Treatment Options For Overactive Bladder Research Articles

Sacral Magnetic Neuromodulation with Intermittent Theta Burst Waveform Enhances Overactive Bladder: In Vivo Study

BackgroundThe current treatment options for overactive bladder (OAB) continue to pose challenges for refractory cases and may involve invasive procedures. To assess the potential benefit of non-invasive repetitive peripheral magnetic stimulation (rPMS) on sacral roots using intermittent theta burst stimulation (iTBS) as treatment option for OAB. The study involved a total of 33 rats, which were divided into three different experimental phases. Materials and methodsTo induce bladder overactivity rats were pretreated with a continuous transvesical infusion of 0.5% acetic acid (AA). During bladder infusion, the intravesical pressure was recorded using cystometrography (CMG) to investigate the effects of AA pretreatment and the therapeutic intervention of acute sacral rPMS using iTBS. ResultsPre-application of rPMS with iTBS at a 100% intensity significantly extended the mean first voiding time (Tv) in normal healthy rats to 132%. Acute rPMS iTBS at a 100% intensity resulted in a significant increase of the inter-contraction interval (ICI) to 121%. An AA model was established with continuous saline infusion after 0.5% AA treatment and resulted in significant reductions of Tv to 42% and ICI to 56% of the corresponding control values. Subsequently, rPMS iTBS at a 100% intensity on the sacral nerve effectively inhibited AA-induced bladder overactivity and significantly increased the ICI to 167%∼222%. No significant changes in maximum bladder pressure (Pmax) were found. ConclusionsSacral nerve rPMS with iTBS demonstrated the ability to suppress AA-induced bladder overactivity. This promising modality could be developed as an alternative approach to enhance bladder continence in OAB syndrome patients.

Multicomponent Intervention Is an Effective Treatment Option for Overactive Bladder in Women.

According to this study: A randomized clinical trial showed that a multicomponent intervention with cognitive components improved health-related quality of life in women with moderate-to-severe overactive bladder.

Percutaneous tibial nerve stimulation for the overactive bladder: A single-arm trial.

We hypothesise that PTNS is a safe and effective treatment for OAB. Overactive bladder (OAB) is estimated to affect 11.8% of women worldwide, causing diminished quality of life. Lifestyle modifications, muscarinic receptor antagonist and beta-adrenoreceptor agonist remain the mainstay of treatment but are limited by their efficacy and adverse effects. Access to third-line therapies of intravesical botulinum toxin type A or sacral neuromodulation is limited by their invasive nature. Percutaneous tibial nerve stimulation (PTNS) has emerged as a non-invasive treatment option for OAB. This study was a single-arm trial of women requesting third-line treatment for OAB. The primary treatment outcome was patient-reported visual analogue score (VAS) improvement of at least 50%. Secondary outcome measures were Urinary Distress Inventory Short Form (UDI-6) score and two-day bladder diary. Patients also provided feedback on adverse effects encountered. In the 84 women recruited, initial treatment protocol showed a success rate of 77.2% among those who completed treatment based on VAS, with a statistically significant improvement in mean UDI-6 score of 20.13 (P < 0.01, standard deviation: 12.52). Continued success following tapering protocol of 60.8% and a mean maintenance protocol of 14.2 months was achieved. No adverse effects were reported. The results from this study are in concordance with previously published literature on the effectiveness and safety of PTNS as a treatment modality for OAB. Further randomised controlled trials to evaluate the optimal treatment protocol are warranted to establish a standardised regime.

Evolving types of pudendal neuromodulation for lower urinary tract dysfunction.

Sacral neuromodulation and posterior tibial nerve stimulation for lower urinary tract dysfunction (LUTD) and overactive bladder yield good and reliable results. However, neuromodulation research is continuously evolving because there is still need for more patient-friendly treatment options in the therapeutic management of LUTD. Pudendal neuromodulation (PNM) has been emerging as a promising alternative treatment option for the last few decades. The aim of this study is to review the current state of the art of PNM. A wide literature search was conducted in the field of PNM using Medline through the PubMed database and Elsevier using the Scopus database; a critical review of the results was then carried out. PNM has been studied in its various possible aspects: percutaneous PNM, transrectal/transvaginal PNM, and both percutaneous and transcutaneous dorsal genital nerve stimulation. Each technique was found to result in promising improvements in different clinical outcomes, with some trials reporting even better results than sacral neuromodulation. As a result of a comparison between the various PNM techniques with both sacral neuromodulation and posterior tibial nerve stimulation, we think that PNM should be seen as seriously promising, and we believe it will expand the treatment options for overactive bladder. Even though several studies accordingly showed PNM to be safe and effective, a systematic review and meta-analysis were not feasible. PNM in its various techniques is a promising treatment for LUTD. Nevertheless, further research is needed to include it in treatment algorithms.

Long-Term Cost Analysis of Third-Line Treatment Options for Overactive Bladder.

We aimed to analyze the long-term cost of overactive bladder third-line treatments. This insurance claims review analyzed the 2015 to 2020 MarketScan (MKS) claims data set subjects age ≥ 18, diagnosis of overactive bladder (OAB) using ICD-9/ICD-10 codes and receipt of treatment for percutaneous tibial nerve stimulation, sacral neuromodulation (SNM), or botulinum A. Age, gender, treatment types, and cost were extracted. Treatment costs were aggregated at the level of patient and treatment type for total payment and patient contribution by combining copay, coinsurance, and deductible. We used the Wilcoxon rank-sum test for continuous and chi-square test for categorical variables. SAS v9.4 was used for analyses. Significance was set at P < .05. We identified 17,755 patients from the commercial claims MKS and 10,912 patients from the Medicare supplemental (MDC) database with mean age 50.7±11.1 and 75.5±7.6 years, respectively, who underwent ≥ 1 third-line OAB treatment. Patients receiving third-line treatment were predominantly female (84.9%, MKS, 74.8%, MDC). Long-term costs over a 15-year period were estimated. Percutaneous tibial nerve stimulation is the most expensive in terms of total net payment ($105,337.50 MKS, $94,102.50 MDC) and patient contribution ($9177.60 MKS, $3921.00 MDC). Total net payment for botulinum A was $67,968 (MSK), $54,261 (MDC), and patient contribution cost was $2850 (MSK), $1110 (MDC). The most cost-effective option was SNM in terms of both total net payment ($5179.10 MKS, $6099.00 MDC) and patient contribution ($59.10 MKS, $60.00 MDC). SNM was the most cost-effective third-line treatment for OAB looking over a 15-year period in terms of both total net payment and patient contribution.

Digital health information on surgical treatment options for overactive bladder is underrepresented

PurposeDigital health information gains growing importance in the medical landscape. Despite its opportunities, there is a risk of patient misinformation which may adversely influence the patient–physician relationship. This investigation aimed to identify and compare differences in the content and quality of online health information on overactive bladder (OAB) between different digital platforms.MethodsThe platforms Google search, Facebook, Instagram, LinkedIn, and YouTube were searched for the keyword OAB. The search result links were classified as useful or misleading, advertisement and personal experience. Information regarding the organization of the source and available content on treatment modalities was collected. Descriptive analysis was applied. Univariate and multivariate analyses were performed to evaluate heterogeneity regarding the distribution of information depending on the source. A p value < 0.05 was considered statistically significant.ResultsThe source with the highest quantity of useful content was YouTube (100%) and Google (100%), whereas LinkedIn included mostly misleading content (73%). YouTube and Google provided the greatest variety of health information and were dominated by professional associations. Surgical procedures for treating OAB were only described in 32% and 48% of Google and YouTube results, respectively. On Google, sacral neuromodulation and OnabotulinumtoxinA were described in 26% and bladder augmentation in only 16% of the search results. In contrast, alternative medicine was present in 76%.ConclusionsA large gap in the information on surgical treatments of OAB could be identified independently from the utilized source. In contrast, conservative treatments and alternative medicine dominate the current informational sources.

MP03-05 DETRUSOR NERVE RADIOFREQUENCY ABLATION (DENERA): EXPERIMENTAL STUDY OF SAFETY AND EFFICACY IN OVINE MODEL

You have accessJournal of UrologyCME1 Apr 2023MP03-05 DETRUSOR NERVE RADIOFREQUENCY ABLATION (DENERA): EXPERIMENTAL STUDY OF SAFETY AND EFFICACY IN OVINE MODEL Gamal Ghoniem, Rongwei Mao, David Csuka, Bilal Farhan, and Sami Souccar Gamal GhoniemGamal Ghoniem More articles by this author , Rongwei MaoRongwei Mao More articles by this author , David CsukaDavid Csuka More articles by this author , Bilal FarhanBilal Farhan More articles by this author , and Sami SouccarSami Souccar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The sub trigonal peri-vesical nerve plexus has a considerable proportion of the bladder afferent and autonomic innervation. It has been a targeted area to treat Overactive Bladder (OAB) and Bladder Painful Syndrome (BPS). The transurethral approach for radiofrequency ablation (RFA) of this region has been successful in denervating it to alleviate symptoms. However, there were some adverse effects because of the induced scarring. Here, we report a novel transvaginal approach of low-temperature RFA device (DENERA) and assess its feasibility and efficacy and safety of transvaginal ablation of peri-vesical nerve plexus in Vivo ovine model. METHODS: We used 14 adult female sheep in this prospective study. They were divided into control (n=4) without ablation. Post-ablation groups were: 1 week (n=3), 4 weeks (n=4), and 12 weeks (n=3). RFA probe inserted into the vagina aiming to deploy RFA needles through the anterior vaginal wall into the sub trigonal peri-vesical plexus. Pulsed RF energy is applied for three cycles of 4 minutes with 30 seconds rest between each cycle, maintaining the tissue temperature at 45°C. After termination, the bladder and proximal urethra were harvested and subjected to gross and histological assessment, including neural histopathology analysis with H&E, S100, TH, and VAcht immunostaining. To quantify the tissue's neural density and neural vacuolization, they were graded on a 0-3 scale proportional to the number of vacuoles or nerves counted on the microscope slide, with higher scores being a greater effect of ablation (more vacuoles and fewer nerves) vice versa. RESULTS: The ablation effects were most pronounced as neural vacuolization at one week and decreased neural density the most at four weeks (Figure 1). Both variables displayed a slight rebound towards baseline at 12 weeks. The pathology analysis also showed that the needles penetrated deep into the sub trigonal detrusor muscle. There was no urothelium damage or injury reported in the post-ablation group. The sheep recovered from the DENERA procedure with no signs of pain or complications. CONCLUSIONS: This study shows that DENERA device can cause sub trigonal perivesical nerve denervation, with some rebound at 12 weeks. The ease of the procedure and using low temperature offers DENERA as an encouraging new office treatment option for OAB and or BPS. Future clinical data is needed. Source of Funding: University of California Innovation grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e22 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gamal Ghoniem More articles by this author Rongwei Mao More articles by this author David Csuka More articles by this author Bilal Farhan More articles by this author Sami Souccar More articles by this author Expand All Advertisement PDF downloadLoading ...

Hyperactive Bladder in Men: Modern Recommendations and Practical Approaches to Diagnosis and Treatment

An analysis of modern recommendations of the European Association of Urologists (EAU) regarding diagnosis and treatment options for overactive bladder (OAB) in men was carried out, taking into account real practice. The article discusses the general principles of diagnosis and treatment of non-neurogenic male lower urinary tract symptoms (LUTS) in the case where the predominant clinical features are urgency, pollakiuria, nocturia, which can be combined with urinary incontinence – complaints typical of GSM. Approaches to the treatment of such patients are still not clearly defined, and the effectiveness of treatment does not always satisfy both doctors and patients. It is indicated that in recent years, doctors have received completely new treatment options for this disease in men. In addition to adrenoblockers (AB) and cholinolytics (HL), phosphodiesterase-5 inhibitors (IPDE) and beta-3 adrenomimetics (BAM) were added, which showed their effectiveness and safety not only in women, but also in men. In addition, new options for combined treatment appeared in the recommendations – in addition to AB+HL, a combination of AB+IPDE and HL+BAM is possible. The article discusses various groups of drugs and their combinations recommended for the treatment of LUTS, the specifics of their use and possible side effects, especially the risks of urinary retention in men with infravesical obstruction. It is emphasized that the EAU currently recommends the use of HL in men with moderate and severe LUTS, who mainly have symptoms of accumulation with a residual urine of no more than 150 ml. It is recommended to determine the patient’s residual urine after a week of taking HL. The practical aspects of choosing the category of patients to be treated with certain drugs (or their combinations) are discussed, taking into account the possible side effects of each of the treatment options.

EFFICACY AND SAFETY OF MEDICAL TREATMENTS FOR THE MANAGEMENT OF OVERACTIVE BLADDER: A MINI-LITERATURE REVIEW

Overactive bladder (OAB) is a widespread condition that significantly impairs one's quality of life, yet it often goes undiagnosed and is treated inadequately due to various obstacles such as shame, poor communication, and poor patient compliance. There are several treatment options for OAB, including bladder and behavioural training, medications, and surgical therapies. Oral antimuscarinics are the primary choice for pharmacological treatment of OAB. There are a variety of drugs available to treat bladder storage and voiding issues, and soon, novel compounds with higher specificity for the lower urinary tract receptors will be available. This will help to optimize therapy, reducing side effects and improving adherence, particularly in patients with existing medical conditions and in women. This article provides an overview of the pharmacotherapy of OAB.

Efficacy of Transcutaneous Tibial Nerve Stimulation With Silver Spike Point® Electrodes for Refractory Overactive Bladder: A Single-Arm Study.

Background Tibial nerve stimulation therapy is a treatment option for an overactive bladder. A surface electrode called a Silver Spike Point® electrode, which does not directly puncture the skin as in transcutaneous tibial nerve stimulation, but is expected to exert the same therapeutic effect as percutaneous tibial nerve stimulation, was developed. This study investigated the efficacy and safety of tibial nerve stimulation with Silver Spike Point® electrodes for refractory overactive bladder. Methodology This was a six-week, single-arm, prospective study on the efficacy and safety of transcutaneous tibial nerve stimulation for patients with refractory overactive bladder. Each treatment lasted 30 minutes and was performed twice a week. The stimulation sites of the tibial nerve were the Sanyinjiao point (SP6) and Zhaohai point (KI6) in both legs. The primary endpoint was the change in the total overactive bladder symptom score. Results In total, 29 patients (20 males and nine females: 64.86 ± 17.98 years old) were included in this study. Two women dropped out; one because of an adverse event and the other as requested. Therefore, 27 patients completed the study. The total overactive bladder symptom and International Consultation on Incontinence Questionnaire-Short Form scores significantly decreased by 2.22 and 2.39 points, respectively (p < 0.01 each). In the frequency volume chart, the numbers of urgency episodes and leaks in 24 hours significantly decreased by 1.53 and 0.44, respectively (p = 0.02 each). Conclusions Transcutaneous tibial nerve stimulation therapy using Silver Spike Point® electrodes was useful for patients with refractory overactive bladder and, thus, has potential as a new treatment option for refractory overactive bladder.

CYP2D6 Substrate Dispensing Among Patients Dispensed Mirabegron: An Administrative Claims Analysis.

Overactive bladder (OAB) is characterized by the presence of bothersome urinary symptoms. Pharmacologic treatment options for OAB include anticholinergics and β3-adrenergic agonists. Use of β3-adrenergic agonists may result in similar treatment efficacy with a decreased side effect profile compared with anticholinergics because high anticholinergic burden is associated with cardiovascular and neurologic side effects. However, the β3-adrenergic agonist mirabegron, one of two approved drugs within this class, is a moderate cytochrome P450 (CYP) 2D6 inhibitor, and coadministration of drugs that are CYP2D6 substrates with mirabegron may lead to adverse drug effects. The aim of this study was to quantify how often CYP2D6 substrates were dispensed in patients receiving mirabegron among adults of any age and among those ≥ 65 years of age. In this retrospective descriptive analysis, a deidentified administrative claims database in the United States, IQVIA PharMetrics® Plus, was used to identify dispensing claims for CYP2D6 substrates and mirabegron from November 2012 to September 2019. Prevalence of CYP2D6 substrate dispensing was assessed in patients dispensed mirabegron among all adults ≥ 18 years old and additionally among a cohort of those ≥ 65 years old. Patient baseline profiles at the time of mirabegron and CYP2D6 substrate codispensing and at the time of mirabegron dispensing were compared. CYP2D6 substrates were categorized as those with the potential for increased risk of QT prolongation, with anticholinergic properties, with narrow therapeutic index (NTI), contraindicated or having a black box warning when used with CYP2D6 inhibitors, or used for depression or other psychiatric disease. Dispensing data and patient profiles were summarized descriptively. Overall, 68.5% of adults ≥ 18 years old dispensed mirabegron had overlapping dispensings for one or more CYP2D6 substrate; 60.6% and 53.6% had overlapping dispensings for CYP2D6 substrates with anticholinergic properties or risk of QT prolongation, respectively. CYP2D6 substrates with NTI, contraindicated with CYP2D6 inhibitors, or for psychiatric use were codispensed in 17.7%, 16.6%, and 38.0% of adult mirabegron users, respectively. Mirabegron users receiving one or more concurrent CYP2D6 substrate were more likely to be older, have more comorbidities and baseline polypharmacy, and have increased healthcare resource utilization compared with those without concurrent CYP2D6 substrates. Commonly codispensed CYP2D6 substrates included hydrocodone, oxycodone, tramadol, metoprolol, and tamsulosin. Findings were similar for patients in the older cohort (≥ 65 years old), with 72.1% receiving overlapping CYP2D6 substrates. Codispensing of CYP2D6 substrates, especially those with anticholinergic properties or risk of QT prolongation, was common among adults and older adults receiving mirabegron. Results highlight the need for improved awareness of CYP2D6 substrate prescribing among patients receiving pharmacologic treatment for OAB that inhibits the CYP2D6 pathway.

Novel Thioxothiazolo[3,4-a]quinazolin-5(4H)-one Derivatives as BKCa Channel Activators for Urinary Incontinence.

Overactive bladder (OAB) is a syndrome causing a sudden and unstoppable need to urinate with significant global prevalence. Several drugs are used to treat OAB; however, they have various side effects. Therefore, new treatment options for OAB are required. A series of novel 5-oxo-N-phenyl-1-thioxo-4,5-dihydro-1H-thiazolo[3,4-a]quinazoline-3-carboxamide derivatives were synthesized and evaluated for their large-conductance voltage- and Ca2+-activated K+ channel activation through a cell-based fluorescence assay and electrophysiological recordings. Several compounds, including a 7-bromo substituent on the heterocyclic system, showed increased channel currents. Among the derivatives, compound 12h exhibited potent in vitro activity with a half-maximal effective concentration (EC50) of 2.89 μM, good oral pharmacokinetic properties (area under the curve and half-life), and in vivo efficacy in a spontaneously hypertensive rat model.

Do we need more patient-friendly treatment options for overactive bladder (OAB)?

AimsTo collect feedback from subjects diagnosed with overactive bladder (OAB) on its impact on their quality of life, their satisfaction with current treatment options, and to assess nonsurgical, tibial nerve stimulation as a treatment option.MethodsSubjects were asked a variety of questions about the impact of OAB on their lives, their satisfaction with current and previous treatment approaches. Subjects evaluated the comfort of a nonworking prototype garment and were given electrical stimulation over their posterior tibial nerve to assess comfort and tolerability. Electromyographic (EMG) signals were recorded.ResultsA total of 40 subjects with OAB symptoms were evaluated in the study. Urgency (55%), frequency (47.5%), nocturia (40%), and incontinence (30%) were the most bothersome symptoms. At the time of the study only 32.5% of the subjects were treating their OAB symptoms. Of those that had tried and discontinued treatments, most had failed medications (n = 14) due to no improvements or side effects. Only 2 subjects found stimulation to be uncomfortable before an EMG signal could be detected. The most common word used to describe the feeling of stimulation was “constant,” followed by “tingling,” “vibrating,” and “comfortable.”ConclusionsMost subjects who had tried OAB treatments were dissatisfied and discontinued their use. A new patient‐friendly approach to OAB therapy that delivers efficacy but overcomes drawbacks associated with currently available treatments is needed. Subjects found electrical stimulation over the tibial nerve to be comfortable and tolerable and this should be considered as an alternative treatment approach for OAB.

New agent offers once-daily oral treatment option for overactive bladder

New agent offers once-daily oral treatment option for overactive bladder

Treatment options for overactive bladder and urinary incontinence in patients with comorbid conditions

Treatment options for overactive bladder and urinary incontinence in patients with comorbid conditions

Combination drug therapy against OAB normalizes micturition parameters and increases the release of nitric oxide during chemically induced cystitis.

Today, monotherapy is the most common pharmacological treatment option for patients suffering from overactive bladder (OAB). Recent reports have indicated potential benefits of combination therapy, using a muscarinic antagonist and a β3‐adrenoceptor agonist. This may be of particular interest for therapy‐resistant patients with OAB and concomitant cystitis. The objective of the current study was to assess how combination therapy affects bladder parameters in health and cystitis and if the efficacy of the drugs can be linked to altered release of nitric oxide (NO). Rats were pretreated with either a combination of the muscarinic antagonist tolterodine and β3‐selective adrenoceptor agonist mirabegron or saline for 10 days. Forty‐eight hours prior to assessing micturition parameters in a metabolic cage, the rats were intraperitoneally injected with cyclophosphamide, causing cystitis, or saline. Urine samples were collected and analyzed for NO content. Bladder contractile properties were assessed in an organ bath setup. Induction of cystitis led to bladder overactivity. Combination therapy normalized bladder parameters. Both induction of cystitis and drug treatment increased the release of NO. The innate contractile properties of the bladder were unaffected by combination therapy. This study demonstrates positive effects of combination drug therapy on symptoms of OAB, possibly indicating it to be a good option for treatment of OAB during concomitant cystitis. It remains to be determined if increased release of NO is crucial for successful pharmacological treatment of bladder overactivity during cystitis.

Clinical Roundup: Selected Treatment Options for Overactive Bladder

Clinical Roundup: Selected Treatment Options for Overactive Bladder

A Patient-Centered Approach to Refractory Overactive Bladder and Barriers to Third-Line Therapy.

To explore the decision-making process in women who do not pursue treatment with onabotulinumtoxinA, sacral neuromodulation, or percutaneous nerve stimulation in patients with overactive bladder (OAB). This was a qualitative research study. Participants were females aged 18-80 years with a diagnosis of OAB and were evaluated by a urologic or urogynecologic physician between January 2017 and March 2018. Patients who were counseled for third-line therapy, refractory to two or more medications, or lost to follow-up after initiating a second medication were considered study candidates. Data were gathered using a semi-structured phone interview. Interview topics included medical knowledge and beliefs, quality of life, and treatment experience. The interviews were transcribed and coded thematically using grounded theory. Of a total of 381 women, 56 women qualified for our study. The average interview length was 30 minutes, and theoretical saturation occurred at 30 interviews. General themes included treatment delay, education, treatment attitudes, and office factors. The most common modifiable barrier to third-line therapy was insufficient in-office education. Participants expressed a poor understanding of the etiology, natural history, and treatment options for OAB. Participants were heavily influenced by outside factors including the opinions of friends and the media. Negative experiences with less-advanced options and treatment fatigue negatively affected participants' perceptions of third-line therapies. Office factors such as wait times and male physicians also negatively affected participants' ability to discuss their bladder symptoms. In conclusion, office education is tremendously important to patients' understanding of OAB, expectations of therapy, and treatment compliance. Education about third-line therapy counseling should be incorporated into the initial office visit. This may mitigate expectations, improve patient compliance, and promote graduation to advanced therapy in women who later go on to develop refractory symptoms.

PT234 - Salt intake reduction as a treatment option for overactive bladder

PT234 - Salt intake reduction as a treatment option for overactive bladder

OnabotA best treatment option for overactive bladder

OnabotA best treatment option for overactive bladder