Overactive Bladder Medications Research Articles

Comparative assessment of efficacy and safety of approved oral therapies for overactive bladder: a systematic review and network meta-analysis.

Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022. Randomized controlled double-blind trials of oral medication for overactive bladder were screened against the protocol's entry criteria. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 software. A total of 60 randomized controlled double-blind clinical trials were included involving 50,333 subjects. Solifenacin 10mg was the most effective in mean daily micturitions and incontinence episodes, solifenacin 5/10mg in mean daily urinary urgency episodes and nocturia episodes, fesoterodine 8mg in urgency incontinence episodes/d and oxybutynin 5mg in voided volume/micturition. In terms of safety, solifenacin 5mg, ER-tolterodine 4mg, mirabegron, vibegron and ER-oxybutynin 10mg all showed a better incidence of dry mouth, fesoterodine 4mg, ER-oxybutynin 10mg, tolterodine 2mg, and vibegron in the incidence of constipation. Compared to placebo, imidafenacin 0.1mg showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and darifenacin 15mg in headache. Solifenacin showed better efficacy. For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated. The choice of drugs should be tailored to the patient's specific situation to find the best balance between efficacy and safety.

Analyzing Access and Costs of Oral Medications for Overactive Bladder: Uncovering Disparities

To report out-of-pocket costs associated with overactive bladder (OAB) medications among Medicare beneficiaries and the uninsured. We performed a cross-sectional analysis of the Centers for Medicare & Medicaid Services Prescription Drug Plan Formulary Data (Q1-2022). FDA-approved medications for OAB were identified. We calculated out-of-pocket costs for Medicare beneficiaries in each Part D prescription benefit phase, average retail price, total yearly costs and discounted prices through cash-pay discount coupons (GoodRx) or online pharmacies like Mark Cuban Cost Plus Drug Company (MCCPDC). We also report plan utilization management requirements. We analyzed 5721 plan formularies for 18 medications. Mirabegron was the only beta-3 agonist (B3). Only Vesicare oral solution (14.3% of plans) and Mirabegron (0.1%) required prior authorization. Many plans required step therapy for selective generic anticholinergics (ACH) (12.4%-43.3%), while the B3 rarely required step therapy (0.6%). Monthly costs varied by coverage phase and averaged $59 for ACHs in the initial coverage phase ($14 in catastrophic; $72 in coverage gap). The monthly cost for the B3 averaged $47 in the initial coverage phase ($26 in catastrophic; $129 in coverage gap). The total yearly cost for generic ACHs ranged from $494 (oxybutynin IR) to $1452 (darifenacin) and the yearly cost for brand-name ACHs ranged from $1175 (Toviaz ER) to $2198 (Oxytrol). The total yearly cost for the B3 was $1283. We evaluated coverage, out-of-pocket costs, total yearly costs, and utilization management for OAB medications to make pricing more transparent. While selective medications may be "covered," coverage does not translate into affordable drug prices.

Patient and Clinician Challenges with Anticholinergic Step Therapy in the Treatment of Overactive Bladder: A Narrative Review.

Anticholinergics have been used in the treatment of overactive bladder (OAB), but their use is limited by poor tolerability and anticholinergic-related side effects. Increasingly, providers are discontinuing anticholinergic prescribing because of growing evidence of the association of anticholinergic use with increased risk of cognitive decline and other adverse effects. Newer medications for OAB, the β3-adrenergic receptor agonists mirabegron and vibegron, do not have anticholinergic properties and are typically well tolerated; however, many insurance plans have limited patient access to these newer OAB medications by requiring step therapy, meaning less expensive anticholinergic medications must be trialed and/or failed before a β3-agonist will be covered and dispensed. Thus, many patients are unable to easily access these medications. Step therapy and other drug utilization strategies (e.g., prior authorization) are often used to manage the growing costs of pharmaceuticals, but these policies do not always follow treatment guidelines and may harm patients as a result of treatment delays, discontinuations, or related increases in adverse events. Medical professionals have called for reform of drug utilization strategies through partnerships that include clinicians and policymakers. This narrative review discusses prescribing patterns for OAB treatment and the effect of switching between drugs, as well as the costs of step therapy and prior authorization on patients and prescribers.

Overactive Bladder Medication Prescribing Trends in the Era of Known Cognitive Effects from Anticholinergic Drugs

Overactive Bladder Medication Prescribing Trends in the Era of Known Cognitive Effects from Anticholinergic Drugs

Treatment Patterns in Men Prescribed Benign Prostatic Obstruction or Overactive Bladder Medications in Canada: A Retrospective Population-based Study

To characterize first therapeutic change and healthcare resource utilization in older men initiating an overactive bladder (OAB) or benign prostatic obstruction (BPO) medication. A retrospective cohort study using health administrative data from ICES in Ontario, Canada (from April 01, 2010 to December 31, 2018) was conducted in men aged ≥66 years with ≥1 OAB (β3 agonist, antimuscarinic) or BPO (α-blocker, 5-α-reductase inhibitor) prescription and ≥1-year postindex data (index=first observed dispensation). prescriptions for these drugs ≤1 year preindex, a related procedure ≤5 years. Patients were grouped by condition based on index prescription. Treatment changes in relation to OAB and BPO were characterized by type. Costs and healthcare resource utilization pre- and post-index were compared. Age, geographic region, and income were similar between groups. The most common initial treatments were antimuscarinics (78.1%) in the OAB group and alpha-blockers (86.4%) in the BPO group. The OAB group was more likely to experience a therapeutic change and had a shorter time to first change in therapy (78 [30,231] vs 104 [30,350] days) and higher mean healthcare costs both pre- ($12,354 vs $11,497) and postindex ($14,423 vs $12,852). The most common first therapeutic change in both groups was discontinuing treatment (OAB: 75.6%; BPO: 69.9%). Men initiating OAB medications changed therapy sooner than those initiating BPO medications. Most discontinued first-line therapy without initiating further treatment, suggesting unmet need in this population.

Ninjin'yoeito Improves Genitourinary Symptoms in Patients With Frailty.

Introduction In geriatric medicine, there is currently significant attention on frailty, a condition commonly associated with aging and characterized by muscle weakness and other age-related changes. Within the fields of urology and gynecology, conditions such as overactive bladder (OAB) and genitourinary syndrome of menopause (GSM) have been identified as crucial concerns due to their negative impact on the quality of life of elderly individuals. In this study, we investigated the potential of Ninjin'yoeito (NYT), a traditional Chinese herbal medicine, as a viable treatment option for frailty. Additionally, we hypothesized that NYT may also contribute to the improvement of symptoms associated with OAB and GSM, and potentially help in reducing the dosage of OAB medications. Methods In this retrospective cohort study conducted from November 2016 to November 2022, we created a website describing the relationship between frailty and genitourinary symptoms in frail patients aged ≥ 65 years with GSM who underwent pelvic floor muscle training. The patients were divided into two propensity score-matched groups: NYT group (received NYT for one year) and no-NYT group (did not receive NYT), based on their wishes. The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale was used to assess frailty status. Urinary symptoms were evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Overactive Bladder Symptom Score (OABSS). Genital symptoms were investigated using the vaginal health index score and vulvodynia swab test. The value of each score was obtained before (T0) and 12 months after (T12) treatment, and the difference (ΔT0/T12) was calculated. Results During the study period, 985 outpatients visited our clinic, of whom 725 were considered frail/pre-frail; 402 women with frailty/pre-frailty (mean age 77.5 ± 6.49 years) were included, with a median follow-up of 14.5 months. The NYT and no-NYT groups had 220 and 182 patients, respectively. After propensity score matching, each group had 159 patients. ΔT0/T12FRAIL scale score was significantly higher in the NYT group (0.13 ± 0.37) than in the no-NYT (0.01 ± 0.10) group (p=0.001.) However, urinary symptoms improved in the NYT group more than in the no-NYT in terms of the following parameters: ΔT0/T12OABSS (NYT: 0.89 ± 1.65; no-NYTl: 0.36 ± 1.14, p=0.001) and ΔT0/T12ICIQ-SF score (NYT: 1.51 ± 1.75; no-NYT: 0.42 ± 1.18, p<0.001). Genital symptoms were better in the NYT group in terms of ΔT0/T12VHIS (NYT: 0.58 ±1.08; no-NYT: 0.21 ±0.65, p<0.001). The vulvodynia swab test showed improvements in left para-hymen evoked pain in both groups. In the NYT group, 5% of the patients underwent antimuscarinic drug dose reduction for overactive bladder treatment. NYT use was not associated with significant side effects, and only 0.6% of patients reported drug allergies. Conclusion NYT improved activity levels in frail/pre-frail patients. Moreover, NYT use improved various genitourinary symptoms experienced by patients with frailty/pre-frailty. Treatment with NYT may reduce the dose of overactive bladder medications. The anticholinergic load-reducing effect of NYT may help solve the problem of polypharmacy.

Is there an increased risk of dementia with use of medications for overactive bladder?

East Pierce Family Medicine Residency Program, Puyallup, WA The corresponding author is Chelsi Goodman; [email protected] The authors declare no conflicts of interest.

One treatment with onabotulinumtoxinA relieves symptoms of overactive bladder in patients refractory to one or more oral medications.

Patients with overactive bladder (OAB) often undergo prolonged treatment with one or more oral OAB medications. OnabotulinumtoxinA (onabotA), a type A botulinum toxin, may provide an appropriate alternative to oral treatments in patients intolerant of or refractory to one or more oral OAB medications. The GRACE study demonstrated real-world benefits of onabotA treatment for OAB in patients refractory to oral medications. This exploratory post hoc analysis of data from the GRACE study aims to determine if treatment history impacts benefit from treatment with onabotA. This is a subanalysis of the GRACE study, a prospective observational study (NCT02161159) that enrolled patients with symptomatic OAB inadequately managed by at least one oral OAB medication. Patients had a treatment history of one or more anticholinergics (AC) and/or β-3 adrenoreceptor agonists (β-3) for relief of OAB; results were stratified according to treatment history. Patients in this analysis elected to discontinue oral medications upon treatment with onabotA. Safety was followed for 12 months in all patients that received at least 1 dose of onabotA; efficacy was determined over a 12-week period. Compared to baseline levels, significant reductions in urinary incontinence(UI), urgency, micturition, and nocturia were noted as early as 1week and were sustained at 12 weeks, regardless of the type and number of oral medications taken before treatment with onabotA. At 12 weeks post-onabotA, the mean change from baseline UI episodes/day for those with a treatment history of only one AC was -2.4 (n = 43, p ≤ 0.001); more than one AC, -2.4 (n = 52, p ≤ 0.001); one β-3, -3.3 (n = 12, p < 0.05); at least one AC and at least one β-3, -3.2 (n = 56, p ≤ 0.001). Pad and liner use was significantly decreased at 12 weeks post-onabotA across all treatment history groups. Reductions in diaper pant use varied, with less of a reduction in patients with a treatment history of more than one AC compared to patients with a history of at least one AC and one β-3 (p < 0.05) or those with a history of only one AC (p < 0.05). Overall, a total of 253/288 of patients (88%) reported improvements on the treatment benefit scale 12 weeks after treatment with onabotA, regardless of type and number of prior oral medications. In the population of patients that received at least one dose of onabotA (N = 504), 57 adverse events were reported in 38 patients (7.5%); 9 were serious (1.8%). Urinary retention was reported in 5 patients (1.0%); 1 was severe (0.2%). Symptomatic urinary tract infection was reported in 2 patients (0.4%). In this exploratory post hoc analysis of real-world data from the GRACE study, there were few significant differences in outcomes based on the type and number of prior oral medications. Thus, patients who are refractory to one or more oral OAB medications may benefit from earlier treatment with onabotA.

Characteristics of providers who prescribed only anticholinergic medications for overactive bladder in 2020

Pharmacologic therapy for overactive bladder typically includes either an anticholinergic or a beta-3 agonist. Based on research that has demonstrated increased risks of cognitive impairment and dementia associated with anticholinergic use, current guidelines support the use of beta-3 agonists rather than anticholinergics in older patients. This study aimed to describe the characteristics of providers prescribing only anticholinergics to treat overactive bladder in patients aged ≥65 years. The US Centers for Medicare and Medicaid Services publishes data on medications dispensed to Medicare beneficiaries. Data include the National Provider Identifier of the prescriber and the number of pills prescribed and dispensed for any given medication for beneficiaries aged ≥65 years. We obtained each provider's National Provider Identifier, gender, degree, and primary specialty. National Provider Identifiers were linked to an additional Medicare database that includes graduation year. We included providers who prescribed pharmacologic therapy for overactive bladder in 2020 for patients aged ≥65 years. We calculated the percentage of providers who prescribed only anticholinergics (and did not prescribe beta-3 agonists) for overactive bladder and stratified by provider characteristics. Data are reported as adjusted risk ratios. In 2020, 131,605 providers prescribed overactive bladder medications. Of those identified, 110,874 (84.2%) had complete demographic information available. Although only 7% of providers who prescribed medications for overactive bladder were urologists, prescriptions from urologists accounted for 29% of total prescriptions. Among providers prescribing medications for overactive bladder, 73% of female providers prescribed only anticholinergics, whereas 66% of male providers prescribed only anticholinergics (P<.001). The percentage of providers that prescribed only anticholinergics also varied by specialty (P<.001), with providers specialized in geriatric medicine being least likely to prescribe only anticholinergics (40%), followed by urologists (44%). Nurse practitioners (75%) and family medicine physicians (73%) were more likely to prescribe only anticholinergics. The percentage of providers who prescribed only anticholinergics was the highest for recent medical school graduates and decreased with time since graduation. Overall, 75% of providers within 10 years of graduation prescribed only anticholinergics, whereas only 64% of providers who were >40 years of age from graduation prescribed only anticholinergics (P<.001). This study identified considerable differences in prescribing practices based on provider characteristics. Female physicians, nurse practitioners, physicians trained in family medicine, and those who recently graduated from medical school were the most likely to prescribe only anticholinergic medications and not prescribe any beta-3 agonist for the treatment of overactive bladder. This study identified differences in prescribing practices based on provider demographics that may guide educational outreach programs.

Inequities in Filled Overactive Bladder Medication Prescriptions in the US

Anticholinergic medications to treat overactive bladder (OAB) have been associated with increased risk of cognitive decline, whereas β3-adrenoceptor agonists (hereafter, β3-agonists) have comparable efficacy and do not carry the same risk. Yet, anticholinergics remain the predominant OAB medication prescribed in the US. To evaluate whether patient race, ethnicity, and sociodemographic characteristics are associated with receipt of anticholinergic vs β3-agonist OAB medications. This study is a cross-sectional analysis of the 2019 Medical Expenditure Panel Survey, a representative sample of US households. Participants included individuals with a filled OAB medication prescription. Data analysis was performed from March to August 2022. A prescription for medication to treat OAB. The primary outcomes were receipt of a β3-agonist or an anticholinergic OAB medication. An estimated 2 971 449 individuals (mean age, 66.4 years; 95% CI, 64.8-68.2 years) filled prescriptions for OAB medications in 2019; 2 185 214 (73.5%; 95% CI, 62.6%-84.5%) identified as female, 2 326 901 (78.3%; 95% CI, 66.3%-90.3%) self-identified as non-Hispanic White, 260 685 (8.8%; 95% CI, 5.0%-12.5%) identified as non-Hispanic Black, 167 210 (5.6%; 95% CI, 3.1%-8.2%) identified as Hispanic, 158 507 (5.3%; 95% CI, 2.3%-8.4%) identified as non-Hispanic other race, and 58 147 (2.0%; 95% CI, 0.3%-3.6%) identified as non-Hispanic Asian. A total of 2 229 297 individuals (75.0%) filled an anticholinergic prescription, and 590 255 (19.9%) filled a β3-agonist prescription, with 151 897 (5.1%) filling prescriptions for both medication classes. β3-agonists had a median out-of-pocket cost of $45.00 (95% CI, $42.11-$47.89) per prescription compared with $9.78 (95% CI, $9.16-$10.42) for anticholinergics. After controlling for insurance status, individual sociodemographic factors, and medical contraindications, non-Hispanic Black individuals were 54% less likely than non-Hispanic White individuals to fill a prescription for a β3-agonist vs an anticholinergic medication (adjusted odds ratio, 0.46; 95% CI, 0.22-0.98). In interaction analysis, non-Hispanic Black women had an even lower odds of filing a β3-agonist prescription (adjusted odds ratio, 0.10; 95% CI, 0.04-0.27). In this cross-sectional study of a representative sample of US households, non-Hispanic Black individuals were significantly less likely than non-Hispanic White individuals to have filled a β3-agonist prescription compared with an anticholinergic OAB prescription. These differences may reflect an inequity in prescribing behaviors promulgating health care disparities. Targeted research should assess the relative contribution of a variety of individual and societal factors.

Diagnosis and Treatment of Japanese Children with Neurogenic Bladder: Analysis of Data from a National Health Insurance Database.

In pediatric patients with neurogenic bladder (NGB), urinary tract evaluation, early diagnosis, and individualized management are important. We aimed to clarify the current status of diagnosis and treatment of NGB in Japanese children. This descriptive, observational, retrospective cohort study using the JMDC claims database included NGB patients aged ≤17 years over a 12-month follow-up period. Of the 1065 pediatric NGB patients, 38.9% had spina bifida. Dermatological and gastrointestinal comorbidities were common in the baseline period. Renal/bladder ultrasound was a commonly performed investigation (38.3%), but urodynamics was infrequently used (3.0%). Of all the overactive bladder medications, anticholinergics were used commonly (17.9% patients), and most patients used anticholinergics alone (without combination therapy). Clean intermittent catheterization (CIC; alone or in combination with medications) was performed in 9.3% of patients, and 3.9% of patients were concomitantly treated with medications. The most common incident complication was lower urinary tract infection (18.1%), which was especially common in patients with open spina bifida (54.1%). Despite guideline recommendations, lower urinary tract dysfunction is not thoroughly evaluated. Adequate understanding of patient status is critical to optimal patient management (behavioral therapy, CIC, and medication) in clinical practice.

MP48-19 MEDICATIONS FOR OVERACTIVE BLADDER IN THE ELDERLY: QUANTITATIVE ANALYSIS OF A NATIONWIDE PRESCRIBING DATABASE

You have accessJournal of UrologyCME1 Apr 2023MP48-19 MEDICATIONS FOR OVERACTIVE BLADDER IN THE ELDERLY: QUANTITATIVE ANALYSIS OF A NATIONWIDE PRESCRIBING DATABASE Alan Quach, Geoffrey Rosen, Katie Murray, and Christopher Deibert Alan QuachAlan Quach More articles by this author , Geoffrey RosenGeoffrey Rosen More articles by this author , Katie MurrayKatie Murray More articles by this author , and Christopher DeibertChristopher Deibert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is a common chronic condition in adults that increases in prevalence with age. AUA guidelines recommend first line treatment with behavioral therapy, with the next step being anti-muscarinic or beta-3 agonist medications. The risks of anti-muscarinic use in the elderly may outweigh the benefit, as reflected in the Beers Criteria for Potentially Inappropriate Medications for the Elderly. We hypothesized that urologist prescribing for OAB medications better adheres to the principals of the Beers Criteria than does that of other prescribers. METHODS: We queried the IQVIA Human Data Science Cloud, representing >90% of retail pharmacy fills in the US, for OAB medication from Jan 1, 2018 – Oct 31, 2020. We assessed effect of prescriber type on distribution of common OAB medications in those 65 or older (to whom the Beers Criteria are intended). Statistical analysis was performed using Chi-Square. RESULTS: There were 25,544,234 OAB medication fills for patients 65 years or older. 6,590,683 (25.8%) and 18,953,551 were prescribed OAB medication by urologists and non-urologists. Oxybutynin was the most frequently prescribed medication (50%). When comparing individual OAB medications, urologists were significantly more likely to adhere to Beers Criteria, moving away from antimuscarinics and towards beta-3 agonists for patients 65 or older (Figure 1, p<0.05). CONCLUSIONS: Urologists prescribe 25% of OAB medications for patients 65 years of age or older. In this population, urologists are more likely to prescribe beta-3 agonists than are other prescribers, reflecting expertise in treating patients with OAB. Pharmacologic treatment of OAB requires shared decision-making, taking into account patient-specific side-effect and efficacy profiles. Source of Funding: Data were supplied by IQVIA through the Human Data Science Research Collaborative in the Era of COVID-19. This material is based upon work supported by the Google Cloud Research Credits program with the award 202575010. The funders had no role in preparation of this work and this work was not subject to their review © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e663 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan Quach More articles by this author Geoffrey Rosen More articles by this author Katie Murray More articles by this author Christopher Deibert More articles by this author Expand All Advertisement PDF downloadLoading ...

MP71-10 LONGITUDINAL EVALUATION OF LOWER URINARY TRACT SYMPTOMS POST ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH THE CORE LOWER URINARY TRACT SYMPTOM SCORE

You have accessJournal of UrologyCME1 Apr 2023MP71-10 LONGITUDINAL EVALUATION OF LOWER URINARY TRACT SYMPTOMS POST ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH THE CORE LOWER URINARY TRACT SYMPTOM SCORE Yuma Waseda, Minato Yokoyama, Kasumi Yoshitomi, Masaki Kobayashi, Bo Fan, Yuki Nakamura, Motohiro Fujiwara, Yudai Ishikawa, Shohei Fukuda, Hajime Tanaka, Soichiro Yoshida, and Yasuhisa Fujii Yuma WasedaYuma Waseda More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Kasumi YoshitomiKasumi Yoshitomi More articles by this author , Masaki KobayashiMasaki Kobayashi More articles by this author , Bo FanBo Fan More articles by this author , Yuki NakamuraYuki Nakamura More articles by this author , Motohiro FujiwaraMotohiro Fujiwara More articles by this author , Yudai IshikawaYudai Ishikawa More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While the artificial urinary sphincter (AUS) can significantly improve continence status, improved continence has been shown to worsen slightly over time. However, few studies have evaluated the trend in lower urinary tract symptoms (LUTS) other than incontinence. The frequently used International Prostate Symptom Score questionnaires may not adequately assess LUTS due to a lack of queries regarding incontinence and pain. The Core LUTS Score (CLSS) allows for an overall assessment of LUTS, which addresses 10 important symptoms from the 25 defined by the International Continence Society standardization steering committee. The CLSS questionnaire was used to assess LUTS after AUS implantation, longitudinally. METHODS: The subjects were 19 male who underwent initial AUS implantation at Tokyo Medical and Dental University from 2018 to 2021. LUTS were assessed before AUS implantation as well as one month (early use) and 12 months (late use) after implantation. CLSS data was collected from 13 patients before implantation and 19 patients during early and late use. This study was approved by our ethics committee (approval number: #2018-157). RESULTS: The median age at surgery was 74 years. The causes of urinary incontinence were radical prostatectomy and benign prostatic hyperplasia surgery in 18 and one patient, respectively. All patients achieved social continence of ≤1 pad/day, and the quality of life index improved significantly from 5.6 to 1.8 (0: delighted to 6: terrible) in early use (p<0.001) in 13 patients with preoperative evaluations. The most bothersome symptom was urinary incontinence in 11 (85%) patients and frequent urination in 2 (15%) patients before use, while two in early use and four in late use listed incontinence-related symptoms. Longitudinal change between early and late use showed improvement in voiding and post-micturition symptoms. On the other hand, no apparent improvement in storage symptoms was observed (Figure 1). On late use, 3 (16%) were receiving medication for overactive bladder. CONCLUSIONS: Post AUS implantation, urinary incontinence distress decreased, and other LUTS became more prominent. There was no trend toward improvement of the storage symptoms over time, and pharmacotherapy should be adiministered as needed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1018 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuma Waseda More articles by this author Minato Yokoyama More articles by this author Kasumi Yoshitomi More articles by this author Masaki Kobayashi More articles by this author Bo Fan More articles by this author Yuki Nakamura More articles by this author Motohiro Fujiwara More articles by this author Yudai Ishikawa More articles by this author Shohei Fukuda More articles by this author Hajime Tanaka More articles by this author Soichiro Yoshida More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-14 CHOICE OF FIRST MEDICATION PRESCRIBED FOR OVERACTIVE BLADDER CHANGES WITH TIME: TRENDS FROM THE AUA AQUA REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP37-14 CHOICE OF FIRST MEDICATION PRESCRIBED FOR OVERACTIVE BLADDER CHANGES WITH TIME: TRENDS FROM THE AUA AQUA REGISTRY Camille Vélez, Max Bowman, Katherine Shapiro, Rachel Mbassa, Raymond Fang, Benjamin Brucker, and Michelle van Kuiken Camille VélezCamille Vélez More articles by this author , Max BowmanMax Bowman More articles by this author , Katherine ShapiroKatherine Shapiro More articles by this author , Rachel MbassaRachel Mbassa More articles by this author , Raymond FangRaymond Fang More articles by this author , Benjamin BruckerBenjamin Brucker More articles by this author , and Michelle van KuikenMichelle van Kuiken More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is a clinical condition that can greatly affect quality of life. Pharmacological management of OAB may involve use of anticholinergic (ACH) or beta-3 agonists (B3) medications; however, there is increasing evidence of cognitive side-effects associated with the long-term use of ACH medications. Using the AUA AQUA Registry, we aim to evaluate how prescription trends between ACH and B3 agonists has changed over time. METHODS: We queried the AUA Quality (AQUA) Registry database, a national Qualified Clinical Data Registry, for patients >18 years with a new diagnosis of OAB including urinary urgency, frequency, and urgency urinary incontinence (UUI) from 2014-2020 using ICD-9 and ICD-10 codes. Patients with a diagnosis of neurogenic bladder or neurologic diagnosis associated with neurogenic bladder were excluded. The choice of first medication prescribed for OAB was assessed and these trends were observed and analyzed. RESULTS: A total of 641,112 patients were diagnosed with OAB over the study period, 17.5% of whom received a medication prescription. In 2014, ACH comprised 76.3% of OAB treatment prescriptions, while B3 agonists made up 22.1%; Over time, ACH use steadily declined to only 60.3% of first prescriptions, while B3 agonist prescriptions nearly doubled to a peak of 41.4% in 2019, leveling off to 38% in 2020. (Figure 1a). When comparing individual ACH medications, a sharp decrease was observed in solifenacin prescriptions, which went from the most prescribed ACH at 34.8% in 2014 to third most prescribed at 7.7% in 2020. As solifenacin use declined, oxybutynin ER use increased from 11.9% in 2014 to a peak of 26.4% in 2020 to become the most prescribed ACH (Figure 1b). CONCLUSIONS: These prescription trends illustrate that ACH medications remain the most common class of medications first prescribed for OAB, however B3 agonist use has steadily increased with time. Further investigation leveraging the AUA AQUA Registry will help understand what drives OAB medication prescription trends by urologists in the US. Source of Funding: This study was supported by AUA statistical services © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e519 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Camille Vélez More articles by this author Max Bowman More articles by this author Katherine Shapiro More articles by this author Rachel Mbassa More articles by this author Raymond Fang More articles by this author Benjamin Brucker More articles by this author Michelle van Kuiken More articles by this author Expand All Advertisement PDF downloadLoading ...

Characteristics of providers who only prescribed anticholinergic medications for overactive bladder in 2019

Characteristics of providers who only prescribed anticholinergic medications for overactive bladder in 2019

An Analysis of Stated Insurance Coverage and Estimated Patient-Incurred Costs of Treatments for Lower Urinary Tract Symptoms.

Lower urinary tract symptoms (LUTSs) affect more than half of all adults, yet clinical care remains poor. Anecdotally, patients and health care providers express frustration over obstacles from insurance providers to obtaining LUTS treatment; however, little information concerning actual patient-incurred costs for these medications is available. This study aimed to analyze coverage by 5 major insurance companies and patient costs for LUTS pharmacotherapy. For each of 5 major nationwide insurance providers (Aetna, Blue Cross/Blue Shield, Cigna, Humana, United HealthCare), formulary coverage of medications for overactive bladder, interstitial cystitis/bladder pain syndrome, and genitourinary syndrome of menopause were reviewed for low- and high-cost plans. When not covered, the best preinsurance cash price of medications was determined from GoodRx. This qualitative analysis demonstrates that no guideline-directed therapy was universally covered by all insurance providers at low cost, regardless of the availability of generic alternatives. Medication prices ranged from $3 to $900 per month across plans. Inconsistencies in coverage and medication prices were common across insurance providers, between similar medications used for treatment of a given condition, and between a provider's low- and high-cost plans. Even medications that are U.S. Food and Drug Administration-approved and indicated by guidelines can have patient costs that are prohibitive. Because lack of care for LUTSs profoundly affects quality of life, the ability to live independently, and overall morbidity, improved price transparency is required to understand the health implications of limited coverage on LUTS care.

STOMp: sexual function trial of overactive bladder medication.

Female sexual function has been shown to improve with overactive bladder (OAB) treatment. The objective of this study was to evaluate the effects of anticholinergics (ACHs) or a beta-agonist (BAG) on female sexual function. This was a prospective multicenter cohort study. Sexually active women with OAB completed the Overactive Bladder questionnaire (OAB-q) and Female Sexual Function Index (FSFI) prior to and after 12weeks of therapy. Sample sizes of 63 per group were calculated to detect a clinically relevant difference in the FSFI. The primary outcome was FSFI change from baseline at 12weeks. A total of 157 patients were recruited, and 91 completed follow-up (58/108, ACH; 31/49, BAG). There were within-group FSFI differences from pre- to posttreatment: a worsening of arousal in the ACH group (P = .046) and an improvement in overall FSFI (P = .04) and pain (P = .04) in the BAG group. After treatment, postmenopausal women in the BAG group had significantly better overall FSFI (P = .01), desire (P = .003), arousal (P = .009), and orgasm (P = .01). While further research is necessary, this study provides information about the comparative effects of OAB treatments on female sexual function, which may ultimately lead to better patient selection and outcomes. While there was no difference between the subjects who completed the study and those who did not, the study remained underpowered after the loss to follow-up. The multicenter cohort design allows for generalizability of results. Although this study was underpowered, an improvement in overall sexual function was seen with BAGs, while ACHs were associated with worsening aspects of sexual function.

Patients' Preferences and Expectations in Overactive Bladder: A Systematic Review.

The aim of our study is to review the current available knowledge regarding preferences and expectations of patients with overactive bladder (OAB). The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines were followed for this manuscript's preparation. Three online databases were searched: PubMed/Medline, Embase, and Scopus, while a combination of the following keywords was used: detrusor overactivity, overactive bladder, urinary incontinence, perspectives, expectations, and preferences. Overall, 1349 studies were retrieved and screened while only 10 studies appeared to be relevant for the scope of this review. Most of the studies were related to preferences about OAB medications (i.e., antimuscarinics); four of them reported patients' inclinations to alternative treatments in the case of medication therapy failure (i.e., neuromodulation, Botox). No data were found about diagnosis or other aspects of disease management (i.e., surgery, follow-up). Based on these findings, from the patient's point of view, the ideal medication should be cheap, without risk of cognitive function impairment, and able to reduce daytime urinary frequency and incontinence episodes.

Treating overactive bladder symptoms after transurethral prostatic surgery for benign prostatic hyperplasia - Which medication to choose?

Overactive bladder (OAB) symptoms are often encountered in patients after transurethral resection of the prostate (TUR-P) or transurethral incision of the prostate (TUI-P) for benign prostatic obstruction (BPO). Either antimuscarinics or β-3 agonist has been found effective in relieving OAB symptoms. However, urologists usually do not prescribe such medication immediately after TUR-P or TUI-P to avoid an increase in postvoid residual and risk of urinary tract infection. If OAB medication can be used and adverse events (AEs) can be reduced to minimum, patients' quality of life after bladder outlet obstruction surgery could be improved. This study compared the safety and efficacy between solifenacin and mirabegron in men undergoing TUR-P or TUI-P. This prospective, randomized trial compared the safety and efficacy of OAB medication on the reduction in Urgency Severity Score (USS), OAB Symptoms Score (OABSS), International Prostate Symptom Score, and urgency urinary incontinence episodes in men with BPO undergoing surgical intervention. All patients could void smoothly after catheter removal and were randomly received daily solifenacin 5 mg, mirabegron 50 mg, or no interventions for 4 weeks. At 2 and 4 weeks postoperatively, participants' OAB symptoms and AEs were evaluated. A total of 57 men were enrolled in this study with a mean age of 70.8 ± 6.1 years. At 2 weeks postoperatively, USS (1.56 ± 1.72 vs. 2.39 ± 1.72 vs. 2.26 ± 1.73, P < 0.011) and OABSS (5.33 ± 3.65 vs. 7.67 ± 4.19 vs. 8.58 ± 4.31, P < 0.000) were significantly reduced in patients taking solifenacin, mirabegron, or control, respectively. Two patients in the solifenacin group developed urinary retention. However, the changes of variables at 4 weeks postoperatively were insignificant among the three groups. Solifenacin and mirabegron are two different drug classes both equally effective in treating immediate OAB symptoms after TUR-P or TUI-P. However, OAB symptoms could be relieved at 4 weeks without any medication. Considering AEs, β-3 agonist has a more favorable safety profile than antimuscarinics.

First reported study of daily, high dose transdermal application of oxybutynin in a humid country

Objectives:We investigated the efficacy and safety of a transdermal oxybutynin patch in treating patients with overactive bladder (OAB). Methods:Ninety-three adult patients with OAB who were under stable treatment with antimuscarinic agents, mirabegron, or both for at least 1 month were prospectively recruited from seven hospitals in Taiwan. Patients who agreed to participate in the study stopped oral OAB medication for 2 weeks and started once-daily transdermal oxybutynin 75 mg. We evaluated the Overactive Bladder Symptom Score (OABSS), Patient Perception of Intensity of Urgency Scale (PPIUS), Patient Perception of Bladder Condition (PPBC), voiding diary, uroflowmetry, post-voiding residual urine, Global Response Assessment (GRA), and adverse events at baseline, 2 weeks, and 4 weeks. Results:Mean patient age was 66.7 ± 14.8 years. Compared with the measurements at baseline, the GRA, OABSS, PPIUS, PPBC, urinary urgency incontinence, urgency, and frequency significantly improved after 2 and 4 weeks of treatment. At 4 weeks, 20 patients (25%) reported markedly improvement (GRA = +3), 11 (13.8%) reported moderate improvement (GRA = +2), and 28 (35%) reported mild improvement (GRA = +1). Patients with GRA ≥ 1 had a significantly less proportion of oral combination therapy compared with those with GRA < 1 (5/59, 8.5% vs 8/21, 38.1%, p < 0.01). Common adverse events included skin itching in 34 (36.6%) patients, dry mouth in 20 (21.5%), and erythema in 7 (7.5%). Conclusion:The transdermal oxybutynin patch was effective and safe in the treatment of patients with OAB after switching from oral OAB medications.