Overactive Bladder Questionnaire Short Form Research Articles

Structural Changes in Brain White Matter Tracts Associated With Overactive Bladder Revealed by Diffusion Tensor Magnetic Resonance Imaging: Findings From a Symptoms of Lower Urinary Tract Dysfunction Research Network Cross-Sectional Case-Control Study.

Our objective was to investigate structural changes in brain white matter tracts using diffusion tensor imaging (DTI) in patients with overactive bladder (OAB). Treatment-seeking OAB patients and matched controls enrolled in the cross-sectional case-control LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) Neuroimaging Study received a brain DTI scan. Microstructural integrity of brain white matter was assessed using fractional anisotropy (FA) and mean diffusivity. OAB and urgency urinary incontinence (UUI) symptoms were assessed using the OAB Questionnaire Short-Form and International Consultation on Incontinence Questionnaire-Urinary Incontinence. The Lower Urinary Tract Symptoms Tool UUI questions and responses were correlated with FA values. Among 221 participants with evaluable DTI data, 146 had OAB (66 urinary urgency-only without UUI, 80 with UUI); 75 were controls. Compared with controls, participants with OAB showed decreased FA and increased mean diffusivity, representing greater microstructural abnormalities of brain white matter tracts among OAB participants. These abnormalities occurred in the corpus callosum, bilateral anterior thalamic radiation and superior longitudinal fasciculus tracts, and bilateral insula and parahippocampal region. Among participants with OAB, higher OAB Questionnaire Short-Form scores were associated with decreased FA in the left inferior fronto-occipital fasciculus, P < .0001. DTI differences between OAB and controls were driven by the urinary urgency-only (OAB-dry) but not the UUI (OAB-wet) subgroup. Abnormalities in microstructural integrity in specific brain white matter tracts were more frequent in OAB patients. More severe OAB symptoms were correlated with greater degree of microstructural abnormalities in brain white matter tracts in patients with OAB.

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.

Nocturia and Sleep in Parkinson's Disease.

Nocturia has a high prevalence in Parkinson's Disease (PD) and is known to be a bothersome symptom for people with Parkinson's disease (PwPD). to characterize nocturia in a sample of PwPD, in relation to sleep, fatigue and other non-motor symptoms (NMS). we assessed 130 PwPD using a comprehensive battery of scales, which includes the Non-Motor Symptoms Questionnaire (NMSQ), International Parkinson and Movement Disorder Society Non-Motor Rating Scale (MDS-NMS), Parkinson's Disease Sleep Scale version 2 (PDSS-2), Parkinson's Disease Questionnaire (PDQ-39), The Overactive Bladder Questionnaire-Short form (OABq-SF), and the Parkinson's Fatigue Scale (PFS-16). according to the positive answers to the item of the NMSQ related to nocturia, patients were divided into PwPD + nocturia, and PwPD - nocturia. Nocturia was reported by 112 patients (86.15%). Quality of life in PwPD + nocturia was worse than in PwPD - nocturia, according to the PDQ-39 scores (13.32 ± 9.00 vs. 26.29 ± 14.55, p < 0.001). Sleep was significantly disturbed in PwPD + nocturia compared to PwPD - nocturia, according to the total scores of various scales, such as PDSS-2, PFS-16. PwPD who complained of nocturia presented higher scores of several NMS. nocturia has a high prevalence in PwPD and it is associated with impaired sleep, fatigue, and reduced quality of life.

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.

PD14-01 FRACTIONAL CARBON DIOXIDE VAGINAL LASER FOR THE TREATMENT OF URINARY SYMPTOMS: 24 MONTHS RESULTS

You have accessJournal of UrologyCME1 Apr 2023PD14-01 FRACTIONAL CARBON DIOXIDE VAGINAL LASER FOR THE TREATMENT OF URINARY SYMPTOMS: 24 MONTHS RESULTS Nataljia Kovacevic, Bernadette Zwaans, Royal Oak, Mi, Ly Hoang Roberts, Evelyn Shea, Lisa Vergos, Danielle Tenney, Larry Sirls, Priya Padmanabhan, and Kenneth Peters Nataljia KovacevicNataljia Kovacevic More articles by this author , Bernadette ZwaansBernadette Zwaans More articles by this author , Royal OakRoyal Oak More articles by this author , Mi Mi More articles by this author , Ly Hoang RobertsLy Hoang Roberts More articles by this author , Evelyn SheaEvelyn Shea More articles by this author , Lisa VergosLisa Vergos More articles by this author , Danielle TenneyDanielle Tenney More articles by this author , Larry SirlsLarry Sirls More articles by this author , Priya PadmanabhanPriya Padmanabhan More articles by this author , and Kenneth PetersKenneth Peters More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fractional carbon dioxide laser (fCO2) has been proposed to treat frequency, urgency, urge urinary incontinence (UUI), and stress urinary incontinence (SUI) in genitourinary symptoms of menopause (GSM). The laser’s thermal effects help collagen remodeling, thereby improving vaginal tissue integrity and urethral support. Our aim was to prospectively measure the effect of vaginal fCO2 laser therapy on SUI and overactive bladder (OAB) symptoms at 24 months. METHODS: Women over 18 years with urogenital symptoms were enrolled in an open-label prospective trial. Participants underwent 3 laser treatments, each 6 weeks apart. Patients were required to be off vaginal estrogen for 3 months prior to receiving any treatments. Patients were offered additional annual treatment sessions. Follow up consisted of 6, 12-, 18-, and 24-month visits during which various questionnaires were administered including the Incontinence-Quality of Life (I-QOL), Overactive Bladder Questionnaire short form (OABq-SF), and Questionnaire for Urinary Incontinence Diagnosis (QUID). A voiding diary was collected at baseline, 6-, 12-, and 24- month visits. ANOVA analysis was used to compare means at each time point. RESULTS: 100 patients were enrolled at time of analysis. Baseline urinary symptoms consisted of 44.8% of patients with SUI, 57.1% with UUI, and 75.4% with frequency. Significant reduction in SUI episodes was observed at 6, and 24 months (p=0.0135; Figure 1), and participants noted improvement on QUID-SUI at 6, 12, and 24 months (p<0.0001). Number of urge leaks did not significantly improve on voiding diary (=0.0512), but significant subjective improvement was noted for OAB/UUI based on QUID-UUI and OABq-SF symptom scores at each time point (p<0.0001; Figure 1). Mean Patient Global Impression of Improvement scores improved at each treatment and follow up visit, with 46.4% reporting significant symptom improvement by 24 months. Participants had improvement between baseline and 24 months in vulvar dryness (50.9% vs 25%) and vulvar pain (48% vs 13%). CONCLUSIONS: This represents the longest prospective follow-up of laser effects on GSM associated urinary symptoms. Significant subjective improvement was noted for SUI and OAB/UUI up to 24 months after treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e412 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nataljia Kovacevic More articles by this author Bernadette Zwaans More articles by this author Royal Oak More articles by this author Mi More articles by this author Ly Hoang Roberts More articles by this author Evelyn Shea More articles by this author Lisa Vergos More articles by this author Danielle Tenney More articles by this author Larry Sirls More articles by this author Priya Padmanabhan More articles by this author Kenneth Peters More articles by this author Expand All Advertisement PDF downloadLoading ...

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 ...

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.

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.

Longitudinal urinary microbiome characteristics in women with urgency urinary incontinence undergoing sacral neuromodulation.

The objective was to evaluate the stability of the urinary microbiome communities in women undergoing sacral neuromodulation (SNM) for urgency urinary incontinence (UUI). We hypothesized that clinical response to SNM therapy would be associated with changes in the urinary microbiome. Women completed the Overactive Bladder Questionnaire Short-Form, the International Consultation on Incontinence Questionnaire Short Form, and the Female Sexual Function Index at baseline and 3 months post-SNM implantation. Transurethral urinary specimens were obtained for microbiome analysis at baseline and 3 months postoperatively. The V4 region of the 16S rRNA gene (515F-806R) was amplified with region-specific primers, and Amplicon Sequence Variants (ASVs) were identified with a closed-reference approach of taxonomic classification. Alpha-diversity was calculated using the phylogenetic (i.e., Faith's phylogenetic diversity) and nonphylogenetic metrics (i.e., Shannon diversity, and Pielou's evenness) using the QIIME2 plugin. Longitudinal paired volatility analysis was performed using the DEICODE and Gemelli plugin to account for host specificity across both time and space. Nineteen women who underwent SNM and provided both baseline and 3-month urine samples were included in this analysis. Women reported improvement in objective (number of UUI episodes) and subjective (symptom severity and health-related quality of life) measures. Ninety percent of the bacteria were classified as Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria. No significant differences were observed in each subject's beta-diversity at 3 months compared with their baseline microbiome. Our descriptive pilot study of a cohort of women who had achieved objective and subjective improvements in UUI following SNM therapy demonstrates that the urinary microbiome remains relatively stable, despite variability amongst the cohort.

PD06-05 FRACTIONAL CARBON DIOXIDE VAGINAL LASER FOR THE TREATMENT OF URINARY SYMPTOMS: 12 MONTHS RESULTS

You have accessJournal of UrologyCME1 May 2022PD06-05 FRACTIONAL CARBON DIOXIDE VAGINAL LASER FOR THE TREATMENT OF URINARY SYMPTOMS: 12 MONTHS RESULTS Ly Hoang Roberts, Annah Vollstedt, Hailey Eisner, Lauren Tennyson, Evelyn Shea, Lisa Vargos, Danielle Tenney, Bernadette Zwaan, Larry Sirls, Priya Padmanabhan, and Kenneth Peters Ly Hoang RobertsLy Hoang Roberts More articles by this author , Annah VollstedtAnnah Vollstedt More articles by this author , Hailey EisnerHailey Eisner More articles by this author , Lauren TennysonLauren Tennyson More articles by this author , Evelyn SheaEvelyn Shea More articles by this author , Lisa VargosLisa Vargos More articles by this author , Danielle TenneyDanielle Tenney More articles by this author , Bernadette ZwaanBernadette Zwaan More articles by this author , Larry SirlsLarry Sirls More articles by this author , Priya PadmanabhanPriya Padmanabhan More articles by this author , and Kenneth PetersKenneth Peters More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002525.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fractional carbon dioxide (fCO2) has been suggested to alleviate urinary symptoms such as frequency, urgency, urge urinary incontinence (UUI), and stress urinary incontinence (SUI) given its therapeutic effects on genitourinary symptoms of menopause (GSM). In a previous pilot study, we did not observe objective or subjective improvement in SUI at 6 months; however, there was a trend towards improvement for UUI. The goal of this study was to measure the effect of vaginal fCO2 laser therapy on SUI and OAB symptoms at 12 months. METHODS: After IRB approval, women > 18 years with urogenital symptoms were enrolled in an open-label prospective trial. A 3-month washout period was mandated for patients previously on vaginal estrogen therapy. Participants underwent 3 laser treatments, each 6 weeks apart from the previous. With baseline at time of treatment 1, cough stress test (CST) was performed at every visit while a voiding diary was completed at baseline, 6- and 12-months. Subjective data was obtained using the Incontinence-Quality of Life (I-QOL), Overactive Bladder Questionnaire short form (OABq-SF), Questionnaire for Urinary Incontinence Diagnosis (QUID), and Female Sexual Function Index (FSFI) at 6- and 12-months. ANOVA analysis with Dunnett’s multiple comparison was used to compare means at each time point. RESULTS: At time of analysis, 85 patients were enrolled. Of these, 36 patients had 12-month data and reported baseline SUI (n=25; 29%), frequency (n=28; 33%), urgency (n=29; 34%), or UUI (n=24; 28%). There was no statistically significant difference in number of SUI leaks (p=0.569) or rates of positive CST over time. Patients reported improvement on the I-QOL (mean ± SD diff: 12.23±10.90, p<0.0001) and QUID SUI sub-section (mean ± SD diff:-1.65±2.48, p=0.0065) at 12 months. There were no objective changes in frequency or UUI episodes, but urge intensity was significantly decreased at 12 months (mean ± SD diff: -0.28±0.51, p=0.0008). This correlated with a similar improvement in the OABq-SF and QUID UUI subsection (p=0.0003 and 0.002 at 12 m, respectively). CONCLUSIONS: In this study, we have demonstrated that vaginal fCO2 laser therapy significantly reduces urge intensity and improves patient reported symptom scores up to 12 months after onset of treatment. However, objective outcomes for SUI did not improve. Vaginal fCO2 laser may be a viable treatment option for women with GSM who suffer from urinary urgency, but it does not improve SUI. Source of Funding: Susan Cooper Fund/Women's Urology Center © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e94 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ly Hoang Roberts More articles by this author Annah Vollstedt More articles by this author Hailey Eisner More articles by this author Lauren Tennyson More articles by this author Evelyn Shea More articles by this author Lisa Vargos More articles by this author Danielle Tenney More articles by this author Bernadette Zwaan More articles by this author Larry Sirls More articles by this author Priya Padmanabhan More articles by this author Kenneth Peters More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD38-04 A COMMUNITY-BASED EDUCATION PROGRAM FOR OVERACTIVE BLADDER IN A PREDOMINANTLY MINORITY OLDER FEMALE POPULATION: A PILOT STUDY

You have accessJournal of UrologyCME1 May 2022PD38-04 A COMMUNITY-BASED EDUCATION PROGRAM FOR OVERACTIVE BLADDER IN A PREDOMINANTLY MINORITY OLDER FEMALE POPULATION: A PILOT STUDY Susana Martinez Diaz, Hudson Pierce, John Lee, Tirsit Asfaw, Andrew Abram, Naeem Bhojani, Dean Elterman, Kevin Zorn, and Bilal Chughtai Susana Martinez DiazSusana Martinez Diaz More articles by this author , Hudson PierceHudson Pierce More articles by this author , John LeeJohn Lee More articles by this author , Tirsit AsfawTirsit Asfaw More articles by this author , Andrew AbramAndrew Abram More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Dean EltermanDean Elterman More articles by this author , Kevin ZornKevin Zorn More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002596.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Knowledge gaps in available treatment and social stigmatization are barriers to care in patients with overactive bladder (OAB), especially for minority populations. We assess the feasibility of an OAB education program targeting older, minority community-dwelling females. METHODS: Women over age 55 were recruited from community centers in New York City. Individuals with a previous diagnosis of OAB were excluded to control for baseline knowledge about OAB. Eligible participants underwent an education program consisting of a slide presentation covering the following topics: bladder function, lower urinary tract anatomy, pathophysiology of OAB, effect of OAB on quality of life, pelvic floor exercise training, and bladder training. OAB symptom score and general and condition-specific quality of life scores were measured at baseline and 1 week, 3 months, and 6 months post-intervention using the Overactive Bladder Questionnaire-Short Form and Short Form-12. Change in scores over time was analyzed using a linear mixed-effects model for repeated measures. RESULTS: 37 female patients with OAB symptoms at baseline participated in the study. Most participants were from a Latino/Hispanic or Black/African American ethnic/racial background (Table 1). For our youngest subgroup (≤68 years old) significant improvements were observed at 3 and 6 months compared to 1 week post-intervention for symptom bother (3 months, -22.75, p=0.006; 6 months, -25.76; p=0.001) and condition-specific related quality of life sub-scale scores for concern (3 months, +23.76, p=0.006; 6 months, +22.15, p=0.011) and social interaction (3 months, +21.11, p=0.017; 6 months, +20.51; p=0.021). For all ages, improvements in general quality of life measures for mental health were seen at 3 and 6 months compared to baseline (3 months, +7.57, p=0.02; 6 months, +6.70; p=0.048). CONCLUSIONS: There were statistically significant improvements in symptom bother, condition-specific, and general quality of life measures following an OAB education program in a predominantly minority older female population. Further studies are needed to support efficacy and optimize design to benefit these patients in the long-term. Source of Funding: Weill Cornell Clinical and Translational Science Center grant support (CTSC GRANT UL1 TR000457) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e646 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Susana Martinez Diaz More articles by this author Hudson Pierce More articles by this author John Lee More articles by this author Tirsit Asfaw More articles by this author Andrew Abram More articles by this author Naeem Bhojani More articles by this author Dean Elterman More articles by this author Kevin Zorn More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Community-Based Education Program for Overactive Bladder in a Predominantly Minority Older Female Population: A Pilot Study

Introduction: Knowledge gaps regarding available treatment and social stigmatization are barriers to care in patients with overactive bladder (OAB). We assessed the feasibility of an OAB education program targeting older community-dwelling females. Methods: Community-dwelling women over 55 years old were recruited. Eligible participants underwent an education program covering continence-promotion strategies. The Overactive Bladder Questionnaire-Short Form and Short Form-12 were completed at baseline, 1 week, 3 months, and 6 months post-intervention to measure symptom bother and condition-specific and general quality of life (QoL). Data were analyzed using a linear mixed-effects model for repeated measures. Results: Thirty-seven female patients with OAB symptoms at baseline were assessed with the majority from Latino/Hispanic or Black/African American ethnic/racial backgrounds. For our youngest subgroup (≤68 years old), significant improvements were observed at 3 and 6 months compared to 1 week post-intervention for symptom bother (3 months, −22.75, p = 0.006; 6 months, −25.76; p = 0.001) and condition-specific and health-related QoL subscale scores for concern (3 months, +23.76, p = 0.006; 6 months, +22.15, p = 0.011) and social interaction (3 months, +21.11, p = 0.017; 6 months, +20.51; p = 0.021). For all age subgroups, improvements in general QoL measures for mental health were seen at 3 and 6 months compared to baseline (3 months, +7.57, p = 0.02; 6 months, +6.70; p = 0.048). Conclusions: Statistically significant improvements in symptom bother, condition-specific, and general QoL measures were observed following an OAB education program pilot study in a predominantly minority female population. Further studies are needed to support efficacy and optimize program design.

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.

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.

Night shift workers refer higher urinary symptoms with an impairment quality of life: a single cohort study.

The aim of the present study is to assess the impact of night shift work (NSW) on urinary symptoms. Between March 2018 to October 2018, we evaluated a group of National Health care system workers. Urinary symptoms and quality of life were measured by Overactive Bladder Questionnaire Short Form (OABq-sf). Clinical variables (i.e. age, smoking status, medical history) were collected and analyzed according to be NS workers (NSWs) from subjects working at least one time from 8 pm to 8 am or from traditional workers (TWs). Univariate and multivariate analysis was performed to identify predictive variables of worse OAB outcomes (OABq-sf>30, OABq-SB≥12, OABq HRQL≥18). A total of 136 participants (68 males and 68 females) were included in the study. On OABq-sf, total score, symptoms bother (OABq-SB) and health related quality of life (OABq-HRQL) domains were significantly (P<0.05) higher in NSWs group, respectively: 31 (IQR 26-35) vs. 19 (IQR 19-20); 11 (IQR 10-13) vs. 6 (IQR 6-7); 19 (IQR 16-22) vs. 13 (13-14). Finally, seven NSWs (10.6%) referred nocturia respect to only one (1%) TWs, (P=0.02). On multivariate analysis NSW was an independent predictor of OABq-sf>30 units (OR:30; CI: 9-111, P=0.001), OABq-SB ≥12 units (OR:16, CI: 6-43, P=0.001) and OABq HRQL≥18 units (OR:20, CI: 6-70, P=0.001). Night shift workers presented worst OAB Score and poor QL when compared to similar traditional workers. Long-term data on NSWs patients are also needed to further clarify this relationship.

Translation and validation of the Portuguese version of the International Consultation on Incontinence Questionnaire (ICIQ) Bladder Diary.

The International Consultation on Incontinence Questionnaire (ICIQ) Bladder Diary (BD) is a standardized and validated diary, developed in the English language, designed to assess lower urinary tract symptoms (LUTS) in men and women. This study reports the translation, cross-cultural adaptation and validation process of this diary to the Portuguese language. After translation and back-translation of the ICIQ-BD to Portuguese, 140 urologic patients were asked to fill in this 3-day diary as well as the Overactive Bladder questionnaire Short Form (OABqSF) and a questionnaire evaluating the difficulties in filling out the ICIQ-BD. A subset of 60 patients filled out a second diary with/without LUTS treatment in between (30 patients in each group). In addition, content validity, internal consistency, criterion and construct validity were tested. The Portuguese version of the ICIQ-BD showed adequate internal consistency (Cronbach's alpha of 0.78), and patients reported few difficulties in filling out this tool, answering most commonly 1 on a 1-6 scale of difficulty. Excellent test-retest reliability and responsiveness of the diary were observed when comparing the first diary to a second completed 2-6weeks later. Criterion validity was also confirmed, given the good correlation with the OABqSF (Pearson's 0.386-0.447). Finally, construct validity was established through statistically significant concordance between data obtained in the BD with generally accepted theories. The present version of the ICIQ-BD is the first bladder diary successfully validated in the Portuguese language. It is a suitable and standardized tool for scientific research and diagnostic assessment of LUTS in adult men and women.

Treatment of refractory overactive bladder with OnabotulinumtoxinA vs PTNS: TROOP trial.

We hypothesized that patients with refractory overactive bladder (rOAB) have similar improvement with percutaneous tibial nerve stimulation (PTNS) and OnabotulinumtoxinA (BTX). This multicenter cohort study compared BTX and PTNS in women with rOAB. Baseline information included Overactive Bladder Questionnaire (OABq) short form, Urinary Distress Inventory-6 (UDI-6), and voiding diary. Primary outcome was cure, defined as "very much better" or "much better" on the Patient Global Impression of Improvement (PGII) AND a reduction in OABq symptom severity scale (SSS) ≥10 at 3 months after treatment. Assuming 80% power to detect a ten-point difference in OABq-SSS, 80 participants were required per group. A total of 150 patients were enrolled; 97 completed 3 months of therapy and were included. At baseline, BTX patients had more detrusor overactivity (70% vs 40%, p= 0.025), urgency incontinence (UUI; OABq-SSS#6 4 vs 3, p = 0.02, SSS 65 vs 56, p= 0.04), but similar health-related quality of life (HRQL 49 vs 54, p= 0.28), voids (7 vs 8, p= 0.13), and UUI episodes (2 vs 2, p= 1.0). At 3months, cure rates were similar: BTX 50% vs PTNS 44.2% (p= 0.56). Both groups had improved SSS (-37 vs -29, p= 0.08) and HRQL (31 vs 24, p= 0.14). Patients receiving BTX had a greater improvement in urgency (ΔOABq-SSS#2-3 vs -2; p= 0.02) and UUI (ΔOABq-SSS#6-2 vs -1; p = 0.02). No characteristics were predictive of cure. BTX resulted in significantly greater improvement in urgency and UUI than PTNS, but no difference in success based on PGII and OABq-SSS, which may be due to a lack of power.

Pooled analysis of the efficacy and safety of tibial nerve stimulation versus antimuscarinic agents in the management of overactive bladder syndrome.

The purpose of this meta-analysis was to evaluate the efficacy and safety of tibial nerve stimulation (TNS) versus antimuscarinic agents in the management of overactive bladder (OAB) syndrome. The databases MEDLINE, EMBASE, the Cochrane Controlled Trial Register of Controlled Trials from 2000 to May 2021 were searched to identify randomized controlled trials that referred to the use of TNS and antimuscarinic agents for the treatment of OAB syndrome. A systematic review and meta-analysis was conducted. Eight publications involving 420 patients were included in the meta-analysis. In the analysis, we found TNS had a comparable effect with antimuscarinic agents on micturition per day, nocturia, urge incontinence, and voided volume (P = .9; .4; .78; .44, respectively). Scores measured by questionnaires Overactive Bladder Symptom Score and Overactive Bladder questionnaire Short Form items also indicated no statistical difference between 2 groups. TNS group had a significantly less discontinuation rate and adverse events (P = .003; .0001). TNS is as effective as antimuscarinic agents for the treatment of OAB. Moreover, TNS appears to be more tolerable and safer than antimuscarinic agents.

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.

Mirabegron improves erectile function in men with overactive bladder and erectile dysfunction: a 12-week pilot study.

Phosphodiesterase type 5 inhibitors (PDE5i) is the only approved oral treatment for erectile dysfunction (ED) in the US, and alternative management remains necessary when this treatment fails or is contraindicated. Targeting other pathways than the NO-cGMP pathway and/or combining this approach with PDE5i may introduce new treatments for men who are unresponsive to PDE5i. This study aims to evaluate whether Mirabegron improves erectile function in men with concurrent overactive bladder and mild to moderate ED. Twenty subjects, 40-70 years old, registering International Index of Erectile Function (IIEF) score 11-25 and International Prostate Symptom Score 8-20, were treated with Mirabegron therapy for 12 weeks. Study participants were re-administered IIEF and OAB-q questionnaires on weeks 2, 4, 8, and 12 and assessed for adverse events. The primary and secondary endpoints were an increase in the IIEF-5 score of 4 units and a decrease in the Overactive Bladder questionnaire (OAB-q) symptom severity score of 10 units between study time points. Thirteen men completed the 12-week study. Mirabegron treatment improved the IIEF-5 scores in five patients (38.4%) by 4 points or more, whereas IIEF-5 scores were not affected by Mirabegron treatment in eight patients (61.5%). There were no clinically relevant decreases in the IIEF-5 score. Significant improvements were observed in intercourse satisfaction at week eight compared to baseline (p = 0.01). Orgasmic function and sexual desire were not affected by Mirabegron treatment. As expected, Mirabegron treatment reduced OAB symptoms based on OAB-q short form (p = 0.006) and OAB-q total health-related quality of life (HRQL) scores compared to baseline (p = 0.03). Residual bladder volumes were not affected by treatment. No serious side effects were reported during the study period. This study suggests that Mirabegron may improve both EF and OAB-related symptoms in some individuals without causing serious adverse events.