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Overactive bladder syndrome (OBS) is a symptom complex consisting of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence (Table 1). It is not explained by metabolic (eg. diabetes) or local pathological factors (eg. infection, stones, urothelial cancer). Urgency is the key symptom of OBS.
Over...
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Background:
Nocturia is a common urinary symptom of multiple sclerosis (MS) which can affect quality of life (QoL) adversely. Melatonin is a hormone known to regulate circadian rhythm and reduce smooth muscle activity such as in the bladder. There is limited evidence supporting use of melatonin to alleviate urinary frequency at night in the treatm...
The overactive bladder (OAB) is a debilitating condition in which patients suffer from urinary urgency, frequency and nocturia with or without urge urinary incontinence. The mainstay of pharmacotherapy for OAB is muscarinic receptor antagonists, which have been shown to be effective treatments for the symptoms of OAB. The mechanism underlying the e...
Aim:
The aim of study was to evaluate the influence of ageing, lifestyle, and co morbid illnesses on treatment outcome of nocturia among men with BPH.
Methods:
Patients with BPH on medical therapy of least 6 months and up to 48 months were interviewed. Nocturia episodes, co morbid illnesses, beverage intake frequency, medications and work histor...
Female storage lower urinary tract symptoms are
prevalent and bothersome. They are usually attributed
to an overactive bladder and treated with antimuscarinics.
Nevertheless, failure of conventional treatment
to alleviate nocturia in particular and epidemiological
data suggesting that nocturnal polyuria is the only or
a contributing factor to noctu...
OnabotulinumtoxinA injection is a safe and effective treatment for adults with refractory overactive bladder. There is sufficient level 1 evidence to support offering onabotulinumtoxinA injections as a second-line treatment to patients who have failed behavioral therapy and oral medications such as antimuscarinics and β3 agonists. An intradetrusor...
Citations
... β3-adrenergic receptor agonists are used as an alternative to anticholinergic drugs for OAB treatment, especially in patients who cannot tolerate or do not respond well to anticholinergics [8]. Several studies have reported significant therapeutic effects of monotherapy using both classes of medications [9][10][11]. However, oral antimuscarinics, commonly used as first-line treatment and in monotherapy, have high discontinuation rates because of bothersome side effects or inadequate clinical response [12][13][14][15]. ...
... To improve therapeutic efficacy, clinicians either increase the dose of the drug [16], switch to a different antimuscarinic, or try a combination of antimuscarinics, resulting in higher rates of side effects [17]. In cases where medication does not provide satisfactory treatment, procedures such as magnetic stimulation, bladder distension, alcohol injection, botulinum toxin injection, urinary diversion, augmentation cystoplasty, and neuromodulation are performed [9,18]. Given that these procedures are more invasive or inconvenient treatment options [18], combination pharmacotherapy may offer an additional promising non-invasive therapeutic management step between single-agent pharmacotherapy and more invasive approaches for the treatment of patients with OAB [19]. ...
Overactive bladder (OAB) is characterized by urinary urgency and increased urinary frequency, substantially affecting quality of life. Tamsulosin and mirabegron combination therapy has been studied as a safe and effective treatment option for patients with OAB. This study evaluated the effects of combining these two drugs on their pharmacokinetics and safety profiles in healthy Korean males. In this open-label, fixed-sequence, three-period, drug–drug interaction phase 1 study, a total of 36 male participants were administered multiple doses of tamsulosin alone (0.2 mg once daily), mirabegron alone (50 mg once daily), or a combination of both drugs. The results showed that the combination of tamsulosin and mirabegron increased tamsulosin exposure in the plasma by approximately 40%. In contrast, the maximum plasma concentration of mirabegron was reduced by approximately 17% when administered with tamsulosin. No clinically significant changes in the safety profiles, vital signs, or clinical laboratory test results were observed in this study. In conclusion, there were no clinically relevant drug–drug interactions between tamsulosin and mirabegron in terms of pharmacokinetics, safety, and tolerability, suggesting that their combination could be a promising treatment option for patients with OAB.
... β3-2 adrenergic receptor agonists are used as an alternative to anticholinergic drugs for OAB treatment, especially in patients who cannot tolerate or do not respond well to anticholinergics [8]. Several studies have reported significant therapeutic effects of monotherapy using both classes of medications [9][10][11]. However, oral antimuscarinics, commonly used as first-line treatment and in monotherapy, have high discontinuation rates because of bothersome side effects or inadequate clinical response [12][13][14][15]. ...
... To improve efficacy, clinicians either increase the dose of the drug [16], switch to a different antimuscarinic, or try a combination of antimuscarinics to improve the therapeutic efficacy at the expense of producing higher rates of side effects [17]. In cases where medication does not provide satisfactory treatment, procedures such as magnetic stimulation, bladder distension, alcohol injection, botulinum toxin injection, urinary diversion, augmentation cystoplasty, and neuromodulation are performed [9,18]. Given these procedures are more invasive or inconvenient treatment options [18], combination pharmacotherapy may offer an additional promising non-invasive therapeutic management step between single-agent pharmacotherapy and more invasive approaches for the treatment of patients with OAB [19]. ...
Overactive bladder (OAB) is characterized by urinary urgency and increased urinary frequency, and can impact quality of life significantly. Tamsulosin and mirabegron combination therapy has been studied as a safe and effective treatment option for patients with OAB. This study evaluated the effects of combining these two drugs on their pharmacokinetics and safety profiles in healthy Korean males. In this open-label, fixed-sequence, 3-period, drug-drug interaction phase 1 study, a total of 36 male participants were administered multiple doses of tamsulosin alone (0.2 mg once daily), mirabegron alone (50 mg once daily), and a combination of both drugs. The results showed that the combination of tamsulosin and mirabegron increased tamsulosin exposure in the plasma by approximately 40%. In contrast, the maximum plasma concentration of mirabegron reduced by approximately 17%, when administered along with tamsulosin. No clinically significant changes in safety profiles, vital signs, or clinical laboratory test results were observed in this study. In conclusion, there were no clinically relevant drug-drug interactions between tamsulosin and mirabegron in terms of pharmacokinetics, safety, and tolerability, suggesting that their combination therapy could be a promising treatment option for patients with OAB.
... Overactive bladder (OAB) is a symptom complex condition characterised by frequent urinary urgency, nocturia, and urinary incontinence with or without urgency [1,2]. It can affect people of any age and is the most common voiding dysfunction in the children [3]. ...
... The neurogenic diseases affect the central nervous system responsible for controlling the functions and thus can cause neurogenic detrusor overactivity [9]. Contrarily, detrusor overactivity in non-neurogenic OAB can result from non-neurological diseases like urinary tract infection, muscle disease, bladder stones or can be idiopathic [2] or can be induced by drugs e.g. benzodiazepines and antidepressants [10][11][12]. ...
... where v = volume of the tablet, π = circular constant, and d = diameter of the tablet (2) where ρ = density of the tablet, m = mass of the tablet, and v = volume of the tablet 3.4.2. Three-Dimensional Surface Texture Analysis A 3D surface texture analysis was carried out using an electrically tuneable lensbased imaging system ( Figure 15) described and used by Nirwan et al., 2022 [63].The sample was prepared using a method described elsewhere [48,64].The tablet was placed on a stainless-steel wafer (3 × 3 cm) using double-sided adhesive tape and a whole tablet was scanned instead of a specified region. ...
Overactive bladder (OAB) is a symptomatic complex condition characterised by frequent urinary urgency, nocturia, and urinary incontinence with or without urgency. Gabapentin is an effective treatment for OAB, but its narrow absorption window is a concern, as it is preferentially absorbed from the upper small intestine, resulting in poor bioavailability. We aimed to develop an extended release, intragastric floating system to overcome this drawback. For this purpose, plasti-ciser-free filaments of PEO (polyethylene oxide) and the drug (gabapentin) were developed using hot melt extrusion. The filaments were extruded successfully with 98% drug loading, possessed good mechanical properties, and successfully produced printed tablets using fused deposition modelling (FDM). Tablets were printed with varying shell numbers and infill density to investigate their floating capacity. Among the seven matrix tablet formulations, F2 (2 shells, 0% infill) showed the highest floating time, i.e., more than 10 h. The drug release rates fell as the infill density and shell number increased. However, F2 was the best performing formulation in terms of floating and release and was chosen for in vivo (pharmacokinetic) studies. The pharmacokinetic findings exhibit improved gabapentin absorption compared to the control (oral solution). Overall, it can be concluded that 3D printing technology is an easy-to-use approach which demonstrated its benefits in developing medicines based on a mucoadhesive gastroretentive strategy, improving the absorption of gabapentin with potential for the improved management of OAB.
... 2,3 La mayoría de las mujeres con vejiga hiperactiva no reciben tratamiento lo que de manera importante afecta su calidad de vida en la función psicosocial, con altas tasas de depresión y ansiedad, 4 con disminución en la productividad laboral, satisfacción sexual y calidad de sueño. 5 La vejiga hiperactiva puede asociarse en 44 a 54% con hiperactividad del detrusor demostrada en los estudios de urodinamia. En el otro 50% de los casos no hay una causa identificable, por lo que generalmente se denomina "idiopática". ...
OBJETIVO:
Determinar si la estimulación transcutánea bilateral del nervio tibial posterior disminuye los síntomas de la vejiga hiperactiva y mejora la calidad de vida.
MATERIALES Y MÉTODOS:
Estudio de cohorte simple, retrospectivo, efectuado en pacientes atendidas en la clínica de Urología Ginecológica del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes en la Ciudad de México, del 8 de octubre de 2021 al 14 de julio de 2022 a quienes se aplicó terapia de electroestimulación bilateral transcutánea del nervio tibial posterior para tratar el síndrome de vejiga hiperactiva.Parámetros de estudio: severidad, calidad de vida y diario miccional en las sesiones 1, 6 y 12. Para la comparación al inicio y al final del tratamiento se utilizó estadística descriptiva y prueba de t pareada; la p < 0.05 se consideró estadísticamente significativa.
RESULTADOS:
Se estudiaron 25 pacientes: 23 con disminución del puntaje en el cuestionario de calidad de vida King’s Health de 24.5 entre las sesiones 1 y 12 (p < 0.001). La disminución del puntaje de severidad de síntomas (Overactive Bladder Symptom Severity [OABSS]) fue de 16.6 entre las sesiones 1 y 12 (p < 0.001). Se observó mejoría significativa en todos los parámetros del diario miccional.
CONCLUSIÓN:
En esta muestra, la estimulación transcutánea bilateral del nervio tibial posterior disminuyó de manera importante los síntomas de vejiga hiperactiva y mejoró la calidad de vida.
... Initial therapy is supervised pelvic floor rehabilitation, in particular bladder retraining. The goal of bladder retraining is to modify bladder function, reduce voiding frequency, increase bladder capacity and eliminate detrusor overactivity by using scheduled voiding rather than voiding in response to urgency (Arnold et al., 2012). ...
While globally, many efforts have been deployed to improve access to and use of surgical services to reduce the burden of female genital fistula; there still remain challenges about the health of women after surgical repair of fistula. This chapter provides new insights on the matter using our experience from Guinea. Using mixed methods approaches, I analyze the findings from a longitudinal study with 481 women discharged from hospital with a closed fistula (the biggest cohort of its kinds to date) to assess health outcomes including recurrence of fistula, pregnancy, and pregnancy outcomes for the mother and the child. I then use the data from two qualitative studies conducted at national level with various stakeholders to complete the analysis. One study explores the perceptions of these stakeholders on women’s health after obstetric fistula repair. The second study describes the social reintegration of women after surgical repair along with describing the experiences of various stakeholders involved in the reintegration process. By triangulating the findings of these three studies, this chapter provides a more comprehensive understanding of the current situation in Guinea and sheds light on the necessary challenges that need to be addressed toward a fistula-free generation.KeywordsObstetric fistulaSocial reintegrationReproductive healthWomenPostfistula repairGuinea
... Possible treatment strategies for functional urological disorders consist of behavioral interventions, pharmacological treatment, and invasive medical therapies, such as botulinum toxin A injections, sacral nerve stimulation, and to a lesser extent bladder augmentation or urine deviating techniques. 20,21 Approximately, 40% of OAB patients; however, do not achieve acceptable therapeutic benefit and are eventually refractory to treatment. 15 Accordingly, the associations between urgency incontinence and both anxiety disorders and depression are established. ...
Background:
Functional urological disorders are highly prevalent, frequently interrelated, and characterized by a chronic course and considerable treatment resistance. From our point of view, poor treatment outcomes are often attributable to underlying but undetected mental disorders.
Objective:
To investigate the effect of integrated outpatient care by a urologist and a psychiatrist on the symptomatology of patients with functional urological disorders in a tertiary referral Pelvic Care Centre.
Setting:
Retrospective observational cohort study in functional urological disorders in combination with psychosomatic co-morbidity. When treatment by a urologist alone was not sufficient, the suitability for a multidisciplinary approach was considered i) if there was a susceptibility for psychiatric comorbidity, ii) if diagnostic procedures did not reveal a treatable somatic cause, or iii) if multiple failed somatic treatments did not relieve complaints. Patients underwent urological treatments before, without reduction of complaints, no treatable somatic cause could be found after diagnostic procedures; or patients suffered from psychiatric comorbidity.
Method:
Outcome was measured using patient global impression of improvement, hospitality anxiety and depression scale (HADS), global assessment of functioning (GAF), and a health consumption questionnaire.
Results:
A significant reduction in HADS-depression score was found (p = 0.001) after multidisciplinary treatment. The GAF score increased from 61 to 80, leading to no more than slight impairment in social, occupational, or school functioning. Patients reported their situation as better in comparison with before multidisciplinary treatment. An association was found between pelvic pain and anxiety (p = 0.032) and panic disorder (p = 0.040). Psychological trauma was found to be associated with depression (p = 0.044), with an odds ratio of 2.93 (1.01-8.50). Psychological trauma coincided in 62.3% of patients with urological pain syndromes and in 83.3% with pelvic pain.
Conclusion:
Overall results indicate that functional urological patients, previously refractory to urological treatment, benefit from an integrated care approach by urologists and psychiatrists. Explanation about the bladder-brain axis and the alarm falsification model enlightens understanding of urological and psychological contributions to functional syndromes and creates an opportunity for integrated care.
... 3 nocturia, and prevent incontinence, by directing patients to interrupt or inhibit detrusor contractions via pelvic floor muscle training. 9,12 In motivated patients, this can prove to be very efficacious reducing leakage by 50-80% and up to 30% becoming dry. 13 Limiting fluid intake to 1-1.5 L a day is recommended. ...
... There are a number of antimuscarinic agents available in both transdermal and oral preparations (Table 1), and these remain the mainstay of treatment in OAB with an efficacy of 65-70% in reducing major symptoms. 12 Side effects such as dry mouth and constipation may prove bothersome to some patients in spite of efficacy. In addition, as these agents have the ability to bind and block muscarinic receptors in the whole body, including those in the brain, there is concern regarding the anticholinergic burden in elderly patients contributing to adverse events such as falls, constipation, cognitive impairment and development of delirium. ...
... In addition, as these agents have the ability to bind and block muscarinic receptors in the whole body, including those in the brain, there is concern regarding the anticholinergic burden in elderly patients contributing to adverse events such as falls, constipation, cognitive impairment and development of delirium. 12,19,20 Anticholinergic scales attempt to quantify the risk versus benefits of prescribing anticholinergic medication, however there remains no consensus between the medications assessed on these scales and the degree of effect. 21 Patient compliance with antimuscarinic therapy remains poor due to intolerable side effects, with discontinuation rates up to 85% over 12 months. ...
Overactive bladder (OAB) syndrome is a common condition characterised by urinary urgency, with or without urgency incontinence, frequency and nocturia, in the absence of any other pathology. Clinical diagnosis is based upon patient self-reported symptomology. Currently there is a plethora of treatments available for the management of OAB. Clinical guidelines suggest treatment via a multidisciplinary pathway including behavioural therapy and pharmacotherapy, which can be commenced in primary care, with referral to specialist services in those patients refractory to these treatments. Intradetrusor botulinum A and sacral neuromodulation provide safe and efficacious management of refractory OAB. Percutaneous tibial nerve stimulation and augmentation cystoplasty remain available and efficacious in a select group of patients. Unfortunately, there remains a high rate of patient dissatisfaction and discontinuation in all treatments and thus there remains a need for emerging therapies in the management of OAB.
... Diagnostic cystoscopy, urine cytology, and diagnostic ultrasound of the kidneys and bladder are not recommended in the early stages of disease diagnosis (5) . Urodynamic test purpose is to distinguish between different types of incontinency; therefore, it is the most effective diagnostic method (21) . Many patients who suffer from bladder overactivity need long-term treatment to relieve the symptoms (12) . ...
Purpose:
SNRIs (serotonin and norepinephrine reuptake inhibitors) like duloxetine are known to have role in the treatment of anxiety disorder and stress urinary incontinence. According to the correlation of anxiety disorder and overactive bladder, this study aimed to evaluate the clinical efficacy and complications of duloxetine (SNRI) as a medication in the treatment of overactive bladder in the female patients. We were interested to know the probable therapeutic effect and side effects of duloxetine in overactive bladder.
Methods and materials:
In this single-blinded interventional randomized clinical trial, 60 female patients with idiopathic overactive bladder (hyperreflexia) referred to the urology clinic, were divided into two groups as pilots. The first group were treated by 10mg/daily solifenacin and the second group received 20mg/daily duloxetine. The patients were evaluated by the ICIQ-OAB Questionnaire before and after one-month follow-up period. The intervention primary outcomes were evaluated by the patient's presentation of the frequency, nocturia, urgency, urge urinary incontinence and the drugs side effects as secondary outcomes were checked. Results: Sixty women with confirmed overactive bladder disease were evaluated. Solifenacin and duloxetine had the same effect on the treatment of overactive bladder (p value=0.148). The clinical symptoms were obviously relieved in both groups after treatment. Side effects were insignificantly more common in the solifenacin group (p value>0.05). However, the different frequency of blurred vision in the two groups was statistically significant (p value=0.04). The most common complication in solifenacin and duloxetine group was anxiety.
Conclusion:
The results showed that solifenacin and duloxetine improved overactive bladder symptoms. According to this evaluation, duloxetine can be a suitable alternative option for overactive bladder treatment, due to the acceptable therapeutic effect and side effects.
... This trend reflects concerns regarding the prescribing pattern because (i) safer and more tolerable selective agents are available and (ii) safer nonanticholinergic alternatives such as mirabegron are available. [54][55] As previously mentioned, the differential binding of non-selective antimuscarinics to different receptor subtypes that have minimal or no involvement in bladder detrusor contractions (M1, M2, M4 and M5 receptors) leads to the various central and peripheral adverse events such as increased heart rate, decreased secretions, pneumonia, sedation, visual disturbances. 12,19,[22][23][24][25][26][27][28][29][30][31][32] Of particular importance is the inhibition of M1 receptors that leads to adverse cognitive effects and makes it a grave concern for the cognitivelycompromised dementia patients. ...
Objectives:
This study examined the incidence and predictors of antimuscarinic medication use including non-selective antimuscarinics among older adults with dementia and overactive bladder (OAB).
Methods:
The study used a new-user cohort design involving older adults (≥65 years) with dementia and OAB based on 2013-2015 Medicare Data. Antimuscarinics included non-selective (oxybutynin, tolterodine, trospium, fesoterodine) and selective (solifenacin, darifenacin) medications. Descriptive statistics and multivariable logistic regression models were used to determine the incidence and predictors of new antimuscarinic use including non-selective antimuscarinics, respectively.
Results:
Of the 3.38 million Medicare beneficiaries with dementia, over one million (1.05) had OAB (31.03%). Of those, 287,612 (27.39%) were reported as prevalent antimuscarinics users. After applying continuous eligibility criteria, 21,848 (10.34%) incident antimuscarinic users were identified [77.6% non-selective; 22.4% selective]. Most frequently reported antimuscarinics were oxybutynin (56.3%) and solifenacin (21.4%). Multivariable analysis revealed that patients ≥75 years, of black race, and those with schizophrenia, epilepsy, delirium, and Elixhauser's score were less likely to initiate antimuscarinics. Women, those with abnormal involuntary moments, bipolar disorder, gastroesophageal reflux disease, insomnia, irritable bowel syndrome, muscle spasm/low back pain, neuropathic pain, benign prostatic hyperplasia, falls/fractures, myasthenia gravis, narrow-angle glaucoma, Parkinson's disease, syncope, urinary tract infection and vulvovaginitis were more likely to initiate antimuscarinics. Further, patients with muscle spasms/low back pain, benign prostatic hyperplasia and those taking higher anticholinergics had lower odds of receiving non-selective antimuscarinics, whereas white patients, black patients and those with schizophrenia and delirium were more likely to receive them.
Conclusions:
Nearly one-third of dementia patients had OAB and over one-fourth of them used antimuscarinics. Majority of the incident users were prescribed non-selective antimuscarinics with several demographic and clinical factors contributing to their prescribing. Given the high prevalence of OAB among dementia patients, there is a need to optimize their antimuscarinics use, considering their vulnerability for anticholinergic adverse effects.
... There are many kinds of drugs used for improving OAB symptoms, such as anticholinergics/antimuscarinic drugs, estrogen replacement therapy, antidepressants (eg, duloxetine, imipramine), and intravesical botulinum toxin. 3 There are several subtypes of muscarinic receptors (M1 to M5), and the human detrusor contains mainly the M2 and M3 subtypes. 4 Available antimuscarinics marketed worldwide differ from each other. ...
Objective
This study evaluated the efficacy and safety of imidafenacin 0.1 mg twice daily vs placebo for Taiwanese patients with overactive bladder (OAB) after a 12‐week oral administration.
Methods
This randomized, double‐blind, placebo‐controlled, two‐arm, parallel‐group, prospective study enrolled 118 patients across 11 study sites in Taiwan. Subjects were randomized to imidafenacin or placebo in a 2:1 ratio and entered the 12‐week treatment period. At the subsequent visits, efficacy outcome measures and safety assessments were collected for analysis. The primary efficacy outcome was the change in the mean number of micturitions per day. Secondary endpoints included mean changes from baseline in urgency episodes and urge incontinence episodes per day and mean volume voided per micturition. Safety outcomes were also collected and compared between groups.
Results
A total of 78 and 40 patients were allocated to the imidafenacin and placebo groups, respectively. Among them, 100 patients (imidafenacin, 65 and placebo, 35) completed the trial. Compared with placebo, imidafenacin was significantly better at reducing the number of micturitions per day (−1.29 ± 2.23 vs ‐0.46 ± 3.49, P = .0171) and reducing the mean number of urge incontinence episodes (−0.15 ± 0.52 vs 0.04 ± 0.50, P = .0386) at week 12. Adverse events were reported in 35 subjects (44.9%) and 16 (40%) in the imidafenacin and placebo groups, including constipation (n = 3, 4), dry mouth (n = 11, 2), and urinary tract infection (n = 7, 4), respectively. One patient in the imidafenacin group had mild dysuria.
Conclusion
Imidafenacin demonstrated efficacy and safety in the treatment of OAB in Taiwanese patients.
