Treatment Of Overactive Bladder Syndrome Research Articles

Low Intensity Extracorporeal Shock Wave Therapy as a Potential Treatment for Overactive Bladder Syndrome.

Simple SummaryOveractive bladder (OAB) is a common urologic condition with urinary frequency, urinary urgency, nocturia, and urgency incontinence, which can get in the way of a patient’s social life, exercise, work, and sleep. Exploring a promising option for OAB patients is very important, especially one with less side effects or invasive alternations. This study uses low intensity extracorporeal shock wave therapy (LiESWT) to investigate the therapeutic effect and duration on OAB symptoms.Background: The present study attempted to investigate the therapeutic effect and duration of low intensity extracorporeal shock wave therapy (LiESWT) on overactive bladder (OAB) symptoms, including social activity and the quality of life (QoL). Methods: In this prospective, randomized, single-blinded clinical trial, 65 participants with OAB symptom were randomly divided into receive LiESWT (0.25 mJ/mm2, 3000 pulses, 3 pulses/second) once a week for 8 weeks, or an identical sham LiESWT treatment without the energy transmission. We analyzed the difference in overactive bladder symptom score (OABSS) and 3-day urinary diary as the primary end. The secondary endpoint consisted of the change in uroflowmetry, post-voided residual (PVR) urine, and validated standardized questionnaires at the baseline (W0), 4-week (W4) and 8-week (W8) of LiESWT, and 1-month (F1), 3-month (F3) and 6-month (F6) follow-up after LiESWT. Results: 8-week LiESWT could significantly decrease urinary frequency, nocturia, urgency, and PVR volume, but meaningfully increase functional bladder capacity, average voided volume and maximal flow rate (Qmax) as compared with the W0 in the LiESWT group. In addition, the scores calculated from questionnaires were meaningfully reduced at W4, W8, F1, F3, and F6 in the LiESWT group. Conclusions: Our results revealed that the therapeutic efficacy of LiESWT could improve voided volume and ameliorate OAB symptoms, such as urgency, frequency, nocturia, and urinary incontinence, and lasted up to 6 month of follow-up. Moreover, LiESWT treatment brought statistically significant and clinically meaningful improvements in social activity and QoL of patients. These findings suggested that LiESWT could serve as an alternative non-invasive therapy for OAB patients.

Effectiveness and safety of tibial nerve stimulation versus anticholinergic drugs for the treatment of overactive bladder syndrome: a meta-analysis.

This meta-analysis aimed to evaluate the efficacy and safety of tibial nerve stimulation (TNS) and anticholinergic drugs (ACDs) for the treatment of overactive bladder syndrome (OAB). Qualified studies up to November 3, 2020 were retrieved from PubMed, Embase, the Cochrane Library and Web of Science. Pooled mean differences (MDs) were calculated to evaluate the improvement of micturition frequency per day, nocturia per night, urinary urgency episodes per day, incontinence episodes per day, and voided volume each time. Odd ratios (ORs) were used to assess the discontinuation rate. A total of 6 RCTs including 291 patients were included. Comparing with those receiving ACDs, patients receiving TNS had a significantly better improvement of urge incontinence episodes (MD =-1.11; 95% CI: -1.66, -0.55; P<0.001), but had comparable effect on micturition (MD =-0.75; 95% CI: -1.78, 0.28; P=0.16), nocturia (MD =-1.11; 95% CI: -2.93, 0.72; P=0.23), urgency (MD =-0.57; 95% CI: -1.93, 0.79; P=0.41) and voided volume (MD =11.61; 95% CI: -3.95, 27.18; P=0.14). Moreover, TNS group had a significantly lower discontinuation rate (OR =0.13; 95% CI: 0.03, 0.51; P=0.003) during the trials. TNS is as effective as ACDs for treating OAB, but with better performance on the decrease of urge incontinence episodes. Besides, TNS appears to be more tolerable than ACDs.

Twelve-month Durability of a Fully-implanted, Nickel-sized and Shaped Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome with Urgency Urinary Incontinence: A Single-Arm, Prospective Study

To evaluate the safety and efficacy of the eCoin - a nickel-sized, primary battery-powered, neuromodulation device for the treatment of urgency urinary incontinence which is implanted in the lower leg in a 20-minute procedure under local anesthesia. A feasibility clinical trial was conducted and the results after 1 year of treatment with the eCoin are presented. A total of 46 participants with refractory urgency urinary incontinence were included in this prospective, single-arm, open-label study. This study was conducted at 7 sites in the United States and New Zealand. Participants in this study were implanted with the eCoin in the lower leg over the tibial nerve and activated after 4 weeks. Bladder diary data and validated quality-of-life instruments, collected at 3, 6, and 12 months' post-activation, were compared to baseline values. Responders were defined as those who had a ≥50% reduction in reported episodes of urgency urinary incontinence. At 12 months', 65% of participants were considered responders with 26% of participants achieving complete continence. The median number of urgency urinary incontinence episodes per day decreased from 4.2 at baseline to 1.7 at 12 months'. Seventy percent of participants reported feeling "better", "much better", or "very much better" on the Likert 7-point maximum scale. One participant experienced a related serious adverse event. The eCoin is a safe and effective treatment for urgency urinary incontinence associated with overactive bladder syndrome, with significant reduction or complete resolution of symptoms and no significant safety concerns.

Persistence with mirabegron or antimuscarinic treatment for overactive bladder syndrome: Findings from the PERSPECTIVE registry study.

ObjectivesThis analysis from the PERSPECTIVE (a Prospective, Non‐interventional Registry Study of Patients Initiating a Course of Drug Therapy for Overactive Bladder) study evaluated treatment persistence with mirabegron or antimuscarinics over a 12‐month period.MethodsParticipants were adults diagnosed with overactive bladder (OAB) by their health care provider (HCP), who were initiating mirabegron or antimuscarinic treatment. The HCP made all treatment decisions, and patients were followed for 12 months with no mandatory scheduled visits. Information requests were sent to patients at baseline and months 1, 3, 6, and 12. Patients were nonpersistent if they switched, discontinued, or added OAB medications/therapies to their initial treatment. Reasons for discontinuation and switching patterns were investigated.ResultsOverall, 1514 patients were included (613 mirabegron and 901 antimuscarinic initiators). Persistence rates decreased steadily over time in both groups. A low proportion of patients added or switched medication at each time point. Unadjusted Kaplan‐Meier analysis showed similar persistence rates for both groups. When the data were adjusted for patient characteristics (age, sex, and OAB treatment status), mirabegron initiators had higher persistence rates. No significant differences were noted in unadjusted median time to end of persistence. However, end of treatment persistence by any cause was longer with mirabegron (median: 9.5 vs 6.7 months for antimuscarinics). HCPs stated that the most common reasons for nonpersistence were no symptomatic improvement and side effect aversion.ConclusionsTreatment persistence was longer for mirabegron compared with antimuscarinic initiators after controlling for patient characteristics. End of treatment persistence by any cause was also longer with mirabegron.

The Urogynecology Section of the Polish Society of Gynecologists and Obstetricians guidelines on the management of non-neurogenic overactive bladder syndrome in women

The aim of the publication was to present the interdisciplinary guidelines of the Urogynecology Section of the Polish Society of Gynecologists and Obstetricians (PSGO) for the treatment of overactive bladder (OAB) syndrome based on the available literature, expert knowledge, and everyday practice. A review of the literature, including current recommendations for the treatment of overactive bladder syndrome, urinary incontinence, urgency and mixed urinary incontinence, as well as the earlier recommendations of the PSGO Urogynecology Section, was conducted. Management of the patients with OAB is presented. Four lines of therapy were identified: 1) educating the patient, behavioral therapy with pelvic floor muscle training, 2) pharmacotherapy, 3) botulinum toxin injection and tibial nerve stimulation; and sacral nerve stimulation even though so far it has been used only in selected populations, 4) surgical intervention. The literature reports which provided supporting evidence and presented various aspects of the therapy were discussed. OAB pharmacotherapy-related issues which are vital in everyday clinical practice were presented. A systematic review of the available guidelines and an analysis of OAB (including urgency urinary incontinence) management were conducted. The Polish Society of Gynecologists and Obstetricians issued the guidelines for the therapeutic management of OAB patients. The need for an individualized approach was emphasized.

Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk.

Recent publications show an association between exposure to anticholinergic medications and the risk of developing dementia. We hypothesized that urogynecology providers have changed their overactive bladder syndrome treatment as a result of this literature. This was an anonymous, cross-sectional, web-based survey of American Urogynecologic Society members. Survey questions queried awareness of the referenced literature, prescribing practices, the impact of insurance on treatment plans, and demographics. Our primary outcome measured the change in prescribing practice in response to literature linking anticholinergic medications with the risk of dementia. Descriptive statistics were used. A total of 222 urogynecology providers completed the survey. Nearly all respondents (99.1%) were aware of the recent literature, and, as a result, 90.5% reported changing their practice. Prior to the publication of recent literature, a "non-CNS-sparing" anticholinergic (e.g., oxybutynin) was most commonly prescribed (64.4%), whereas after the literature was published, this shifted to ß3-adrenoceptor agonists (58.5%, p < 0.001). A majority of respondents (96.6%) reported that insurance restrictions led to a change in treatment for some patients, with 73.5% describing the prior-authorization process as difficult. Many providers (61.8%) reported that a trial of anticholinergics was required by insurance companies prior to authorizing mirabegron. The recent literature associating anticholinergic medications with the development of dementia has changed practice patterns among survey respondents, with a shift away from anticholinergic medications and toward ß3-adrenoceptor agonists. The majority of respondents report insurance barriers to non-anticholinergic therapies, resulting in alteration of their preferred practices.

Real-life patient experiences of TTNS in the treatment of overactive bladder syndrome.

Introduction and objectives:Overactive bladder syndrome (OAB) is defined as urinary urgency, with or without urgent urinary incontinence; it is often associated with urinary frequency and nocturia, in the absence of any pathological or metabolic conditions that may cause or mimic OAB. The aim of this study was to evaluate the long-term real-life adherence of transcutaneous tibial nerve stimulation (TTNS) in the treatment of OAB, patient satisfaction of the treatment, and reasons for quitting therapy.Materials and methods:In this single center study, all patients who had a positive effect on percutaneous tibial nerve stimulation (PTNS) and continued to receive home-based treatment with TTNS since 2012 were included for analysis. Patients were retrospectively asked to fill out a questionnaire regarding satisfaction, reasons for quitting, and additional or next line of therapy.Results:We included 42 patients for this study, 81% of these patients were female (n = 34). The median age was 67 years (range 36–86). Most of the patients (64%, n = 27) were diagnosed with OAB wet. The median TTNS treatment persistence was 16 months (range 1–112 months). Reasons and percentages for stopping therapy were: 55% stopped treatment due to loss of effect, and 24% stopped because of preferring other type of neuromodulation. The mean satisfaction score (scale 1–10) in patients who continued TTNS was 6.2 (n = 9, SD 1.30) versus 5.4 (n = 29, SD 2.24) for patients who quit therapy. We did not find a statistically significant difference between the two groups (p = 0.174).Conclusion:TTNS, although effective in the short-term, is not effective in the long-term. In combination with a low satisfaction rate among patients, there is a need for improvement in terms of OAB treatment modalities.

The Efficacy and Safety of OnabotulinumtoxinA with Different Dosages for the Treatment of Overactive Bladder Syndrome: A Systematic Review and Meta-analysis

OnabotulinumtoxinA therapy has become widely used in overactive bladder syndrome (OAB), and many relevant articles have been published, however, there is no consensus regarding the clinical effect of onabotulinumtoxinA with the different dosages. Therefore, we conducted this meta-analysis to assess the efficacy and safety of 100 U, 200 U and 300 U onabotulinumtoxinA for the treatment of (OAB). In this project, We performed a comprehensive literature search, which was performed using EMBASE, PubMed, Cochrane database, and Google Scholar for randomized controlled trials (from inception to February 2017). As a result, fourteen studies with 1999 participants were selected. For the efficacy, 200 U of OnabotulinumtoxinA was significantly superior to 100 U, especially in the maximum cystometric capacity (MCC) and maximum detrusor pressure (MDP). Also, its subjective cure rate showed the same tendency. There were no statistical differences between 200 U and 300 U in MCC, MDP and subjective cure rate. For the adverse events, there were no statistical differences among 100 U, 200 U and 300 U OnabotulinumtoxinA in urinary tract infection (UTI) and urinary retention. Therefore, in our study. Compared to 100 U OnabotulinumtoxinA, 200 U OnabotulinumtoxinA has better efficacy while maintaining safety. Although 200 U OnabotulinumtoxinA is comparable to 300 U OnabotulinumtoxinA in terms of safety and efficacy, 200 U OnabotulinumtoxinA is a cost-effective intervention and may appear to be the optimal dosage for OAB populations.

Persistence in Percutaneous Tibial Nerve Stimulation Treatment for Overactive Bladder Syndrome is Best Predicted by Patient Global Impression of Improvement Rather Than Symptom-Specific Improvement

To evaluate whether progression to maintenance percutaneous tibial nerve stimulation (PTNS) was related to perceived global impression of improvement (PGII) rather than symptom-specific improvement in patient with overactive bladder (OAB). We hypothesize that PGII will predict continuation of PTNS long-term. This prospective observational study included 90 patients with OAB that initiated PTNS. The PGII and OAB short-form questionnaires (OABq-SF) were used to assess bladder symptom severity and improvement. Those that completed the 12-week induction phase were offered to continue PTNS monthly maintenance or pursue other options. The primary outcome was difference in PGII score between those pursuing maintenance therapy versus other options. Descriptive statistics and mixed effect modeling analysis were employed. Seventy patients (78%) completed 12 weeks of PTNS. The majority of completers pursued monthly maintenance (P< .01) and had significantly lower median PGII scores compared with those who sought alternatives (P < .01), while OABq-SF scores did not differ significantly (P=.65). Patients that pursued monthly PTNS maintenance had lower body mass index than those who chose alternative therapies (P < .01). Only 19% continued PTNS therapy for at least 1 year. More patients pursued PTNS monthly maintenance over any other therapy, and this was significantly associated with lower PGII scores. Global improvement, and not symptom-specific response, predicts long-term PTNS maintenance. No symptom-specific predictors were identified in those who pursued maintenance over other options. One-year continuation rates are low.

Traitement de l’hyperactivité vésicale d’origine idiopathique chez la femme : électrostimulation transcutanée du nerf tibial postérieur transcutanée seule versus combinée à la rééducation périneale

The treatment of overactive bladder syndrome (OABS) by percutaneous pelvic nerve stimulation (PTNS) is usually recommended as a third line treatment. The purpose of this work was to compare PTNS alone on idiopathic OABS in women against a treatment combining PTNS and pelvic floor muscle training (PFMT). This was a retrospective comparative study of 58patients, followed at the urodynamic unit. Thirty patients received PTNS alone and 28PTNS+pelvic floor rehabilitation. The main instrument used to measure the outcomes was the voiding diary. The average age of our patients was 55.2years. In the PTNS group, there was a significant improvement in daily micturitions (6after PTNS vs. 10before, P<0.001), nocturia (1.08after PTNS vs. 1.75before, P=0.003), urgency (7daily before PTNS vs. 11before (P<0.001) and maximum voided volume (378mL after PTNS vs. 306mL before, P=0.004). The Ditrovie score and USP scores showed a significant decrease. In the PTNS+PFMT group, a significant improvement was noted for the criteria: daily frequency episodes (5.7after PTNS+PFMT vs. 7.56before, P<0.001), nocturia (1.4after PTNS+PFMT vs. 2.3before, P=0.001), and daily urgency episodes (7after PTNS+PFMT vs. 9before, P<0.01). The OAB and SUI USP scores and the Ditrovie score decreased significantly (USP SUI score: 1.2after PTNS+PFMT vs. 3.4before (P<0.001); USP OAB score: 5.2after PTNS+PFMT vs. 10.4before, P<0.001). The comparison of the two groups (PTNS vs. PTNS+PFMT) did not show any significant difference in the voiding dairy outcomes and in the subjective scores outcomes (USP and Ditrovie). No significant difference was observed concerning outcomes following PTNS alone and combined PTNS and PFMT in women presenting OABS. 3.

Tibial nerve stimulation in the treatment of overactive bladder syndrome: technical features of latest applications.

Overactive bladder syndrome (OAB) is a chronic condition, which can be treated by tibial nerve stimulation. The present review will focus on the technical aspects, advantages, drawbacks, and limitations of the latest available applications of posterior tibial nerve stimulation. We describe the technical aspects of recent developed implants and techniques of tibial nerve stimulation in a transcutaneous, percutaneous, and minimal invasive way. All different treatment options have advantages and disadvantages based on type of surgery, energy transfer, impedance, treatment setting options, risk of migration, and patient usability, which are described in this review. Only devices with data that are publicly available were included. New technologies are on their way in the field of tibial nerve stimulation for the treatment of OAB. Technical aspects are important to demonstrate safety and efficacy and user friendliness in order to obtain high acceptance of the various devices.

Potential of Mirabegron and its Extended-release Formulations for the Treatment of Overactive Bladder Syndrome.

Overactive bladder syndrome is a broadly occurring urological disorder with a distressing impact on the quality of life. The commonly used antimuscarinic drugs show poor patient compliance because of unsatisfactory potency, tolerability and high occurrence of adverse effects such as dry mouth, blurred vision, constipation, dizziness etc. Mirabegron is the first approved β3-adrenoreceptor agonist, used as mono or in combination therapies for overactive bladder syndrome. The present review provides an insight into the mechanism, pharmacokinetics, toxicokinetics, clinical trials and the development of various conventional and modified-release dosage forms of mirabegron for the treatment of overactive bladder syndrome. The clinical trials of phase II and phase III of mirabegron demonstrated symptomatic relief from the overactive bladder without disturbing the micturition cycle. To date, mirabegron showed promising results for safety, tolerability and efficacy in patients with overactive bladder syndrome. The modified-release tablet dosage form of mirabegron appear to be a proficient and suitable replacement for antimuscarinics and revealed the tremendous potential to overcome the adverse effects of conventional antimuscarinic drugs like Oxybutyline chloride ER, Detrol LA, VESIcare, etc. Conclusion: Mirabegron shows a distinct mode of action, i.e., targeting β3-adrenoreceptors and improving bladder storage without altering void contractions. The limited side effects, high safety, efficacy and tolerability of mirabegron present an adequate substitute to antimuscarinics. However, long-term analysis and clinical studies are prerequisites for assessing the safety, tolerability and efficacy profile of mirabegron.

3-Year Followup of a New Implantable Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome.

We evaluated the 3-year safety and efficacy of the BlueWind Medical RENOVA™ iStim system for the treatment of overactive bladder syndrome. All patients who previously underwent implantation with the RENOVA system were offered continued participation. The primary long-term study end point was to evaluate the safety profile based on incidence of serious adverse events (system and/or procedure related), which was measured by the impact and frequency of serious adverse events. The secondary end points included clinical improvement compared to baseline and quality of life improvement compared to baseline at 36 months, which was measured by 3-day voiding diary and quality of life questionnaires at certain time points. Of the 34 patients with overactive bladder syndrome who previously underwent implantation with the RENOVA system 20 consented to continuation in this 3-year followup study. Mean patient age was 56.1 years and 80% (16) of the study cohort was female. The overall treatment success rate was 75% at 36 months in the per protocol (16) and the intent to treat (20) analyses. In total, 73% of the patients reported improvement in health related quality of life scores above the minimal important difference of 10 points. This 3-year followup study using the BlueWind RENOVA iStim system for the treatment of overactive bladder syndrome symptoms confirms the long-term good safety profile with no technical failures reported. Lasting treatment efficacy is mirrored by a sustained positive impact on patient quality of life.

Editorial Comment to Where will the next generation of medical treatments for overactive bladder syndrome come from?

Editorial Comment to Where will the next generation of medical treatments for overactive bladder syndrome come from?

Therapeutic effect of myofascial trigger point electroacupuncture technology on the treatment of overactive bladder syndrome in female.

To explore the therapeutic effect of myofascial trigger point electroacupuncture technology on treating female overactive bladder syndrome. Forty female patients with overactive bladder were randomly divided into 2 groups: an experimental group and a control group. The experimental group was treated with myofascial trigger point electroacupuncture therapy combined with solifenacin succinate while the control group was only treated with solifenacin succinate. Patients in both groups were treated for 12 weeks. The overactive bladder symptom score (OABSS), urinary urgency score and urination frequency of 24 h in the 2 groups were compared to analyze the therapeutic effect. Before the comprehensive treatment, there was no significant difference between the experimental group and the control group (P>0.05). After 2 and 12 weeks of continuous treatment, the OABSS, urinary urgency symptoms score and 24 h urination frequency in the experimental group and the control group were lower than those before the treatment, and the degree of decline in the experimental group was more obvious, with significant difference (P<0.05). Treating overactive bladder syndrome in women with myofascial trigger point electroacupuncture combined with solifenacin succinate can significantly improve the OABSS and improve the life quality of the patients.

Where will the next generation of medical treatments for overactive bladder syndrome come from?

This review article discusses the medical need for improved medical treatments of overactive bladder syndrome, and the hurdles and research required to address that need. Currently, few overactive bladder syndrome patients stay on long-term treatment, largely because efficacy expectations are not met, and tolerability is considered insufficient for the chronic treatment of a non-life-threatening condition. Therefore, a medical need exists for improved tolerability and, even more importantly, improved efficacy. It is unlikely that major improvements of efficacy and tolerability can be achieved within the currently approved drug classes. Work in experimental animals suggests that many causes of overactive bladder syndrome exist - each with a distinct pathophysiology. This makes it unlikely that a single medication can address the pathophysiology and treatment needs of all overactive bladder syndrome patients; accordingly, any medication will appear to have only moderate efficacy in the overall group of overactive bladder syndrome patients, even if it fully eliminates symptoms within a subset of patients. It is proposed that only identification of subsets of patients with a defined pathophysiology (and biomarkers thereof) will allow the development and use of targeted treatment that can be highly effective in such subsets.

Review of New Implantable Tibial Nerve Stimulators in Comparison to Established Third Line Treatment Modalities for Nonneurogenic Overactive Bladder.

New technologies are currently evolving in the treatment of overactive bladder syndrome, giving physicians and patients additional options when conservative care fails to resolve symptoms. The purpose of this review is to compare the prospective clinical data of the new small implantable devices stimulating the tibial nerve to recent prospective clinical studies of sacral nerve stimulation, percutaneous tibial nerve stimulation and botulinum toxin injection, which are currently the most established third line treatment modalities in overactive bladder syndrome. A literature search on PubMed®/MEDLINE® was performed for new technologies in neuromodulation to improve overactive bladder syndrome. Additionally, a search was performed for all currently established third line treatment options for comparison of treatment results. The reported prospective clinical data were statistically compared using Fisher's exact test. Two new small implantable devices that stimulate the tibial nerve have been reported over the recent years, BlueWind RENOVA™ and eCoin™. These new implantable devices that stimulate the tibial nerve show very comparable 3-month and 6-month clinical success rates regarding reduction of urinary incontinence episodes when compared to well-established treatment options such as sacral nerve stimulation, percutaneous tibial nerve stimulation and botulinum toxin injections. The 2 new small implantable devices stimulating the tibial nerve, BlueWind RENOVA and eCoin, show promising clinical results. Both devices are currently undergoing U.S. Food and Drug Administration approval and 1-year followup data should soon be available. Still more clinical data with larger patient cohorts and multicenter studies are necessary to verify the therapeutic efficacy of these new small implantable devices. If confirmed these new small implantable neuromodulation devices may become well-established in the treatment of patients with overactive bladder syndrome.

Posterior tibial nerve stimulation vs trospium chloride in treatment of overactive bladder in elderly women

Objective This study aimed to assess the outcome of posterior tibial nerve (PTN) stimulation vs trospium chloride in the treatment of overactive bladder syndrome (OAB) in elderly women regarding safety and efficacy. Patients and methods A prospective randomized study was done on 30 postmenopausal women presented with OAB symptoms (wet or dry) in Al-Zahraa University Hospital from March 2019 to March 2020. Patients were classified into two groups. Group Ι included 15 patients who received trospium chloride. Group ΙΙ included 15 patients who were managed by percutaneous posterior tibial nerve stimulation (PTNS). The authors compared the patients in both groups for OAB symptoms (urgency, frequency, nocturia, and urge urinary incontinence) at 4, 8, and 12 weeks, and for urodynamic parameters at the beginning and the end of treatment. Results There was a statistically significant improvement regarding OAB symptoms and urodynamic parameters at the end of the treatment, with no significant difference between both groups. However, the adverse effects were observed mainly with trospium chloride group (dry mouth, constipation, and headache), which were not detected in the PTNS group. Conclusion The authors concluded that trospium chloride and PTN stimulation had the same effect in the treatment of OAB symptoms, and the two lines of treatment are effective and can be used safely in patients with OAB syndrome. However, PTNS is safe, and associated with significant improvement of OAB symptoms, with no significant adverse effect in comparison with trospium chloride, which led to discontinuation of treatment. However, initial studies showed promise. A more comprehensive evaluation of PTNS is needed to support its universal use for the treatment of OAB syndrome.

Comparison of Different Treatments for Overactive Bladder Syndrome

Comparison of Different Treatments for Overactive Bladder Syndrome

Initial report on distribution of β3-adrenoceptor in the human female urethra.

Past research has demonstrated that the urethral tonus is mainly under sympathetic control. Since 5 years, a beta 3-adrenoceptor (ADRB3) agonist is available in the treatment of overactive bladder syndrome. The presence of ADRB3 within the human urethra has not been demonstrated to date. Presence of ADRB3 in the urethra could influence urethral tonus. The aim of this study is to investigate the presence of ADRB3 in the human female urethra. We performed anatomical studies in fivefemale specimens. Three specimens were obtained from the body donation program, two from female patients with muscle-invasive bladder cancer, where radical resection of bladder and urethra was performed. The urethra up till the bladder neck was separated from the rest of the bladder and freshly obtained for this study. For demonstrating ADRB3 expression, we used rabbit polyclonal anti-human ADRB3 LS-A4198. Expression of ADBR3 was demonstrated in the epithelial layer of all urethral parts, except at the level of the meatus. The level of ADRB3 expression was highest in the mid urethra. There was no direct contact between ADRB3 and nerve tissue. ADRB3 expression was also demonstrated in the stratified muscle layer at the level of the external urethral sphincter. This is the first study to demonstrate the expression of ADRB3 in the human female urethra. There is an absence of a direct connection between ADRB3 and nerve tissue.