Management Of Overactive Bladder Research Articles

512 - The placebo effect and the future direction in management of overactive bladder: A systematic review and meta-analysis

512 - The placebo effect and the future direction in management of overactive bladder: A systematic review and meta-analysis

Vibegron 50 mg is the optimal algorithm in the pharmacologic management of overactive bladder: outcomes from a systematic review and meta-analysis

The efficacy and safety of vibegron, which is a novel β3-adrenoceptor agonist, need to be systematically evaluated in the treatment of overactive bladder (OAB) patients. This study aimed to assess, using meta-analytic methods, the efficacy and safety of vibegron for OAB compared with placebo or antimuscarinics, considering all available data from comparative studies. A systematic search was performed on MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials database to identify studies from their date of inception before 15 March 2020. Meta-analysis was performed based on eligible studies. Six studies derived from four clinical trials with 4314 randomized patients were finally included in our analysis. We found that vibegron 50mg and 100mg were both significantly more efficacious than placebo for all efficacy outcomes. Furthermore, no significant differences were found between vibegron 50mg or 100mg and placebo for all the AEs assessed. In addition, the efficacy between vibegron 50mg or 100mg and antimuscarinics were comparable except for voided volume. Moreover, vibegron was associated with a decreased risk of dry mouth and an increased risk of nasopharyngitis versus antimuscarinics. Our study also demonstrated that the vibegron 50mg and 100mg were equally effective and safe across all the efficacy and AEs' outcomes. Vibegron is effective and safe for treating patients with OAB. Based on the current evidence, we recommended that the initial use of vibegron 50mg was the optimal algorithm in the pharmacologic management of OAB.

Effectiveness of the transcutaneous tibial nerve stimulation and pelvic floor muscle training with biofeedback in women with multiple sclerosis for the management of overactive bladder

Background: Overactive bladder (OAB) is common in patients with multiple sclerosis (MS) with a limited number of treatment options. Objective: To investigate the effect of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on OAB symptoms in female MS patients. Methods: This study was conducted at the outpatient MS clinic in Istanbul. At baseline bladder diary, post-voiding residue (PVR), OAB, and Qualiveen Scales (QoL: Quality of Life; Siup: Specific Impact of Urinary Problems on QoL) were assessed. Patients were allocated to receive TTNS or PFMT daily for 6 weeks and reevaluated using the same tests. Results: Fifty-five patients (TTNS = 28, PFMT = 27) were included. Compared with baseline, both TTNS and PFMT groups improved in terms of OAB (p = 0.0001, p = 0.0001), Qualiveen-siup (p = 0.0001, p = 0.0001), Qualiveen-QoL (p = 0.002, p = 0.006), PVR (p = 0.0001, p = 0.21), frequency (p = 0.0001, p = 0.69), nocturia (p = 0.0001, p = 0.19), urgency (p = 0.0001, p = 0.0001), and urge incontinence (p = 0.0001, p = 0.0001). Between-group comparisons showed significant differences in 24-hour frequency (p = 0.002) in favor of TTNS. Conclusion: Our study demonstrates the efficacy of both TTNS and PFMT for managing OAB symptoms in MS, associated with a significant impact on QoL, but did not show superiority of the methods. Further studies are needed to explore differences between these two non-invasive treatments.

The Role of Urodynamic Testing Prior to Third-Line OAB Therapy

This review outlines current guidelines and evidence for the use of urodynamic testing prior to the initiation of third-line overactive bladder (OAB) treatment options. OAB currently affects many patients with a significant impact on quality of life as well as health care resources. Treatment algorithms proceed from least to most invasive in an attempt to ameliorate symptoms, namely, urgency, frequency, and urgency incontinence. The current third-line OAB management strategies include percutaneous tibial nerve stimulation (PTNS), sacral nerve stimulation (SNS), and onabotulinumtoxinA injection. These modalities are reserved for patients that have gained insufficient symptom control or are intolerant of less invasive treatments. Urodynamic studies (UDS) are typically performed to help guide treatment planning and/or to evaluate for harmful urologic conditions. Currently available studies do not show a clear link between UDS results and treatment OAB success. The finding of detrusor overactivity (DO) has not been clearly established as a prerequisite to have clinical benefit with third-line OAB treatments in the uncomplicated idiopathic OAB patient population. There is some evidence that patients with DO on UDS may benefit more; however, additional blinded placebo-controlled studies are needed. Urodynamics should be used judiciously for patients with known or suspected voiding phase dysfunction, those with rapidly changing symptoms, those in whom the diagnosis is not clear, those who have medical or urological histories that can affect outcomes of treatment, and in those with known or suspected neurological disease. Although urodynamics may influence clinical decision-making, our review does not support the role of these investigations as predictors of outcomes in patients with uncomplicated, idiopathic overactive bladder.

Is urodynamic evaluation able to change and improve the management of women with idiopathic overactive bladder?

For women with overactive bladder (OAB), current guidelines recommend the use of urodynamic studies (UDS) only in complicated cases. This study aimed to investigate whether UDS can also be helpful in uncomplicated cases. Specific aims of the study were: 1) to evaluate objective benefit and subjective patient satisfaction with tailored treatment based on the UDS diagnosis compared to the outcomes of the pharmacological treatment only based on the symptoms; 2) to investigate the correlation between symptoms and UDS findings in women with uncomplicated idiopathic OAB symptoms; 3) to assess the ability of UDS to modify management decisions in these patients. Women presenting to our clinic with a history of uncomplicated OAB symptoms for the past three months or more, and who completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), were considered for this study. We proposed UDS to all participants. In women who accepted UDS (group 1), management decisions were made on the basis of urodynamic findings and post-treatment evaluation was scheduled at three months. The outcomes of treatments in these patients were compared to the results in women who did not accept UDS and who received pharmacological treatment symptoms-based (group 2). Objective outcomes were based on completion of a 3-day micturition diary. Subjective outcomes were captured using the Overactive Bladder Questionnaire Short Form (OABq-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a patient satisfaction scale. A total of 680 women were enrolled in the study; 478 underwent UDS and 202, at the contrary, declined UDS. In 53.6% of cases, UDS led to modification of the proposed management approach. At the 3-month follow-up, the overall patient satisfaction rate in group 1 and group 2 was 77% and 65.8%, respectively (P=0.003). We showed that OAB management tailored according to the UDS diagnosis results in higher subjective satisfaction if compared with a pharmacological treatment symptoms-based. Our study confirmed a lack of correlation between OAB symptoms and the urodynamically proven diagnosis of detrusor overactivity (DO). It also suggested that UDS can determine the underlying pathophysiology of every woman with OAB syndrome, whether complicated or uncomplicated, allowing treatment to be appropriately tailored with better results.

Undertreatment of overactive bladder among men with lower urinary tract symptoms in the United States: A retrospective observational study.

AimsTo characterize the epidemiology and treatment patterns of adult men (≥40 years) diagnosed with, or treated for, overactive bladder (OAB) and/or benign prostatic hyperplasia (BPH).MethodsThis retrospective observational study used data extracted from the IBM MarketScan Commercial Claims and Encounters database and the Medicare Supplemental Coordination of Benefits database. Men with BPH and/or OAB were identified and observed to assess treatment and diagnostic patterns.ResultsWithin the entire study sample (N = 462 400), BPH diagnosis (61.5%) and BPH treatment (73.7%) were more common than the corresponding values for OAB (25.8% and 7.0%, respectively). Notably, among diagnosed individuals, the dispensation of a corresponding treatment was more likely in individuals diagnosed with BPH (183 672 out of 284 416 = 64.6%) compared with OAB (16 468 out of 119 236 = 13.8%). Among newly diagnosed and/or treated patients (n = 196 576), only 60.3% received treatment. Among treated patients, most experienced only a single type of treatment (93.4%), 6.6% went on to receive a secondary treatment and 3.5% a tertiary. The most common primary treatment was alpha‐blocker monotherapy (76.9%) followed by tadalafil monotherapy (16.4%). Among those untreated at first diagnosis, the median time between diagnosis and treatment initiation was 128 days.ConclusionsDiagnosis and management of OAB among males are challenging given the inherent overlap in symptoms observed with BPH. Unsurprisingly, we found that BPH is diagnosed and treated more frequently than OAB; but the differences between diagnosis and treatment patterns for the two conditions highlight the potential undertreatment of OAB and misdirection of therapy for men with a combination of voiding and storage symptoms.

Management of Patients with Overactive Bladder in Brazil: A Retrospective Observational Study Using Data From the Brazilian Public Health System.

IntroductionIn Brazil, current data on the use of healthcare resources to manage individuals with overactive bladder (OAB) are lacking. This study aimed to characterize contemporary treatment and the economic burden among patients with OAB managed under the Brazilian public health system (Sistema Único de Saúde [SUS]).MethodsPopulation-based data from January to December of 2015 were acquired from Brazil’s public health database. Adults at least 18 years of age with an ICD-10 diagnostic code for OAB within the period were included. Records of outpatient visits, hospitalizations, and onabotulinumtoxinA injections were used to calculate estimates of resource use and costs (in Brazilian reals [R$]) among those with OAB (frequency [%] and mean (standard deviation [SD]) as appropriate). Patient identifiers were not available, so a record linkage methodology was used to match medical encounters to individuals. Pharmacologic management of OAB was informed by government medication purchases available from the official Brazilian government databases.ResultsDuring 2015, 26,640 patients with OAB were identified. All cohort members had at least one outpatient visit and 15,349 (57.6%) were hospitalized. Of the study cohort, 10.0% visited a general practitioner (GP), 41.3% visited a specialist, and 52.0% visited other non-medical healthcare practitioners within the year. Mean (SD) healthcare costs among the study cohort totaled R$355 (R$866) per patient per year; and were R$291 (R$654), R$27 (R$130), R$27 (R$30), and R$11 (R$17) for hospitalizations, GP, specialist, and non-medical healthcare practitioner visits per patient per year, respectively. Regional analysis of reported government medication purchases suggested that access to OAB treatments is highly limited.ConclusionsHigh resource use and costs were estimated among patients with OAB managed within the SUS. These data provide a snapshot of the management of patients with OAB in Brazil, with the patients seeking treatment under SUS likely representing a more burdened subpopulation.Electronic Supplementary MaterialThe online version of this article (10.1007/s12325-020-01318-w) contains supplementary material, which is available to authorized users.

Comparing the Efficacy of OnabotulinumtoxinA, Sacral Neuromodulation, and Peripheral Tibial Nerve Stimulation as Third Line Treatment for the Management of Overactive Bladder Symptoms in Adults: Systematic Review and Network Meta-Analysis.

The American Urological Association guidelines for the management of non-neurogenic overactive bladder (OAB) recommend the use of OnabotulinumtoxinA, sacral neuromodulation (SNM), and peripheral tibial nerve stimulation (PTNS) as third line treatment options with no treatment hierarchy. The current study used network meta-analysis to compare the efficacy of these three modalities for managing adult OAB syndrome. We performed systematic literature searches of several databases from January 1995 to September 2019 with language restricted to English. All randomized control trials that compared any dose of OnabotulinumtoxinA, SNM, and PTNS with each other or a placebo for the management of adult OAB were included in the study. Overall, 17 randomized control trials, with a follow up of 3–6 months in the predominance of trials (range 1.5–24 months), were included for analysis. For each trial outcome, the results were reported as an average number of episodes of the outcome at baseline. Compared with the placebo, all three treatments were more efficacious for the selected outcome parameters. OnabotulinumtoxinA resulted in a higher number of complications, including urinary tract infection and urine retention. Compared with OnabotulinumtoxinA and PTNS, SNM resulted in the greatest reduction in urinary incontinence episodes and voiding frequency. However, comparison of their long-term efficacy was lacking. Further studies on the long-term effectiveness of the three treatment options, with standardized questionnaires and parameters are warranted.

Risk of Mortality Associated with Non-selective Antimuscarinic medications in Older Adults with Dementia: a Retrospective Study.

Selective antimuscarinics may offer a favorable safety profile over non-selective antimuscarinics for the management of overactive bladder (OAB) in patients with dementia. To test the hypothesis that non-selective antimuscarinics are associated with increased risk of mortality compared to selective antimuscarinics in older adults with dementia and OAB. Propensity score-matched retrospective new-user cohort design among Medicare beneficiaries in community settings. Older adults with dementia and OAB with incident antimuscarinic use. The primary exposure was antimuscarinic medications classified as non-selective (oxybutynin, tolterodine, trospium, fesoterodine) and selective (solifenacin, darifenacin) agents. All-cause mortality within 180days of incident antimuscarinic use formed the outcome measure. New users of non-selective and selective antimuscarinics were matched on propensity scores using the Greedy 5 → 1 matching technique. Cox proportional-hazards model stratified on matched pairs was used to evaluate the risk of mortality associated with the use of non-selective versus selective antimuscarinics in the sample. The study identified 16,955 (77.6%) non-selective antimuscarinic users and 4893 (22.4%) selective antimuscarinic users. Propensity score matching yielded 4862 patients in each group. The unadjusted mortality rate at 180days was 2.6% (126) for non-selective and 1.6% (78) for selective antimuscarinic users in the matched cohort (p value < 0.01). The Cox model stratified on matched pairs found 50% higher risk of 180-day mortality with non-selective antimuscarinics as compared to selective ones (hazard ratio (HR) 1.50; 95% confidence interval (CI) 1.04-2.16). The study findings remained consistent across multiple sensitivity analyses. Use of non-selective antimuscarinics was associated with a 50% increase in mortality risk among older adults with dementia and OAB. Given the safety concerns regarding non-selective antimuscarinic agents, there is a significant need to optimize their use in the management of OAB for older patients with dementia.

Impact of urodynamic evaluation on the treatment of women with idiopathic overactive bladder: a systematic review.

Overactive bladder (OAB) is a common clinical condition affecting women. The impact of urodynamics (UDS) on the management of idiopathic OAB in women is highly debated. This systematic review analyzes the impact of UDS on the choice and on the outcomes of treatment of female idiopathic OAB. A systematic literature search in the PubMed/Medline, Web of Science, Scopus and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement to identify clinical trials, randomized controlled trials, meta-analyses, and guidelines on female OAB and UDS published from 2000. A total of 1554 records were initially identified and 12 articles were included in the final qualitative synthesis. UDS represents the main tool to diagnose detrusor overactivity (DO) in OAB female patients which is considered one of the major OAB underlying pathophysiology factor. UDS can underline the presence of voiding dysfunction that could be considered as another underlying cause of uncomplicated female OAB. On the basis of this urodynamic findings, we can better define different aspects of OAB syndrome leading to a more tailored and proper treatment. UDS can have a useful role in the diagnosis of idiopathic OAB in women given the possibility to gain a precise diagnosis and, therefore, a tailored treatment based on the underlying cause. The integration of clinics with UDS and all the other diagnostic available tools is desirable.

Advances in pharmacotherapy for the treatment of overactive bladder.

To present the current literature on the pharmacologic management of overactive bladder, including combination therapies, agents still in clinical development, and special considerations related to individuals with cognitive decline, frailty and cardiovascular risk. Combination therapy is shown to be more effective than monotherapy, without additional side effects. Preliminary studies on novel treatment methods, including new medications, as well was novel use of established medications, demonstrates improved efficacy with a favorable side effect profile. Investigation into new target pathways may be an area for future pharmacologic development. Special consideration should be given when prescribing anti-muscarinic medication in the frail adult population. Overactive bladder has been associated with frailty and anti-muscarinic medications have been associated with the worsening cognitive decline. Combination therapy is a safe and effective alternative to patients with refractory overactive bladder. Caution should be taken in prescribing medications for the frail older adult, and alternative first- and third-line treatments should be considered. Future studies should involve long term data on safety and outcomes stratified by age with objective measurements of cognition and frailty.

Overactive Bladder in Diabetes Mellitus

To explore the current literature regarding the epidemiology, pathophysiology, diagnosis, and management of overactive bladder in diabetic patients. Overactive bladder is a syndrome complex of urinary urgency, often accompanied by frequency and nocturia. Several studies have established the relationship between diabetes mellitus and bladder dysfunction. However, there is limited literature available to evaluate the prevalence of overactive bladder in this population and to guide clinical practice. The introduction of medications such as mirabegron and minimally invasive techniques such as intravesicular onabotulinumtoxinA injections has resulted in a shift in the treatment model for overactive bladder. New technologies for treatment such as radiofrequency therapy are also under active development. Ongoing research seeks to further understand the mechanisms involved in the pathogenesis of overactive bladder and identify biomarkers. With the increasing prevalence of diabetes mellitus, it is expected that patients with overactive bladder symptoms will be seen more frequently. The American Urological Association (AUA) and Society of Urodynamics and the Female Pelvic Medicine & Urogenital Reconstruction (SUFU) recently updated the guidelines for the diagnosis for overactive bladder in 2019. However, there are important considerations in diabetic patients that may alter clinical evaluation and management. We tried to shed some light on these diagnostic considerations and the management options available to diabetic patients.

Initial Evaluation of a Novel Modulated Radiofrequency-based Bladder Denervation Device

ObjectiveTo determine if targeted and modulated radiofrequency ablation (RFA) of the urinary bladder using our novel ablation device (Denerblate) reduces bladder nerve density, potentially leading to a novel strategy for the management of overactive bladder. MethodsFifteen pigs were divided into 4 groups: control (n = 3), 1-week (n = 4), 4-week (n = 4) and 12-week (n = 4) survival times. Denerblate was deployed on the trigone area of the bladder. Three 240-second cycles of modulated RFA were applied with 30 seconds between cycles. At the end of each survival term, urinary bladders were harvested for histopathologic evaluation. Nerve count and density were manually calculated. ResultsAll procedures were successfully completed, and all animals survived to the desired time points. Mean nerve density (nerves/mm2) was highest in the control and 1-week survival group compared to the 4-week and 12-week groups, both of which demonstrated significant diminishment. Nerve density in the bladder neck at control, 1 week, 4 weeks, and 12 weeks were 1.8, 1.35, 0.87, and 0.12, respectively (P <.001). Nerve density in the bladder trigone area at control, 1 week, 4 weeks, and 12 weeks were 1.5, 0.98, 0.65, and 0.112, respectively (P <.001). Epithelial heat injury was observed in 14.3% at 1 week, 10.7% at 4 weeks, but completely resolved by 12 weeks. ConclusionIn the porcine model, modulated RFA delivered by our novel device reduced nerve density in the bladder neck and trigone by 88.6% and 88.9% at 12 weeks without evidence of lasting epithelial injury.

Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.

The purpose of this guideline is to provide a clinical framework for the diagnosis and treatment of non-neurogenic overactive bladder (OAB). The primary source of evidence for the original version of this guideline was the systematic review and data extraction conducted as part of the Agency for Healthcare Research and Quality (AHRQ) Evidence Report/Technology Assessment Number 187 titled Treatment of Overactive Bladder in Women (2009). That report was supplemented with additional searches capturing literature published through December 2011. Following initial publication, this guideline underwent amendment in 2014 and 2018. The current document reflects relevant literature published through October 2018. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low). Such statements are provided as Standards, Recommendations, or Options. In instances of insufficient evidence, additional guidance information is provided as Clinical Principles and Expert Opinions. The evidence-based statements are provided for diagnosis and overall management of OAB, as well as for the various treatments. Diagnosis and treatment methodologies can be expected to change as the evidence base grows and as new treatment strategies become obtainable.

Patient navigation for overactive bladder improves access to care.

Patients with overactive bladder (OAB) become discouraged with medication therapy because of the side effects, minimal subjective improvement and costs of therapy. With the implementation of a patient navigation pathway there is increased communication, subsequently leading to increased patient retention rates and utilization of third-line therapies. This was a quality improvement study carried out over a 17-month period comparing utilization of a navigation pathway versus patients without navigation. The data were obtained using an online database (PPS Analytics) to compare medication use, cystoscopy, urodynamic studies, use of third-line therapy, and return visits. A total of 535 patients were included in the analysis and broken down into two respective groups. Group 1 were those placed on the navigation pathway and able to be reached via telephone (n= 431). Group 2 were those started on the navigation pathway who were not able to be reached via telephone, but were chart reviewed by a navigator (n= 104). Third-line therapy usage for groups 1 and 2 was 24% and 11% respectively. Return visits for additional OAB management for groups 1 and 2 were found to be 71% and 50% respectively. Patient retention levels and utilization of third-line therapies are significantly improved when utilizing a navigation pathway. With 24% of the patients included in this study opting for third-line therapy, this represents a 600% increase in third-line therapies over national averages.

Gait speed and overactive bladder in the healthy community-dwelling super elderly: The Sukagawa Study.

The objective of this study is to assess the association of muscle mass, grip strength, and gait speed with overactive bladder (OAB) in community-dwelling elderly adults. This cross-sectional study was based on the data collected from 350 Japanese healthy community-dwelling elderly individuals aged 75 years or older from the Sukagawa Study. Muscle mass (kg) was measured by bioelectrical impedance, whereas grip strength (kg) and gait speed (m/s) were measured by performance testing. Muscle mass and grip strength were corrected for body mass index (BMI). The primary outcome was the presence of OAB, evaluated using the OAB symptom score. Of the 314 participants analyzed, 146 (47%) were men and 88 (28%) presented with OAB. The mean(SD) BMI, muscle mass, grip strength, and gait speed were 23.2 (3.2) kg/m 2 , 38.4 (7.5) kg, 26.6 (8.1) kg, and 1.2 (0.2) m/s, respectively. Multivariable logistic regression analysis revealed that slower gait speed was associated with a greater likelihood of OAB (adjusted odds ratio [aOR] per -1 SD, 1.47; 95% confidence interval [CI], 1.11-1.95). No significant associations between muscle mass or grip strength and OAB were noted (aOR per -1 SD, 0.75, 1.03; 95% CI, 0.41-1.37, 0.62-1.72, respectively). Slower gait speed was also associated with higher likelihood of urgency and urgency incontinence (aOR per -1 SD, 1.35, 1.40; 95% CI, 1.04-1.74, 1.06-1.84, respectively). In the healthy community-dwelling elderly, gait speed was associated with OAB, including urgency and urgency incontinence. Our findings may provide a new framework for OAB management with respect to functional mobility.

Acupuncture for overactive bladder in adults: a systematic review and meta-analysis.

Overactive bladder is prevalent in adults over 40 years of age and its prevalence increases with age. The use of acupuncture in adults with overactive bladder is increasing globally. However, its effectiveness/efficacy and safety have not yet been confirmed. To determine the effectiveness/efficacy and safety of acupuncture and to identify the pattern of commonly used traditional acupuncture points in the management of overactive bladder in adults. Ten electronic English and Chinese language databases were systematically searched and two English together with four Chinese journals relevant to acupuncture were manually searched in libraries for randomised controlled trials (RCTs) of acupuncture for overactive bladder in adults from their inception to March 2017. The Cochrane risk of bias tool was used to assess the methodological quality of the RCTs. RevMan v.5.3 software was employed for data analysis. Seven eligible trials involving 695 participants were included. Meta-analysis showed that acupuncture was comparable to drugs (tolterodine tartrate/solifenacin) in the reduction of micturition episodes over 24 hours (pooled standardised mean difference (SMD) 0.36, 95% CI -0.23 to 0.95; I2=83%), increase in voided volume of each micturition episode (pooled SMD -0.15, 95% CI -0.36 to 0.05; I2=0%), and reduction of overactive bladder symptom score (pooled SMD -0.23, 95% CI -1.30 to 0.85; I2=91%). In addition, acupuncture was not significantly different compared with placebo in the reduction of overactive bladder symptom score (pooled SMD -2.36, 95% CI -5.64 to 0.93; I2=97%). No serious adverse events were reported. No significant differences in effectiveness or efficacy were found between acupuncture and drug or between verum and sham acupuncture, respectively. Further high-quality studies are required.

Management of Overactive Bladder in the Young Man

In this review, the current literature regarding idiopathic overactive bladder (OAB) in the young male will be discussed. We will also share the unique experience of providers at a single military institution in treating this specific patient population and their recommendations based on the unique etiologies, comorbidities, and treatment response and adherence. Despite several studies addressing idiopathic OAB and providing the basis for existing guidelines, none offer guidance on how this syndrome affects a younger male population in whom OAB is less likely to be due to an obstructive etiology, nor is there guidance on the optimal approach to efficient assessment and management in this patient population. Adherence to the American Urological Association guidelines with more liberal use of adjunctive diagnostic measures with early escalation of therapy when symptoms are not adequately controlled may expedite OAB symptom management more appropriately in young men. Prospective studies focusing on OAB treatment in this patient population are needed to better understand and better treat OAB in this patient population.

The real-life management of overactive bladder: Turkish Continence Society multicenter prospective cohort study with short-term outcome.

Turkish Continence Society aimed to analyze how overactive bladder (OAB) is being managed in routine practice by the urologists in Turkey. Fourteen urology departments were randomly selected to represent the whole population in this multicenter study. An online data entry and storage software was created for patient recruitment and data assessment. A survey including demographic data, daily habits, lower urinary tract symptoms, and Turkish-validated OAB-V8 and ICIQ-SF questionnaires were completed by all patients. Second part of the survey, including the questions about clinical evaluation and management of the patient, was completed by the treating physician. A total of 507 patients (394 female and 113 male) were included. Behavioral therapy was recommended to 73.2% of female and 81.4% of male patients although bladder diary was requested for 59.5% and 52.7% of the female and male patients, respectively. In the first visit, 86.1% of the female and 89.3% of the male patients were given antimuscarinics (P = .431). Antimuscarinic-related side effects occurred in 94.9% and 88.9% of the female and male patients, respectively (P = .937). However, the rate of medical treatment change due to antimuscarinic-related side effects was only 1.7% in female and 4.8% in male patients at the end of 4 months. Behavioral therapy and antimuscarinics were the preferred initial treatment modalities of OAB in concordance with the guidelines. Despite guideline recommendations, bladder diaries were not utilized in half of the patients. Insufficient efficacy appeared to be the main reason for treatment modification.

Management of Overactive Bladder After Treatment of Bladder Outlet Obstruction

To discuss the epidemiology and pathophysiology of overactive bladder (OAB) after bladder outlet surgery (BOS), review the prognostic factors associated with persistent OAB, and present evaluation and management strategies. A randomized trial of preoperative urodynamics in male lower urinary tract symptoms is underway; however, high-level evidence for management of persistent OAB after BOS is lacking. Identification of prognostic factors for persistent OAB symptoms is important for counseling patients before BOS; however, the data guiding such counseling are limited. In general, patients who are older, have lower bladder capacity, and higher amplitude and earlier detrusor overactivity are more likely to have persistent symptoms. After BOS, men may be less likely than women to respond favorably to advanced therapies for OAB than women and should be appropriately counseled.