Urgency Score Research Articles

Clinical outcomes of sacral neuromodulation in non-neurogenic, non-obstructive dysuria: A 5-year retrospective, multicentre study in China.

BACKGROUNDManagement of non-neurogenic, non-obstructive dysuria represents one of the most challenging dilemmas in urological practice. The main clinical symptom is the increase in residual urine. Voiding dysfunction is the main cause of dysuria or urinary retention, mainly due to the decrease in bladder contraction (the decrease in contraction amplitude or duration) or the increase in outflow tract resistance. Sacral neuromodulation (SNM) has been used for > 10 years to treat many kinds of lower urinary tract dysfunction. It has become increasingly popular in China in recent years. Consequently, studies focusing on non-neurogenic, non-obstructive dysuria patients treated by SNM are highly desirable.AIMTo assess the outcome of two-stage SNM in non-neurogenic, non-obstructive dysuria.METHODSClinical data of 54 patients (26 men, 28 women) with non-neurogenic, non-obstructive dysuria treated by SNM from January 2012 to December 2016 in ten medical centers in China were retrospectively analyzed. All patients received two or more conservative treatments. The voiding diary, urgency score, and quality of life score before operation, after implantation of tined lead in stage I (test period), and during short-term follow-up (latest follow-up) after implantation of the implanted pulse generator in stage II were compared to observe symptom improvements.RESULTSAmong the 54 study patients, eight refused to implant an implanted pulse generator because of the unsatisfactory effect, and 46 chose to embed the implanted pulse generator at the end of stage I. The conversion rate of stage I to stage II was 85.2%. The average follow-up time was 18.6 mo. There were significant differences between baseline (before stage I) and the test period (after stage I) in residual urine, voiding frequency, average voiding amount, maximum voiding amount, nocturia, urgency score, and quality of life score. The residual urine and urgency score between the test period and the latest follow-up time (after stage II) were also significantly different. No significant differences were observed for other parameters. No wound infection, electrode breakage, or other irreversible adverse events occurred.CONCLUSIONSNM is effective for patients with non-neurogenic, non-obstructive dysuria showing a poor response to traditional treatment. The duration of continuous stimulation may be positively correlated with the improvement of residual urine.

Overactive bladder and sleep disturbance have a significant effect on indoor falls: Results from the community health survey in Japan.

To evaluate the effect of overactive bladder (OAB) and frailty on indoor fall events in community-dwelling adults aged 50 or older. We conducted a cross-sectional study involving 723 adults between 2016 and 2017 in Hirosaki, Japan. OAB symptoms and sleep disturbance were assessed using the Overactive Bladder Symptom Score (OABSS) and the Pittsburgh Sleep Quality Index (PSQI). Indoor fall events (falls or near-falls) within 1 year were evaluated. Frailty was evaluated by the frailty discriminant score. We investigated the association of OAB symptoms with sleep disturbance, frailty, and indoor fall events. Multivariate logistic regression analysis was performed to investigate the effect of OAB symptoms on fall events controlling for confounding factors such as age, gender, comorbidity, frailty, and sleep disturbance. The median age was 64. We observed OABSS ≥6 in 98 participants (14%), nocturia ≥2 in 445 (62%), urgency score ≥3 in 80 (11%), urge incontinence score ≥3 in 36 (5.0%), PSQI ≥6 in 153 (21%), frailty in 169 (23%), and indoor fall events in 251 (35%). Older age, diabetes, OABSS, nocturia, urgency, urge incontinence, and the PSQI were significantly associated with indoor fall events. Multivariate logistic regression analyses showed that OAB symptoms and sleep disturbance were significantly associated with fall events. The effect of OAB symptoms and sleep disturbance on indoor fall events was significant. The causal relationship between OAB and falls needs further study.

Intravesical prostatic protrusion does not compromise the therapeutic effects of Mirabegron in male patients with overactive bladder

Intravesical prostatic protrusion (IPP) is associated with the degree of benign prostatic obstruction. We evaluated the effects of Mirabegron, a selective β3 adrenoceptor agonist, on overactive bladder (OAB) in male patients with different degrees of IPP. About 185 male patients ≥40years with lower urinary tract symptoms were recruited from a tertiary referral center. OAB was defined by the overactive bladder symptom score (OABSS) urgency score of ≥2 and sum score of ≥3. IPP was measured in the midsagittal section using transrectal ultrasound and patients were divided into IPP ≤5mm and IPP >5mm groups. Outcomes were assessed at the baseline, 4, and 12weeks. About 104 patients (56.2%) were diagnosed with OAB and received Mirabegron (50mg) daily use. Both IPP groups (≤5 and >5mm) had similar baseline OABSS and International Prostate Symptom Scores (IPSS). Four-week Mirabegron usage was associated with significant decreases in both symptom score measurements, OABSS: IPP ≤5mm -27.4% and IPP >5mm -19.7% (P=.419) and IPSS: -32% and -22.5% (P=.202), respectively. Urgency, urge incontinence, and nocturia sub-scores were decreased in both groups, -26.3% and -27.4% (P=.690), 53.3% and 46.2% (P=.916), and 20.8% and 15.4% (P=.958). Effects were maintained at 12weeks. We found no significant improvement in the frequency sub-score in either group. One patient stopped medication because of intolerable hypertension. Most frequent adverse event was increased residual urine (≥50mL higher than baseline), IPP ≤5mm 9.2% and IPP >5mm 5.1% (P=.707), but no case had acute urinary retention. Mirabegron is an effective drug to treat male OAB regardless of IPP grade.

Effect of two different doses of solifenacin succinate therapy (5mg, 10mg) for the treatment of ureteral stent (Double J) related symptoms in comparison to placebo

Background and objective: Double-J ureteral stent is widely used in endourologic surgery. However, it might cause some annoying side effects. This study aimed to evaluate the effect of two different doses of solifenacin (5mg, 10mg) on double-J stent-related symptoms after uncomplicated ureteroscopic lithotripsy. Methods: This study involved 120 patients. A total of 80 patients undergoing double-J ureteral stent insertion after ureteroscopic lithotripsy were involved in this study and provided with solifenacin postoperatively; 40 patients received 5mg and another 40 patients received 10mg. Another 40 age- and sex-matched patients without solifenacin therapy (received placebo) were enrolled as a placebo group. All patients completed the modified-form of the Ureteral Symptom Score Questionnaire to evaluate the lower urinary tract symptoms, hematuria and stent-related body pain two weeks following the operation. The severity of stent-related symptoms was compared between the three groups. Results: The mean age was 45.4 years in the 5 mg solifenacin group, 48.2 years in the 10 mg solifenacin group, and 46.8 years in the placebo group. Compared to the placebo group, both solifenacin groups had significantly lower total symptom score, urgency, and urge incontinence scores. Solifenacin groups had significantly less urethral, abdominal and flank pain and hematuria scores. There was no statistically significant difference between the two solifenacin groups of 5mg and 10mg. The solifenacin groups versus the placebo group showed significant benefits in lower urinary tract symptoms, hematuria, and stent-related pain in both genders. Ten subjects encountered minor adverse events in solifenacin groups (8 in the 10 mg group and 2 in the 5 mg group), which was mostly dry mouth and constipation. Conclusion: Postoperative solifenacin was effective and well-tolerated in patients undergoing ureteroscopic lithotripsy and double-J stent indwelling irrespective of genders, particularly for the treatment of stent-related body pain, hematuria and the lower urinary tract symptoms.

The Efficacy of Mirabegron for the Relief of Ureteral Stent-Related Symptoms.

To investigate the efficacy of mirabegron for lower urinary tract symptoms in patients with an indwelling ureteral stent after ureterorenoscopic lithotripsy. This was a prospective follow-up study of 76 patients with stent-related symptoms (SRSs). Patients with upper urinary calculi who were pre-stented for > 2 weeks before lithotripsy were examined for the presence of SRSs by tests including the International Prostate Symptom Score (IPSS), OAB Symptom Score (OABSS), and urinary bother and pain measured by a Visual Analogue Scale (VAS) before lithotripsy. Mirabegron (50 mg/day) was prescribed post-lithotripsy for 2 weeks. SRSs were assessed at the time of stent removal. The IPSS scores improved significantly from 16.2 to 14.3 (p<0.001) and the IPSS-QoL scores decreased significantly from 5.0 to 4.6 (p=0.012). The OABSS scores improved significantly from 7.7 to 6.8 (p=0.006), and the urinary urgency scores (OABSS-Q3) decreased significantly from 3.24 to 2.68 (p<0.001). The number of nocturia episodes decreased significantly from 2.5 to 2.2 (p=0.045). Urinary bother and pain assessed by the VAS declined from 4.2 and 3.1 to 3.8 (p=0.15) and 2.5 (p=0.075), respectively. Mirabegron significantly improved SRSs and the number of nocturia episodes due to a ureteral stent.

Association of advanced glycation end-product accumulation with overactive bladder in community-dwelling elderly: A cross-sectional Sukagawa study

ObjectiveThis study aimed to evaluate the influence of advanced glycation end-product (AGE) accumulation on the prevalence and severity of overactive bladder (OAB) in community-dwelling elderly adults. MethodsWe conducted a cross-sectional study involving 269 Japanese community dwellers aged ≥75 years in 2015. AGE accumulation was non-invasively measured via skin autofluorescence (SAF) values using AGE Reader. The primary and secondary outcomes were the presence and severity of OAB evaluated using the Overactive Bladder Symptom Score (OABSS). Individuals with an urgency score of ≥2 and sum score of ≥3 were considered to have OAB. The associations of SAF with the prevalence and severity of OAB were assessed using logistic and linear regression models, respectively, adjusted for clinically important confounders. ResultsThe median age of participants was 78 years. Of 269 participants, 110 (40.9%) were men and 75 (27.9%) had OAB. The median SAF was 2.2 arbitrary units (AUs). Increasing median SAF was observed with increasing age. Multivariable analysis revealed that SAF was not associated with either the likelihood of having OAB (odds ratio per AU=0.77, 95% confidence interval: 0.37–1.62) or the natural log-transformed OABSS (β per AU=−0.07, 95% confidence interval: −0.26–0.12). ConclusionsIn this study, AGE accumulation, as assessed by SAF, was not associated with the prevalence and severity of OAB in Japanese community-dwelling elderly people aged ≥75 years.

25: Mechanisms underlying nocturia in women with bladder pain syndrome/interstitial cystitis

Little is known about mechanisms underlying nocturia in women with bladder pain syndrome/interstitial cystitis (BPS/IC). The thalamus plays a primary role in the organization of the sleep-wake cycle. Our hypothesis was that nocturia is associated with activation of the thalamus in women with BPS/IC as compared to controls. Data from 27 subjects (14 women with BPS/IC and 13 age-matched controls) enrolled in a Multi-Disciplinary Approach to Chronic Pelvic Pain (MAPP) ancillary study through November 30, 2018 were analyzed. All subjects completed the Interstitial Cystitis Symptom and Problem Indices and PROMIS Sleep Disturbance Short Form to assess BPS/IC and sleep quality, respectively. All subjects also underwent arterial spin labeling functional magnetic resonance imaging to quantitatively measure cerebral blood flow (CBF) in the thalamus in the empty-bladder state and after oral bladder fill in low urgency (score 1-3) and high urgency (score > 3) states. Nocturia was defined as ≥2 episodes of nocturnal voiding. CBF in the thalamus at baseline, low urgency, and high urgency states in women with BPS/IC and controls was compared using two-way mixed model ANOVA. Associations between nocturia, CBF, sleep disturbance and BPS/IC scores were analyzed using linear regression. There was no significant difference in the mean age (49 ± 13 vs. 45 ± 12 years, p=0.4) of BPS/IC subjects and controls. The BPS/IC group had a greater number of nocturia episodes (median 3 vs. 1, p <0.01) and greater sleep disturbance (60.7 ± 8.8 vs. 41.2 ± 9.9, p<0.001) than controls. CBF in bilateral thalamus increased as the level of urgency increased in the BPS/IC group but not in controls (p<0.01, Figure 1). Baseline CBF in bilateral thalamus correlated with the number of episodes of nocturia in women with BPS/IC but not in controls (Figure 2). CBF at baseline and in the low urgency state was not significantly associated with sleep disturbance or bladder pain scores. However, CBF in the right thalamus in the high urgency state was significantly associated with sleep disturbance score (r= -0.42, p=0.03). Nocturia and sleep disturbance in women with BPS/IC are likely modulated through the thalamus.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

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.

Unpacking common and distinct neuroanatomical alterations in cocaine dependent versus pathological gambling

Pathological gambling and cocaine dependence are highly pervasive disorders. Functional neuroimaging evidence implicates aberrant activity of prefrontal striatal pathways in both disorders. It is unclear if the neuroanatomy of these areas is also affected. Participants with pathological gambling (n = 18), cocaine dependence (n = 19) and controls (n = 21) underwent high-resolution structural MRI scan and cognitive assessments. In line with emerging functional neuroimaging findings, we hypothesised (i) lower volumes of corticostriatal areas ascribed to decision-making/inhibitory control, craving and reward processing (i.e., orbitofrontal cortex, inferior frontal gyrus, amygdala, striatum, insula) in both pathological gamblers and cocaine dependent participants versus controls; (ii) selected dopaminergic/glutamatergic pathways directly taxed by cocaine (i.e., superior, dorsolateral and anterior cingulate cortices) would be altered in cocaine dependent versus control participants only. Analyses were conducted with a bonferroni correction. Our results showed that both pathological gambling and cocaine dependent participants, compared to controls, had larger volumes of the right inferior frontal gyrus (ps <.01, ds = 0.66 and 0.62). Cocaine dependent participants had lower nucleus accumbens and medial orbitofrontal cortex volumes than pathological gamblers (ps <.05, ds = 0.51 and 0.72), with the latter being predicted by higher negative urgency scores. Inferior frontal gyrus volume may reflect common alterations of cocaine and gambling addictions, whereas cocaine dependence may be uniquely associated with reduced volume in dorsolateral and middle frontal regions. Cocaine's supra-physiological effects on mesolimbic neurons may explain reduced accumbens-orbitofrontal structure compared to gambling.

P127 FACTORS ASSOCIATED WITH FECAL URGENCY IN INFLAMMATORY BOWEL DISEASE PATIENTS: A CROSS-SECTIONAL STUDY FROM SPARC IBD

Abstract Background Fecal urgency among patients with inflammatory bowel disease (IBD) can lead to psychological, functional, and social distress. Factors associated with urgency remain poorly understood. Objective To examine the association between urgency and fecal calprotectin concentration, rectal bleeding, stool frequency, perianal disease, rectal involvement, and disease duration. Methods The results are based on data obtained from the IBD Plexus program of the Crohn’s &amp; Colitis Foundation. This cross-sectional study used data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD), a multicenter longitudinal study. We included patients with an urgency score at their first study visit. Urgency was rated on a 5-point Likert scale from no to severe urgency. The Kruskal-Wallis test was used to compare fecal calprotectin levels across fecal urgency scores. Logistic regression models were used to evaluate the association of fecal urgency with the amount of rectal bleeding, stool frequency, perianal disease (for Crohn’s disease (CD)), disease involving the rectum (for CD), disease duration, while adjusting for age and gender in each model. Results 2289 patients were included (54% female, 67% CD, mean age 43). The fecal calprotectin concentration was significantly associated with fecal urgency scores (P-value= 0.01). In adjusted models of the overall population, CD vs UC was not associated with urgency (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.70–1.13). Fecal urgency was associated with stool frequency (&amp;gt; 4 stools more than normal, OR 2.49; 95% CI 1.46–4.25) but not amount of bleeding. Among patients with CD, perianal disease (OR, 3.40; 95% CI, 1.18–9.79) was associated with fecal urgency. Conclusion In this study of patients in SPARC IBD, factors associated with fecal urgency were fecal calprotectin levels, stool frequency, and perianal disease.

A randomized controlled study of the efficacy of tadalafil monotherapy versus combination of tadalafil and mirabegron for the treatment of persistent overactive bladder symptoms in men presenting with lower urinary tract symptoms (CONTACT Study).

AimTo evaluate efficacy and safety of combination of tadalafil + mirabegron for overactive bladder/benign prostatic hyperplasia (OAB/BPH).MethodsMale patients with lower urinary tract symptoms (50 to 89 years), with remaining OAB symptoms even after administering tadalafil for more than 8 weeks were randomly assigned to either tadalafil monotherapy group (5 mg/day) or tadalafil/mirabegron combination therapy group (5 mg/50 mg/day). The primary endpoint was change from baseline in total OAB symptom score (OABSS) at week 12. The secondary endpoints were changes in International Prostate Symptom Score (IPSS), NIH‐chronic prostatitis symptom index (NIH‐CPSI), and micturition chart parameters at weeks 4 and 12.ResultsA total of 176 patients were randomized to either monotherapy (87 patients) or combination therapy (89 patients). The baseline characteristics of patients in the two groups were similar. The total OABSS (95% confidence interval) of combination therapy was significantly decreased by 1.78 (1.05‐2.50) points compared with that of monotherapy (P < .001). Changes from baseline in OABSS nighttime voiding score, urgency score, urgency incontinence score, IPSS storage subscores, NIH‐CPSI total score, and numbers of voids, nighttime‐voids, and urgency episodes/day in micturition chart were significantly reduced in combination therapy (all P < .001). Patient‐reported outcome was significantly more satisfactory in combination therapy than in monotherapy (P < .001). One moderate adverse event (pain in hip joint) with hardly presumed causal relationship with therapy and seven mild adverse events were noted in monotherapy and combination therapy group, respectively.ConclusionsThe effect of tadalafil/mirabegron combination therapy on relieving OAB symptoms appeared to be greater than that of tadalafil monotherapy and can be safely used.

The role of intravesical prostatic protrusion in the evaluation of overactive bladder in male patients with LUTS.

To evaluate the association of intravesical prostatic protrusion (IPP) and overactive bladder (OAB) in male patients with lower urinary tract symptoms (LUTS). IPP has been suggested to correlate with storage symptoms in addition to bladder outlet obstruction. This was an open-labeled, single-center, prospective study involving 128 men older than 40years presenting with LUTS. We analyzed the relationship of IPP with age, prostate volume, uroflowmetry, post-void residual urine volume (PVR), International Prostate Symptom Score (IPSS), urgency severity scale (USS), and OAB symptom score (OABSS). The patients with an urgency score of ≥ 2 (OABSS question 2) and sum score of ≥ 3 were considered to have OAB. IPP was measured in the mid-sagittal section using transrectal ultrasound. The degree of IPP was classified as grade 1 (≤ 5mm), grade 2 (> 5-10mm), and grade 3 (> 10mm). The mean age of the patients was 64.9 ± 9.2years, and 101 patients were diagnosed with OAB (79%). Mean IPPs were 2.4 ± 1.4mm (grade 1, n = 77), 7.6 ± 1.4mm (grade 2, n = 27), and 14.8 ± 4.4mm (grade 3, n = 24). IPP was positively correlated with age, prostate size, PSA, PVR, and OABSS nocturia subscore, but not correlated with the presence or severity of OAB. Areas under the receiver-operating characteristic (ROC) curves for the diagnosis of OAB were 0.807 and 0.604 for IPSS-storage subscore and IPP, respectively. IPP is not a good predictor of OAB in men presenting with LUTS. However, grade 3 IPP indicates higher frequency of nocturia.

Biomarkers in Overactive Bladder

Nerve growth factor (NGF), brain derived neurotrophic factor (BDNF), cytokines, stem cell factor etc. are some promising biomarkers for overactive bladder (OAB). To diagnose OAB urinary NGF/Creatinine (Cr) has 87.5% sensitivity and 100% specificity, and BDNF/Cr has 87.5% sensitivity and 83.3% specificity. In female OAB patient, urinary MCP-1 (monocyte chemotactic protein) was very high. In plasma 5 biomarkers IL-4 (Interleukin), TNF-α (Tumor necrosis factor), MIP-1β (macrophage inflammatory protein), SAA (Serum amyloid A), and Tie2 (Tyrosine kinase receptor) could significantly differentiate between OAB patients and control individuals. c-kit ligand, stem cell factor (SCF) found to be significantly more on overactive bladder than control. mRNA expression of connexin (Cx) and transient receptor potential (TRP) channel on urothelial cells from urine showed positive correlations of Cx26 vs urgency score, Cx40 vs nocturia, TRPM2 (Transient receptor potential melastatin 2) vs intermittency, TRPV1 (Transient receptor potential cation channel subfamily V member 1) vs urgency incontinence, and negative correlation of Cx40 vs intermittency. In plasma measurement of miR-98-5p (upregulation) + miR-139-5p (downregulation) seems to be a good biomarker (AUC = 0.839).

Effect of mirabegron on erectile function in sexually active men with bothersome overactive bladder symptoms.

To evaluate the change of erectile function (EF) in sexually active male overactive bladder (OAB) patients treated with Mirabegron. Mirabegron, a selective β3 adrenoceptor agonist, approved for the treatment of OAB, has been reported to relax human and rat corpus cavernosum and might have beneficial effect on EF. A total of 128 consecutive men with lower urinary tract symptoms attended urology outpatient clinic were evaluated for OAB and EF. Thirty-four sexually active OAB patients were prospectively enrolled in this study and received mirabegron 50 mg oral once a day. The evaluation of EF and OAB was based on a self-administered questionnaire containing International Index of Erectile Function (IIEF-5) and OAB symptom score (OABSS), respectively. Men with an OABSS urgency score of ≥2 and sum score of ≥3 were considered to have OAB. The therapeutic outcomes were assessed at baseline, 4, and 12 weeks. Mirabegron usage was associated with a statistically significant improvement of OAB symptoms (OABSS 32.1% decrease) at 4-week follow-up and the therapeutic effects were maintained at 12-week follow-up. Mirabegron usage did not improve EF (IIEF-5 4.9% decrease at 4-week; p = 0.106, and 9.1% decrease at 12-week follow-up; p = 0.077). However, the IIEF-5 was significantly decreased in the higher baseline IIEF-5 (≥17) group (11.7% decrease; p = 0.044), noncoronary artery disease (13.2%; p = 0.007), or non-DM group (13.9% decrease; p = 0.021) at 12-week follow-up. This preliminary study demonstrates that mirabegron treatment of men with OAB improved OAB symptoms, but has no beneficial effect on EF.

Effect of biofeedback training on bowel function among patients undergoing rectal cancer anus preserving operation

Objective To evaluate the effect of biofeedback on bowel function among rectal cancer patients with chemoradiotherapy and temporary enterostomy. Methods This study was designed as a randomized controlled trial. The patients with low and middle rectal cancer in a Cancer Hospital of Guangzhou from June 2015 to December 2016 were randomly divided into pelvic floor muscle exercise group (control group, n=36) and biofeedback training group (intervention group, n=35) . The intestinal function questionnaire of the Chinese version of Memorial Sloan-Kettering Cancer Center (MSKCC) was used to longitudinally track and compare the intestinal function of the two groups for 16 months and 5 times in total. Results The total score of MSKCC, frequency and urgency of defecation and defecation sensory disturbance in intervention group were higher than those in control group at 4 days and 3 months after stoma inclusion operation, and the differences were statistically significant (P<0.05) . Conclusions Biofeedback training can improve the intestinal function of patients with middle and low rectal cancer, promote their recovery, and prevent intestinal and anal dysfunction of patients with middle and low rectal cancer. Key words: Rectal neoplasms; Biofeedback; Pelvic floor muscle exercise; Anus preserving operation; Intestinal function

Metabolism of fatty acids and bile acids in plasma is associated with overactive bladder in males: potential biomarkers and targets for novel treatments in a metabolomics analysis.

The present study was conducted to identify metabolites using a metabolomics approach and investigate the relationship between these metabolites and urgency as a major symptom of overactive bladder (OAB). In 47 male participants without any apparent neurological disease, OAB was defined as an urgency score on the International Prostate Symptom Score of 2 and higher (OAB group, n = 26), while patients with a score of 1 or 0 were placed in a control group (n = 21). A comprehensive study on plasma metabolites was conducted, and metabolites were compared between the OAB and control groups. Age was significantly higher in the OAB group, while prostate volume did not differ between the groups. A 24-h bladder diary revealed that nocturnal urine volume, 24-h micturition frequency, nocturnal micturition frequency, and the nocturnal index were significantly higher in the OAB group, whereas maximum voided volume was significantly lower in this group. The metabolomics analysis identified 79 metabolites from the plasma of participants. The multivariate analysis showed that increases in the fatty acids (22:1), erucic acid and palmitoleic acid, and a decrease in cholic acid correlated with incidence of male OAB. A decrease in acylcarnitine (18:2)-3 and an increase in cis-11-eicosenoic acid also appeared to be associated with OAB in males. OAB in males may occur through the abnormal metabolism of fatty acids and bile acids. Further studies on these pathways will contribute to the detection of new biomarkers and development of potential targets for novel treatments.

Efficacy of Percutaneous Tibial Nerve Stimulation for Overactive Bladder in Women and Men at a Safety Net Hospital.

We investigated efficacy and compliance related to percutaneous tibial nerve stimulation in patients treated for overactive bladder at a large, urban safety net hospital. Consecutive patients who underwent percutaneous tibial nerve stimulation at Grady Memorial Hospital from May 2015 through January 2019 were included in our cohort and records were reviewed retrospectively. Primary outcomes of interest included self-reported urinary symptoms and episodes of urinary incontinence. Our secondary outcome of interest was patient compliance, defined as completion of 12 or more treatment sessions. Descriptive analysis and paired t-tests were performed. Of the 50 patients with a mean ± SD age of 59 ± 12 years 80% were black, 52% were male, 34% were uninsured and 54% subscribed to government insurance. Prior treatment included behavioral modification in 100% of cases, anticholinergics in 86% and mirabegron in 4%. Patients completed a mean of 10.7 ± 2.7 of the 12 planned weekly percutaneous tibial nerve stimulation treatments. Of the patients 70% completed all 12 weekly treatments and 77% of those who completed 12 treatments continued to maintenance treatment. After percutaneous tibial nerve stimulation treatment average symptoms improved across all metrics, including mean daytime frequency (from 11.0 to 6.6 episodes per day or -24.5%), nighttime frequency (from 4.8 to 2.5 episodes per night or -47.1%), urgency score (from 3.4 to 1.9 or -42.1%) and incontinence (from 1.6 to 0.4 episodes per day or -79.6%) (each p <0.001). A total of 43 patients (86%) reported symptom improvement. Percutaneous tibial nerve stimulation had favorable efficacy and compliance in a traditionally underserved patient population. This should be considered as a feasible modality to manage overactive bladder symptoms in patients in a similar demographic.

Sacral neuromodulation preliminary outcomes in male patients with idiopathic dysuria

Objective: To assess the effectiveness and safety of sacral neuromodulation (SNM) therapy for men with idiopathic dysuria. Methods: From January 2012 to December 2016, a total of 26 patients treated with SNM therapy from multi-center across the country were retrospectively studied. The age ranged from 19 to 86 years with an average age of 45.2 years. Patients suffered from one or multiple urinary symptoms such as frequency of urination, urgency, urinary retention, etc. All patients had received more than two types of conservative therapy including oral and behavioral therapy, but had poor or no improvement. The voiding diary, urgency score and the quality of life score before implantation, in stageⅠ after implantation and stage Ⅱ after permanent implantation were recorded and compared. Results: A total of 22 patients chose to receive IPG at the end of stageⅠ therapy while 4 patients refused further stage Ⅱ therapy because of dissatisfactory effect. The conversion rate of stage Ⅰ to stage Ⅱ was 84.6% (22/26). The average follow-up time was 19.2 months, ranging from 3 to 63 months. The baseline of residual urine, voiding frequency and average voiding amount and those after stage Ⅰ therapy were [5 (0, 137.5) ] ml vs [0 (0, 40) ] ml, 14.6±6.1 vs 9.1±2.8, [100 (80, 135) ] ml vs [190 (150, 210) ] ml, respectively. The differences were statistically significant(all P<0.05).However, no significant differences were found in urination volume and quality of life (QoL) before and after implantation(P>0.05). During an average follow-up time of 19.2 months after the permanent implantation, over 80% patients had an improvement of residual urine volume by more than 50% after permanent implantation while the improvement was 55.6% after stage Ⅰ therapy, suggesting that the improvement of residual urine volume might be positively correlated with the duration of regulation. No significant differences were found in other parameters between stage Ⅰ and Ⅱ therapy. No adverse events like wound infection and electrode dislocation happened during our study. Conclusions: SNM is an effective and safety procedure for male patients with idiopathic dysuria, with a relatively high transfer rate. The medium-term curative effect is stable. The duration of regulation may be positively correlated with the improvement of residual urine.

Analysis of Issues and Future Trends Impacting Drug Safety in South Korea.

New drug safety issues are emerging that are beyond the existing medication safety management system. To pre-empt these problems, forecasting future drug safety trends and issues is a necessity. The objective of this study was to identify issues and future trends impacting drug safety using foresight methodologies. The study started by identifying global megatrends, trends in safety management of medicines, and key issues in drug safety. A total of 25 global megatrends were selected by extracting and clustering keywords from 26 reports concerning the future. Using the text-mining method, 10 trends in drug safety were identified from 3593 news articles. This study derived 60 issues which can arise from the trends, and finally, the 20 key issues with the highest urgency and impact scores were selected. Some examples of issues with high scores were as follows: illegal distribution of medicines, lack of technology for managing and utilizing big data, change in the pharmaceutical trade environment, lack of education and safety management for specific populations, lack of artificial intelligence-based technology for the safety management of medicines, and the prevalence of drug advertisements through social network services. The key issues could be used to establish plans for medication safety management.

A noninvasive smart wearable for diaper moister quantification and notification

A baby feels uncomfortable in a wet diaper and it can cause health issues such as diaper rash. Diaper rash can be avoided by changing the diaper as soon as the baby urinates or passes stool. In this project, a smart wearable gadget is developed which sends an automatic notification to a caregiver’s smartphone whenever the baby urinates. The proposed wearable detects urination event noninvasively by sensing the temperature rise on the outer surface of the diaper and quantifies the event using a decision tree and a midpoint based k-nearest neighbor (KNN) hybrid classification algorithm. The gadget is a small size, low power, low cost and reusable electronic device that is attached externally to the outer surface of the diaper. The gadget can be used with any disposable diaper, thus no change in the diaper production process or price increase is required. The smartphone app shows the diaper change urgency score and logs all the urination events. This record can facilitate treating diseases where accurate records of urination are required. A prototype of the hardware gadget and a smartphone app is developed and tested.