Treatment Of Non-neurogenic Overactive Bladder Research Articles

Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.

The purpose of this guideline is to provide a clinical framework for the diagnosis and treatment of non-neurogenic overactive bladder (OAB). The primary source of evidence for the original version of this guideline was the systematic review and data extraction conducted as part of the Agency for Healthcare Research and Quality (AHRQ) Evidence Report/Technology Assessment Number 187 titled Treatment of Overactive Bladder in Women (2009). That report was supplemented with additional searches capturing literature published through December 2011. Following initial publication, this guideline underwent amendment in 2014 and 2018. The current document reflects relevant literature published through October 2018. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low). Such statements are provided as Standards, Recommendations, or Options. In instances of insufficient evidence, additional guidance information is provided as Clinical Principles and Expert Opinions. The evidence-based statements are provided for diagnosis and overall management of OAB, as well as for the various treatments. Diagnosis and treatment methodologies can be expected to change as the evidence base grows and as new treatment strategies become obtainable.

Treatment of Non-neurogenic Overactive Bladder with OnabotulinumtoxinA: Systematic Review and Meta-analysis of Prospective, Randomized, Placebo-controlled Clinical Trials.

We performed a systematic review and meta-analysis of randomized placebo-controlled trials that studied non-neurogenic overactive bladder patients who were treated with 100 units of onabotulinumtoxinA or placebo. The primary purpose of our study was to evaluate the clinical effectiveness with regard to urinary urgency, urinary frequency, nocturia, and incontinence episodes. Our secondary purpose consisted of evaluating the adverse effects. Our initial search yielded 532 entries. Of these, seven studies met all the inclusion criteria (prospective, randomized, placebo-controlled studies, ≥ 3 points on the Jadad scale) and were selected for analysis. For all primary endpoints, the toxin was more effective than placebo (p < 0.0001; 95% confidence interval [95CI]), namely: urgency (mean difference = -2.07; 95CI = [-2.55-1.58]), voiding frequency (mean difference = -1.64; 95CI = [-2.10-1.18]), nocturia (mean difference = -0.25; 95CI = [-0.39-0.11]) and incontinence episodes (mean difference = -2.06; 95CI= [-2.60-1.52]). The need for intermittent catheterization and the occurrence of urinary tract infection (UTI) were more frequent in patients treated with onabotulinumtoxinA than in patients treated with placebo (p < 0.0001). Compared with placebo, onabotulinumtoxinA had significantly and clinically relevant reductions in overactive bladder symptoms and is associated with higher incidence of intermittent catheterization and UTI.

Transcutaneous posterior tibial nerve stimulation in pediatric overactive bladder: A preliminary report

Non-neurogenic overactive bladder (OAB) is a common problem in children that may affect their quality of life. Various methods of neuromodulation have been reported to treat refractory lower urinary tract dysfunction. Since most of these techniques are invasive, they are less applicable in children. To evaluate the efficacy of transcutaneous PTNS in treatment of OAB in children, in a randomized clinical setting. This study was single-blinded, prospective, sham controlled randomized trial. 40 children with non-neurogenic OAB refractory to behavioural and anticholinergic therapy were randomized either to test group or sham group. Neuromodulation was performed using two self-adhesive electrodes cephalad to medial malleolus. In test group the stimulation was given with voltage pulse intensity of 0 to 10 mA, pulse width of 200 μs and frequency of 20 Hz. In sham group patch electrodes were applied to simulate the test group but no stimulation was given. In both groups, weekly session of 30 min was given for a period of 12 weeks. The OAB symptoms, severity of incontinence, number of voids daily (NV), average voided volume (AVV) and maximum voided volume (MVV) were evaluated before and after treatment. On assessment of subjective improvement of OAB symptoms, 66.66% patients reported cure and 23.81% patients reported significant improvement of symptoms in test group whereas in sham group only 6.25% patients reported significant improvement. In test group 71.42% patients reported complete improvement in incontinence whereas in sham group only 12.5% patient reported complete improvement. The AVV, MVV and NV improved significantly in test group (p <0.001) as compared to sham group (Table). The present study is unique as none of the earlier studies in children were sham controlled. It is also first PTNS study in which patch electrodes were used; therefore it is completely noninvasive. This technique provides better patient acceptability and compliance. This study proved that, there is a definite effect of PTNS as compared to placebo because when patients from sham group were treated actively, they responded well. The present study has few limitations as it has relatively short follow-up period of 12 weeks. Relapse of OAB symptoms and maintenance schedule of PTNS need to be assessed further. Transcutaneous PTNS is superior to placebo in treatment of non-neurogenic overactive bladder in children. In view of its effectiveness and acceptability we believe that transcutaneous PTNS should be part of pediatric urology armamentarium for treatment of OAB.

Botulinum toxin type A for the treatment of non-neurogenic overactive bladder: does using onabotulinumtoxinA (Botox®) or abobotulinumtoxinA (Dysport®) make a difference?

Botulinum toxin type A for the treatment of non-neurogenic overactive bladder: does using onabotulinumtoxinA (Botox®) or abobotulinumtoxinA (Dysport®) make a difference?

Botulinum toxin therapy for nonneurogenic overactive bladder: first experience

The paper presents early experience in the treatment of 20 patients with botulinum toxin injections into the detrusor muscle for the treatment of non-neurogenic overactive bladder (OAB) resistant to anticholinergic drugs. Background. Botulinum toxin, a presynaptic neuromuscular blocking agent, reduces the involuntary bladder contractions that cause urgency, frequency and urge incontinence. We present our early experience with Dysport® injections into the detrusor for the treatment of non–neurogenic overactive bladder (OAB) resistant to anticholinergic drugs. Materials and methods. Using intravenous anaesthesia, 20 patients (18 female and 2 male) with non-neurogenic OAB were injected with botulinum toxin A (Dysport®250 IU diluted in 4 ml normal saline) under cystoscopic visualization in 20 sites in the detrusor muscle, sparing the trigone. The urethral catheter was removed 24 hours after the procedure. Follow-up at 3 and 6 months after the injection included the Urogenital Distress Inventory UDI-6, the Incontinence Impact Questionnaire IIQ-7, clinical parameters and ultrasound measurement of bladder capacity and post-void residual urine volume. Results. All 20 patients completed questionnaires and were examined after 3 and 6 months. At the 3-month follow-up, the median daytime micturation frequency decreased from 10.4 to 4.6 times (p &lt; 0.0001) and at the 6 months follow-up 5 times (p &lt; 0.0001), while nocturia decreased from 4.2 to 1.3 times after 3 months (p &lt; 0.0001) and after 6 months to 2 times (p &lt; 0.0001). Urgency decreased from 6 to 1.5 times after 3 months (p &lt; 0.0001) and to 2 times after 6 months (p &lt; 0.0001), and incontinence decreased from 4.2 times to 1.5 times after 3 months (p &lt; 0.0001) and to 2.1 times after 6 months (p &lt; 0.0001). The median maximum bladder capacity increased from 250 to 420 ml after 3 months (p &lt; 0.0001) and decreased to 350 ml after 6 months (p &lt; 0.0001). The post-void median residual urine volume was 10 ml. Only one patient mentioned a post-operative obstructive voiding difficulty. Eighteen (90%) patients were satisfied with the treatment. In two patients (10%), the amelioration of symptoms lasted for one month only, and later OAB symptoms reappeared. Analysis of the UDI-6 and IIQ-7 questionnaires revealed that botulinum toxin A intradetrusor injection had decreased discomfort for patients and ameliorated their quality of life. Conclusions. Botulinum toxin A injections in the detrusor are effective for the treatment of non-neurogenic OAB. Botulinum toxin A injections are a minimally invasive therapy and offer an alternative treatment for non–neurogenic OAB dysfunction resistant to conservative treatment. The durability of the treatment effect is the objective of the further investigation. Keywords: botulinum toxin, overactive bladder, urinary incontinence

Eight-Year Experience With Botulinum Toxin Type-A Injections for the Treatment of Nonneurogenic Overactive Bladder: Are Repeated Injections Worthwhile?

Purpose:To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drug-refractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome.Methods:Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson’s chi-square tests.Results:Fifty-two patients with a mean age of 67.4 years (range, 26–93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9–101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥70 years) and younger (<70 years) patient cohorts.Conclusions:Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.