Treatment Of Urge Incontinence Research Articles

Treatment of urge incontinence in postmenopausal women: A systematic review.

Urinary incontinence and other urinary symptoms tend to be frequent at menopause because of hormonal modifications and aging. Urinary symptoms are associated with the genitourinary syndrome of menopause which is characterized by physical changes of the vulva, vagina and lower urinary tract. The treatment strategies for postmenopausal urinary incontinence are various and may include estrogens, anticholinergics, and pelvic floor muscle training. A comparison of these treatments is difficult due to the heterogeneity of adopted protocols. We systematically reviewed the evidence from randomized controlled trials (RCTs) focusing on treatment of postmenopausal women with urge incontinence. We conducted a systematic review and meta-analysis by searching PubMed and EMBASE databases for randomized controlled trials (RCTs) reporting results of treatments for postmenopausal urinary urge incontinence. Odds ratios for improvement of urinary incontinence were calculated using random effect Mantel-Haenszel statistics. Out of 248 records retrieved, 35 eligible RCTs were assessed for risk of bias and included in the meta-analysis. Compared with placebo, systemic estrogens were associated with decreased odds of improving urinary incontinence in postmenopausal women (OR = 0.74, 95% CI: 0.61-0.91, 7 series, 17132 participants, Z = 2.89, P = 0.004, I2 = 72%). In most studies, no significant improvement in urinary symptoms was observed in patients treated with local estrogens, although they showed to be helpful in improving vaginal symptoms. Vitamin D, phytoestrogens and estrogen modulators were not effective in improving symptoms of incontinence and other symptoms of genitourinary menopause syndrome or yielded contradictory results. A randomized controlled trial demonstrated that oxybutynin was significantly better than placebo at improving postmenopausal urgency and urge incontinence. The combination of anticholinergics with local estrogens has not been shown to be more effective than anticholinergics alone in improving urinary incontinence symptoms in postmenopausal women. Physical therapy showed an overall positive outcome on postmenopausal urinary incontinence symptoms, although such evidence should be further validated in the frame of quality RCTs. The evidence for effective treatment of postmenopausal urinary incontinence is still lacking. Welldesigned large studies having subjective and objective improvement primary endpoints in postmenopausal urinary incontinence are needed. At present, a combination of different treatments tailored to the characteristics of the individual patient can be suggested.

History of Sacral Neuromodulation in Urology

Introduction: Approximately 16.5% of the U.S. population is estimated to have overactive bladder (OAB), significantly impacting their daily life. Sacral nerve stimulation (SNS) has been a successful method of treating urge incontinence, urgency, frequency, and non-obstructive retention since its development. This article reviews the development of SNS from its inception to the procedure we know it as today. Sources and Methods: We conducted a literature review using the PubMed database, Google Scholar, and JSTOR regarding the history of SNS and the discoveries leading to its development. Results: As our ability to incorporate electricity into medical practice improved in the mid-1900s, the pressing question in urology was whether it could be used in treatment of the neurogenic bladder. Initial efforts focused on direct detrusor stimulation and pelvic nerve stimulation, with limited efficacy. In the 1970s, Drs. Emil Tanagho and Richard Schmidt found that stimulation of sacral nerves in dog models resulted in a detrusor contraction response, resulting in the voiding of urine. They focused on improving these techniques and published a paper in 1989 on the first use of SNS on human subjects, paving the way for our modern-day procedure. Eventually, Medtronic developed the InterStim system, which received FDA approval in 1997 for the treatment of urge incontinence. The basic SNS technique has since remained largely the same. In 2019, the Axonics Sacral Neuromodulation System was also approved for treatment of OAB symptoms as an alternative to the InterStim system. Given the efficacy of SNS in the treatment of OAB, further iterations of SNS devices were recently developed, such as devices with rechargeable batteries and prolonged battery life. Conclusions: Since Tanagho and Schmidt first described its use, SNS has been and continues to be a successful method for treating OAB. Going forward, SNS will remain a viable option for the treatment of urge incontinence and retention.

Causes and treatment of urge incontinence in women

Journal of Prescribing PracticeVol. 4, No. 5 News AnalysisCauses and treatment of urge incontinence in womenAysha MendesAysha MendesE-mail Address: [email protected]Freelance journalist specialising in health, psychology and nursingSearch for more papers by this authorAysha MendesPublished Online:13 May 2022https://doi.org/10.12968/jprp.2022.4.5.186AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Artusi CA, Romagnolo A, Ledda C et al. COVID-19 and Parkinson's disease: what do we know so far? J Parkinsons Dis. 2021;11(2):445–454. https://doi.org/10.3233/JPD-202463 Google ScholarAustralian Menopause Society. Stress and urge incontinence info sheet. 2013. https://www.menopause.org.au/images/stories/infosheets/docs/AMS_Stress_and_urge_incontinence.pdf (accessed 29 April 2022) Google ScholarBritish Medical Journal. Best Practice: Urinary incontinence in women. 2020. https://bestpractice.bmj.com/topics/en-gb/169 (accessed 29 April 2022) Google ScholarKołodynska G, Zalewski M, Rozek-Piechura K. Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Prz Menopauzalny. 2019;18(1): 46–50 https://doi.org/10.5114/pm.2019.84157 Google ScholarNational Institute for Health and Care Excellence. Clinical Knowledge Summary: Incontinence, urinary, in women. 2019a. https://cks.nice.org.uk/incontinence-urinary-in-women#!scenario:1 (accessed 29 April 2022) Google ScholarNational Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline [NG123]. 2019b. https://www.nice.org.uk/guidance/ng123 (accessed 29 April 2022) Google ScholarZhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). Diabetes Metab Res Rev. 2021;37(2):e3377. https://doi.org/10.1002/dmrr.3377 Google Scholar FiguresReferencesRelatedDetails 2 May 2022Volume 4Issue 5ISSN (print): 2631-8385ISSN (online): 2631-8393 Metrics History Published online 13 May 2022 Published in print 2 May 2022 Information© MA Healthcare LimitedPDF download

Treatment of urge incontinence in women.

Treatment of urge incontinence in women.

Management of urinary incontinence in postmenopausal women: An EMAS clinical guide

IntroductionThe prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care. AimThe aim of this clinical guide is to provide an evidence-based approach to the management of urinary incontinence in postmenopausal women. Materials and methodsLiterature review and consensus of expert opinion. Summary recommendationsHealthcare professionals should consider urinary incontinence a clinical priority and develop appropriate diagnostic skills. They should be able to identify and manage any relevant modifiable factors that could alleviate the condition. A wide range of treatment options is available. First-line management includes lifestyle and behavioral modification, pelvic floor exercises and bladder training. Estrogens and other pharmacological interventions are helpful in the treatment of urgency incontinence that does not respond to conservative measures. Third-line therapies (e.g. sacral neuromodulation, intravesical onabotulinum toxin-A injections and posterior tibial nerve stimulation) are useful in selected patients with refractory urge incontinence. Surgery should be considered in postmenopausal women with stress incontinence. Midurethral slings, including retropubic and transobturator approaches, are safe and effective and should be offered.

Electrochemical oxidation of 5-hydroxymethyl tolterodine and identification of its oxidation products using liquid chromatography and mass spectrometry

The electrochemical behavior of 5-hydroxymethyl tolterodine (5-HMT), the active metabolite of antimuscarinic drugs tolterodine and fesoterodine used to treat urge incontinence and overactive bladder, was investigated using cyclic and differential pulse voltammetry at glassy carbon electrode. Electrooxidation of 5-HMT proceeds as a complex pH-dependent process. Controlled potential electrolysis of 5-HMT solutions was performed at platinum gauze electrode in aqueous-methanolic media. Electrolyzed solutions were analyzed using ultra performance liquid chromatography with electrospray ionization quadrupole time-of-flight mass spectrometry. Two main oxidation centers of the studied molecule were located: the p-hydroxybenzyl alcohol group and the tertiary amino group. Oxidation of the first center proceeds in several steps leading to the formation of 5-formyl tolterodine, p-benzoquinone derivative and several dimeric, hydroxylated and methoxylated products depending on pH of the solution and electrode potential. The second center is oxidized preferentially in alkaline media at higher potentials under the hydrolytic cleavage of diisopropylamine and formation of corresponding aldehydes. Mechanism of the electrochemical oxidation of 5-HMT has been proposed.

Pharmacotherapy of urinary incontinence in the elderly

The prevalence and the incidence of Urinary Incontinence is growing. Women suffer predominantly from stress and mixed urinary incontinence and men from urge incontinence. In elderly people, the pathophysiological and the physiological change in the lower urinary tract system must be considered as well as an underlying multimorbidity. Stress urinary incontinence is among others caused by an insufficient urethral closure mechanism and urge incontinence is followed by unhibited detrusor contractions. Medical treatment is beside other important conservative options only one part of the treatment strategy in incontinence. Duloxetine, aserotonine-norepinephrine reuptake inhibitore can increase activity of the external urethral sphincter and is able to reduce incontinence episodes in up to 64 %. Antagonists of muscarinic receptors can reduce urgency, frequency and urge incontinence as well as increase bladder capacity significantly. In Germany, darifenacin, fesoterodin, oxybutynin, propiverine, solifenacin, tolterodine and trospium chloride are available to treat urge incontinence. The efficacy of these agents are almost comparable in the elderly with the exception of oxybutynin IR. However, tolerability is different and not well studied in the elderly population with the exception of fesoterodin. Side effects, especially dry mouth, dizziness and constipation often limit their use. None of the agents show ideal efficacy or tolerability in all patients. Last summer therefore aβ3-agonist mirabegron was also introduced in Germany but was withdrawn.

Combined Vaginal Pelvic Floor Electrical Stimulation (PFS) and Local Vaginal Estrogen for Treatment of Overactive Bladder (OAB) in Perimenopausal Females. Randomized Controlled Trial (RCT)

To evaluate the efficacy of combined vaginal pelvic floor electrical stimulation (PFS) and local vaginal estrogen in treatment of female overactive bladder (OAB). This is a randomized controlled trial carried out on 315 perimenopausal females with OAB who were randomly allocated into 3 equal groups. Group A underwent PFS using vaginal probes twice weekly for 12 sessions. Group B received local vaginal estrogen, whereas group C received both PFS and local estrogen. All patients were evaluated by a voiding diary, quality-of-life questionnaire, vaginal examination, urine analysis, blood sugar, ultrasonography, and urodynamic study before and after therapy. Patients were followed up 1 week, 3, and 6 months post-therapy. The analyzed variables included day and night time frequency, incontinence episodes, urgency, quality of life, detrusor overactivity), and functional bladder capacity). Outcome measure was urge incontinence. Within each group, there was a statistically significant improvement in all variables after treatment. Improvement of urgency was better in group C than in groups A and B (P = .000, .009). Improvement of incontinence was better in groups A and C than in group B (P = .005, .004). Follow-up showed worsening of symptoms within 6 months in all groups except incontinence in group C. Vaginal PFS and estrogen found to be effective in treating OAB symptoms in perimenopausal females. Estrogen seems to augment the effect of PFS especially in the treatment of urgency incontinence and can delay its recurrence.

Streamlining Biofeedback for Urge Incontinence

The aim of this study was to determine the important elements of biofeedback-assisted pelvic floor muscle exercises to treat urge incontinence. Urge suppression and pelvic floor muscle exercises were most beneficial. Responders can be identified early in treatment, allowing for fewer sessions.

Update on Behavioral and Physical Therapies for Incontinence and Overactive Bladder: The Role of Pelvic Floor Muscle Training

Behavioral and physical therapies have been used for many years to treat incontinence and overactive bladder (OAB). This paper focuses on programs that include pelvic floor muscle training (PFMT) as a component in treatment for women or men. PFMT was long used almost exclusively for treatment of stress incontinence. When it became evident that voluntary pelvic floor muscle contraction can be used to control bladder function, PFMT was also integrated into the treatment of urge incontinence and OAB as part of a broader behavioral urge suppression strategy. PFMT has evolved over decades, both as a behavioral therapy and a physical therapy, combining principles from behavioral science, nursing, and muscle physiology into a widely recommended conservative treatment. The collective literature indicates that PFMT is effective for incontinence, as well as urgency, frequency, and nocturia. It can be combined with all other treatment modalities and holds potential for prevention of bladder symptoms.

Mirabegron: β3-Adrenergic Receptor Agonist for the Treatment of Overactive Bladder

To review the place in therapy of mirabegron, a new oral β3-adrenergic receptor agonist, for the treatment of overactive bladder (OAB). A literature search of MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations Databases (1996-April 2013) was conducted using the key words mirabegron, receptor, adrenergic, beta-3; adrenergic beta-3 receptor; beta-3 receptor, and overactive bladder; urinary bladder; overactive. All published articles regarding mirabegron were included. References of selected articles, data from poster presentations, and abstract publications were additionally reviewed. Available English-language data from reviews, abstracts, presentations, and clinical trials of mirabegron in humans were reviewed; relevant clinical data were selected and included. Mirabegron is the newest option for treatment of OAB with symptoms of urge incontinence. As a β3-receptor agonist, it reduces bladder muscle contractions. In two 12-week, randomized, double-blind, placebo-controlled Phase 3 studies, mirabegron significantly reduced the number of incontinence episodes per 24 hours from baseline (-1.47, -1.63, and -1.13; p < 0.05; and -1.57, -1.46, and -1.17; p < 0.05; all values for mirabegron 50 mg, 100 mg, and placebo). Micturitions per 24 hours were also reduced from baseline (-1.66, -1.75, and -1.05; p < 0.05; and -1.93, -1.77, and -1.34; p < 0.05; all values for mirabegron 50 mg, 100 mg, and placebo). A 12-month trial found mirabegron to have a safety and efficacy profile similar to that of tolterodine. Treatment of OAB initially includes lifestyle and nonpharmacologic intervention; for patients with persistent symptoms despite these treatments, drug therapy represents a next-step approach for symptom control. Mirabegron alleviates symptoms of OAB while having a mechanism of action that provides an alternative for patients who are intolerant of or who have contraindications to anticholinergic agents. The place in therapy of mirabegron relative to anticholinergics in the treatment of urge incontinence has not yet been established.

Mobility impairment is associated with urge but not stress urinary incontinence in community‐dwelling older women: results from the Ossébo study

To assess the association between functional limitations related to mobility and urinary incontinence (UI) in elderly women. An observational cross-sectional study. Nine 'balance' workshops in France. A total of 1942 community-dwelling women aged 75-85 years, who were invited, based on voter registration lists, to a 'balance assessment'. Mobility and balance test results for incontinent women were compared with those for continent women according to the severity and type of incontinence. Data on UI were collected using a self-administered questionnaire (International Consultation on Incontinence Questionnaire-Short Form). Motor-related physical abilities were assessed using standardised balance and functional gait tests. Forty-two per cent of women had involuntary urine leakage, with daily leaks in 57% of them; 24% had stress UI, 31% had urge UI, and 37% had mixed UI. Results for each functional test were poorer for women with UI and the limitation was more pronounced when the incontinence was severe. Multivariate logistic regression analyses showed that balance and gait impairments were significantly and independently associated with urge UI (walking speed, lower versus higher quartile, odds ratio (OR) 2.2; 95% confidence interval (95% CI) 1.4-3.5; walking balance, unable versus able to do four tandem steps (OR 1.6; 95% CI 1.2-2.2) but not with stress UI. In this large population of older women living at home, there was a strong association between limitation of motor and balance skills and UI, which was proportional to the severity of incontinence and related specifically to urge incontinence. These results offer new perspectives on the prevention and treatment of urge incontinence in elderly women.

PUK10 - Treating urge incontinence in older adults: A quality adjusted life-year (QALY) bargain

PUK10 - Treating urge incontinence in older adults: A quality adjusted life-year (QALY) bargain

Electrochemical Oxidation of Tolterodine

AbstractThe electrochemical behavior of tolterodine, an antimuscarinic drug used to treat urge incontinence and overactive bladder, was investigated using cyclic and differential pulse voltammetry at glassy carbon electrode. Electrooxidation of tolterodine proceeds as a complex two‐step pH‐dependent process. Controlled potential electrolysis of tolterodine solutions was performed at platinum gauze electrode in methanolic, aqueous‐methanolic and acetonitrile media. Electrolyzed solutions were analyzed using liquid chromatography with electrospray ionization quadrupole time‐of‐flight mass spectrometry. 5‐Hydroxymethyl tolterodine, the main biologically active metabolite of tolterodine, was identified among monomeric oxidation products. Dimeric products, formed by oxidative coupling of phenoxy radicals, were found in all electrolyzed solutions. The mechanism of the electrochemical oxidation of tolterodine has been proposed.

Quantity-effect relationship of electroacupuncture for urge incontinence: A multicenter randomized controlled trial

Objective To investigate the quantity-effect relationship of electroacupuncture in treating urge incontinence (UI).

Local Estriol Treatment

All women with urinary incontinence should be provided with the opportunity for individualized treatment. In women with an overactive bladder, this includes local vaginal administration of estriol (0.5 mg/day). This metabolite of estradiol, which does not affect the endometrium, does not require addition of gestagen because it binds to the estrogen receptor for 1–4 hours only, compared with 6–24 hours for estradiol. This difference, by a factor of 6, means that local estriol treatment does not incur any risk of thromboembolism or increased diagnoses of breast cancer, according to studies from Scandinavia To treat urge incontinence that develops after the menopause as a result of tissue atrophy subsequent to estrogen deficiency, estriol has been successful for 30 years. In urinary urge in women of perimenopausal age, progesterone deficiency should be borne in mind. Substitution treatment (locally-vaginally, without any relevant risks) reduces detrusor overactivity. This applies to women with a fairly recent menopause. Estriol has a proliferative effect in the vaginal, urethral, and bladder epithelium via beta-receptors. Estriol binds by a factor of 7 less often to the alpha-receptor than estradiol (dominant in the endometrium and glandular breast tissue). Estriol improves perfusion in the urethral area including closure mechanisms via beta-receptors in the endothelia. Local estriol 0.5 mg/day for 2–3 weeks is then reduced to 3-day intervals and later 1-week intervals. Optimum therapy is reached after 3 months. A prospective, multicenter study (1) showed for 80% of 600 postmenopausal women with symptoms of incontinence a subjective improvement after 6 weeks (even for grade 3 incontinence). High frequency of micturition halved. These findings were confirmed by a smaller study (2) and a placebo controlled study (3): local estriol significantly improved incontinence as a result of urogenital atrophy in 7 out of 10 women; in the placebo group, only 1 in 7 women experienced an improvement.

Randomized Trial of Percutaneous Tibial Nerve Stimulation Versus Sham Efficacy in the Treatment of Overactive Bladder Syndrome: Results From the SUmiT Trial

The Study of Urgent PC vs Sham Effectiveness in Treatment of Overactive Bladder Symptoms (SUmiT) was a multicenter, double-blind, randomized, controlled trial comparing the efficacy of percutaneous tibial nerve stimulation to sham through 12 weeks of therapy. The improvement in global response assessment, voiding diary parameters, and overactive bladder and quality of life questionnaires was evaluated. A total of 220 adults with overactive bladder symptoms were randomized 1:1 to 12 weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy. Overactive bladder and quality of life questionnaires as well as 3-day voiding diaries were completed at baseline and at 13 weeks. Subject global response assessments were completed at week 13. The 13-week subject global response assessment for overall bladder symptoms demonstrated that percutaneous tibial nerve stimulation subjects achieved statistically significant improvement in bladder symptoms with 54.5% reporting moderately or markedly improved responses compared to 20.9% of sham subjects from baseline (p <0.001). All individual global response assessment subset symptom components demonstrated statistically significant improvement from baseline to 13 weeks for percutaneous tibial nerve stimulation compared to sham. Voiding diary parameters after 12 weeks of therapy showed percutaneous tibial nerve stimulation subjects had statistically significant improvements in frequency, nighttime voids, voids with moderate to severe urgency and urinary urge incontinence episodes compared to sham. No serious device related adverse events or malfunctions were reported. This pivotal multicenter, double-blind, randomized, sham controlled trial provides level I evidence that percutaneous tibial nerve stimulation therapy is safe and effective in treating overactive bladder symptoms. The compelling efficacy of percutaneous tibial nerve stimulation demonstrated in this trial is consistent with other recently published reports and supports the use of peripheral neuromodulation therapy for overactive bladder.

Tolterodine causes measurable restoration of urethral sensation in women with urge urinary incontinence

INTRODUCTION & HYPOTHESIS: Determine if treatment of urge incontinence with tolterodine results in changes in bladder and/or urethral sensation using Current Perception Threshold (CPT) testing. Women with >or=1 incontinence episode on 7-day diary were treated with 4 mg of long-acting tolterodine for 2-months. At baseline and 2-months, participants had CPT testing of the urethral and bladder at 3 frequencies 2000, 250, and 5 Hz. Baseline and post-treatment measures were compared using Wilcoxon Signed Rank Test. Seventeen women underwent baseline CPT testing. Four discontinued medication due to side effects and did not have repeated testing. Urethral CPT at 250 Hz was lower after treatment (median 1.3 [Interquartile range .69-2.1] and .75 [.45-1.2], p = .003) and at 5 Hz trended toward a significant decrease (1.1 [1-1.9] and .84 [.32-1.1], p = .06). Urethral sensitivity improves after 2-months of tolterodine, suggesting it may restore urethral sensory nerves in addition to known motor effects.

Randomized Trial of Percutaneous Tibial Nerve Stimulation Versus Extended-Release Tolterodine: Results From the Overactive Bladder Innovative Therapy Trial

The Overactive Bladder Innovative Therapy trial was a randomized, multicenter, controlled study that compared the effectiveness of percutaneous tibial nerve stimulation to extended-release tolterodine. The reduction in overactive bladder symptoms along with global response assessments was evaluated. A total of 100 adults with urinary frequency were randomized 1:1 to 12 weeks of treatment with weekly percutaneous tibial nerve stimulation or to 4 mg daily extended-release tolterodine. Voiding diaries and an overactive bladder questionnaire were completed at baseline and at the end of therapy to compare 24-hour voiding frequency, urinary urge incontinence episodes, voids causing waking, volume voided, urgency episodes and quality of life indices. Global response assessments were completed by subjects and investigators after 12 weeks of therapy. The global response assessment demonstrated that subject assessment of overactive bladder symptoms compared to baseline was statistically significant in the percutaneous tibial nerve stimulation arm with 79.5% reporting cure or improvement compared to 54.8% of subjects on tolterodine (p = 0.01). Assessments by investigators were similar but did not reach statistical significance (p = 0.05). After 12 weeks of therapy objective measures improved similarly in both groups for reductions in urinary frequency, urge urinary incontinence episodes, urge severity and nighttime voids, as well as for improvement in voided volume. There were no serious adverse events or device malfunctions. This multicenter, randomized trial demonstrates that percutaneous tibial nerve stimulation is safe with statistically significant improvements in patient assessment of overactive bladder symptoms, and with objective effectiveness comparable to that of pharmacotherapy. Percutaneous tibial nerve stimulation may be considered a clinically significant alternative therapy for overactive bladder.

Behavior Therapy to Enable Drug Discontinuation in the Treatment of Urge Incontinence: A Randomized Controlled Trial

Behavior Therapy to Enable Drug Discontinuation in the Treatment of Urge Incontinence: A Randomized Controlled Trial