OAB-q SF Research Articles

Telerehabilitation Program Impact on Overactive Bladder Symptoms and Metabolic Health in Obese Women: a Randomized Controlled Trial

INTRODUCTION. Overactive bladder syndrome is caused by many factors including obesity, insulin resistance and poor dietary habits. Since it is a chronic disease and needs time to be treated, introducing telepilates in addition to Mediterranean diet would encourage better adherence and results to the treatment program. AIM. To assess the impact of a virtual group-based telerehabilitation program on overactive bladder symptoms and metabolic health in women with obesity. MATERIAL AND METHODS. Eighty obese women (BMI 30.0–34.9 kg/m2) between the ages of 35 and 45 were allocated into two equal groups, 40 for each: (A) supervised telepilates and (B) unsupervised telepilates. The supervised group participated in a 12-week Pilates workout program over videoconference platforms three times a week. Meanwhile, the unsupervised group only received four online meetings. The groups’ diet was the Mediterranean style. The Hemostatic Model of Insulin Resistance (HOMA-IR), body mass index (BMI), waist circumference (WC), Patient Perception of Urgency Scale (PPIUS), Overactive Bladder Questionnaire Short Form (OAB-q SF), and Telehealth Usability Scale (TUS) were measured. RESULTS AND DISCUSSION. The supervised telepilates group exhibited statistically significant amelioration of overactive bladder symptoms and a reduction in HOMA-IR (p 0.001), while the unsupervised telepilates group showed insignificant changes in these measures (p 0.05). Furthermore, the supervised telepilates group showed significantly greater reductions in BMI and WC (p 0.001) than the unsupervised telepilates group (p 0.05). Additionally, the supervised telegroup outperformed the unsupervised telegroup on all parameters of TUS (p 0.001) CONCLUSION. Women with obesity experienced decrease in overactive bladder symptoms and improved metabolic health after completing a 12-week telepilates training program.

Unsupervised Machine Learning Reveals a Vulvodynia-Predominant Subtype in Bladder Pain Syndrome/Interstitial Cystitis.

Background Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic condition characterized by pelvic pain and urinary symptoms. Despite its significant impact on patients' quality of life, the heterogeneity of BPS/IC symptoms and the presence of comorbidities such as vulvodynia may not be adequately captured by validated questionnaires. Identifying vulvodynia in BPS/IC patients is crucial for providing appropriate treatment options. This study aimed to identify subtypes of BPS/IC patients using unsupervised machine learning and to investigate the prevalence of vulvodynia in each subtype. Methods We conducted a prospective cross-sectional study of 123 BPS/IC patients and 64 age-matched controls. Hierarchical clustering was performed using data from validated questionnaires, including the Numerical Rating Scale-11, Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Pelvic Pain and Urgency/Frequency scores, Overactive Bladder Questionnaire Short Form (OABq SF), Overactive Bladder Symptom Score (OABSS), and Pelvic Floor Distress Inventory-20. The optimal number of clusters was determined using the elbow method, and the characteristics of each cluster were analyzed. All participants underwent a vulvodynia swab test to assess vulvodynia symptoms. Results Unsupervised machine learning revealed three distinct clusters of BPS/IC patients. Clusters 0 and 2 differed significantly, with Cluster 2 characterized by significantly higher vulvodynia scores compared to other clusters (P < 0.001). In contrast, Cluster 2 had lower bladder pain scores (ICSI and ICPI) and overactive bladder symptom scores (OABq SF and OABSS) compared to other clusters. Clusters 0 and 1 were characterized by a predominance of bladder pain and urinary frequency symptoms, with Cluster 0 exhibiting more severe symptoms. Conclusions Our study identified distinct subtypes of BPS/IC patients using unsupervised machine learning, with Cluster 2 representing a vulvodynia-predominant subtype. This finding, along with the potential of targeted therapies such as non-ablative erbium YAG laser for vulvodynia, underscores the importance of assessing extravesical symptoms, particularly vulvodynia, for the diagnosis and treatment of BPS/IC. A tailored approach, including laser therapy for vulvodynia-predominant patients, may be necessary for optimal management of BPS/IC. The vulvodynia swab test plays a crucial role in assessing vulvodynia symptoms, underlining the limitations of validated questionnaires in capturing the full spectrum of BPS/IC symptoms. A comprehensive evaluation of patients, including the vulvodynia swab test, is essential for accurate subtyping and management of BPS/IC. Further research with larger sample sizes and investigation of the relationship between identified subtypes and other clinical data is warranted to advance our understanding and management of BPS/IC.

Efficacy and sex-specific outcomes after six episodes of percutaneous tibial nerve stimulation treatment on overactive bladder syndrome symptoms

ObjectiveThis study aimed to investigate the efficacy of six episodes of percutaneous tibial nerve stimulation (PTNS) treatment for overactive bladder (OAB) symptoms in men and women and to determine the duration of the effects over a 6-month period.MethodsWomen and men with OAB symptoms participated in the study, which was conducted in accordance with an approved ethical protocol (ISRCTN15733799). Patients underwent six 30-min PTNS sessions, twice per week. The symptoms of OAB were assessed using a voiding diary, the short form of the Overactive Bladder Symptom Score questionnaire (OAB-q SF), and the Patient Perception of Bladder Condition (PPBC), which were self-completed by patients before and after treatment (24 h and at 1, 3, and 6 months). The outcome data were compared for sex and time points using two-way ANOVA for repeated measures.ResultsPTNS treatment significantly improved the OAB symptoms and quality of life in men and women. PTNS increased the voided volume (p &amp;lt; 0.05) and decreased the frequency of voiding, nocturia, and urgency at 24 h and up to 6 months (p &amp;lt; 0.001). The OABq-SF and PPBC scores were significantly decreased after PTNS (p &amp;lt; 0.001). Urgency was greater in men than in women. The duration of PTNS clinical success on frequency and the perception of improvement in quality of life were greater in women than in men.ConclusionThe clinical effects of six sessions of PTNS strongly suggest its potential for shortening, from the standard 12 sessions, to effectively alleviate symptoms of OAB. This therapeutic procedure would reduce both the time and economic costs of OAB treatment.

Evaluating symptom severity and urinary cytokine levels in interstitial cystitis/bladder pain syndrome patients, with and without Hunner's lesions.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a condition characterized in part by urinary urgency, frequency, and pain. There is a strong interest in gathering more data to compare and assess the differences in characteristics based on the presence of Hunner's lesions in patients with IC/BPS. Using a nationwide crowdsource effort, we collected surveys and urine samples from patients with a history of IC/BPS. Participants completed the Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), Overactive Bladder questionnaire (OABq SF), and pain scores. In addition, participants reported any co-morbidities and lifestyle modifications. Urinary cytokine levels were measured and compared to symptom severity. 491 participants enrolled: 119 with history of ulcerative Hunner's lesions (UIC), 372 reported no lesions (NHIC), and 2 unknowns. 96.3% were female, and prevalence of UIC was equal for both genders. Average age was higher for UIC vs. NHIC group (P = 0.011), as was the duration since diagnosis (P < 0.001). Symptom scores were elevated in UIC patients (P < 0.001). Both groups widely implemented lifestyle modifications, with dietary changes being most prevalent (70.1%), followed by prescription medication usage (63.1%). More UIC compared to NHIC participants experienced co-morbidities (P = 0.010). Urine samples were analyzed for GRO, IL-6, IL-8, and MCP-1. MCP-1 levels were significantly higher in UIC patients (P = 0.044). Weak positive correlation was found between cytokines and symptom scores. Patients with UIC and NHIC from across the United States displayed distinct phenotypic and urine biological characteristics. These findings contribute to increased understanding of IC/BPS and may aid in improving our knowledge of the condition.

Efficacy of pharmacological and non-pharmacological treatment of patients with cystocele

In patients with cystocele, the effectiveness of conservative therapy is contradictory and does not allow making recommendations for clinical practice. The aim of the study was to evaluate the efficacy of combination therapy for patients with cystocele based on electrical stimulation of the pelvic floor muscles with biofeedback and fractional photothermolysis with a CO2‑laser, alone or in combination with medications (antimuscarinics and selective β3‑agonist). The prospective randomized study included 105 patients, of whom 60 had cystocele. The patients were divided into three groups: group 1 included the patients who underwent a course of electrical stimulation of the pelvic floor muscles and photothermolysis (with fractional CO2 laser) (Physiotherapy group); in group 2, the patients received a combination of physiotherapeutic exposure and pharmacological treatment (Combination group); in group 3, the patients received only pharmacological treatment (Pharmacology group). The stimulation of the pelvic floor muscles was carried out for 10 days, the fractional CO2‑laser was used 2 times, and pharmacological treatment continued for 3 months. The bladder diary was analyzed. In group 1 there were 25 patients with cystocele, in group 2–10 patients, in group 3–25 patients with cystocele. The indicators of the bladder diary improved significantly in all groups. Increasing the urinary flow rate was more effective with physiotherapy treatment, and reducing the frequency of urination was more efficient with drug therapy. The combination therapy was the most effective. The OAB-q SF score after 3 months may be a predictor of urination frequency less than 8 times per day 6 months after therapy, and the urinary flow rate greater than 14.5 ml / sec before treatment may be a predictor of a high urinary flow rate after 3 months of therapy. Thus, in women with cystocele, the effectiveness of physiotherapy is comparable to drug therapy, and the combination therapy contributes to a better result.

Impact of Sling at Time of Prolapse Surgery on Overactive Bladder.

Prolapse surgery and sling surgery both lead to improvement in overactive bladder. However, less is known regarding how slings performed concurrently with less is know about how overactive bladder symptoms change in patients having prolapse surgery with a sling compared to prolapse surgery without a sling. The primary aim was to compare change in postoperative overactive bladder symptoms in patients with preoperative overactive bladder who underwent sling placement versus no sling with prolapse surgery. This was a secondary analysis of a cohort study evaluating overactive bladder in patients undergoing prolapse surgery. Sling procedures were performed concomitantly for treatment or prevention of stress incontinence. Baseline and 3-month follow-up urinary symptoms were assessed with the Overactive Bladder Questionnaire Short Form (OAB-q SF) and Urinary Distress Inventory-6 (UDI-6). Of patients with overactive bladder, 26 (40.0%) underwent midurethral sling (MUS) placement and 39 (60.0%) no sling. Preoperative OAB-q SF bother (score [SD], 46.8 [20.2] vs 40.2 [22.1]; P = 0.23) was similar between groups, but UDI-6 scores (59.2 [28.8] vs 43.8 [29.1]; P = 0.04) were higher in the sling group. At 3 months, the change (improvement) in OABq-SF bother (-16.9 [24.1] vs -22.4 [23.0]; P = 0.36), OABq-SF health-related quality of life (22.8 [28.6] vs 22.9 [23.9]; P = 0.99), and UDI-6 (-38.8 [32.9] vs -34.0 [27.8]; P = 0.53) were similar in the MUS and no MUS groups. Patients with prolapse and overactive bladder undergoing prolapse surgery with a sling had similar improvements in OAB-q SF bother scores compared with those who did not have a sling.

The prevalence of overactive bladder and its impact on the quality of life: A cross-sectional study

ABSTRACT Objective Overactive bladder (OAB) is a common condition affecting both men and women and has been shown to affect the quality of life. We conducted this study to estimate the prevalence of OAB, and to incorporate symptom severity, symptom bother and health-related quality of life (HRQL) in the assessment of OAB and evaluate associated factors. Methodology A total of 940 participants were categorized into non-OAB and OAB using the Overactive Bladder Symptom Score (OABSS). HRQL and symptom bother were measured using the Overactive Bladder Questionnaire – Short Form (OAB-q SF). Descriptive analyses and multivariable regression analyses were performed. Results The prevalence of OAB among our population was 27.4%. Patients with older age (Odd ratio [OR] = 2.26, 95% confidence interval [CI]: 1.6–3), higher body mass index (BMI) (OR = 2.6, 95% CI: 1.8–3.8), comorbidities (OR = 2.6, 95% CI: 1.9–3.5) and history of recurrent urinary tract infection (UTI) s (OR = 1.9, 95% CI: 1.4–2.6) were significantly associated with increased risk of OAB (p < 0.001). The mean OAB symptom bothers score was 35.7 + 22.9 and increased significantly across OAB severity groups (p < 0.001). The mean HRQL score was 73.3 + 22 and a significant decreased across OAB severity groups (p < 0.001). All OAB symptoms showed significant positive correlation with increased symptom bother (p < 0.001) in addition to significant inverse correlation with HRQL (p < 0.001). Conclusion OAB is a prevalent condition in our population and the associated symptoms negatively affect HRQL. In this study, the detrimental effect is not exclusive to UUI and can be attributed to the other elements in the symptom spectrum of OAB. Screening for OAB should be considered during routine clinical visits using validated and reliable measures for early detection of symptoms and possible modification of risk factors to improve the outcome.

Vibegron 50 mg Once Daily Improves OABSS, OAB-q SF Score in OAB Patients ≥80 Years Old in Real-World Clinical Settings and Switching from Other OAB Drugs May Reduce Residual Urine Volume.

The treatment effects of vibegron have not previously been evaluated in a prospective, non-interventional observational study of elderly Japanese patients, particularly those ≥80 years old. In addition, no reports have referred to residual urine volume in switching cases. We therefore grouped patients by condition and investigated the treatment effects of vibegron on Overactive Bladder Symptom Score (OABSS), Overactive Bladder Questionnaire Short Form (OAB-q SF), and residual urine volume in each group. This multicenter, prospective, non-interventional, observational study consecutively enrolled OAB patients with total OABSS score ≥3 and OABSS question 3 score ≥2. Sixty-three patients from six centers were recruited. Vibegron 50 mg once daily was administered for 12 weeks as first-line monotherapy (first-line group), monotherapy switching from antimuscarinics or mirabegron due to failure of prior therapy (no washout period), or combination therapy with antimuscarinics (second-line group). OABSS, OAB-q SF, and residual urine volume were collected after 4 and 12 weeks. Adverse events were also recorded at each visit. Of the 63 patients registered, 61 were eligible for analysis (first line, n=36; second line, n=25). The OABSS, excluding daytime frequency scores, and OAB-q SF scale showed significant improvement in all conditions. Switching from mirabegron to vibegron significantly reduced residual urine volume. No serious treatment-related adverse events were encountered. Vibegron 50 mg once daily significantly improved OABSS and OAB-q SF even in patients ≥80 years old. Notably, switching from mirabegron to vibegron resulted in significant improvements to residual urine volume.

MP71-18 PERIPHERAL TIBIAL NERVE STIMULATION DEMONSTRATES LIMITED IMPROVEMENT IN SELF-REPORTED SYMPTOMS FOR PATIENTS WITH OVERACTIVE BLADDER: SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP71-18 PERIPHERAL TIBIAL NERVE STIMULATION DEMONSTRATES LIMITED IMPROVEMENT IN SELF-REPORTED SYMPTOMS FOR PATIENTS WITH OVERACTIVE BLADDER: SINGLE CENTER EXPERIENCE Leo D Dreyfuss, Maryam Saghir, Christina Sze, Mary O Strasser, Dean Elterman, Naeem Bhojani, Kevin C Zorn, and Bilal Chughtai Leo D DreyfussLeo D Dreyfuss More articles by this author , Maryam SaghirMaryam Saghir More articles by this author , Christina SzeChristina Sze More articles by this author , Mary O StrasserMary O Strasser More articles by this author , Dean EltermanDean Elterman More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Kevin C ZornKevin C Zorn More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peripheral tibial nerve stimulation (PTNS) is a novel technique for treatment of overactive bladder (OAB), with demonstrated efficacy in reduction of OAB symptoms. We seek to evaluate efficacy of PTNS in self-reported reduction of OAB symptoms at a single academic urologic clinic. METHODS: Single institution cohort was performed of PTNS therapy in men and woman with refractory OAB symptoms. Overactive bladder questionnaire short form (OAB-q SF) was used to track urinary symptoms after each session of PTNS. Descriptive analysis was conducted on baseline characteristics. T-tests were used for continuous variables (or Wilcoxon signed-rank tests, as appropriate). RESULTS: 138 patients (87 women and 51 men) underwent PTNS placement during study period. Median (IQR) PTNS treatments was 11 (6-12) sessions and 56 patients (40.6%) underwent 12 or more sessions. 82 patients (59.9%) had failed previous medical therapy and 97 (70.8%) had failed previous behavioral therapy. Of men, 30 (58.8%) were on concurrent alpha blocker therapy. Pre-procedure OAB-q SF data was available for 88 patients (female, male) and post-procedure data was available for 28 patients. When comparing OAB-q SF responses before and after treatment, no difference was seen for total symptom bother score (survey items 1-6) for all participants (15.9 vs. 15.5, p=0.38), female participants (15.9 vs. 15.5, p=0.38) or male participants (19.0 vs. 18.3, p=0.41). No difference was seen for total HRQOL (survey items 7-19) for all participants (34.9 vs. 34.7, p=0.46), female participants (35.0 vs. 34.7, p=0.46) or male participants (36.1 vs. 34.9, p=0.82). Significant differences were seen for specific items within the symptom bother section of survey including item 1 “Uncomfortable urge to urinate” (female pre 2.8 vs. post 2.2, p=0.02), item 2 “Sudden urge to urinate with little or no warning” (female pre 2.8 vs. post 2.1, p=0.001) and item 5 “Waking up at night because you had urge to urinate” (pre 2.9 vs. post 2.4, p=0.02). No difference was seen for any survey items within male cohort. CONCLUSIONS: In real-world cohort of patients with OAB, PTNS has limited impact on improvement in self-reported symptom bother and quality of life. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1021 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leo D Dreyfuss More articles by this author Maryam Saghir More articles by this author Christina Sze More articles by this author Mary O Strasser More articles by this author Dean Elterman More articles by this author Naeem Bhojani More articles by this author Kevin C Zorn More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-07 COGNITIVE IMPAIRMENT, TECHNOPHILIA, AND SACRAL NEUROMODULATION DEVICE USE IN AN OLDER PATIENT POPULATION WITH OVERACTIVE BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP37-07 COGNITIVE IMPAIRMENT, TECHNOPHILIA, AND SACRAL NEUROMODULATION DEVICE USE IN AN OLDER PATIENT POPULATION WITH OVERACTIVE BLADDER Chen Shenhar, Jacquelyn Booher, Lauren Gleich, Sarah Martin, Glenn T. Werneburg, Emily Slopnick, Sandip P. Vasavada, Bradley Gill, Howard B. Goldman, and Jacqueline Zillioux Chen ShenharChen Shenhar More articles by this author , Jacquelyn BooherJacquelyn Booher More articles by this author , Lauren GleichLauren Gleich More articles by this author , Sarah MartinSarah Martin More articles by this author , Glenn T. WerneburgGlenn T. Werneburg More articles by this author , Emily SlopnickEmily Slopnick More articles by this author , Sandip P. VasavadaSandip P. Vasavada More articles by this author , Bradley GillBradley Gill More articles by this author , Howard B. GoldmanHoward B. Goldman More articles by this author , and Jacqueline ZilliouxJacqueline Zillioux More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anticholinergics, a common treatment for overactive bladder (OAB), are associated with new-onset dementia and their use for >3 months was recently cautioned against in all age groups. Non-anticholinergic therapies, including sacral neuromodulation (SNM), should therefore be optimized; however, data on SNM in older or cognitively impaired (CI) populations are limited. The aim of this study was to assess cognitive impairment, technophilia, and device utilization in an older population undergoing SNM for refractory OAB. METHODS: This is a secondary analysis of an ongoing IRB-approved prospective study on cognitive function and SNM outcomes, focusing on technophilia and device utilization. Patients aged ≥60 years undergoing test-phase SNM for refractory OAB were recruited. Cognitive function was assessed using the validated Montreal Cognitive Assessment (MoCA) tool, with scores <26/30 considered CI. Baseline functional status and technology comfort/use were assessed using a novel questionnaire, and OAB symptoms were assessed initially and at follow-up utilizing validated questionnaires (OAB-q SF, IIQ7, UDI-6, PGI-I). Patient device utilization, familiarity with communicator and ability to adjust amplitude/program were recorded at follow-up. Baseline technology use/comfort and post-implant device utilization were compared based on CI. RESULTS: Fifty-eight patients underwent test-phase (36 PNE, 22 Stage 1). Mean age was 73±8 years and 95% were women. Mean MoCA score was 23.1±4.4, and 67% met CI criteria. Forty-nine (85%) had successful test-phase, of which 45 patients have undergone full implant and 38 have available follow-up data. At baseline, patients with CI had lower use and comfort levels with various technologies (Table 1). At mean 4.1±2 months follow-up, patients with CI were less involved in changing programs (p=0.004) or amplitudes (p=0.007) on their own, but patient-reported improvement did not differ (Table 1). CONCLUSIONS: Older patients presenting for SNM for OAB have a high incidence of CI. Despite lower baseline self-reported use/comfort with technology and lower SNM device utilization post-implant among those with CI, patient-reported outcomes appear similar over short-term follow-up. Source of Funding: Investigator initiated Medtronic research grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e515 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chen Shenhar More articles by this author Jacquelyn Booher More articles by this author Lauren Gleich More articles by this author Sarah Martin More articles by this author Glenn T. Werneburg More articles by this author Emily Slopnick More articles by this author Sandip P. Vasavada More articles by this author Bradley Gill More articles by this author Howard B. Goldman More articles by this author Jacqueline Zillioux More articles by this author Expand All Advertisement PDF downloadLoading ...

Urinary Biomarkers and Overactive Bladder Symptoms Before and After Prolapse Surgery.

Women with pelvic organ prolapse (POP) have increased prevalence of overactive bladder (OAB) and the evaluation of urinary biomarkers associated with OAB in the setting of POP is limited. The objective is to determine whether associations exist between urinary biomarkers measured before POP surgery with postoperative OAB symptoms. In this prospective cohort study, women with anterior and/or apical POP beyond the hymen undergoing POP surgery were assessed using the OAB Questionnaire Short Form (OAB-q SF) and the Urogenital Distress Inventory 6 (UDI-6) preoperatively and 3 months postoperatively. A first morning voided urine specimen was collected preoperatively and 3 months postoperatively. Urinary biomarkers for inflammation, neuroinflammation, and tissue remodeling were measured. Univariate generalized linear models measured the relationship between biomarkers and symptoms. Between- and within-cohort assessments were made using 2-sample paired and unpaired t tests, respectively. Seventy-seven participants with OAB (n = 67, 87.0%) and without OAB (n = 10, 13.0%) were enrolled. Seventy-four participants (96%) completed 3-month follow up. The OAB-q SF and UDI-6 scores significantly improved between preoperative and postoperative measures. Preoperative urinary biomarkers did not demonstrate significant correlations with postoperative OAB-q SF or UDI-6 scores. No significant differences were measured in preoperative biomarkers between patients with and without OAB or when comparing preoperative and postoperative biomarkers in patients with OAB. Urinary biomarkers for tissue remodeling, inflammation, and neuroinflammation were not significantly correlated with OAB symptoms in a population of patients with OAB and POP.

Mid-term results of water vapor thermal therapy in patients with lower urinary tract symptoms related to benign prostatic hyperplasia

ObjectiveIn this study, we evaluate the short- and mid-term results of water vapor thermal therapy (WVTT) for LUTS (lower urinary tract symptoms) due to benign prostatic hyperplasia (BPH).MethodsPatients with LUTS due to BPH who underwent WVTT from September 2019 to April 2022 were included in this prospective, single-center study. Data regarding functional and sexual outcomes were evaluated by validated questionnaires as well as uroflowmetry, urinalysis and cultures, digital rectal examination, serum prostate-specific antigen, and transrectal ultrasound. The patients were followed-up with 3, 6, 12, and 18 months after the procedure.ResultsEighty-four men were treated. Mean ± SD prostate volume, operative time, and hospital stay were 76.9 ± 26.3 ml, 14 ± 18.5 min, and 0.9 ± 0.7 days, respectively. The catheter was removed after 7 ± 4.4 days. A significant (p &amp;lt; 0.05) improvement in Qmax, IPSS, QoL, OAB-q SF, ICIQ-SF, and IIEF- 5 from the baseline at the last follow-up (18 months) was recorded. Seventy-six (90%) patients reported a significant improvement in ejaculatory function (de novo dry ejaculation in 4 patients). Early (≤30 days) postoperative complications were reported in 70% of patients, all grade 1 according to Clavien–Dindo. No late (&amp;gt;30 days) Clavien–Dindo &amp;gt;1 procedure-related complications occurred. Three patients required reoperation (6–12 months after surgery).ConclusionWVTT is an effective and safe treatment for the management of LUTS due to BPH in the short- and mid-term follow-up, and it provides negligible sequelae with respect to ejaculation.

Association of lower urinary tract symptoms and diuretic adherence.

To assess whether more severe urinary symptoms and poorer quality of life among patients on diuretic therapy are associated with decreased adherence to the diuretic regimen. Participants were recruited via ResearchMatch.org and sent a REDCap survey. The Overactive Bladder Questionnaire-Short Form (OAB-q SF) was used to assess urinary symptom bother and health-related quality of life (HRQL). Participants were asked if they skip diuretic doses due to urinary symptoms with a bivariate (yes or no) outcome. Subgroup analyses of loop vs non-loop diuretic and those taking the diuretic for a cardiovascular indication (hypertension or heart failure) were performed. A total of 4029 surveys were sent, 285 were returned (7.1% response rate), and 279 were included in the study. Fifty-three participants admitted to skipping diuretic doses due to urinary symptoms. Lower HRQL scores were significantly associated with poorer adherence scores among all participants (P < .001), among participants taking a loop diuretic (P < .001), and among participants with hypertension and heart failure (P < .039). Association between symptoms and adherence remained significant after adjustment in the multivariate model for the whole cohort and loop diuretic subgroup but lost significance in the hypertension and heart failure subgroup. Worsening quality of life due to urinary symptoms may be associated with poorer adherence to diuretics, particularly loop diuretics.

Efficacy of 3 Tesla Functional Magnetic Stimulation for the Treatment of Female Urinary Incontinence.

Functional magnetic stimulation (FMS) is a new technique for the conservative treatment of Urinary incontinence (UI), based on magnetic induction. It induces controlled depolarization of the nerves, resulting in pelvic muscle contraction and sacral S2-S4 roots neuromodulation. The aim of this study was to assess the efficacy of the new 3 Tesla FMS chair, both in patients with pure stress urinary incontinence (SUI) and in women with pure overactive bladder (OAB) symptoms. A prospective observational study was conducted in our urogynaecologic unit. All the patients involved were consecutive women with pure SUI or pure OAB symptoms treated by a 3 Tesla electromagnetic chair. The primary outcome was a subjective outcome evaluation by the PGI-I Scale and a patient-satisfaction scale. The secondary outcome was the change score of the UDI-6, IIQ-7, ICIQ-SF and OAB-q SF questionnaires from baseline to final visit. At 2 months follow-up, 28 out of 60 patients (47%) with SUI symptoms and 20 out of 40 patients (50%) with OAB symptoms declared themselves cured. Considering cured and improved patients, the subjective cure rates were 68.3% (41/60) and 70% (28/40) for patients with SUI and OAB symptoms, respectively. The results of this study showed that the 3 Tesla electromagnetic chair may be an effective option for the treatment of UI.

PD34-04 IMPACT OF COGNITIVE FUNCTION IN OLDER PATIENTS UNDERGOING SACRAL NEUROMODULATION FOR OVERACTIVE BLADDER: A PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 May 2022PD34-04 IMPACT OF COGNITIVE FUNCTION IN OLDER PATIENTS UNDERGOING SACRAL NEUROMODULATION FOR OVERACTIVE BLADDER: A PROSPECTIVE STUDY Jacqueline Zillioux, Sarah Martin, Lauren Gleich, Glenn T. Werneburg, Emily Slopnick, Raymond R. Rackley, Sandip Vasavada, Bradley Gill, and Howard B. Goldman Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Sarah MartinSarah Martin More articles by this author , Lauren GleichLauren Gleich More articles by this author , Glenn T. WerneburgGlenn T. Werneburg More articles by this author , Emily SlopnickEmily Slopnick More articles by this author , Raymond R. RackleyRaymond R. Rackley More articles by this author , Sandip VasavadaSandip Vasavada More articles by this author , Bradley GillBradley Gill More articles by this author , and Howard B. GoldmanHoward B. Goldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002585.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) and cognitive impairment (CI) are both increasingly prevalent with age. Given the association between anticholinergics and dementia, there is need to optimize other therapies. SUFU/AUA OAB guidelines cite adequate cognitive function as necessary for sacral neuromodulation (SNM); however, the impact of CI on SNM in older patients remains unknown. This is an interim analysis of a prospective study assessing the impact of cognitive function on outcomes of SNM for refractory OAB. METHODS: With IRB-approval, we recruited patients aged ≥60 years scheduled for test-phase (peripheral nerve evaluation (PNE) or stage 1) SNM for refractory OAB. Baseline cognitive function was assessed using the validated Montreal Cognitive Assessment (MoCA) screening test. Scores ≥26/30 are considered normal and <26 considered CI. Patients completed validated questionnaires (OAB-q SF, IIQ7, UDI-6, PGI-I) at baseline and 1-month follow-up (if implanted). Number of program adjustments performed by the patient and whether patients demonstrated appropriate device use (i.e. familiarity with communicator/programmer) were recorded. Implant rate, patient-reported questionnaires, and SNM utilization were compared based on MoCA/CI. RESULTS: 27 patients underwent test-phase (17 PNE, 10 Stage 1). Mean age was 71.9 (6.7) years. Median baseline MoCA was 24 [21.5,26.5], ranging 14-29. Although 5 (19%) patients had a pre-existing CI diagnosis, 16 (59%) demonstrated CI per MoCA. The table compares patient characteristics, baseline questionnaires and utilization outcomes based on CI. Overall, 23 (85%) patients underwent permanent implant after successful test-phase. Implant rates did not differ based on MoCA or CI. Among 15 patients with 1-month follow-up, those demonstrating appropriate device use had significantly higher MoCA scores (26 vs 17, p=0.004). Postoperative change in validated questionnaires scores, however, did not differ. CONCLUSIONS: Despite few pre-existing diagnoses, there is a high incidence of CI in older patients with OAB undergoing SNM. While implant rate did not differ based on MoCA/CI, patients with lower MoCA scores were less likely to demonstrate appropriate device use on follow-up. Impact on clinical efficacy of SNM remains to be determined. Source of Funding: Medtronic © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e560 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacqueline Zillioux More articles by this author Sarah Martin More articles by this author Lauren Gleich More articles by this author Glenn T. Werneburg More articles by this author Emily Slopnick More articles by this author Raymond R. Rackley More articles by this author Sandip Vasavada More articles by this author Bradley Gill More articles by this author Howard B. Goldman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Does urinary urgency drive urinary frequency in overactive bladder?

To determine if reduction in urgency in patients with refractory overactive bladder syndrome (rOAB) is correlated with a reduction in voiding frequency and symptom bother. Data from a prospective series of women with rOAB undergoing radiofrequency ablation of the subtrigonal tissue, termed selective bladder denervation (SBD), was analyzed. Main outcome measures included urgency voids, nonurgency voids, and urgency urinary incontinence (UUI) epidsodes from a 3-day voiding diary and quality of life (QoL) measures (Overactive Bladder Questionnaire Short Form [OAB-q SF]). The dataset comprised 62 completer subjects at 6 months. Compared to baseline, UUI and urgency voids were lower (P < .001), but nonurgency voids were increased (P < .001) and QoL measures were improved (P < .001), but functional bladder capacity did not increase. At baseline and 6 months post treatment, symptom bother was correlated with urgency voids (P < .05) but inversely correlated with nonurgency voids (P < .001). Urgency and nonurgency voids were inversely related at baseline and at 6 months (P < .0001). Following treatment, urgency voids decreased by 41% and nonurgency voids increased by 33%. As with other interventions for OAB, SBD resulted in a reduction in OAB symptoms and an improvement in QoL measures. However, the decrease in urgency voids was offset by an increase in nonurgency voids, suggesting that habit or defensive voiding is a significant driver of urinary frequency. It is not certain if this is a unique finding of the SBD effect, but these data do suggest that analyses of outcomes of other OAB interventions are warranted to gain a better understanding of the genesis of OAB symptoms.

Outcomes of a complementary and alternative medicine based on vitamins, herbal products, and amino acid as a first line treatment in idiopathic overactive bladder syndrome in men and women without bladder outlet obstruction.

To evaluate the efficacy and tolerability of a complementary and alternative medicine (CAM) called Kubiker (Naturmed, Montegranaro, FM, Italy), consisting of vitamins (C and D), herbal products (cucurbita maxima, capsicum annum, polygonum cuspidatum), and amino acid L-Glutamine, as first line treatment of (OAB). According to institutional protocols, data on patients addressing to a tertiary referral centre for OAB symptoms were recorded. OAB was evaluated through validated questionnaires including ICIQ-SF, USS, and OAB-q-SF. Patients with previous antimuscarinic or β3 agonist treatment, neurological disease or pathologies which may mimic OAB, including infections, were excluded. Only unobstructed patients were considered and were given CAM twice daily for 12 weeks. After treatment, symptoms were re-evaluated repeating previous questionnaires and PGI-I was given to evaluate perceived improvement. A total of 41 patients were evaluated and 35 respected inclusion criteria and were enrolled. All subjects had a full compliance and adherence with CAM medication intake. The median patient's age was 65 (56-73). Male were 8 (22.9%) while females were 27 (77.1%). Median baseline OAB-q SF and ICIQ-SF scores were 18 (15-25) and 9 (6-13), respectively. After treatment, 85.7% patients had a clinical benefit, with a significant reduction of OAB symptoms, also according to USS (p < 0.01). The median OAB-q SF and ICIQ-SF scores were 10 (7-15) and 6 (0-8) (p < 0.01). CAM was successful with an improvement in subjective patient's satisfaction, with a median PGI-I score of 2 (1-3). Patients (men and women) who still had UUI after 3 months CAM medication were eight (22.8%), and among them, those who did not refer any therapeutic benefit were five (14.3%). According to our study, CAM may be useful medication for a first line treatment of uncomplicated idiopathic OAB cases, providing a nonnegligible effects on symptoms. However, further studies are mandatory to draw definitive conclusions.

The safety and effectiveness of mirabegron in Parkinson’s disease patients with overactive bladder: a randomized controlled trial

Purpose To assess the safety and effectiveness of mirabegron in patients with PD complaining of overactive bladder (OAB). Patients and methods From January 2017 to November 2020, we performed a prospective randomized, double-blind, placebo-controlled trial that enrolled PD patients with symptoms of OAB. The total duration of the study was 13 weeks, comprising a 1-week screening period and a 12-week treatment period. A total of 110 patients were randomized in one of two groups: treatment group (mirabegron 50 mg) or placebo group. The primary outcomes of our study were the change from baseline in OAB symptom score (OABSS) and the overactive bladder questionnaire short form (OAB-q SF) score. The secondary outcomes were the change from baseline in the mean number of micturitions/24 hours, the mean number of urgency episodes/24 hours, the mean number of urgency incontinence episodes/24 hours and the mean number of nocturia episodes/night, volume voided/micturition (ml) as recorded on a 3-day bladder diary. Safety assessments included adverse events, electrocardiogram, QT corrected for heart rate using Fridericia’s correction (QTcF) interval and blood pressure and pulse rate measurements. Results There was a significant improvement in the primary outcome and secondary outcome measures in the treatment group compared to the placebo group. Adverse events were mild and the same in the two groups. The cardiovascular safety profile was high. This study is limited by its sample size and its short follow-up period. Conclusions Mirabegron is a promising drug to control OAB symptoms in patients with PD with an excellent safety profile.

Prevalence of overactive bladder symptoms and their impact on health-related quality of life of medical and dentistry students: a multicenter cross-sectional study

BackgroundOveractive bladder (OAB) is a popular distressing health condition that has negative impact on health-related quality of life (HRQoL) of the inflicted individuals. This multicenter study was conducted to determine the prevalence of OAB symptoms and their impact on the HRQoL of medical and dentistry students.MethodsThis study was conducted in a cross-sectional design in the 3 main universities in Palestine. In addition to the sociodemographic, health, and academic characteristics of the medical and dentistry students, the questionnaire also contained the OAB symptom bother (6-items) and HRQoL (13-items) Short-Form (OAB-q SF) scales. Kruskal–Wallis test, Mann–Whitney U test, Pearson Chi-Square/Fisher's Exact Test, Spearman’s rank correlations, and a multiple linear regression model were used to analyze the data.ResultsResponses were collected from medical and dentistry students (n = 402). The median OAB symptom bother score was 54.1 [44.8, 81.9] and the median HRQoL score was 94.4 [88.4, 94.4]. There was a strong negative correlation between the OAB and HRQoL scores (Spearman’s rho = 64.4%, p value < 0.001). OAB scores were significantly higher among dentistry students, females, who had chronic disease, and those who reported stressful life. HRQoL scores were significantly higher among medicine students, those who reported less stressful life, and those who reported satisfaction with their social life. Dentistry students, female, and those who self-reported high stress were 1.94-fold (95% CI 1.05, 3.56), 1.91-fold (95% CI 1.16, 3.14), and 1.88-fold (95% CI 1.21, 2.91) more likely to report less than optimal HRQoL compared to medicine students, male, and those who self-reported low stress, respectively.ConclusionsOur findings suggested that OAB symptoms were prevalent among medical and dentistry students across Palestinian universities. Decision makers in academia, healthcare authorities, and advocacy groups might need to design appropriate interventions to address health and wellbeing issues of medical and dentistry students. Using appropriate diagnostic procedures, reducing stress, and improving the social life might help in reducing the burden on OAB and improve the HRQoL of medical and dentistry students. More investigations should be conducted to investigate if such interventions are effective in reducing OAB symptoms and improving HRQoL.

Water vapor therapy (Rezūm) for lower urinary tract symptoms related to benign prostatic hyperplasia: early results from the first Italian multicentric study.

PurposeRezūm is the latest developed minimally invasive treatment for benign prostatic hyperplasia (BPH). We aimed to carefully assess the functional outcomes of patients treated with Rezūm for BPH.MethodsWe prospectively followed 135 consecutive patients treated by Rezūm at 5 institutions from June 2019 to August 2020. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), the Overactive Bladder Questionnaire-Short Form (OAB-q SF) score, the International Index of Erectile Function (IIEF-5) and questions 9 and 10 to assess ejaculatory dysfunction were recorded.Election criteria were age > 18, no prior prostate interventions, IPSS ≥ 13, post-void residual ≤ 250 mL, prostate volume between 30 and 120 cc.ResultsThe median operative time was 10.5 (IQR 8.7–15) min. All patients were dismissed few hours after surgery with indwelling urinary catheter that was removed after a median of 7 (IQR 7–10) days. A significantly decrease of IPSS from baseline at first (p = 0.001) and third (p < 0.0001) month after surgery was reported. No difference was reported in terms of ICIQ-UI SF score postoperatively. A mild reduction of the OAB-q SF score was reported at 1 month from surgery (p = 0.06) that turned significant at 3 months postoperatively (p < 0.0001). A slight but statistically significant increase of the IIEF-5 score was reported from baseline at 6 months (p = 0.04). Postoperatively, patients reported a significantly decrease of ejaculatory dysfunction after alpha-blocker interruption.ConclusionRezūm treatment is a feasible minimally invasive option for patients with BPH symptoms and showed optimal early functional outcomes.