INSTILLATION OF BOTULINUM A TOXIN (BTX)/DIMETHYL SULFOXIDE (DMSO) BLADDER SOLUTION FOR THE TREATMENT OF VOIDING DYSFUNCTION SECONDARY TO DETRUSOR OVERACTIVITY (DO) IN WOMEN: A PHASE I/II STUDY
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To investigate the relationship between sleep disturbance, fatigue, and urinary incontinence (UI) and overactive bladder (OAB) symptoms among patients with OAB.Patients who were diagnosed with OAB and age-matched control subjects without OAB were enrolled. Sleep disturbance and fatigue symptoms were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. UI and OAB symptoms were assessed using the International Consultation on Incontinence Questionnaire—Urinary Incontinence (ICIQ-UI), the International Consultation on Incontinence Questionnaire—Overactive Bladder (ICIQ-OAB), the Overactive Bladder Questionnaire (OAB-q), the Urogenital Distress Inventory Short Form (UDI-6), and the Incontinence Impact Questionnaire Short Form (IIQ-7). Psychosocial health (depression, anxiety, and perceived stress level) was also assessed.Patients with OAB reported a significantly greater sleep disturbance compared with controls (PROMIS 8b T-scores: 54.3 ± 10.3 vs 43.8 ± 9.2). Patients with OAB also reported a significantly greater fatigue compared with controls (PROMIS 7a T-scores: 54.7 ± 9.6 vs 46.0 ± 6.4). After adjusting for nocturia, the differences in sleep disturbance between OAB and controls became insignificant (P = .21), whereas the differences in fatigue between OAB and controls remained significant (P = .014). Among patients with OAB, there were positive correlations between sleep disturbance and the severity of OAB symptoms (ICIQ-OAB), poorer health-related quality of life (OAB-q QOL), the severity of UI symptoms (ICIQ-UI), greater incontinence impact (IIQ-7), and urinary bother (UDI-6). Positive correlations were also observed between fatigue and worse UI and OAB symptoms and quality of life. Both sleep disturbance and fatigue were associated with poor psychosocial health (depression, anxiety, and higher stress level) among patients with OAB.Sleep disturbance and fatigue are present in substantial percentages of patients with OAB. Among patients with OAB, sleep disturbance and fatigue were associated with more severe UI and OAB symptoms, worse health-related quality of life, and poorer psychosocial health.Keywords:
Nocturia
Urinary urgency
Depression
Abstract Aim To determine the relation between urgency alone, or in combination with frequency and nocturia, and adaptive behavior in overactive bladder (OAB) syndrome. Methods We used survey data from the General Longitudinal Overactive Bladder Evaluation (GLOBE) of primary care patients over 40. Participants (n = 2,752: 1,557 females; 1,195 males) completed the same survey at two time points, 6 months apart. Questions assessed OAB symptoms and adaptive behavior. We estimated correlation coefficients (R 2 ) between urgency, frequency, and nocturia symptom scores (alone and in combination) and adaptive behavior measures at baseline and change in symptom scores and behavioral measures from baseline to 6 months. Results At baseline, urgency was the dominant predictor of all behavioral measures for females (R 2 = 0.19–0.48) and males (R 2 = 0.15–0.39). Lower R 2 values were observed for the change in measures from baseline to 6 months, but again change in urgency was the strongest predictor of change in adaptive behavior (R 2 = 0.04–0.13 in females, and 0.02–0.08 in males). The correlation between symptoms and measures of adaptive behavior was almost completely explained by the urgency score. Frequency and nocturia did not substantially improve the overall correlation. Conclusion The relation between measures of OAB symptoms and adaptive behavior at baseline and over time are largely explained by urgency, not by frequency and nocturia. Neurourol. Urodynam. 30:406–411, 2011. © 2011 Wiley‐Liss, Inc.
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We determined overactive bladder symptoms in combination with other lower urinary tract symptoms and illustrated their relationships using a statistical analysis. Furthermore, we also describe the potential contributory factors and adaptation strategies in patients that are associated with overactive bladder subtypes.A total of 1,930 women with a mean age ± SD of 46 ± 15 years (range 15 to 91) with troubling lower urinary tract symptoms were successfully interviewed with a validated questionnaire at the urology and urogynecology clinics at 14 medical centers in Taiwan. The questionnaire was constructed to evaluate 6 lower urinary tract symptoms and 7 adaptation strategies. A log linear statistical model and multiple logistic regression analysis were used to assess the associations among lower urinary tract symptoms and the potential overactive bladder contributory factors, respectively.No single or isolated symptom presented in patients with overactive bladder. Most patients reported a combination with other lower urinary tract symptoms. These female patients can be categorized into 3 groups, including 1 is associated with dry symptoms (urgency, frequency and nocturia), 1 associated with wet symptoms (urgency, urge incontinence and mixed stress incontinence) and a small group that may have overactive bladder symptoms combined with voiding difficulty symptoms. in contrast to patients with dry overactive bladder (urgency associated with frequency and/or nocturia without urge incontinence), after multiple logistic regression analysis patients with wet overactive bladder (urgency with urge incontinence) had a greater average age and higher body mass index, and made more adaptation efforts (p <0.05).We used statistical analysis to determine and suggest that urgency is the core symptom of female overactive bladder syndrome and there are 3 distinctive overactive bladder subtypes, which differ in their symptom combinations. Different symptom combinations and patient characteristics affect female adaptation to overactive bladder syndrome.
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Background: Urinary system involvement is a well-known extraglandular manifestation in primary Sjogren ’ s syndrome (pSS). The term “ Overactive Bladder ” (OAB) is used to define the symptom complex of urinary urgency, generally accompanied by nocturia, with or without urinary incontinence, in the absence of urinary tract infection or other obvious pathologies. In our study, the frequency of OAB was investigated in patients with pSS and compared with the frequency observed in normal healthy controls (NHC). Methods: In this cross-sectional study, 50 patients with pSS and 44 NHC were included. For all the participants, the forms of OAB-Validated 8-question Awareness Tool (OAB-V8) and 3-day voiding diary were completed. The diagnosis of OAB was made in the presence of OAB-V8 scores higher than 8. The 3-day means of the parameters in the voiding diary form were calculated and recorded. Results: The rate of OAB was found to be 56% in patients with pSS, while it was 22.7% in the NHC group. Comparing the pSS patients with the NHC group, significant differences were observed in terms of mean OAB-V8 score (11.5 ± 8.8 ; 6.5 ± 5.3 P < 0.05), daytime frequency (8.4 ± 3.7; 3.6 ± 2.6 P < 0.05) and nocturia (2.2 ± 1.24; 1.2 ± 1.1 P < 0.05). No incontinence was observed in any patients. Conclusion: OAB was encountered more frequently in pSS patients than in the NHC group. Since OAB is a treatable symptom complex, it should not be ignored, and symptoms of OAB should always be searched in pSS patients. doi: https://doi.org/10.4021/wjnu85w
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Solifenacin is an anticholinergic agent selective to M3 cholinergic receptor and has been widely used to treat overactive bladder (OAB). In this study, the efficacy and safety of solifenacin in patients with OAB were evaluated. A prospective study for evaluating the therapeutic results of solifenacin in patients with “OAB dry” (OAB without urge incontinence) or “OAB wet” (OAB with urge incontinence) was performed. Solifenacin 5 mg daily was given and the endpoint was set at the 6th month to evaluate the changes in urgency severity score (USS) after treatment. The measured parameters, including urinary frequency, nocturia, USS, maximum flow rate (Qmax), voided volume, post-voiding residual volume (PVR) and functional bladder capacity (FBC), were recorded at every visit. Patients were further categorized into OAB wet (USS, 4) and OAB dry (USS, 1, 2 and 3), and the effect and adverse events of solifenacin treatment were analyzed. A total of 54 patients was enrolled in this study and completed all follow-up visits. Significant improvements of USS, daytime urinary frequency and nocturia were noted in both OAB dry and OAB wet groups. The urinary frequency and nocturia episodes also improved significantly after taking solifenacin. Mean USS improved from 3.28 ± 0.94 to 2.02 ± 1.62 (p < 0.001), and Qmax increased significantly from 13.9 ± 8.9 mL/s to 15.8 ± 9.6 mL/s (p = 0.04) at baseline and 6 months, respectively. FBC and voiding volume were also found to have significant improvement; however, no significant change in PVR was noted from baseline to endpoint. The therapeutic efficacy showed no significant difference between the OAB dry and OAB wet groups. Minor adverse effects were noted in only seven patients (13.0%), and the most common complaint was difficult urination (5.6%). This study demonstrated that solifenacin is an effective antimuscarinic for treatment of OAB with few adverse effects. Patients with either OAB wet or OAB dry can benefit from solifenacin treatment, in terms of improvement in USS, frequency, nocturia episodes and bladder capacity, without compromising voiding efficiency. Only 13.0% of patients had minor adverse effect, typically dysuria.
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Background In earlier studies, one in six adults had overactive bladder which may impair quality of life. However, earlier studies have either not been population-based or have suffered from methodological limitations. Our aim was to assess the prevalence of overactive bladder symptoms, based on a representative study population and using consistent definitions and exclusions. Methodology/Principal Findings The aim of the study was to assess the age-standardized prevalence of overactive bladder defined as urinary urgency, with or without urgency incontinence, usually with urinary frequency and nocturia in the absence of urinary tract infection or other obvious pathology. In 2003–2004, a questionnaire was mailed to 6,000 randomly selected Finns aged 18–79 years who were identified from the Finnish Population Register Centre. Information on voiding symptoms was collected using the validated Danish Prostatic Symptom Score, with additional frequency and nocturia questions. Corrected prevalence was calculated with adjustment for selection bias due to non-response. The questionnaire also elicited co-morbidity and socio-demographic information. Of the 6,000 subjects, 62.4% participated. The prevalence of overactive bladder was 6.5% (95% CI, 5.5% to 7.6%) for men and 9.3% (CI, 7.9% to 10.6%) for women. Exclusion of men with benign prostatic hyperplasia reduced prevalence among men by approximately one percentage point (to 5.6% [CI, 4.5% to 6.6%]). Among subjects with overactive bladder, urgency incontinence, frequency, and nocturia were reported by 11%, 23%, and 56% of men and 27%, 38%, and 40% of women, respectively. However, only 31% of men and 35% of women with frequency, and 31% of subjects of both sexes with nocturia reported overactive bladder. Conclusions/Significance Our results indicate a prevalence of overactive bladder as low as 8% suggesting that, in previous studies, occurrence has been overestimated due to vague criteria and selected study populations regarding age distribution and low participation.
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