Overactive Bladder Symptoms In Women Research Articles

Bladder training compared to bladder training associated with pelvic floor muscle training for overactive bladder symptoms in women: A randomized clinical trial.

To compare the effects of bladder training (BT) versus BT with pelvic floor muscle training (PFMT) in women with overactive bladder (OAB) symptoms. Randomized controlled clinical trial including women with OAB symptoms, randomized into two groups: BT versus BT + PFMT. For 12 consecutive weeks, the women received home BT. The BT + PFMT performed supervised PFMT, once/week, associated at home PFMT protocol. Primary outcomes were urinary urgency, daytime voiding frequency, nocturia and urgency urinary incontinence assisted by both 3-day bladder diary and International Consultation on Incontinence OAB (ICIQ-OAB) questionnaire. Secondary outcomes were 24-h pad test and Patient Global Impression of Improvement. T-test, analysis of variance, Mann-Whitney (SPSS 20.0) and power/effect size (G-power) were applied in data analyses. Sixty-three women were included (B = 31; BT + PFMT = 32). There was no significant statistical difference between groups in terms of urinary symptoms: daytime frequency (BT: pre: 11.59 [±5.80], post: 9.10 [±4.05]; BT + PFMT: pre: 10.67 [±3.73], post: 8.08 [±3.38]) p = 0.75; nocturia: (BT: pre: 1.46 [±0.91], post: 0.82 [±0.82]; BT + PFMT: pre: 1.80 [±2.26], post: 0.82 [±1.15]) p = 0.70; urinary urgency (BT: pre: 3.22 [±4.70], post: 4.49 [±4.32]; BT + PFMT: pre: 6.87 [±5.60], post: 6.15 [±4.52]) p = 0.10; ICIQ-OAB total score: (BT: pre: 9.16 [±2.55], post: 6.32 [±3.77]; (BT + PFMT: pre: 9.75 [±2.06], post: 5.06 [±3.44] p = 0.30. Supervised PFMT added to BT did not provide further improvements than isolated BT in women with OAB symptoms.

A Retrospective Cohort Study on the Prevalence, Risk Factors, and Improvement of Overactive Bladder Symptoms in Women with Pelvic Organ Prolapse.

Overactive bladder (OAB) symptoms are common in women with pelvic organ prolapse (POP), but the explanation is unclear. It is also uncertain whether OAB symptoms improve or persist after POP reduction. This study aimed to determine the prevalence and risk factors for OAB symptoms in women with POP, and to compare the improvement of OAB symptoms among women in three treatment groups: pelvic floor exercise, pessary, and surgery. This retrospective cohort study included patients who visited our urogynecology clinic from January 2016 to December 2020. The Pelvic Floor Bother Questionnaire was used to evaluate selected pelvic floor symptoms (OAB and POP). Demographic characteristics and clinical findings, including Pelvic Organ Prolapse Quantification System and number of prolapsed compartments, were analyzed. Univariate and multivariate analyses were conducted to identify risk factors for OAB symptoms in women with POP. Subgroup analyses were performed in 533 patients to evaluate the improvement of OAB symptoms following POP treatment. A total of 754 patients were analyzed. The incidence of OAB symptoms was 70% (533/754) and two-thirds (65%) reported moderate to severe bother. The lowest points of the anterior wall (OR 0.60; 95% CI 0.41-0.87; p = 0.01), longer perineal body (OR 0.78; 95% CI 0.21-0.76; p = 0.02), and previous vaginal delivery (OR 2.10; 95% CI 1.14-3.89; p = 0.02) were identified as significant risk factors. In the subgroup analyses, improvement in OAB symptoms was observed in 36.6% (195/533) of women who underwent POP treatment. Compared with pelvic floor exercise, pessary (OR 1.40; 95% CI 0.94-2.07; p = 0.10) and surgery (OR 1.30; 95% CI 0.80-2.12; p = 0.28) had higher odd ratios but the effects were not significant. The prevalence of OAB symptoms in women with POP was high at 70%. Improvement in OAB symptoms was observed in one-third of women who underwent POP treatment. However, there were no significant differences between the treatment methods.

Efficacy and Safety of Vibegron for the Treatment of Overactive Bladder in Women: A Subgroup Analysis From the Double-Blind, Randomized, Controlled EMPOWUR Trial

ABSTRACT The sudden, intense urge to urinate, with or without urge urinary incontinence (UUI), is the predominant characterization of overactive bladder (OAB). Despite a similar prevalence of OAB between both women and men (respectively 17% and 16%), the disproportionate effects of the most bothersome symptoms of UUI fall to women. In addition, OAB’s prevalence in women increases with age when compared with men, leading to decreased scores in quality of life (QoL) measures, sexual function, depression, and sleep quality. Although behavioral therapies such as bladder training and pelvic floor muscle exercises are recommended as the first-line treatment of OAB symptom management, other treatments do exist. These second-line treatments, such as anticholinergics, are commonly prescribed as treatment for these conditions, but their use also entails persistence-limiting adverse effects. Such adverse effects include risk of dementia and cognitive impairment. The American Urogynecologic Society recommends alternative medication consideration for all patients and outright avoidance of anticholinergics for OAB treatment in women older than 70 years. Vibegron, a selective b3-adrenergic receptor agonist, was approved in 2020 for adult OAB treatment. The EMPOWUR trial, the international, placebo- and active-controlled, randomized, double-blind, phase 3 trial, demonstrated over the course of 12 weeks both the efficacy and safety of both vibegron and tolterodine for adults with OAB. Based on the disproportionate nature and bother of OAB symptoms in women, this study intended to analyze subgroups of the EMPOWUR trial to compare the QoL outcomes, 12-week treatment safety, and efficacy of vibegron treatment in women. End points for coprimary efficacy were altered from baseline at week 12 in mean daily number of UUI episodes and micturitions. Secondary efficacy end points included daily number of urgency episodes (also week 12). Exploratory outcomes included change from baseline at weeks 2, 4, and 8 for the same factors. The full set analysis for this study included all women (randomized) receiving greater than 1 dose of vibegron or placebo who experienced greater than 1 measured change using baseline valuations of urgency episodes, micturitions, and QoL outcomes unrelated to incontinence. A total of 1515 patients were included in the safety set, 1289 (84.9%) of which were women (placebo, n = 459; vibegron, n = 463; tolterodine, n = 364), with the mean age being 59.5 years. The study determined that vibegron was associated with a statistically significant greater reduction among women from baseline at week 12 in comparison to placebo. QoL also improved significantly across the board, including total, concern, sleep, coping, and symptom bother subscale scores compared with placebo. Treatment emergent adverse effects incidence was 39.3% with vibegron, 34.9% with placebo, and 39.6% with tolterodine, leading to 1.5%, 1.1%, and 3.8% of women, respectively, discontinuing treatment. The most common treatment emergent adverse effects reported was headache. An analytical limitation was the relatively brief study period of 12 weeks. The double-blind 40-week extension of the EMPOWUR trial (52 total treatment weeks) substantiated long-term safety and efficacy of vibegron (J Urol. 2021;205:1421–1429). Although a relatively high placebo response rate was observed (consistent with other analyses), vibegron was still associated with statistically significant improvements when compared with placebo in OAB symptoms in women. This subgroup analysis of OAB-diagnosed women yielded results consistent with those of the EMPOWUR 12-week trial, which indicated statistically significant reductions versus placebo in efficacy end points with once-daily vibegron 75 mg. The results also showed favorable safety and tolerability profiles. Vibegron treatment among women with OAB also significantly improved measures of QoL versus placebo. All results therefore indicate the efficacy and safety of treatment of women’s OAB with vibegron.

Does treatment of lichen sclerosus improve overactive bladder symptoms?

Lichen sclerosus (LS) is a chronic disease which mainly affects the vulvar area in women. A few studies have shown a possible relationship between LS and overactive bladder (OAB) symptoms, but no studies have investigated whether OAB symptoms improve after initiating treatment of LS. The aim of this study was to investigate whether the treatment of LS also improves OAB symptoms in women newly diagnosed with LS. This was a prospective cohort pilot study based on questionnaires from women newly diagnosed with LS and with symptoms of OAB. Women above the age of 18 who were newly diagnosed with LS were included. The women completed two questionnaires on OAB at inclusion and after 3months. The questionnaires consisted of the validated questionnaires OAB-q (33 questions, maximum score 198) and ICIQ-OAB (8 questions, maximum score 56). All women initiated treatment with local steroid by the time of the LS diagnosis. A total of 40 women were included, and 13 women dropped out during the data collection time. Comparing month 0 to month 3 for the remaining 27 women, a mean difference at 28.8 points was observed for OAB-q and a mean difference of 5.7 points was observed for ICIQ-OAB. Both results showed a statistically significant difference after 3months (p < 0.05). A total of 92.6% (25/27) of the women improved their symptoms. Treatment with local steroid might improve OAB symptoms in women newly diagnosed with LS.

Effect of combined use of tolterodine and continuous positive airway pressure vs continuous positive airway pressure only treatment on overactive bladder symptoms in women with moderate-to-severe obstructive sleep apnea syndrome: a randomized clinical trial.

Obstructive sleep apnea syndrome is associated with urological symptoms, including overactive bladder (OAB). This study aims to determine whether combined tolterodine and CPAP therapies are more effective for patients with OSAS than CPAP treatment only. Women who underwent polysomnography test and were diagnosed with moderate-to-severe OSAS with apnea-hypopnea index (AHI) were included in the study. Data were collected on AHI, OAB awareness-8-item tool (OAB-V8), incontinence questionnaire-urinary incontinence short form (ICIQ-UI-SF), total daily urine volume (DUV), and the Benefit, satisfaction with treatment and willingness (BSW) tool. Eligible patients were randomized to receive either CPAP treatment only or combined CPAP and tolterodine treatment for 3 months. Among 103 participants, a total of 60 were included. Patients in both treatment arms showed significant improvements in OAB-V8, ICIQ-UI-SF, and total DUV compared to their baseline. The mean OAB-V8 was 15.7 at baseline and 5.6 at 3 months for the combined treatment arm and 16.6 and 7.6 at 3 months for the CPAP group only (mean baseline-adjusted between-group difference -1.1 [95% CI, -12.3 to -7.4]; p < 0.001). The improvement in the mean ICIQ-UI-SF was also statistically more significant in the combined therapy group than in the CPAP only arm (mean baseline-adjusted between-group difference -3.27 [95% CI, -4.6 to -1.59]; p < 0.001). No statistical significance was found in the improvement of total DUV between the groups. In this study, combined use of tolterodine with CPAP provides beneficial effects to CPAP treatment only regarding OAB symptoms. Further research is required to confirm these findings in a large cohort.

The surgical effect on overactive bladder symptoms in women with pelvic organ prolapse

This study aimed to explore the effect of pelvic reconstruction surgery on the relation of pelvic organ prolapse (POP) and overactive bladder (OAB) and the impact of preoperative vaginal oestrogen supplement on vaginal tissue. A total of 100 postmenopausal women with symptomatic POP who underwent pelvic reconstruction surgery (laparoscopic sacrocolpopexy or transvaginal mesh) were enrolled in this study. Preoperative vaginal oestrogen was prescribed in 28 cases. The evaluation tools consisted of POP-Q, urodynamic study, Overactive Bladder Symptom Score (OABSS), and urinary NGF. Vaginal maturation index and vaginal specimens for hormone receptors study were investigated during operation to evaluate the effect of topical oestrogen. Follow-up assessments were performed at 1, 3, and 6 months after surgery. Preoperatively, 58 (58%) were POP with OAB. After reconstruction surgery, the OABSS decreased significantly (6.87 ± 0.85 vs 3.77 ± 0.61, p < 0.001) at postoperative 6 months in the group. Remarkable increasing trends of urinary NGF levels are noted till 3 months postoperatively, then decreasing to the baseline level at 6 months postoperative follow-up. Remarkable decrease of mRNA of the androgen receptor and significant higher expression of progesterone receptor (PR) were noted after use of the vaginal oestrogen cream. The severity of OAB in the POP women shows moderate degree according to OABSS. Pelvic reconstruction surgery can significantly improve the OAB symptoms. The surgery induced inflammation effect lasts for about 6 months. Short-term preoperative supplement of topical oestrogen brings alterations of the vaginal epithelium.

Treatment of overactive bladder symptoms in women with Diunorm®: preliminary results report

Introduction. Overactive bladder (OAB) with or without urgent incontinence tends to progress with age and occurs in both men and women. However, the frequency of occurrence in the female population averages about 25%.Purpose of the study. To assess the effectiveness and safety of the drug Diunorm® (in caps.) in the prevention and treatment of OAB in women.Materials and methods. The statistical analysis includes the results of a survey of 28 women with symptoms of OAB, whose average age was 35.3 years. The drug Diunorm® was used for treatment in dosage 400 mg QD for 90 days. Patients completed the Overactive Bladder Awareness Tool and a urination diary. Additionally, urinalysis, bacteriological examination of urine, uroflowmetry, bladder ultrasound and cystoscopy were performed.Results. All women throughout the study had negative urine cultures and no pyuria in urinalysis, which excluded an infectious etiology of urinary dysfunction. During therapy, a statistically significant decrease in irritative symptoms was recorded according to the Overactive Bladder Awareness Tool questionnaire. The sum of points after 1 and 3 mo decreased by 3.0 and 4.3 points, respectively (p &lt; 0.05). Positive dynamics in terms of the points' sum was noted in 75%, in relation to nocturia in 82% of patients (p &lt; 0.01). The average urination rate increased from 13.3 ± 0.7 ml/s to 15.1 ± 0.7 ml/s and 15.4 ± 0.5 ml/s after 1.5 and 3 months, respectively (p &lt; 0,0001). A similar trend was observed for maximum urine flow and residual urine volume. The maximum urine flow when taking Diunorm® increased from 15.9 ± 0.6 ml/s to 17.4 ± 0.5 ml/s and 18.1 ± 0.4 ml/s (p &lt; 0.001). Residual urine volume decreased throughout the study. When included in the study, after 1,5 and 3 mo, this indicator was 19.9 ± 1.4; 12.2 ± 1.6 and 6.4 ± 1.1 ml, respectively (p &lt; 0.001).Conclusion. Diunorm® can become a worthy alternative to traditional first-line OAB therapy. Comparative studies are required to obtain a high-level evidence base.

The Prevalence of Overactive Bladder Symptoms in Women in Algeria, Egypt, Jordan and Lebanon: A Cross-Sectional Population-Based Survey

AimsEstimate the prevalence of symptoms suggestive of overactive bladder (OAB) in women living in the Middle East to describe their demographic characteristics and explore treatment-seeking behavior.MethodsCross-sectional, population-based survey of women aged ≥ 40 years resident in Algeria, Jordan, Lebanon or Egypt. Respondents were recruited using computer-assisted telephone interview over approximately 4 months. Eligible respondents were asked to complete the OAB-V8, a validated questionnaire that explores the extent of bother from the key symptoms of OAB without clinical investigations. In addition, information regarding demographics, comorbidities and treatment behavior was collected, and respondents were stratified by age.ResultsA total of 2297 eligible women agreed to participate. Mean age was 54 ± 10 years; over half (59.3%) were aged 40–55 years. Overall, 53.8% of eligible women had symptoms suggestive of OAB (Jordan 58.5%; Egypt 57.5%; Algeria 49.9%; Lebanon 49.0%), with over 90% also reporting symptoms of urinary incontinence. Only 13.0% of women with symptoms suggestive of OAB were currently receiving treatment, while most (74.3%) had never been treated; these data were consistent across country and age categories. Among the untreated subgroup, almost half (48.7%) reported they were ‘not bothered by symptoms,’ while 8.4% considered OAB to be ‘part of normal aging’ and 4.7% did not know it was treatable.ConclusionA high prevalence of symptoms suggestive of OAB was observed, and the majority had symptoms of urinary incontinence. Despite the high prevalence, most women had never received treatment. Considering the potential significant impact of OAB symptoms on health, quality of life and productivity, these findings highlight an unmet medical need in the population studied. Strategies to improve treatment-seeking behavior (e.g., through education and tackling the stigma associated with OAB symptoms) may improve the diagnosis, management and health outcomes of women with OAB in the Middle East.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-020-01588-4.

Transcutaneous tibial nerve home stimulation for overactive bladder in women with Parkinson's disease: A randomized clinical trial.

This study aims to investigate the efficacy of transcutaneous tibial nerve home stimulation for overactive bladder (OAB) in women with Parkinson's disease (PD). The current study is a prospective, randomized, double-blind, sham-controlled trial. Home intervention was carried out andassessments were conducted at a tertiary hospital in South Brazil. Women with PD and OAB symptoms were included in the study. Patients were randomly divided into two groups: (1) stimulation and (2) sham. Both groups underwent intervention at home for 12 weeks. Patients were evaluated at baseline and at 12 weeks (end of intervention),30- and 90-day follow-up. The primary outcome was the mean reduction in the number ofurgency incontinence episodes, and secondary outcomes included daytime and nighttime urinary frequency, urinary urgency episodes, use of pad (reported in a 24-h bladder diary), OAB-V8 andKing's Health Questionnaire scores, and maintenanceof symptom relief after discontinuation of the intervention. In total, 30 consecutive patients completed the study (15/group). The stimulation group showed a reduction in nighttime urinary frequency (0.9 ± 0.6), urinary urgency (1.0 ± 1.2), urgency incontinence episodes (0.5 ± 0.6), use of pads (1.3 ± 1.2), and OAB-V8 (1.3 ± 1.2)and King's Health Questionnaire scores. In a 30-day and 90-day follow-up, 8 (53.3%) and 5 (33.3%) stimulation patients, respectively, reported fullmaintenance of symptom relief after discontinuation of the intervention. Stimulation patients presented a statistically significant improvement of symptoms as compared with sham patients (p = .001). Transcutaneous tibial nerve home stimulation can be used in clinical practice as an effective nonpharmacological resource for the reduction of OAB symptoms in women with PD, and the resulting relief seems to persistin the follow-up (30 and 90 days).

Urinary Incontinence and Overactive Bladder Symptoms in Women with Breast Cancer Being Treated with Oral Hormone Therapy.

The objective of the present study is to observe the frequency and severity of urinary symptoms in women with breast cancer (BC) being treated with oral hormone therapy, associating them to drug adherence. The participants were interviewed once from June to October 2016. The evaluation of urinary symptoms was performed by two questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB). Adherence was evaluated by the Morisky-Green method. Statistical analysis was performed by the Mann-Whitney test, linear regression, and Spearman correlation. Fifty-eight women were interviewed: 42 treated with tamoxifen and 16 with aromatase inhibitor. Twenty-seven women (46.5%) presented urinary incontinence symptoms and 15 (25.8%) presented stress urinary incontinence (SUI). Fourteen (24.1%) women had symptoms of overactive bladder (OAB). There was no statistical difference in symptoms between both treatments and duration of treatments. Higher scores in the ICIQ-SF questionnaire were associated with low/medium adherence and advanced age. Higher scores in the ICIQ-OAB questionnaire were associated with low/medium adherence. The present study showed a high prevalence of urinary symptoms, such as urinary incontinence and OAB, associated with low/medium adherence and older age in women with BC being treated with oral hormone therapy. Health professionals should be alert to these symptoms since it could influence life quality and adherence to treatment.

The Effect of a Sharp Increase in Estrogen Levels on Overactive Bladder Symptoms in Women Undergoing Ovulation Induction

To assess the effect of a sharp increase in estrogen levels on overactive bladder (OAB) symptoms among women undergoing ovulation induction. 100 consecutive women (mean age 36.9 ± 5.2 years) who underwent IVF treatments, were prospectively enrolled. Three validated questionnaires on urinary urgency, urinary incontinence, and lower urinary tract symptoms were used to evaluate patient's OAB symptoms before ovulation induction (low estradiol level) and prior to ovum pickup (peak estradiol level). Of the 100 women, 49 reported OAB symptoms prior to ovulation induction (mean USIQ severity score 33) and 51 women were asymptomatic. Of the 49 symptomatic women, 44 (90%) remained symptomatic (mean USIQ severity score 34) and 5 women became asymptomatic through ovulation induction. Of the 51 asymptomatic women, 24 (47%) developed de novo OAB symptoms, while 27 women (53%) remained asymptomatic through ovulation induction. The mean peak estradiol level was significantly higher among women who remained asymptomatic in comparison to women with de novo OAB symptoms (2069 versus 1372 pg/ml; respectively). Moreover, in most (63%) women who remained asymptomatic, peak estradiol levels were higher than 1500 pg/ml, whereas in most (67%) women who became symptomatic, peak estradiol levels were lower than 1500 pg/ml. A higher estradiol level appears to have a protective effect against the development of OAB symptoms during ovulation induction. Further, in most (63%) women who remained asymptomatic, peak estradiol levels were higher than 1500 pg/ml. This finding may suggest a threshold for estradiol activity in the lower urinary tract.

Effects of the constipation treatment in women who have overactive bladder and functional constipation

Aim: In adults, functional constipation (FC) is more common in individuals with overactive bladder (OAB) than in those without OAB. In this study, we evaluated the effects of the constipation treatment on OAB symptoms in women who have OAB and FC. Material and Methods: : A total of 417 patients, diagnosed with OAB and FC in our clinic between June 2016 and June 2019, were prospectively evaluated. After applying the exclusion criteria, 54 female volunteers between 50-79 years of age were enrolled in the study. FC treatment of the individuals, who were first examined in the Urology clinic, were accomplished under supervision of a gastroenterologist. Internationally validated questionnaires Rome IV and OAB-V8 were used in diagnosis and follow-up of FC and OAB, respectively.Results: The mean OAB-V8 scores before and after the treatment of constipation were 25.21±6.16 and 14.81±5.93, respectively. Among all questions, statistically significant decrease was observed especially 1st, 3rd, and 6th questions (frequency, urgency, nocturia). After FC treatment alone, the total OAB-V8 score decreased below the level of the sensitivity and specificity cut-off value for the diagnosis of OAB in 13 patients (24%).Conclusion: OAB and FC are common clinical problems in the middle-aged and elderly women. In these patients, FC treatment before OAB medication may reduce frequency, urgency and nocturia symptoms of OAB significantly.

Predictive factors for persistence of preoperative overactive bladder symptoms after transvaginal mesh surgery in women with pelvic organ prolapse.

We aimed to evaluate the effect of transvaginal mesh surgery on overactive bladder symptoms in women with pelvic organ prolapse and to identify predictive factors for persistence of a preoperative overactive bladder after surgery. We retrospectively evaluated 102 patients who underwent transvaginal mesh surgery. All patients had stage 2 or greater pelvic organ prolapse accompanied by cystocele. The Overactive Bladder Symptom Score, International Prostate Symptom Score, uroflowmetry, and postvoid residual urine volume were evaluated preoperatively and 6 months postoperatively. To identify predictive factors for the persistence of a preoperative overactive bladder after surgery, preoperative parameters were statistically compared between patients with and without the persistence of preoperative overactive bladder symptoms. Receiver operator characteristic curves were generated, and the area under the curve was calculated. Preoperatively, 54 women (53%) had an overactive bladder. After surgery, the symptoms disappeared in 34 (63%) and persisted in 20 (37%) women. There were no significant differences in preoperative parameters including age, body mass index, parity, or severity of pelvic organ prolapse between patients with and without persistent preoperative overactive bladder. Preoperative Overactive Bladder Symptom Score and International Prostate Symptom Score were significantly higher in patients with persistent preoperative overactive bladder symptoms. The International Prostate Symptom Score storage subscore had the highest area under the curve, with a cutoff value of 9.5. Transvaginal mesh surgery eliminates overactive bladder symptoms in about two-thirds of pelvic organ prolapse patients. The preoperative International Prostate Symptom Score storage subscore was the most useful predictive factor for the persistence of preoperative overactive bladder symptoms after surgery.

Cure of Underactive and Overactive Bladder Symptoms in Women by 1,671 Apical Sling Operations Gives Fresh Insights into Pathogenesis and Need for Definition Change

Introduction:To check evidence that symptoms identical with those constituting “underactive bladder” (UAB) and “overactive bladder” (OAB) are caused by apical prolapse and cured by repair thereof. Material and Methods: After repair of apical prolapse by mesh tape reinforcement of lax uterosacral ligaments (USL) data form 1,671 women were retrospectively examined to determine the presence of OAB and UAB symptoms and to check, how many were cured surgically. Thereby 3 different techniques were performed: elevate (n = 277), “Posterior IVS” (n = 1,049), and TFS cardinal (CL)/USL (n = 345). Results: Symptoms identical with those comprising UAB and OAB were cured in up to 80% of cases following surgical repair of the CL/USL complex. Conclusions: These symptoms may be consistent with symptoms of the posterior fornix syndrome, which comprises 4 main symptoms: micturition difficulties, urge/frequency, nocturia, chronic pelvic pain, all consequent on USL laxity. Surgical cure of OAB and UAB is inconsistent with existing definitions, which imply pathogenesis of the detrusor muscle itself. A reconsideration and reformulation of existing definitions may be required. Altering UAB definition to “bladder emptying difficulties” and return to former definitions for OAB such as “detrusor” or “bladder instability” may help to restore compatibility with surgical cure of these conditions.

Assessment of Overactive Bladder after Laparoscopic Lateral Suspension for Pelvic Organ Prolapse.

Background Pelvic organ prolapses (POP) and overactive bladder (OAB) may coexist and both negatively impact quality of life in women. The correlation between POP and OAB remains unclear, but these patients may have the OAB resolution after the surgical treatment of POP. Aim of our study was to assess the anatomical results and the effect on OAB symptoms in women who underwent laparoscopic lateral suspension for POP. Materials and Methods This prospective study included all women with apical POP who underwent surgical repair with laparoscopic uterine lateral suspension from January 2016 to December 2017. The baseline and the 1-year follow-up included post-void residual measurement, urinalysis, vaginal examination, OAB symptoms evaluation, and administration of questionnaires (PFDI-20, UDI 6). Results 64 women underwent laparoscopic lateral suspension for uterine prolapse and 78.1% had concomitant anterior vaginal wall defect. At 1-year follow-up the anatomic success rates were 84.4% for the apical and 76.2% for the anterior compartment. The comparison between OAB symptoms before and after the surgical procedure showed the resolution of OAB in 76% of the women, while de novo OAB was present in 2.6%. With the questionnaires 95.3% (61/64) of our patients were satisfied after the POP repair. We documented a trend in ameliorating of OAB regardless of the POP-Q stage. However, the Pearson test showed this correlation as statistically significant only in women with anterior vaginal wall defect stage III and apical stage II. No patient had vaginal exposure of the polypropylene mesh. Conclusion Our data show how laparoscopic lateral suspension is an effective procedure for apical and anterior vaginal wall defects. This study provides further evidence for the concept that OAB in women with POP >II stage improves after a successful POP surgery. These women may benefit from a resolution of OAB and POP symptoms with the improvement of patient's quality of life.

66 - Overactive bladder symptoms in women with incomplete bladder emptying

66 - Overactive bladder symptoms in women with incomplete bladder emptying

Prevalence and Possible Risk Factors of Overactive Bladder Symptoms in Women Living in the City of İzmir

Prevalence and Possible Risk Factors of Overactive Bladder Symptoms in Women Living in the City of İzmir

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.

Urogynecological conditions associated with overactive bladder symptoms in women.

Overactive bladder symptoms (OAB) affect 9-43% of women and are associated with underlying disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The aim of this study is to identify urogynecological conditions associated with OAB symptoms. This prospective, institutional review board-approved study included women referred to a tertiary centre with lower urinary tract symptoms (LUTS). All women completed the self-administered OAB questionnaire (OABSS). Those with an OABSS ≥8, the cutoff, were considered to have OAB symptoms. Patients underwent a history and physical examination (including Baden-Walker prolapse grading and stress test), 24-hour voiding diary, pad test (for urinary incontinence), urinalysis, and uroflow with post-void residual volume. Patients were classified clinically into the following: idiopathic OAB, SUI, POP, bladder outlet obstruction (BOO) neurogenic bladder (NGB), recurrent urinary tract infection (UTI), and miscellaneous. In total, 148 women met the inclusion criteria with a mean age of 67 years. Only 27% had no comorbid conditions and were considered idiopathic OAB. Associated urogynecological conditions included SUI in 37%, POP in 26%, miscellaneous conditions in 18%, recurrent UTI in 11%, NGB in 9%, and BOO in 8%. Some patients met criteria for more than one category, thus the total is greater than 100%. In a tertiary care setting, a significant proportion of women with OAB symptoms have underlying conditions that may cause or contribute to their symptoms. Appropriate evaluation is desirable to enhance our understanding of the relationship of these conditions to the diagnosis, treatment, outcomes, and pathophysiology of OAB.

Successful Lower Motor Voltage Provocation May Lead to Better Patient Improvement from Overactive Bladder Symptoms

Introduction: Will attainment of good bellows/plantar flexion at ≤3 volts fare better in controlling overactive bladder symptoms than at >4 volts? Methods: Between September 2001 and September 2010, we performed a retrospective cohort review of patients who underwent Stages 1 and 2 sacral neuromodulation placement for medically recalcitrant overactive bladder symptoms. All patients had pre- and postoperative overactive bladder symptom voiding diary results undergo statistical multivariable analysis. Group 1 patients had one or more tine leads placed with excellent motor provocation at ≤3 volts while Group 2 at >4 volts. Results: Mean follow-up of Group 1 (≤3 volts) was 8.43 ± 5.22 years and that of Group 2 (>3 volts)] was 9.56 ± 4.89 years. Patients with one lead with bellows and plantar flexion at ≤3 volts performed markedly better with improvements to frequency q24 hours Group 1, 18.72 ± 6.32 to 9.89 ± 3.12, compared with Group 2, 17.82 ± 5.23 to 11.88 ± 4.56, p < 0.02] urgency q24 hours Group 1 [2.87 ± 1.22 to 1.08 ± 0.68 compared with Group 2 2.77 ± 1.38 to 1.89 ± 1.02, p < 0.01], urgency incontinence Group1, 1.55 ± 1.21 to 0.70 ± 0.41 compared with Group 2, 1.48 ± 0.97 to 1.20 ± 0.51, p < 0.01 and nocturia Group 1, 3.02 ± 1.52 to 1.78 ± 0.79, Group 2, 3.33 ± 1.89 to 2.88 ± 1.46 voids per night (p < 0.02). Baseline UDI-6 scores improved from Group 1, 32.8 ± 22.1 to 6.9 ± 10.2, versus Group 2, 30.4 ± 19.6 to 8.9 ± 4.5 (p < 0.001). Similarly, IIQ-7 scores improved from Group 1, 22.1 ± 19.8 to 2.4 ± 8.2, versus Group 2, 20.6 ± 16.4 to 5.5 ± 6.3 (p < 0.02). Conclusions: Attainment of good bellows and plantar flexion at ≤3 volts with one or more leads may portend better qualitative clinical results for overactive bladder symptoms in women. No competing financial interests exist. Runtime of video: 6 mins 40 secs