Treatment Of Overactive Bladder Syndrome Research Articles

Comparative evaluation of bioavailability of Botulinum toxin A complexed with Tizol (titanium glycerosolvate aquacomplex) versus pure Botulinum toxin A solution for bladder mucosa: an experimental study

Introduction. For the treatment of overactive bladder syndrome (OAB), injection of botulinum toxin A (BoNT-A) has been shown to be effective. However, there is a need for a less invasive method for administering BoNT-A, which could significantly expand the treatment options for OAB.Objective. To assess the impact of tizol on the absorption of BoNT-A by the bladder mucosa and compare it to the individual absorption of BoNT-A.Materials & Methods. Dialysis through the mucous membrane of the сalf bladder was used as an experimental model to study changes in bioavailability of BoNT-A complexed with tisol (BoNT-A + T) and pure BoNT-A solution during in vitro experiment. After dialysis, the BoNT-A concentration in both samples was determined using a spectrophotometer. Dialysis curves were plotted according to the data obtained. Kruvchinsky equilibrium dialysis method was used to determine botulinum toxin A bioavailability. The UV spectrophotometry method was used to determine the concentration of BoNT-A in the acceptor medium by reaction of BoNT-A with Benedict's reagent.Results. It was established that the maximum concentration of BoNT-A diffused into the acceptor medium from the blend of the test substance with tizol after nine hours. The area under the curve for dialysis of BoNT-A + T exceeds the area under the curve of pure BoNT-A by almost 20%, suggesting an improvement in the drug's bioavailability when blended with tizol.Conclusion. Based on our experiment, it was found out that the BoNT-A + T has greater bioavailability than a solution of pure BoNT-A. However, the diffusion rate of the component mixture is sufficiently low.

To assess the effectiveness of Mirabegron in reducing urodynamic detrusor overstimulation in patients with Overactive Bladder Syndrome (OAB).

Objective: To investigate the efficacy of mirabegron in treating overactive bladder by assessing its impact on urodynamic detrusor overactivity (DO). Study Design: Cross-sectional study. Setting: Center for Urology and Transplantation in Sindh. Period: April 6, 2022, to October 4, 2022. Methods: Sixty-four individuals presenting OAB symptoms and without prior OAB medication use were included after obtaining informed consent and conducting relevant medical evaluations. Patients demonstrating signs of detrusor overactivity were evaluated through urodynamic assessments. Collected data, including patient history and study outcomes, were recorded using a standardized Proforma (Annexure I). Patient demographics, age, and gender distribution were documented. Patients with urodynamic detrusor overactivity were administered 50.0 mg mirabegron tablets once daily for a period of 13 weeks. A noteworthy percentage of patients reported substantial success after three months of treatment. Results: The average age of study participants was 50 years. The mean duration of OAB symptoms was 20.22 ± 15.38 months. Of the total 64 patients, 41 were female (64.06%) and 23 were male (34.94%). Notably, successful treatment outcomes were observed in 49 cases (76.56%). Conclusion: Mirabegron emerges as a valuable therapeutic option for individuals dealing with overactive bladder. This study underscores its efficacy in managing OAB sympt0oms, with a notable success rate of 76.6%. These findings contribute to the growing body of evidence supporting mirabegron as an effective treatment for overactive bladder syndrome.

Therapeutic effectiveness and adverse drug reactions of mirabegron versus solifenacin in the treatment of overactive bladder syndrome.

Overactive bladder (OAB) syndrome is a chronic disease characterized by urinary urgency with or without urge incontinence, frequency, and nocturia and antimuscarinic drugs such as solifenacin have been the mainstay of treatment. Mirabegron a beta 3 adrenoreceptor agonist has recently gained importance in the management of OAB. The rationale of the study is that mirabegron improves the storage function without affecting voiding which increases the therapeutic effectiveness. The objective was to determine the therapeutic effectiveness of mirabegron versus solifenacin. A prospective observational study was conducted on 298 patients with OAB syndrome attending the urology outpatient department of government medical college after obtaining institutional review board clearance. Patients of both genders, belonging to the 18-65 years of age group, attending the urology outpatient department were selected for the study. Patients were evaluated using the OAB-validated 8-question awareness tool (OAB-V8 score) before and after receiving drugs by direct questionnaire method after receiving informed consent. Patients were prescribed either solifenacin 5 mg or mirabegron 25 mg once daily by the urologist. Follow-up was done after 4 and 12 weeks. Adverse drug reactions of the drugs were assessed using the Central Drug Standard Control Organization suspected adverse reaction (ADR) form, and ADRs were notified to the nearest ADR monitoring center. The mirabegron group showed maximum improvement in the mean OAB-V8 score values from baseline at 4 weeks (12.82 ± 5.86, P < 0.001) and 12 weeks (5.74 ± 3.31, P < 0.001) when compared to solifenacin. OAB-V8 scores of the solifenacin group also showed significant improvement from the baseline at 4 weeks (15.30 ± 5.54, P < 0.001) and 12 weeks (8.05 ± 4.59, P < 0.001). Heart rate, systolic, and diastolic blood pressures did not show significant changes during the follow-up in both the study groups. Thirteen patients developed ADRs such as dry mouth (four patients) and constipation (nine patients) in the solifenacin group. No ADRs were noted in the mirabegron group. Mirabegron showed maximum improvement in the OAB-V8 scores in patients with OAB syndrome, although the solifenacin group also showed improvement. Adverse effects were less in the mirabegron group when compared to the solifenacin group.

Age-Dependent Effects of Oxytocin and Oxytocin Receptor Antagonists on Bladder Contractions: Implications for the Treatment of Overactive Bladder Syndrome.

Overactive bladder (OAB) is an age-related disorder characterised by unstable bladder contractions resulting in disruptive lower urinary tract symptoms (LUTS), thus creating a profound impact on an individual's quality of life. The development of LUTS may be linked to the overexpression of oxytocin receptors (OXTRs) within the bladder detrusor muscle, resulting in increased baseline myogenic tone. Thus, it is hypothesised that targeting OXTRs within the bladder using oxytocin antagonists may attenuate myogenic tone within the bladder, thereby providing a new therapeutic avenue for treating OAB. Organ bath contractility and immunohistochemistry techniques were conducted on bladder tissue sourced from young rats (7-8 weeks and 10-12 weeks) and older rats (4-5 months and 7-9 months). Organ bath studies revealed that oxytocin (OT) significantly increased bladder contractions, which were significantly attenuated by [β-Mercapto-β,β-cyclopentamethylenepropionyl1, O-Me-Tyr2, Orn8]-Oxytocin) (1 µM) (**** p < 0.0001) and atosiban (10 µM) in both young and older rats (** p < 0.01); in contrast, cligosiban (1 µM and 10 µM) did not inhibit OT-induced contractions in both young and older rats (p ≥ 0.05). Interestingly, cligosiban (1 µM and 10 µM) significantly reduced the frequency of spontaneous contractions within the bladder of both young (*** p < 0.001) and older rats (**** p < 0.0001), while atosiban (10 µM) only demonstrated this effect in older rats (** p < 0.01). Furthermore, immunohistochemistry (IHC) analysis revealed significant colocalization of nuclear-specific oxytocin receptors (OXTRs) in the contractile (smooth muscle) cells within young (** p < 0.01) and older rats (* p < 0.05), indicating OT may be a key modulator of bladder contractility.

Therapeutic Potential for Beta-3 Adrenoreceptor Agonists in Peripheral Arterial Disease and Diabetic Foot Ulcers.

Annually, peripheral arterial disease is estimated to cost over USD 21 billion and diabetic foot disease an estimated at USD 9-13 billion. Mirabegron is a TGA-approved beta-3 adrenoreceptor agonist, shown to be safe and effective in the treatment of overactive bladder syndrome by stimulating bladder smooth muscle relaxation. In this review, we discuss the potential use of beta-3 adrenoreceptor agonists as therapeutic agents repurposed for peripheral arterial disease and diabetic foot ulcers. The development of both conditions is underpinned by the upregulation of oxidative stress pathways and consequential inflammation and hypoxia. In oxidative stress, there is an imbalance of reactive oxygen species and nitric oxide. Endothelial nitric oxide synthase becomes uncoupled in disease states, producing superoxide and worsening oxidative stress. Agonist stimulation of the beta-3 adrenoreceptor recouples and activates endothelial nitric oxide synthase, increasing the production of nitric oxide. This reduces circulating reactive oxygen species, thus decreasing redox modification and dysregulation of cellular proteins, causing downstream smooth muscle relaxation, improved endothelial function and increased angiogenesis. These mechanisms lead to endothelial repair in peripheral arterial disease and an enhanced perfusion in hypoxic tissue, which will likely improve the healing of chronic ulcers.

Fluorimetric study on a novel FDA-approved combination used for the treatment of overactive bladder syndrome in different matrices

For the first time, two spectrofluorimetric techniques were created for the concurrent determination of mirabegron (MBN) and solifenacin (SOL) in different matrices. This novel combination recently received FDA approval to treat overactive bladder syndrome and was marketed under the brand name MiragoTMS25. SOL has a native fluorescence and can be estimated directly in the presence of MBN without any interference at 290 nm after excitation at 230 nm. In contrast to SOL, MBN is a weak fluorescent substance that requires the use of a fluorogenic reagent (like NBD-Cl) to be measured simultaneously with SOL in their mixtures. So, we reacted MBN with NBD-Cl to yield a yellow-colored fluorophore that could be estimated at 546 nm after excitation at 471 nm without any preliminary separation or interference from SOL. All experimental conditions of the applied methods were tested and enhanced for the best results. The applied fluorimetric methods succeeded in determining both drugs in nanograms, making them applicable in biological fluids like human plasma. The linearity ranges of SOL and MBN were found to be 5–250 ng/mL and 50–600 ng/mL, respectively. The LOD values were 0.96 ng/mL and 5.09 ng/mL for SOL and MBN, in order. Excellent results were attained for both drugs during their analysis in spiked plasma samples employing the applied fluorimetric methods, confirming their suitability for use in real human plasma samples and paving the way for further bioequivalence studies on both drugs.

Pilot Study of a Novel At-Home Posterior Tibial Nerve System for Overactive Bladder Syndrome.

Urgency urinary incontinence and overactive bladder are common conditions. Third-line therapies are often underutilized because of either being too invasive or being burdensome for the patient. We aimed to determine the efficacy and acceptability of a noninvasive, home-based posterior tibial nerve treatment system for the treatment of overactive bladder syndrome. In this pilot study, 10 postmenopausal women with urgency urinary incontinence were given the SoleStim System for home-based posterior tibial nerve stimulation. Symptoms at baseline and completion of the 8-week study were determined by 3-day voiding diary and quality-of-life questionnaire (Overactive Bladder Questionnaire) to assess for reduction in incontinence episodes. All patients were 100% adherent to the SoleStim System application over the 8-week period and reported statistically significant reductions in the mean number of voids (-16.3%, P = 0.022), urgency episodes (-31.2%, P = 0.02), and urgency urinary incontinence episodes (-31.4%, P = 0.045). Forty percent of participants reported a decrease of ≥50% in their urgency urinary incontinence episodes. SoleStim was scored a value of 1.8 ± 2.0 (mean ± SD) on a 10-point usability scale, indicating that it was highly acceptable from an ease-of-use perspective. No adverse events were reported. The SoleStim System improved key overactive bladder (frequency, urgency, and urgency urinary incontinence episodes) and quality-of-life metrics. The results from this pilot study suggest that the SoleStim System may be a safe, effective, and highly acceptable at-home overactive bladder therapy.

Efficacy and safety of vaginal electrical stimulation as an alternative or adjunct treatment for overactive bladder syndrome in women: a meta-analysis of randomized controlled trials.

The objective was to evaluate the efficacy and safety of vaginal electrical stimulation (VES) as an alternative or adjunct treatment for overactive bladder (OAB) syndrome in women. Five English-language databases and four Chinese-language databases were searched to identify relevant studies. Studies comparing VES (VES alone or VES plus other interventions) with other interventions (medicines, bladder training, or PFMT) were included. Voiding diary, quality of life (QoL), and adverse events were extracted from the included studies for comparison. Seven trials with 601 patients in total were reviewed. The results showed that when compared with other interventions, VES alone significantly improved urgency episodes (p = 0.0008) and voiding frequency (p = 0.01), but did not significantly reduce nocturia (p = 0.85), urinary incontinence episodes (p = 0.90) and number of pads (p = 0.87). When VES plus other interventions was compared with other interventions, the former significantly improved voiding frequency (p < 0.00001), nocturia (p < 0.00001), and number of pads (p = 0.03), but it did not significantly reduce urinary incontinence episodes (p = 0.24). Both VES alone (p < 0.00001) and VES plus other interventions (p = 0.003) showed significant benefit on QoL. This study demonstrated that VES alone decreased urgency episodes and QoL better than other therapies. Although VES alone reduced voiding frequency better and VES plus other therapies decreased nocturia, number of pads, urgency episodes, and QoL better than other therapies, the results should be interpreted with caution for clinical practice because some of the RCTs included were of low quality and because of the small number of studies included.

Mirabegron and Anticholinergics in the Treatment of Overactive Bladder Syndrome: A Meta-analysis.

To compare the use of mirabegron with anticholinergics drugs for the treatment of overactive bladder (OB). Systematic searches were conducted in EMBASE, PUBMED, Cochrane, and LILACS databases from inception to September 2021. We included RCTs, women with clinically proven OB symptoms, studies that compared mirabegron to antimuscarinic drugs, and that evaluated the efficacy, safety or adherence. RevMan 5.4 was used to combine results across studies. We derived risk ratios (RRs) and mean differences with 95% CIs using a random-effects meta-analytic model. Cochrane Collaboration Tool and GRADE was applied for risk of bias and quality of the evidence. We included 14 studies with a total of 10,774 patients. Fewer total adverse events was reported in mirabegron group than in antimuscarinics group [RR 0.93 (0.89-0.98)]. The risk of gastrointestinal tract disorders and dry mouth were lower with mirabegron [RR 0,58 (0.48-0.68); 9375 patients; RR 0.44 (0.35-0.56), 9375 patients, respectively]. No difference was reported between mirabegron and antimuscarinics drugs for efficacy. The adherence to treatment was 87.7% in both groups [RR 0.99 (0.98-1.00)]. Mirabegron and antimuscarinics have comparable efficacy and adherence rates; however, mirabegron showed fewer total and isolated adverse events.

Efficacy and safety of mirabegron in the treatment of overactive bladder syndrome after radical prostatectomy: a prospective randomized controlled study.

To evaluate the effects of mirabegron in the treatment of overactive bladder syndrome (OAB) after radical prostatectomy (RP). A total of 108 post-operative RP patients were randomly assigned to either the mirabegron (study) or the placebo (control) group. The Overactive Bladder Syndrome Self-Assessment Scale (OABSS) was selected as the primary endpoint, and the International Prostate Symptom Score (IPSS) and Quality of Life (QOL) score were selected as secondary endpoints. Statistical analysis was performed using IBM SPSS Statistics 26, and the treatment effects were compared between the two groups using independent samples t-test. In total, 55 patients were included in the study group and 53 patients in the control group. The mean age was(70.08 ± 7.54)years. There was no statistical difference in the baseline data between the two groups. OABSS scores decreased significantly in the study group compared to the control group during drug treatment (6.67 ± 1.06 vs. 9.14 ± 1.83, p < 0.01) and were better than the control group during the follow-up at week 8 and week 12. In addition, the decrease in IPSS scores (11.29 ± 3.89 and 15.34 ± 3.54, p<0.01) and the increase in QOL scores (2.40 ± 0.81 vs. 3.20 ± 1.00) were statistically significant in the study group. And the patients in the study group had better improvement in voiding symptoms and quality of life than the control group during the follow-up period. Daily administration of 50 mg mirabegron after RP surgery significantly improved the symptoms of OAB after surgery with fewer side effects. Additional randomized controlled trials should be conducted in the future to further evaluate the efficacy and safety of mirabegron.

Current and Emerging Pharmacological Targets and Treatments of Urinary Incontinence and Related Disorders.

Overactive bladder syndrome with and without urinary incontinence and related conditions, signs, and disorders such as detrusor overactivity, neurogenic lower urinary tract dysfunction, underactive bladder, stress urinary incontinence, and nocturia are common in the general population and have a major impact on the quality of life of the affected patients and their partners. Based on the deliberations of the subcommittee on pharmacological treatments of the 7th International Consultation on Incontinence, we present a comprehensive review of established drug targets in the treatment of overactive bladder syndrome and the aforementioned related conditions and the approved drugs used in its treatment. Investigational drug targets and compounds are also reviewed. We conclude that, despite a range of available medical treatment options, a considerable medical need continues to exist. This is largely because the existing treatments are symptomatic and have limited efficacy and/or tolerability, which leads to poor long-term adherence. SIGNIFICANCE STATEMENT: Urinary incontinence and related disorders are prevalent in the general population. While many treatments have been approved, few patients stay on long-term treatment despite none of them being curative. This paper provides a comprehensive discussion of existing and emerging treatment options for various types of incontinence and related disorders.

Comparative study of different combinations of mirabegron and antimuscarinics in treatment for overactive bladder syndrome in elderly patients.

To compare the therapeutic efficacy, adverse events (AEs), and patient preference in elderly patients with overactive bladder (OAB) receiving different combinations of mirabegron and solifenacin. Elderly OAB patients received mirabegron 25 mg (M25) daily for 1 month (1M) followed by randomization to receive M25 (Group 1), mirabegron 50 mg (M50, Group 2), solifenacin 5 mg (S5, group 3); or M25 plus S5 (Group 4) for further 2 months. Efficacy and AEs were evaluated. At the end of 3M, patients' preferred option for future treatment was investigated. A total of 168 patients were enrolled, and 100 completed 3-month treatment. At 1M, all parameters improved significantly except postvoid residual (PVR), 23 (13.7%) patients had no symptom, 16 (9.5%) had no improvement, and 10 (6.0%) withdrew from the trial. Compared parameters at 3M with 1M revealed that quality of life, Patient's Perception of Bladder Condition scores, and voided volume improved significantly in group 1; the OAB Symptom Score (OABSS) increased in group 2; mean PVR and Global Response Assessment (GRA) deteriorated in group 3; and the OABSS and GRA improved in group 4. At 3M, the AEs prevalence increased significantly in group 3. Only 38.1% in group 4 preferred long-term usage of combination therapy. M25 daily is effective and safe in treating elderly OAB patients. Dose escalation to 50 mg or shifting to S5 does not increase the therapeutic efficacy. Combining M25 with S5 provides better treatment efficacy but is associated with lower patient compliance than M25 alone.

Are β3 -adrenoceptor gene polymorphisms relevant for urology?

β3 -adrenoceptors (ARs) are an important drug target for the treatment of overactive bladder syndrome (OAB) and are under investigation for other indications. The human β3 -AR gene is polymorphic; an exchange of amino acid tryptophan (Trp) for arginine (Arg) in position 64 of the receptor protein is the most frequent and best-studied polymorphism. A narrative review on the impact of β3 -AR polymorphisms on urological disease and its treatment is presented. Two out of four studies have reported that the 64Arg allele was found more frequently in subjects with OAB thanin healthy controls. A large study in a highly selective population (men undergoing prostatectomy for cancer treatment) did not confirm this. On the other hand, studies examining symptom severity typically found little difference between 64Arg and 64Trp carriers. In vitro studies with endogenously expressed β3 -AR reported a decreased lipolytic response in human adipose tissue. Studies with heterologously expressed receptors sometimes found a decreased responsiveness to agonists including β3 -AR agonists, but others did not confirm that. The overall evidence points to carriers of the 64Arg genotype expressing fewer and/or hypofunctional β3 -ARs and being associated with the presence of OAB but such findings were only detected inconsistently. If this hypofunctionality exists, the consequences may be of insufficient magnitude to allow a robust detection. Only adequately powered studies comparing responses with a β3 -AR agonist in 64Arg carriers versus wild-type patients can address this.

Home-based transcutaneous tibial nerve stimulation for overactive bladder syndrome: a randomized, controlled study.

PurposeTranscutaneous posterior tibial nerve stimulation (TPTNS) for the treatment of overactive bladder syndrome (OAB), with or without urge urinary incontinence (UUI) using electrodes imbedded in the fabric of a conventional sock and an attachable battery-operated stimulation device (ZIDA®—Exodus Innovations, Sufa, Israel), was compared for effectiveness and safety to a sham procedure in a prospective, blinded, randomized, controlled trial.MethodsForty patients with diagnosed with OAB were recruited from a single site. There were two groups: a treatment group (21 patients, mean age 64), which used an active ZIDA® activation device (ZIDA) and a sham control group (SCG, 19 patients, mean age 72) randomized in a 1:1 ratio. After individual fitting of the sock and face-to-face instruction in the use of the device, patients in both groups self-administered the treatment once weekly for 30 min at home for a duration of 12 weeks. Prior to randomization and in Week 12, patients completed two 3-day bladder diaries and a quality-of-life (QOL) survey. Treatment success was defined as at least a 50% reduction in urgency voids with or without incontinence or at least a 30% reduction in 24-h frequency from baseline to Week 12. The key secondary endpoint was change in QOL from baseline to Week 12.ResultsThe success rate for the primary endpoint in the ZIDA group was 80% (n = 16/20) versus 39% (n = 7/18) in the SCG (p = 0.02). For QOL, the least squares mean difference in change from baseline to Week 12 between the ZIDA and sham control arms total score was − 12.7 (95% CI − 20.2 to − 5.1). No significant adverse effects were observed.ConclusionTPTNS using the ZIDA home-based stimulation device offers a safe and effective treatment for patients with OAB syndrome and improves QOL. Trial regestrationTRN: NCT04470765.

Six-Month Outcomes of Reimplantation of a Coin-Sized Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome With Urgency Urinary Incontinence.

ObjectiveThe eCoin (Valencia Technologies Corporation, Valencia, CA) is a battery-powered, nickel-sized and shaped neuromodulation device for the treatment of overactive bladder, and it is implanted in the lower leg in a short office or outpatient procedure under local anesthesia. A follow-on trial was conducted to evaluate the feasibility, safety, and efficacy of eCoin reimplantation.MethodsThis was a prospective, single-arm, open-label study, including 23 participants with refractory urgency urinary incontinence (UUI) who were previously participants in the eCoin clinical feasibility trial. This follow-on study was conducted at 7 sites in the United States and New Zealand. Participants were reimplanted with a new eCoin device and activated after 4 weeks. Bladder diary data and validated quality-of-life instruments, collected at 12 weeks and 24 weeks postactivation, were compared with baseline.ResultsParticipants of the study were considered responders if they reported a ≥ 50% reduction from baseline in episodes of UUI on a 3-day voiding diary. At 12 weeks of treatment, 74% (95% confidence interval [CI], 52%–90%) of participants were considered responders. At 24 weeks of treatment, 82% (95% CI, 60%–95%) of participants were considered responders with 36% (95% CI, 20%–57%) of participants achieving complete continence. There were no device-related serious adverse events reported during the study.ConclusionsThe reimplantation of eCoin was both safe and effective in treating UUI associated with overactive bladder syndrome. The demonstrated significant reduction or resolution of symptoms with no serious safety concern suggests that eCoin is a convenient and maintainable therapeutic device.

Mirabegron: pharmacoeconomic aspects of the use of the drug for the treatment of overactive bladder syndrome

According to the International Continence Society (ICS), symptoms of overactive bladder (OAB) are present in 17 % of the adult population of Europe. The prevalence of overactive bladder in Russia is unknown but is considered comparable to that in European countries. According to Russian guidelines, patients with OAB could be treated with antimuscarinics or beta 3-agonists. The results of a meta-analysis by Wang J et al. (2018) showed comparable efficacy and safety of mirabegron and solifenacin. At the same time, according to Chapple CR et al. (2017) and Yeowell G et al. (2018) the use of mirabegron is associated with greater adherence to therapy and longer average drug use before the need to change therapy compared to antimuscarinics. From an economic point of view, greater adherence to drug therapy is associated with lower costs per patient with OAB per year and mirabegron have demonstrated to be cost-eff ective in comparison to solifenacin. The results of the analysis of the structure and volume of providing various types of medical care to patients with OAB in the Moscow region demonstrate the need to expand approaches to providing drug care to this group of patients. Currently, the majority of costs related to patients with OAB are associated with surgical treatment, which indicates the opportunity to expand the possibilities of drug therapy, including within the framework of preferential drug provision.

Oxybutynin nanosuspension gel for enhanced transdermal treatment for overactive bladder syndrome

Oxybutynin (OXY) is the most common drug to treat overactive bladder (OAB) syndrome. Transdermal administration is a more ideal route replacing oral administration to resolve problems of low bioavailability and severe side effects. However, commercial transdermal products of OXY frequently cause skin irritation and low permeation efficiency arising discontinued medication. Here, oxybutynin nanosuspension (OXY-NS) and its gel preparation (OXY-NG) were constructed to resolve these issues. In vitro permeation test and in vivo pharmacokinetics study confirmed that OXY-NG significantly enhanced the transdermal permeation of OXY, about 4-fold and 3-fold higher than oxybutynin coarse suspension (OXY-CG), respectively, and in vitro retention test certified that OXY-NG increased OXY concentration especially in viable epidermis (VE) and Dermis (about 3 times that of OXY-CG), consequently improving the bioavailability. Skin irritation assay demonstrated that OXY-NG would not trigger skin adverse effects. In addition, selectively blocking hair follicles test evidenced that hair follicles pathway played an important role in OXY-NS transdermal delivery. In general, by virtue of excellent drug loading, low toxicity and ease of scale-up, OXY-NG is a promising strategy to ameliorate skin permeation of insoluble OXY for better transdermal treatment for OAB, hence increasing its bioavailability, reducing adverse effects, and achieving good patient compliance.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

The treatment of overactive bladder syndrome with onabotulinumtoxinA therapy

Introduction: Overactive bladder syndrome is an endemic phenomenon, which has a significant impact on the quality of life. In cases where conservative treatment fails, intradetrusor onabotulinumtoxinA injection can be used as second-line therapy. Objective: To assess the safety and efficacy of onabotulinumtoxinA treatment in the management of non-neurogenic detrusor overactivity among our patients. Also, to examine the influence of perioperative factors on the effects of the efficacy. Method: We have retrospectively collected the perioperative data of 33 patients treated with intradetrusor BOTOX®. The assessment of the efficacy and complications was done by the examination of patient files and questionnaires. The results obtained during the statistical analysis were considered significant for p<0.05. Results: We have not experienced notable complications after the procedures. Only 6 patients had residual urine (p = 0.024), none of them needed to be catheterized. We have observed significant decrease in the incidence of frequency, nocturia, urgency and incontinence, just as in the number of pads needed daily (p<0.01). Quality of life and general health were significantly improved (p<0.001). We have not found any significant connection between preoperative factors and efficacy (72.7%). Discussion: Our results considering the relief of symptoms are well in line with international data. The fact that our rate of complications is - in international comparison - outstanding can be explained by a more careful patient selection and thorough preoperative assessment. Conclusion: OnabotulinumtoxinA therapy is a safe and effective solution of therapy-refractory overactive bladder. We could not identify any perioperative factor to predict postoperative efficacy of therapy. Orv Hetil. 2021; 162(36): 1459-1465.

Axonics® system for treatment of overactive bladder syndrome and urinary urgency incontinence

ABSTRACT Introduction: Overactive bladder and urge urinary incontinence affect millions of women and men and results in billions of dollars in health-care expenses. First- and second-line therapy includes behavioral modifications and/or pharmacotherapies however, many patients’ symptoms remain or progress on these treatments. There has been concern regarding the detrimental side effects of the most widely prescribed medications for these bladder symptom management. Areas covered: As a result, there has been increased interest in continuous sacral neuromodulation, an FDA approved therapy for refractory urinary urgency and urge urinary incontinence. In this article, we specifically review current research on the efficacy and patient/provider satisfaction and safety profile of the Axonics® System. In addition, we address the current state of sacral neuromodulation and potential future direction and applicability. Expert opinion: The Axonics® system is a safe effective device for the treatment of overactive bladder and urinary urge incontinence. Additionally, it affords patient’s the convenience of a rechargeable, compact, MRI safe system. It should be noted that the rechargeable system, while allowing for approximately 15 years of battery and lead life, may have its challenges in terms of charge burden. Furthermore, this system is easily adapted for experienced implanters of sacral neuromodulating devices.