Overactive Bladder Symptom Severity Research Articles

Comparative effectiveness of pelvic floor muscle training, mirabegron, and trospium among older women with urgency urinary incontinence and high fall risk: a feasibility randomized clinical study

BackgroundUntreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling.MethodsForty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling.DiscussionThe proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population.Trial registrationNCT05880862. Registered on 30 May 2023.

MP74-05 WHAT FACTORS DETERMINE WHICH FEMALE PATIENTS WITH OVERACTIVE BLADDER FOLLOW-UP?

You have accessJournal of UrologyCME1 Apr 2023MP74-05 WHAT FACTORS DETERMINE WHICH FEMALE PATIENTS WITH OVERACTIVE BLADDER FOLLOW-UP? Connelly Miller, Arshia Harandi, Jonathan Aronov, Jennifer Ramgopal, Philip Fonesca, Holly Smith, Brian Shkolnik, Jacob Hartman-Kenzler, Aaron Huang, and Jason Kim Connelly MillerConnelly Miller More articles by this author , Arshia HarandiArshia Harandi More articles by this author , Jonathan AronovJonathan Aronov More articles by this author , Jennifer RamgopalJennifer Ramgopal More articles by this author , Philip FonescaPhilip Fonesca More articles by this author , Holly SmithHolly Smith More articles by this author , Brian ShkolnikBrian Shkolnik More articles by this author , Jacob Hartman-KenzlerJacob Hartman-Kenzler More articles by this author , Aaron HuangAaron Huang More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is a common condition responsible for significant morbidity in female patients. Treatment can be complex and multifaceted, requiring strict treatment compliance and often several clinical encounters for effective symptom management. Recognizing risk factors for loss to follow-up is critical to identifying patients who may require supplementary interventions to improve adherence. METHODS: Adult female patients presenting for a new patient visit for OAB symptoms (frequency, urgency, incontinence, nocturia) were identified at an outpatient urology clinic between July 2020 and June 2021. Medical records were abstracted for demographic data, smoking history, medical comorbidities, and baseline OAB symptom severity. Prospective chart review was performed to identify additional urology clinic visits for any reason at 1-month, 3-month, and present-day time horizons. The Student’s t-test for quantitative variables and the chi-squared test for qualitative variables were used to compared characteristics of patients who did and did not have follow-up visits by those time horizons. RESULTS: 816 female patients were included in the analysis, of which 63.1% had a follow-up visit recorded between the initial visit and present-day. There was no difference in follow-up by age or race (see Table 1). Patients with follow-up visits within the catchment period were more likely to live closer (p<.05), have neurogenic OAB (p<.05), and endorse incontinence (p<.05). They were also more likely to have a history of hypertension (p<.01) and heart disease (p<.05), and at the 1-month and 3-month time horizons to report a history of chronic pain (p<.05 and p<.01, respectively). CONCLUSIONS: This study recapitulates known associations between distance to clinic and baseline symptom severity with chance of follow-up, but also reveals a correlation between follow-up for overactive bladder and certain medical comorbidities, which may provide real-world evidence for the potential role of multidisciplinary approaches in the treatment of OAB. The lack of age-based and racial inequity in follow-up rates is also noteworthy. Further research could target interventions to reduce attrition through the creation of a hazard score to identify patients at high-risk for loss to follow-up. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1070 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connelly Miller More articles by this author Arshia Harandi More articles by this author Jonathan Aronov More articles by this author Jennifer Ramgopal More articles by this author Philip Fonesca More articles by this author Holly Smith More articles by this author Brian Shkolnik More articles by this author Jacob Hartman-Kenzler More articles by this author Aaron Huang More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Interplay between bladder microbiota and overactive bladder symptom severity: a cross\u2010sectional study

BackgroundIt is widely accepted that there exist microbiota communities in urinary tract of healthy individuals. Imbalance in the urinary microbiome plays important roles in the development of various benign urological conditions including lower urinary track symptoms (LUTS) and overactive bladder (OAB). However, whether alteration in urinary microbiome exerts influence on the severity of OAB symptom has yet to be elucidated. The purpose of this study is to examine the correlation between urinary microbiome and the severity of OAB.MethodsA total of 70 OAB patients were recruited to finish overactive bladder symptom score (OABSS) questionnaires. Catheterized urine samples were obtained for 16S rRNA gene sequencing. The species richness and evenness were evaluated by α diversity, and the difference in urinary microbiome between patients with mild or moderate/severe severity was evaluated by β diversity. The relationship between urinary microbiome and the severity of OAB symptom was evaluated using Pearson’s correlation analysis.ResultsMild patients (OABSS ≤ 5, n = 17) had lower bacterial diversity (Simpson index, P = 0.024) and richness (Chao1, P = 0.023) than those with moderate/severe symptom (OABSS > 5, n = 53). Beta-diversity of urinary microbiome between two groups were significantly different. Furthermore, the score of OABSS was positively correlated with the richness index (Chao1, P = 0.002) and diversity index (Shannon index, P = 0.044) of urinary microbiome. Certain bacterial genera (e.g., Porphyromona and Prevotella) were significantly correlated with severity of OAB sub-symptoms.ConclusionThis study demonstrated that urinary microbiome was intimately correlated with the severity of OAB symptom and the increase of the diversity and richness of urinary microbiome was accompanied by more severe OAB symptoms, indicating that urinary dysbiosis may play pivotal roles in the deterioration of functional bladder diseases.

Overactive Bladder during Pregnancy: A Prospective Longitudinal Study.

Background and Objectives: Overactive bladder (OAB) is a serious urination-related symptom of unknown pathogenesis that affects one’s everyday activities. The objective of this study was to examine how OAB prevalence, symptom severity, and degree of distress caused by OAB symptoms evolved throughout the course of pregnancy. Materials and Methods: A total of 659 pregnant women were recruited from 2015 to 2020, and were evaluated through the International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) on OAB symptoms, administered in the early, middle, and late stages of pregnancy. Results: Generalized estimating equation analysis revealed that the odds of OAB occurring in the middle and late stages of pregnancy were 1.90 and 2.33 times higher, respectively, than in early pregnancy. The corresponding odds for OAB-wet were 1.63 and 2.07 higher, respectively, and the odds of OAB-dry occurring during late pregnancy were 0.80 higher than during early pregnancy. Symptoms were more severe by 0.07 and 0.21 points (on a 4-point scale) in the middle and late stages of pregnancy, respectively, than in early pregnancy; distress was greater by 0.13 and 0.27 points (on a 10-point scale) in the middle and late stages of pregnancy, respectively, than in early pregnancy. The prevalence of OAB, OAB-dry, and OAB-wet was significantly higher in early pregnancy than pre-pregnancy. Conclusions: The prevalence of OAB and OAB-wet increased over the course of pregnancy, but the prevalence of OAB-dry decreased. Furthermore, symptom severity and degree of distress increased over time.

Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients.

Introduction and hypothesis: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. Methods: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. Results: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.

PD66-03 THE ANXIOUS BLADDER: EFFECTS ON TOILETING BEHAVIORS IN WOMEN WITH ANXIETY AND OVERACTIVE BLADDER

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction III (PD66)1 Sep 2021PD66-03 THE ANXIOUS BLADDER: EFFECTS ON TOILETING BEHAVIORS IN WOMEN WITH ANXIETY AND OVERACTIVE BLADDER Elizabeth Rourke, Elisabeth Sebesta, and Stuart Reynolds Elizabeth RourkeElizabeth Rourke More articles by this author , Elisabeth SebestaElisabeth Sebesta More articles by this author , and Stuart ReynoldsStuart Reynolds More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002110.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior research has demonstrated associations between anxiety and overactive bladder (OAB). However, how anxiety impacts coping and behaviors in OAB remains unknown. The objective of this study was to determine whether anxiety is associated with more frequent adoption of compensatory bladder behaviors in women with OAB. METHODS: This is a secondary analysis of a sample of 1,597 non-institutionalized, adult U.S. women with OAB (defined as urgency and/or urgency incontinence at least sometimes, based on ICIQ-FLUTS) recruited through online advertisement with ResearchMatch. Women completed validated questionnaires assessing demographic and clinical history, toileting behaviors (TB-WEB), urinary symptoms (ICIQ-FLUTS), and specific compensatory behaviors of fluid restriction, impact on daily tasks, avoidance of places/situations, toilet seeking and need to change clothes. Our primary comparison was between women who did and did not report a diagnosis of anxiety. We used chi-squared tests and multivariable logistic regression to compare the two groups, adjusting for age and OAB severity (ICIQ-FLUTS OAB score). RESULTS: 798 (50%) women in the sample reported a diagnosis of anxiety and these were younger (43+/-15 vs 48+/-15 years) and had greater OAB symptom severity (ICIQ-FLUTS-OAB 6.1+/-2.3 vs. 5.8+/-2.2). Associations of compensatory bladder behaviors and toileting behaviors are presented in the figure. Positive associations were seen between anxiety and avoiding places without a restroom, mapping the locations of restrooms, interference with performing daily tasks, avoiding public restrooms, and worrying about cleanliness of restrooms. CONCLUSIONS: There is an established relationship between anxiety and OAB. Our study demonstrates that OAB symptom severity in conjunction with anxiety may have a negative impact on bladder behaviors such that women are more likely to modify these behaviors when faced with OAB and anxiety. These compensatory coping behaviors, while not universal, are important in considering the impact that psychosocial factors can have on urinary symptoms. These relationships could be further assessed in future studies to include severe of anxiety on OAB symptoms. Source of Funding: The Vanderbilt Institute for Clinical and Translational Research Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1159-e1159 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Rourke More articles by this author Elisabeth Sebesta More articles by this author Stuart Reynolds More articles by this author Expand All Advertisement Loading ...

Effect of systemic atherosclerosis on overactive bladder symptoms in men with benign prostatic hyperplasia.

Symptoms of male overactive bladder (OAB) may be caused by several systemic pathophysiological factors rather than a single-source etiology. We investigated the clinical factors associated with the severity of OAB symptoms in treatment-naïve men with coexisting benign prostatic hyperplasia. We obtained records from a health promotion center database of male patients who visited between March 2019 and February 2020. Men without a history of treatment for lower urinary tract symptoms were evaluated using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, transrectal ultrasonography, medical history, and carotid duplex ultrasound for the evaluation of atherosclerosis. Benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) was defined as an IPSS of eight points or higher. Patients with comorbidities that may affect their voiding function were excluded. A total of 764 patients were divided into two groups based on their diagnosis: an OAB group and a non-OAB group. The non-OAB group consisted of 627 patients (82.1%) and the OAB group consisted of 137 patients (17.9%). Using multivariable analysis BPH/LUTS was identified as an independent risk factor for OAB. In the OAB group without BPH/LUTS, carotid atherosclerosis was significantly associated with the severity of OAB symptoms. A history of diabetes mellitus was the only variable that was associated with the severity of urinary urgency. Systolic blood pressure was associated with severity of urinary urgency in the OAB group with BPH/LUTS. Factors associated with male OAB exhibit different pathophysiology in the severity of symptoms depending on the presence of BPH/LUTS. Treatment for atherosclerosis and associated systemic pathophysiological factors could lower OAB symptom severity in male patients without BPH/LUTS.

Comparison of Pelvic Floor Muscle Training With Connective Tissue Massage to Pelvic Floor Muscle Training Alone in Women With Overactive Bladder: A Randomized Controlled Study

ObjectiveThe purpose of this study was to compare the effects of a 6-week program of pelvic floor muscle training (PFMT) plus connective tissue massage (CTM) to PFMT alone in women with overactive bladder (OAB) symptoms on those symptoms, pelvic floor muscle strength, and quality of life. MethodsThirty-four participants were randomly divided into PFMT+CTM (n = 17) and PFMT (n = 17) groups. PFMT was applied every day and CTM was applied 3 days a week for 6 weeks. Before treatment, at week 3, and after treatment (week 6), we assessed pelvic floor muscle strength (with a perineometer), bladder symptoms (with a urine diary), OAB symptom severity (with the 8-item Overactive Bladder Questionnaire [OAB-V8]), urgency (with the Patient Perception of Intensity of Urgency Scale [PPIUS]), and quality of life (with King's Health Questionnaire [KHQ]). The Mann–Whitney U test, χ2 test, Friedman test, and Dunn multiple comparison test were used for analysis. ResultsIn both groups, pelvic floor muscle strength increased, whereas OAB symptoms and PPIUS and KHQ scores decreased after treatment (P < .05). Although the OAB-V8, PPIUS, and KHQ scores decreased at week 3, frequency, OAB-V8, and PPIUS scores, in addition to some parameters of the KHQ, decreased after treatment in the PFMT+CTM group compared to the PFMT group (P < .05). ConclusionCompared to PFMT alone, PFMT+CTM achieved superior outcomes in reducing OAB symptoms in the early and late periods.

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 May 2021Editorial CommentThis article comments on the following:The Effect of Social Determinants of Health on Overactive Bladder Symptom Severity Sonya S. Brady Sonya S. BradySonya S. Brady Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001545.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 205(5), p. 1420

Validation of the Overactive Bladder-Bladder Assessment Tool (OAB-BAT): A Potential Alternative to the Standard Bladder Diary for Monitoring OAB Outcomes

BackgroundAn advisory board concluded that a new, comprehensive overactive bladder (OAB) patient-reported outcome (PRO) measure should be developed in accordance with regulatory guidelines. The OAB-Bladder Assessment Tool (OAB-BAT) was developed with qualitative input from OAB patients and experts to measure symptoms, bother, impacts, and satisfaction with treatment. ObjectivePsychometric evaluation of the OAB-BAT assessing PRO OAB symptoms, bother, and impacts during a 7-d recall period. Design, setting, and participantsPsychometric testing was conducted for a 28-d observational study of 170 OAB patients. Eligibility criteria included clinician-confirmed OAB diagnosis with at least eight micturitions per day. Outcome measurements and statistical analysisAssessments included the OAB-BAT, a 7-d bladder diary, and co-validating OAB PROs. Analysis included classical and modern test theories. A scoring algorithm was developed and psychometric properties were assessed. Results and limitationsThe majority of participants were women (72.4%) with moderate OAB symptom severity (53.5%). More than one-third of participants (34.1%) were incontinent. Responses were well balanced across bother and impact items, while symptom frequency items showed sparse responses. Analysis supported an eight-item unidimensional model based on bother and impacts. No items performed differently by gender or continence status. The OAB-BAT showed internal consistency (ω=0.918), retest reliability (two-way random intraclass correlation coefficient=0.81), and convergent validity with the OAB-q (r>0.4). Known groups showed the expected trend. Comparisons between OAB-BAT scores and components of the bladder diary showed a moderate effect size (r>0.4). ConclusionsThe eight-item OAB-BAT with 7-d recall is valid and reliable as an OAB PRO measure. Structural modeling, balanced with content validity considerations, produced robust scores. The OAB-BAT is a useful addition to the clinical assessment of patients, designed to complement the use of bladder diaries for monitoring OAB outcomes, in clinical trial and clinical practice environments. Future studies will need to assess the treatment satisfaction items in a larger sample of patients receiving OAB treatment. Patient summaryWe tested a questionnaire designed to assess overactive bladder (OAB) symptoms, bother, satisfaction, and impacts by asking patients to complete it on a weekly basis. We found that the questionnaire accurately captures the symptoms and impacts that are most important to patients with OAB. We conclude that the questionnaire could be a useful instrument and, after further assessment in clinical practice and research, a possible alternative to a bladder diary in measuring OAB outcomes.

Potential Role of Monocyte Chemoattractant Protein-1 in Monitoring Disease Progression and Response to Treatment in Overactive Bladder Patients.

PurposeTo compare urinary levels of monocyte chemoattractant protein-1 (MCP-1), an inflammatory cytokine, in healthy controls and overactive bladder (OAB) patients, to correlate changes in urinary MCP-1 with OAB treatment response and symptom severity, and to study the diagnostic potential of MCP-1 for OAB, as well as the efficacy of MCP-1 as a potential biomarker for different phenotypes of OAB.MethodsWe used enzyme-linked immunosorbent assay to measure normalized urinary MCP-1 levels in 56 individuals (43 OAB patients and 13 controls). We assessed the OAB patients at 3 visits with 2 validated symptom severity questionnaires (OAB-V8 and Patient Perception of Bladder Condition).ResultsThe mean pretreatment urinary MCP-1 level at visit 1 (229.2-pg/mg creatinine) was significantly greater than the MCP-1 levels at visit 3 in both the treatment (107.0-pg/mg creatinine) (P<0.001) and control (52.35-pg/mg creatinine) groups (P<0.001). Average OAB symptom severity decreased significantly from visit 1 (baseline) to visits 2 (4 weeks) and 3 (12–14 weeks) and was significantly correlated with urinary MCP-1 levels. Urinary MCP-1 levels dropped significantly (P=0.002) posttreatment in patients whose symptom severity improved by >30%, whereas nonresponders displayed no significant MCP-1 decrease (P=0.164). The receiver operating characteristic analysis of the OAB visit 1 and control groups produced an area under the curve of 0.891. We found no significant differences in sex, race, or age between the OAB and control groups.ConclusionsMCP-1 levels differed significantly between the control and OAB groups and were closely correlated with symptom severity and treatment response. The good diagnostic accuracy of MCP-1 for OAB suggests the potential usage of MCP-1 for OAB diagnosis. The varying response of urinary MCP-1 levels to treatment may indicate at least 2 potential phenotypes of OAB. MCP-1, in combination with other biomarkers and symptom severity questionnaires, could potentially aid in developing a patient-centered OAB treatment approach.

The Effect of Social Determinants of Health on Overactive Bladder Symptom Severity.

Social determinants of health may significantly impact overall health and drive health disparities. We evaluated the association between social determinants of health and overactive bladder severity. We conducted a multicenter, cross-sectional study of patients presenting to outpatient female pelvic medicine and reconstructive surgery clinics at Montefiore Medical Center (Bronx, New York) and Johns Hopkins Bayview Medical Center (Baltimore, Maryland) from November 2018 to November 2019. Surveys were administered to screen for overactive bladder (Overactive Bladder-Validated 8-Question Screener) and to evaluate social determinants of health. Ordinal logistic regression models were used to examine the association between overactive bladder symptom level and social determinants of health items, while adjusting for age, race, body mass index, parity, history of pelvic surgery and clinical site. A total of 256 patients with a mean±SD age of 58.6±14.2 years and body mass index of 30.4±7.5 kg/m2 were recruited over a 12-month period. Our sample was 33.6% White, 32% Black and 29.3% Hispanic, with 5.1% categorized as other. A higher overactive bladder symptom level was associated with food insecurity (OR 2.51, 95% CI 1.03-6.11), financial strain (OR 1.94, 95% CI 1.06-3.53), difficulty finding or keeping employment (OR 3.14, 95% CI 1.01-9.72) and difficulty concentrating (OR 2.48, 95% CI 1.25-4.95), after adjusting for site, age, race, body mass index, parity and previous pelvic surgery. In this cross-sectional study, certain social determinants of health were associated with greater overactive bladder severity. Unmet social needs may impact the success of overactive bladder treatment. Urologists should consider collaborating with social work and mental health specialists to better serve patients with overactive bladder and social determinants of health needs.

A pilot study to investigate the associations of urinary concentrations of NO, ATP and derivatives with overactive bladder symptom severity.

What is the central question of this study? Are the urinary concentrations of NO and ATP, and their metabolites, associated with the severity of symptoms of overactive bladder? What is the main finding and its importance? The urinary ratios of [ATP/NO], [ADP/NO] and a combination of these, [ATP/Cr*ADP/Cr]/[NO/Cr], were correlated with overall OAB symptom severity, with the latter combination also being correlated with the severity of urinary frequency and urgency symptoms individually. Together, these data reveal changes in urothelial signalling that accompany the transition from physiology to pathology. Overactive bladder (OAB) is a highly prevalent symptom complex characterized by symptoms of urinary urgency and increased frequency and waking to void (nocturia), with or without urge incontinence and in the absence of proven infection or other obvious pathology. The underlying pathophysiology of idiopathic OAB is not clearly known, and the existence of several phenotypes has been proposed. Current diagnostic approaches are based on discordant measures, suffer from subjectivity and are incapable of detecting the proposed OAB phenotypes. Nitric oxide, ATP and their metabolites have previously been shown to underlie the perception of bladder fullness, with their release modifying the pathological perception of urgency. Therefore, in this study we assessed the concentrations of NO, ATP and associated metabolites in the urine of 113 consenting participants recruited from the general population. Recruited participants completed a questionnaire to measure the severity of OAB-associated urinary symptoms and provided a mid-stream urine sample. After identification of infection and haematuria using microbiology and microscopy, 95 samples were subjected to assays to measure NO, NO2- , NO3- , ATP, ADP and creatinine (Cr). There was no correlation between [NO/Cr], [NO2- /Cr] or [NO3- /Cr] and overall OAB symptom severity. In contrast, [ATP/NO], [ADP/NO] and a combination of these, [ATP/Cr*ADP/Cr]/[NO/Cr], were correlated with OAB symptom severity, and [ATP/Cr*ADP/Cr]/[NO/Cr] was also correlated with the severity of urinary frequency and urgency. This study adds to a growing literature that demonstrates the potential of urinary biomarkers and provides a foundation for a larger, longitudinal study.

Role of β-3 adrenergic receptor polymorphism in overactive bladder.

Women with overactive bladder (OAB) have a higher frequency of a single-nucleotide polymorphism (SNP) at codon 64 of the β-3 adrenergic receptor gene (ADRB3). Since the SNP results in an amino acid substitution that could theoretically alter receptor protein function, we hypothesized that those with the SNP would display greater OAB symptom severity. Therefore we aimed to compare OAB severity between women with this SNP and women with the wild type genotype. A retrospective cohort study was performed in women with bothersome OAB from two academic institutions. Banked blood samples were tested for the codon 64 SNP. Women were divided into two groups based on genotype: wild-type (WT) and heterozygous (HZ). We compared mean OAB Symptom Severity questionnaire (OAB-q) scores between groups using t tests. Linear regression was performed to control for potential confounders. Of the 303 women with OAB, 254 (83.8%) had the WT genotype, and 49 (16.2%) the HZ genotype. There were no homozygous women for the rare allele. The majority were Caucasian (86%) and non-Hispanic (97%). There were no significant differences in mean OAB-q symptom severity scores (WT 21.2 ± 7 vs HZ 22.0 ± 6.6; P = 0.49) and quality of life scores (WT 39.6 ± 15.5 vs HZ 39.1 ± 16.6; P = 0.83) between groups. These remained nonsignificant in a linear regression model. In a predominantly non-Hispanic, Caucasian population of women with bothersome OAB, symptom severity was not related to ADRB3 codon 64 SNP genotype.

Comparing Vitamin D Supplementation Versus Placebo for Urgency Urinary Incontinence: A Pilot Study.

To estimate the efficacy of vitamin D supplementation to reduce urgency urinary incontinence (UUI) episodes. Pilot, two-arm, randomized trial conducted from 2013 to 2017. Interventions were 12 weeks of weekly oral 50,000 IU vitamin D3 or placebo. Academic, university-based outpatient clinic. Community-dwelling postmenopausal women, 50 years or older, with at least three UUI episodes on 7-day bladder diary and serum vitamin 25-hydroxyvitamin D (25[OH]D) of 30 ng/mL or less. The primary efficacy estimate was the percentage change in UUI episodes. Secondary estimates included changes in other lower urinary tract symptoms, along with exploratory subgroup analysis by race/ethnicity and obesity. We randomized 56 women (aged 50-84 years; mean = 60.5 ± 8.2 years), 28 to vitamin D and 28 to placebo; 51 completed treatments. Mean serum 25(OH)D at baseline (21.2 ± 5.2 and 18.2 ± 5.6, P = .30) improved to 57.9 ± 16.3 ng/mL with vitamin D3 and 21.9 ± 8.2 ng/mL with placebo (P < .001). UUI episodes per 24-hour day decreased by 43.0% with vitamin D3 compared to 27.6% with placebo (P = .22). Among black women (n = 33), UUI episodes decreased by 63.2% with vitamin D3 compared to 22.9% with placebo (P = .03). Among obese women, UUI episodes decreased by 54.1% with vitamin D compared to 32.7% with placebo (P = .29). For all women, changes in voiding frequency (P = .40), nocturia (P = .40), urgency (P = .90), incontinence severity (P = .81), and overactive bladder symptom severity (P = .47) were not different between arms. Postmenopausal women with UUI and vitamin D insufficiency demonstrated a greater than 40% decrease in UUI episodes, which did not reach statistical significance compared to placebo, except in the subset of black women. The results of this pilot study support further investigation of vitamin D3 alone or in combination with other treatments for UUI, particularly for women in higher-risk subgroups. J Am Geriatr Soc 67:570-575, 2019.

Can surgical reconstruction of vaginal and ligamentous laxity cure overactive bladder symptoms in women with pelvic organ prolapse?

To examine the extent and intensity of the coexistence of overactive bladder (OAB) symptoms in women with pelvic organ prolapse (POP) and to evaluate the likelihood of OAB symptom improvement after surgical POP reconstruction over a period of 2 years. The effectiveness of the transvaginal, single-incision 'Elevate' technique for anatomical cure of anterior/apical and posterior/apical vaginal prolapse has been previously reported in a prospective, multicentre study. This technique uses mesh arms attached to the sacrospinous ligaments to recreate apical ligamentous support. Using the same sample population as that used in the multicentre study (n = 281), we conducted the present sub-analysis focusing on estimating the extent of comorbidity between POP and OAB symptoms, as well as the effects of subsequent pelvic floor reconstruction on OAB symptoms over a long period. Assessments of POP and OAB symptom severity before and after surgery at 6, 12 and 24 months were obtained using the Pelvic Floor Distress Inventory (PFDI) questionnaire. Preoperatively, 70% of all POP patients reported moderate to severe OAB symptoms, with almost half (49.5%) noting severe OAB bother ('quite a bit bothersome') for one or more of the classic OAB symptom domains on the PFDI: 'daytime urinary frequency'; 'urinary urgency'; 'urinary urgency incontinence'; and/or 'nocturia'. In fact, across all four OAB symptom domains evaluated, there were significantly more severe symptoms ('quite a bit bothersome') than moderate ('moderately bothersome') or mild ('somewhat bothersome'): 26-31%, 13-21%, and 17-19% of patients, respectively. In patients with symptomatic POP >stage 2, there was no relationship between further degree of prolapse and presence of severity of OAB symptoms; however, patients with POP stage 2 had significantly more complaints regarding the items 'daytime urinary frequency' and 'urinary urgency incontinence' compared with those with stage 3-4 POP. Pelvic floor reconstructive surgery resulted in significant improvement in all OAB symptoms, which seemed to be stable over time. The cure rate of moderate-to-severe OAB complaints ranged between 60% and 80%, which was a durable improvement noted throughout 24 months. Results showed that POP was to a high degree accompanied by moderate-to-severe OAB complaints. Significant long-lasting improvements in bothersome OAB symptoms occurred after adequate surgical reconstruction of anterior/apical and posterior/apical vaginal support.

Review of Economic Value Drivers of the Treatment of Overactive Bladder

Overactive bladder (OAB) is a symptom-driven condition with economic burden estimated to be on the order of several hundred dollars or euros per patient in some North American and European countries. This work reviews recently published economic models to evaluate how health states are defined, what cost components are considered, and what utility values are used to estimate the cost effectiveness of OAB pharmacotherapies, botulinum toxin, or sacral neuromodulation. It was found that no clear standard exists for determining OAB health states, although most were defined by some measure of incontinence frequency. Costs of physician visits and incontinence pads were included in nearly all models; however, OAB-associated depression and nursing home costs were rarely included, despite being large cost drivers of global economic burden studies. Utility values used in the models ranged from 0.544 to 0.933, highlighting the uncertainty associated with how OAB patients value health-related quality of life. More research is warranted so that health states providing delineations among OAB symptom severity and quality of life are clinically and economically meaningful as well as meaningful to affected patients.

PD32-08 VITAMIN D SUPPLEMENTATION FOR URGENCY URINARY INCONTINENCE IN POST-MENOPAUSAL WOMEN: A PILOT RANDOMIZED CLINICAL TRIAL

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II1 Apr 2018PD32-08 VITAMIN D SUPPLEMENTATION FOR URGENCY URINARY INCONTINENCE IN POST-MENOPAUSAL WOMEN: A PILOT RANDOMIZED CLINICAL TRIAL Alayne Markland, T. Mark Beasley, Kathryn Burgio, Camille Vaughan, Vin Tangpricha, and Patricia Goode Alayne MarklandAlayne Markland More articles by this author , T. Mark BeasleyT. Mark Beasley More articles by this author , Kathryn BurgioKathryn Burgio More articles by this author , Camille VaughanCamille Vaughan More articles by this author , Vin TangprichaVin Tangpricha More articles by this author , and Patricia GoodePatricia Goode More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1551AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urgency urinary incontinence (UUI) is a very common, distressing condition. First-line behavioral and drug therapies are effective but novel therapies are needed. The primary aim of this study was to evaluate the efficacy of vitamin D supplementation compared to placebo to improve UUI in postmenopausal women with vitamin D insufficiency. METHODS This was a single-site pilot randomized trial conducted 2013-2017. Participants were community-dwelling postmenopausal women, 50 years of age or older, with at least 3 UUI episodes on 7-day bladder diary and 25(OH)D≤30 ng/mL (insufficiency). They were randomized to 12 weeks of weekly 50,000 IU vitamin D3 or placebo. Using Wilcoxon tests, we calculated the percent reduction in 24-hour UUI episodes (primary outcome), along with urinary frequency and nocturia episodes from the diaries for the overall group and for African American (AA) and obese women (higher-risk subgroups). Secondary outcomes included scores on validated bladder symptom questionnaires. RESULTS We randomized 56 women (50 to 84 years of age; mean age = 60.5 ±8.2; 70% AA; 64% obese), 28 to vitamin D and 28 to placebo; 51 completed treatment. For the completer analysis, mean 25(OH)D at baseline (21.2 ±5.2 and 18.2 ±5.6, p=0.30) improved to 57.9 ±16.3 for the vitamin D3 group and to 21.9 ±8.2 in the placebo group, p<0.001. UUI episodes per 24-hour day decreased 52.4% with vitamin D3 compared to 30.9% with placebo (p=0.09). Among Black women, changes in UUI episodes decreased 63.2% with vitamin D3 compared to 23.0% with placebo (p=0.03). There were no group differences among obese women (p=0.29). For all women, no differences between D3 and placebo were found for improvements in voiding frequency (p=0.40), nocturia (p= 0.40), incontinence symptom severity (p=0.80), or overactive bladder symptom severity (p=0.47). CONCLUSIONS Post-menopausal women with UUI and vitamin D insufficiency recorded a >50% decrease in UUI episodes that did not reach statistical significance compared to placebo, except in the subset of AA women. Based on these pilot study estimates for efficacy, further investigation of vitamin D3 alone or in combination with other treatments for UUI is warranted, particularly for women in higher-risk subgroups. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e648 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Alayne Markland More articles by this author T. Mark Beasley More articles by this author Kathryn Burgio More articles by this author Camille Vaughan More articles by this author Vin Tangpricha More articles by this author Patricia Goode More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Does sex matter? A matched pairs analysis of neuromodulation outcomes in women and men.

To evaluate whether baseline symptoms and outcomes are influenced by gender in a matched cohort undergoing neuromodulation. Patients in our prospective neuromodulation database that had a tined lead placed were reviewed. Those that had implantable pulse generator (IPG) placed were matched on age and urologic diagnosis. History, voiding diaries, satisfaction, Interstitial Cystitis Symptom/Problem Index (ICSIPI), and overactive bladder symptom severity (OABq ss)/health-related quality of life (HRQOL) preimplant and over 3years were evaluated using descriptive statistics, repeated measures, and matched pair GEE or mixed analyses. Of 590 patients in the database, more women than men received an IPG (450/488; 92.2 vs. 84/102; 82.4%; p = 0.0011). Eighty matched pairs (n = 160; 81% ≥ 50years old; 56.25% had urgency/frequency with urge incontinence-UI) were identified and evaluated. On voiding diaries, volume/void was greater in women only at baseline (p = 0.040); both groups improved over time (p < 0.0001). Urinary frequency improved in both women and men (p = 0.0010; p = 0.0025). Over 3years, UI episodes/day improved only in men (p = 0.017) and UI severity improved only in women (p < 0.0001). ICSIPI, OABq ss, and HRQOL scores improved similarly in both groups (p < 0.0001 for all measures in both groups), and although more women were satisfied at 3months (p = 0.027), groups did not differ at other time points. More women undergo neuromodulation and have initial success and subsequent IPG implantation. UI episodes improved only in men, and UI severity improved only in women. Both women and men experienced similar levels of symptom improvement on other measures.

Overactive bladder symptom severity, bother, help-seeking behavior, and quality of life in patients with type 2 diabetes: a path analysis

BackgroundThis study aimed to investigate the relationships among overactive bladder (OAB) symptom severity, bother, help-seeking behavior, and quality of life (QOL) in patients with type 2 diabetes.MethodsA total of 127 diabetic patients, aged at least 18 years, with overactive bladder from a hospital in Shandong Province, China, were recruited for this study. Symptom severity, bother, and quality of life were assessed using the Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and Overactive Bladder Questionnaire Short Form (OAB-q SF), respectively. Help-seeking behavior was assessed by asking patients whether they consulted health care professionals or received treatment for their bladder problems. A two-step path analysis was performed to analyze the data.ResultsOAB symptom severity was directly associated with lower levels of QOL, and the strength of this association was no longer significant when taking bother and help-seeking behavior into account. Bother increased with OAB symptom severity, and patients with bothersome OAB tended to have lower levels of QOL. Moreover, bother increased help-seeking behavior; however, patients who sought help tended to have lower levels of QOL.ConclusionsOur findings highlight the role of bother and help-seeking behavior in the relationship between OAB symptom severity and QOL. To improve a patient’s QOL, health care providers should focus not only on symptom bother but also on dysfunctional help-seeking patterns.