion. Intradetrusor injection of 100 BTA Units in MS patients with NLUTD resulted in improvement of urodynamic parameters followed by reduction of clinical symptoms and life quality improvement for 6 months of observation. Using of BTA low dose didnt provide a total abortion of neurogenic detrusor overactivity symptoms but led to the starting of IC only in 2 patients.

Intradetrusor onabotulinum-a toxin injections in children with therapy-resistant idiopathic detrusor overactivity. A retrospective study

The use of intravesical onabotulinum-A toxin (BoNT-A) injections in the treatment of idiopathic detrusor overactivity has been widely studied in adults [2-5]. However, in pediatric populations, study groups are small, and results are not yet sufficient to support this treatment as a standard practice. The aim of this study is to determine the effectiveness and safety of this treatment in children with non-neurogenic detrusor overactivity, resistant to conservative therapy. We retrospectively evaluated the effect and safety of the intradetrusor injection of 100 Units (U) of BoNT-A in 257 children with therapy-resistant non-neurogenic detrusor overactivity between May 2003 and August 2017. Outcome parameters were the number of daytime incontinence and enuresis episodes per week and bladder capacity (BC). Treatment outcomes were classified into complete response, partial response, or no response. The database includes 257 children, of which are 102 girls and 155 boys. Median age of first BoNT-A injection was 8 years (range 4-18 years). Of the patients with enuresis, daytime incontinence or both, a complete response was seen in 50%, 45.7%, and 17%, respectively. BC was significantly higher after the first, second, and third injection of 100 U BoNT-A. We estimated that the mean duration of the effect of an injection with a dose of 100 U is around 12 months. After the first injection, one girl (0.4%) developed urinary retention, which required temporary clean intermittent catheterization (CIC). Seventeen patients (6.6%) developed a urinary tract infection. In three patients (1.2%), postoperative vesicoureteral reflux was seen. A distinction between the effect on daytime incontinence and enuresis was made. A poorer effect on enuresis in children who suffered from both conditions was observed. Drawbacks of this study are its retrospective design and the lack of anticholinergic treatment standardization before and after BoNT-A injection. BoNT-A injection is a potentially effective adjuvant therapy in the treatment of children with therapy-resistant overactive bladder (OAB). Bladder capacity increases significantly after the first, second, and third injections. A better effect on daytime incontinence than on enuresis was seen. Prospective randomized trials with standardization of conservative treatment and symptoms questionnaires are necessary to confirm the beneficial effect of BoNT-A injections on BC and incontinence.

The Value of Urinary BDNF Levels on Assessment of the Botulinum Toxin Type A Treatment for Neurogenic Detrusor Overactivity in Children with Myelodysplasia

PurposeUrinary cytokines are proposed to predict the urodynamic findings and outcome of intradetrusor botulinum neurotoxin type A injection (iBoNT-Ai) in children with myelodysplasia. The relationship between urinary brain-derived neurotrophic factor (BDNF) and neurogenic and non-neurogenic detrusor overactivity (NDOA) has been shown, as well. In this prospective study, we aimed to investigate the effect of iBoNT-Ai on urine BDNF levels in children with NDOA due to myelodysplasia. Material and MethodsUrine samples of children with NDOA due to myelodysplasia were collected and analyzed, before and after iBoNT-Ai (first and third months) along with urodynamics before and 6 week after iBoNT-Ai. BDNF levels and urodynamic findings were analyzed and statistical comparisons were done. ResultsMean age was 100.0 ± 34.5 months. Rate of girls/boys was 2.8 in 23 children. BDNF levels significantly declined (p<0.006), maximum cystometric capacity and maximum detrusor pressure significantly improved following iBoNT-Ai compared to preoperative levels (p<0.001). No statistical correlations were determined between BDNF levels and urodynamics. Of all analysis, only patients with a bladder compliance of 5 mL/cmH2O or less at the postoperative urodynamics had statistically high urine BDNF levels compared to the ones above 5 mL/cmH2O, suggesting high urine BDNF to predict treatment failure. ConclusionsPresent study can hardly suggest urine BDNF to be a follow-up marker in children with NDOA due to myelodysplasia. However, it has an obscure role in treatment planning which needs to be revealed with large-numbered future prospective studies.

476 - The value of urinary BDNF levels on assessment of the botulinum toxin type A treatment for neurogenic detrusor overactivity in children with myelodysplasia

Abstract Purpose Urinary cytokines are proposed to predict the urodynamic findings and outcome of intradetrusor botulinum neurotoxin type A injection (iBoNT-Ai) in children with myelodysplasia. The relationship between urinary brain-derived neurotrophic factor (BDNF) and neurogenic and non-neurogenic detrusor overactivity (NDOA) has been shown, as well. In this prospective study, we aimed to investigate the effect of iBoNT-Ai on urine BDNF levels in children with NDOA due to myelodysplasia. Material and Methods Urine samples of children with NDOA due to myelodysplasia were collected and analyzed, before and after iBoNT-Ai (first and third months) along with urodynamics before and 6 week after iBoNT-Ai. BDNF levels and urodynamic findings were analyzed and statistical comparisons were done. Results Mean age was 100.0 ± 34.5 months. Rate of girls/boys was 2.8 in 23 children. BDNF levels significantly declined (p 2 O or less at the postoperative urodynamics had statistically high urine BDNF levels compared to the ones above 5 mL/cmH 2 O, suggesting high urine BDNF to predict treatment failure. Conclusions Present study can hardly suggest urine BDNF to be a follow-up marker in children with NDOA due to myelodysplasia. However, it has an obscure role in treatment planning which needs to be revealed with large-numbered future prospective studies.

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with concomitant BBD and neuropsychiatric disorders have less favourable treatment outcomes. Early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, and psychosocial well-being. The majority of patients will improve with urotherapy, adequate fluid intake, and constipation treatment. Pharmacological treatment must only be considered if no improvement occurs after intensive adherence to at least six months of urotherapy ± biofeedback and constipation treatment. Anticholinergics remain the mainstay of medical treatment. Selective alpha-blockers appear to be effective for improving bladder emptying in children with non-neurogenic detrusor overactivity (DO), incontinence, recurrent UTIs, and increased post-void residual (PVR) urine volumes. Alpha-1 blockers can also be used in combination with anticholinergics when overactive bladder (OAB) coexists with functional bladder outlet obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder injections, and recently neurostimulation, are promising alternatives for the management of BBD refractory to behavioural and pharmacological treatment. In this review, we discuss clinical presentation, diagnostic approach, and indications for behavioural, pharmacological, and surgical treatment of BBD in children based on a thorough literature review. Expert opinion will be used when scientific evidence is unavailable.

Efficacy of onabotulinum toxin A injection in pediatric patients with non-neurogenic detrusor overactivity.

To evaluate the effectiveness and reliability of onabotulinum toxin A (onaBoNT-A) injections in pediatric patients with non-neurogenic detrusor overactivity (NNDO). Between January 2010 and February 2016, 39 patients underwent onaBoNT-A injections for NNDO, and were evaluated retrospectively. Three-day voiding diary was filled at baseline, and at the postoperative 9th month. The voiding frequency, incontinence episodes, and the cystometric capacity were noted. Vesicoureteral reflux (VUR) associated with NNDO, and presence of nocturia were recorded. Additional injection requirements were also stated. We reached the data of 33 patients on 9th month. The mean age was determined as 8.75 ± 3.01 (5-16) years. Initially, the mean bladder capacity was calculated as 114.66 ± 35.23 mL on the voiding diary, and 153.15 ± 47.40 mL on the baseline urodynamic study. After the procedures, the mean bladder capacity increased to 140.84 ± 45.61 mL (P = 0.0011), the mean daily voiding frequency decreased from 10.36 ± 1.05 to 7.42 ± 0.83 (P = 0.01), and the mean incontinence episodes decreased from 2.72 ± 1.87 to 1.18 ± 1.13 (P = 0.001), on voiding diary. VUR associated with NNDO was determined in 10 (30.3%) patients. The degree of VUR decreased three in patients, and VUR disappeared in five patients following the injections (P = 0.011). Fourteen (42.4%) patients had nocturia, and after the injections, nocturia disappeared in five (15.15%) patients (P = 0.151). Additional injections were required in 10 (30.3%) patients at the 9th month. OnaBoNT-A injections can be used in the pediatric patients with NNDO as an effective and reliable procedure by decreasing voiding frequency, incontinence episodes, and increasing bladder capacity, with negligible side effects and complications.

Progressive changes in detrusor function and micturition patterns with chroinc bladder ischemia

PurposeLower urinary tract symptoms (LUTS) are bothersome constellation of voiding symptoms in men and women as they age. Multiple factors and comorbidities are attributed to this problem but underlying mechanisms of nonobstructive nonneurogenic detrusor overactivity, detrusor underactivity and LUTS remain largely unknown. Our goal was to characterize detrusor function and voiding patterns in relation to muscarinic receptors expression, nerve fiber density, and neural ultrastructure in chronic bladder ischemia.Materials and MethodsIliac artery atherosclerosis and bladder ischemia were produced in male Sprague-Dawley rats. At 8 and 16 weeks after ischemia, micturition patterns and cystometrograms were recorded in conscious rats then bladder blood flow and nonvoiding spontaneous contractions were measured under general anesthesia. Bladder tissues were processed for Western blotting, immunostaining, and transmission electron microscopy.ResultsBladder responses to ischemic insult depended on the duration of ischemia. Micturition patterns and cystometric changes at 8-week ischemia suggested detrusor overactivity, while voiding behavior and cystometrograms at 16-week ischemia implied abnormal detrusor function resembling underactivity. Upregulation of muscarinic M2 receptor was found after 8- and 16 weeks of ischemia. Downregulation of M3 and upregulation of M1 were detected at 16-week ischemia. Neural structural damage and marked neurodegeneration were found after 8 and 16 weeks of ischemia, respectively.ConclusionsProlonged ischemia may be a mediating variable in progression of overactive bladder to dysfunctional patterns similar to detrusor underactivity. The mechanism appears to involve differential expression of M1, M2, and M3 receptors, neural structural injury, and progressive loss of nerve fibers.

167 Botulinum toxin injection in pediatric patients with non-neurogenic detrusor overactivity

167 Botulinum toxin injection in pediatric patients with non-neurogenic detrusor overactivity

Long-Term Enterocystoplasty Follow-Up: Metabolic and Neoplastic Concerns

Augmentation enterocystoplasty is indicated for the management of refractory neurogenic or non-neurogenic detrusor overactivity, impaired detrusor compliance, and bladder pain. Enlarging the bladder, utilizing segments of the stomach, small bowel, or colon, has been reliably proven to successfully create a low-pressure reservoir with preserved renal function. Incorporating stomach or bowel into the urinary tract may result in genitourinary stone formation, bladder cancer, long-term metabolic disturbances, or other complications. This review focuses on the incidence and management of augmentation enterocystoplasty complications based on the most recent published literature.

Systemic Atherosclerosis Causes Detrusor Overactivity: Functional and Morphological Changes in Hyperlipoproteinemic apoE–/–LDLR–/– Mice

The prevalence of systemic atherosclerosis and overactive bladder/detrusor overactivity increases almost simultaneously with age but an association between these diseases has not yet been proved. We evaluated changes in bladder function and morphology, including vascularization, in apoE(-/-)LDLR(-/-) double knockout mice with systemic atherosclerosis but without central nervous system involvement. Cystometry was performed in awake, freely moving 60-week-old apoE(-/-)LDLR(-/-) mice and C57BL/6N controls. The mice were sacrificed and perfused with Microfil® contrast medium. The bladder was excised, dissected and scanned by nano-computerized tomography, including 3-dimensional reconstruction. Samples then underwent histomorphological analysis. In apoE(-/-)LDLR(-/-) mice cystometry revealed a significant decrease in the peak-peak interval, micturition interval, functional bladder capacity and micturition volume. However, maximum bladder pressure increased. Nano-computerized tomography revealed a significant reduction in bladder wall thickness, segment volume, vascular volume and the vascular volume fraction. Histomorphologically bladder specimens showed a thickened media of intramural vessels, activated endothelial cells and intramural inflammatory cells. To our knowledge this study presents a new in vivo mouse model of nonneurogenic detrusor overactivity caused by systemic atherosclerosis. Decreased bladder wall vascularization seems to be a major factor for detrusor overactivity onset. Capillaries are rarified with reduced lumina due to thickened media. Activated endothelial cells and the infiltration of inflammatory cells in apoE(-/-)LDLR(-/-) mice underlines once more that atherosclerosis is an inflammatory process that may also be relevant to the onset of detrusor overactivity.

Double anticholinergic therapy for refractory neurogenic and nonneurogenic detrusor overactivity in children: Long-term results of a prospective open-label study.

In this study, we optimize pharmacotherapy in children who failed anticholinergic monotherapy by simultaneous administration of 2 anticholinergics (oxybutynin and/or tolterodine and/or solifenacin). This report is an update of our previously published study on double anticholinergic regimen in children with refractory incontinence due to neurogenic (NDO) and non-neurogenic (DO) detrusor overactivity. Patients with an insufficient response (clinically/urodynamically) to an optimized dose of a single anticholinergic (oxybutynin or tolterodine) received a second anticholinergic (tolterodine or solifenacin), in addition to the pre-existing medication. The primary end-point was efficacy (continence) and the secondary end-points were tolerability and safety. The Patient Perception of Bladder Condition (PPBC) scale was used to rate subjective improvement of patients. In total, 56 patients with DO (n = 31) or NDO (n = 25) were enrolled at a mean age of 11.4 ± 3.5 years and were followed for a minimum of 3 months. The duration of double treatment was 36 ± 23 months. Our results found that 23 patients became dry, 18 improved significantly and 15 improved moderately. Urodynamic capacity improved from 158 ± 87 mL to 359 ± 148 mL and maximal pressure of contractions decreased from 76 ± 24 to 22 ± 22 cmH2O (p < 0.0001). The overall success rate was 82%, since 10 patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 28 patients, mild side effects by 20, moderate side effects by 8; 2 patients withdrew from the study due to their side effects. Of the 35 patients who voided spontaneously, 8 developed post-void residuals (>20%). With a larger cohort and prospective follow-up, we reiterated that double anticholinergic regimen in children with DO or NDO refractory to anticholinergic monotherapy is a feasible and efficient approach.

Botulinum toxin injections in the management of non-neurogenic overactive bladders in children

IntroductionNon-neurogenic detrusor overactivity in children leads to varying degrees of functional impairments (urinary urgency, pollakiuria, urge incontinence, nocturia). Botulinum toxin has shown its effectiveness in the management of detrusor overactivity in neurological patients. ObjectivesTo evaluate the relevance of intravesical Botulinum toxin injections for the treatment of non-neurogenic overactive bladders in children. These pediatric patients were resistant to all the usual therapeutics (e.g. bladder/bowel rehabilitation, anticholinergic drugs, management of diet/hygiene habits and constipation, percutaneous posterior tibial nerve stimulation). Materials and methods8 children (mean age: 12.5years), 5 girls, 3 boys with daytime and/or nighttime incontinence and non-neurogenic detrusor overactivity validated by urodynamic testing. Urodynamic testing was conducted before the injections as well as 6weeks and 1year post injections. We used Dysport® 8 Speywood Units/kg injected via cystoscopy into 25 different sites. ResultsWe noted improvements without any complaints during bladder voiding for all patients, in 6 patients the overactivity disappeared after 1 injection. Compliance was improved early-on in half the cases and at 1year for all cases (from 12% to 61%, p=0.01). Noninhibited contractions decreased constantly in both frequency and intensity. Clinical symptoms improved: mean of 7.75 daytime urinary incontinence episodes (IE) per week before the injection vs. 3 after the procedure (p=0.04). For nighttime IE the improvement was even more noticeable with 7.38 nighttime IE episodes per week before the injection vs. 2.06 after the procedure (p=0,02). ConclusionIntradetrusor Botulinum toxin injections are a potential therapeutic option for the management of non-neurogenic detrusor overactivity in children resistant to the usual treatments.

668 Posterior tibial nerve stimulation (PTNS) for treatment of non-neurogenic detrusor overactivity and chronic pelvic pain

668 Posterior tibial nerve stimulation (PTNS) for treatment of non-neurogenic detrusor overactivity and chronic pelvic pain

Reproducibility of Electrical Sensory Testing in Lower Urinary Tract at Weekly Intervals in Healthy Volunteers and Women With Non-neurogenic Detrusor Overactivity

To evaluate the reproducibility of a standardized technique of current perception threshold measurements with square wave and sine wave current, with monopolar and bipolar electrodes in a cohort of patients with overactive bladder (OAB) and healthy volunteers. We enrolled 6 female nulliparous healthy volunteers and 11 female patients with OAB. Current perception threshold measurements of the bladder were performed using several techniques. The same sequence was used for all 3 measurements performed at weekly intervals to assess the reproducibility. An intraclass correlation coefficient >0.75 was considered as very good reproducibility. All the different stimulation forms were well tolerated by all participants and all experienced stimulation at 2.5-Hz and 95-Hz square wave current. The results with sine wave current showed less uniform results. The intraclass correlation showed the greatest reproducibility with bipolar stimulation at a current of 95 Hz. Sine wave current at 5 Hz and 250 Hz showed low reproducibility. Bipolar stimulation had significantly lower thresholds than monopolar stimulation (P < .0001). No significant differences were found between the healthy subjects and the patients with OAB for the 4 settings. In the healthy volunteers and patients with OAB, the determination of the current perception threshold in the bladder using a standardized method is feasible and well tolerated, with both bipolar and monopolar stimulation. In our study, square wave current showed strong reproducibility at weekly intervals at 2.5 Hz and 95 Hz. However, sinusoid current gave weak reproducibility.

Descriptive epidemiological study of the diagnosis of detrusor overactivity in urodynamic units in Spain

ObjectiveTo know the relative weight of the diagnosis of detrusor overactivity (DO) in the Urodynamic Units of Spain and relate the prevalence of the overactive bladder (OB) syndrome. Material and methodAn epidemiological, descriptive, retrospective, multicenter, national study conducted according to registered data in 47 Urodynamic Units covering the Spanish geographic area in the different areas of health distributed among the regional communities. These data inform about the health care received by 35% of the Spanish population. Urodynamic diagnoses and related variables, recorded during 2007 and 2008, were collected. ResultsA mean of 346.45 (SD=304.03) and 349.72 (SD=296.49) urodynamics studies per care unit were performed in women during 2007 and 2008, respectively and 181.20 (SD=212.71) and 195.68 (SD=257.58) in men. The relative weight of the diagnosis of non-neurogenic DO in women per unit was 31.39% and 35.28%, in 2007 and 2008, and in men it was 21.06% and 20.43%. The diagnostic capacity of DO was 19.28 new cases per 100,000 inhabitants/year. The diagnosis of non-neurogenic DO in the woman accounts for one-third of all the urodynamic/year diagnoses and more than half of the diagnoses of DO. In men, DO accounts for 25% of the diagnoses, the most frequent one being that associated with benign prostatic hyperplasia, followed by that of neurogenic cause. Approximately half of the DO diagnoses in children correspond to non-neurogenic DO. ConclusionsThe differences between the capacity of diagnosis of DO (ratio per 100,000 inhabitants) is far from many of the estimations of the prevalence of OB (relationship %). The doubt may exist about whether part of this quota is secondary and not-idiopathic, given the large difference between the frequency of OB and the capacity of diagnosis of DO.

Estudio epidemiológico descriptivo del diagnóstico de hiperactividad del detrusor en las unidades de diagnóstico urodinámico de España

Objective To know the relative weight of the diagnosis of detrusor overactivity (DO) in the Urodynamic Units of Spain and relate the prevalence of the overactive bladder (OB) syndrome. Material and method An epidemiological, descriptive, retrospective, multicenter, national study conducted according to registered data in 47 Urodynamic Units covering the Spanish geographic area in the different areas of health distributed among the regional communities. These data inform about the health care received by 35% of the Spanish population. Urodynamic diagnoses and related variables, recorded during 2007 and 2008, were collected. Results A mean of 346.45 (SD=304.03) and 349.72 (SD=296.49) urodynamics studies per care unit were performed in women during 2007 and 2008, respectively and 181.20 (SD=212.71) and 195.68 (SD=257.58) in men. The relative weight of the diagnosis of non-neurogenic DO in women per unit was 31.39% and 35.28%, in 2007 and 2008, and in men was 21.06% and 20.43%. The diagnostic capacity of DO was 19.28 new cases per 100,000 inhabitants/year. The diagnosis of non-neurogenic DO in the woman accounts for one third of all the urodynamic/year diagnoses and more than half of the diagnoses of DO. In men, DO accounts for 25% of the diagnoses, the most frequent one being that associated with benign prostatic hyperplasia, followed by that of neurogenic cause. Approximately half of the DO diagnoses in children correspond to non-neurogenic DO. Conclusions The differences between the capacity of diagnosis of DO (ratio per 100,000 inhabitants) is far from many of the estimations of the prevalence of OB (relationship %). The doubt may exist about whether part of this quota is secondary and not-idiopathic, given the large difference between the frequency of OB and the capacity of diagnosis of DO.

Botulinum toxin A: First-line therapy for idiopathic detrusor overactivity

Botulinum toxin A: First-line therapy for idiopathic detrusor overactivity

UP-2.34: Impact on quality of life of botulinum toxin-a in non-neurogenic detrusor overactivity refractory to anticholinergics

UP-2.34: Impact on quality of life of botulinum toxin-a in non-neurogenic detrusor overactivity refractory to anticholinergics