Aim: The aim of this study was to compare the differences between angles of bladder neck in girls with overactive bladder and those in healthy ones using transabdominal ultrasonography.Materials and ...Methods: This study consists of 28 girls complicated with overactive bladder (Group I) and 40 healthy girls (Group II). The anteroposterior vesical wall angle (APVA), urethroposterior vesical wall angle (UPVA), urethroanterior vesical wall angle (UAVA), thickness of bladder mucosa, distance of urethral orifices, and distance between ureter and urethra orifice were measured in supine position using transabdominal ultrasonography. The results were compared between the two groups.Results: UAVA in Group I was higher than Group II (135.2 ± 12.2 mm vs. 117.4 ± 14.0 mm; p = 0.009). UPVA was smaller in Group I than Group II (114.6 ± 19.5 mm vs. 135.3 ± 16.5 mm; p = 0.014). The distance between the ureteral orifices was 31.8 ± 8.5 mm in Group I and 17.0 ± 4.1 mm in Group II (p < 0.001). There was no statistically significant difference between groups in terms of APVA, bladder mucosa thickness, and distance between ureter and urethra orifice (p > 0.05).Conclusion: Bladder neck dynamics may play an important role in overactive bladder pathophysiology due to differences in UPVA, UAV, and location of ureteral orifices in this patient population.
Bladder training (BT) is characterized by a programmed voiding regimen with gradually adjusted voiding intervals and is commonly used in the conservative treatment of individuals with overactive ...bladder (OAB).
To investigate and update the literature on the effectiveness of BT treatment alone and/or combined with other therapeutic strategies that can promote improvement in OAB symptoms and quality of life and report adverse events.
The systematic review was performed in eight databases, including PubMed, PEDro, SciELO, LILACS, Cochrane Library, Web of Science, EMBASE and CINAHL. After selecting the titles, abstracts and full texts retrieved. To assess the risk of bias of the studies, the Cochrane RoB 2 tool and the GRADE system were used to determine all the evidence of the studies analyzed. The protocol of this study is available in the PROSPERO systematic review protocol registry database with the registration number (PROSPERO CRD42022301522).
The search generated a total of fourteen randomized controlled trials (RCTs) included in the review. The total participants were 2,319 (men and women) from 9 countries. The minimum age of the sample was 18 and the maximum age was 80 years. RCTs featured BT isolated (n=12), BT + intravaginal electrical stimulation (IVES) (n=2), BT + DT (drug treatment) (n=5), DT (n=7), BT + Biofeedback (BF) + IVES (n=1), PFMT + BF (n=1), BT + PFMT + behavioral education/therapy (n=2), BT + PTNS (percutaneous tibial nerve stimulation) or BT + TTNS (transcutaneous tibial nerve stimulation) (n=1). To the meta-analyses BT combined with IVES in the short-term follow-up period promoted improvement in nocturia (DM: 0.89, 95% CI: 0.59-1.20), urinary incontinence (DM: 1.93, 95% CI:1.32-2.55) and quality of life (DM: 4.87, 95% CI: 2.24-7.50). Three RCTs were considered with a "High" risk of bias, nine studies with "Some concerns," and two with a "Low" risk. In the GRADE system, the RCTs showed very low, of evidence to the GRADE system.
BT combined with IVES showed favorable results for treating OAB in the short-term follow-up period. Thus, the use usingined with IVES is recommended for treating individuals with OAB.
For individuals with OAB treated with BT + IVES there is a report of reduced episodes of nocturia, urinary incontinence and improved quality of life in the short-term follow-up period. The methodological quality of the studies was the best possible for the moment; aspects of the currently available RCTs were analyzed to update the current literature. Most of the data in this review comes from moderate-sized RCTs of very low to moderate methodological quality, verified by GRADE, in addition to heterogeneous risk of bias across RCTs. The findings corroborate the recommendations of the societies guiding conservative treatment for OAB. BT should be offered in combination with IVES as supplemental therapy in conservative treatment to increase treatment efficacy in the short-term follow-up period.
Overactive bladder (OAB) is a highly prevalent symptom condition that affects millions of US men and women. Not only can the symptoms of OAB be very bothersome, but OAB can have significant ...detrimental effects on many aspects of individuals’ lives, representing a particularly impactful health burden to quality of life and productivity. Estimates of the individual and societal costs for the management of OAB continue to rise, particularly as effective treatments remain elusive. As such, OAB represents a significant public health burden to the USA.
Current literature suggests that several pathophysiological factors and mechanisms might be responsible for the nonspecific symptom complex of overactive bladder (OAB).
To provide a comprehensive ...analysis of the potential pathophysiology underlying detrusor overactivity (DO) and OAB.
A PubMed-based literature search was conducted in April 2018, to identify randomised controlled trials, prospective and retrospective series, animal model studies, and reviews.
OAB is a nonspecific storage symptom complex with poorly defined pathophysiology. OAB was historically thought to be caused by DO, which was either “myogenic” (urgency initiated from autonomous contraction of the detrusor muscle) or “neurogenic” (urgency signalled from the central nervous system, which initiates a detrusor contraction). Patients with OAB are often found to not have objective evidence of DO on urodynamic studies; therefore, alternative mechanisms for the development of OAB have been postulated. Increasing evidence on the role of urothelium/suburothelium and bladder afferent signalling arose in the early 2000s, emphasising an afferent “urotheliogenic” hypothesis, namely, that urgency is initiated from the urothelium/suburothelium. The urethra has also recently been regarded as a possible afferent origin of OAB—the “urethrogenic” hypothesis. Several other pathophysiological factors have been implicated, including metabolic syndrome, affective disorders, sex hormone deficiency, urinary microbiota, gastrointestinal functional disorders, and subclinical autonomic nervous system dysfunctions. These various possible mechanisms should be considered as contributing to diagnostic and treatment algorithms.
There is a temptation to label OAB as “idiopathic” without obvious causation, given the poorly understood nature of its pathophysiology. OAB should be seen as a complex, multifactorial symptom syndrome, resulting from multiple potential pathophysiological mechanisms. Identification of the underlying causes on an individual basis may lead to the definition of OAB phenotypes, paving the way for personalised medical care.
Overactive bladder (OAB) is a storage symptom syndrome with multiple possible causes. Identification of the mechanisms causing a patient to experience OAB symptoms may help tailor treatment to individual patients and improve outcomes.
There is a temptation to label overactive bladder (OAB) as “idiopathic” without obvious causation as “idiopathic”, given the poorly understood nature of its pathophysiology. However, OAB should be seen as a complex multifactorial syndrome, resulting from multiple potential pathophysiological mechanisms. Identification of the underlying causes on an individual basis may lead to the definition of OAB phenotypes, paving the way for personalised medical care.
Objective. The purpose of this study was to evaluate the efficacy of daily transcutaneous tibial nerve stimulation (TTNS) versus weekly percutaneous tibial nerve stimulation (PTNS) on the quality of ...life of patients with idiopathic overactive bladder (OAB). Patients and Methods. The study was designed as a randomized controlled trial. The diagnosis of OAB was made on the basis of clinical symptoms, and urodynamic tests were performed to check whether uncontrolled contractions of the derusor during bladder filling were responsible for the OAB symptoms. The tests used to assess symptoms and quality of life were Overactive Bladder Questionnaires (OAB-q) SF. The patients were divided into 2 groups of 30 patients each. The first group was treated with TTNS every day for 3 months and the second group with PTNS once a week, also for 3 months.Results. Stimulation with both TTNS and PTNS led to the reduction of all clinical symptoms of OAB and improved quality of life, with statistical significance (P<0.05) and with no side effects. When comparing these two groups, the improvement was statistically more significant in the group treated with PTNS. When the quality of life scores and symptoms were compared to the type of treatment, it was found that the improved quality of life parameters and the reduced OAB symptoms were more statistically significant in the treatment with PTNS than TTNS therapy (P<0.001).Conclusion. The results of the study suggest good efficacy of both TTNS and PTNS in the treatment of OAB. Better effects are achieved with weekly PTNS, as it leads to a statistically significant reduction in symptoms as well as an improvement in quality of life, without side effects.
The efficacy of intradetrusor onabotulinumtoxinA injections for the management of idiopathic overactive bladder has been well-established. The injections are typically performed in the office setting ...using local analgesia, most commonly a 20 to 30-minute intravesical instillation of lidocaine. There are limited data evaluating alternative bladder analgesics.
To compare pain scores with preprocedure oral phenazopyridine vs intravesical lidocaine in women undergoing intradetrusor onabotulinumtoxinA injections for idiopathic overactive bladder.
Nonpregnant adult females with idiopathic overactive bladder, scheduled for office injection of 100 units of intradetrusor onabotulinumtoxinA were randomized to either 200 mg of oral phenazopyridine taken 1 to 2 hours preprocedure or a 20-minute preprocedure intravesical instillation of 50 mL of 2% lidocaine. We excluded participants with neurogenic bladders, and those who had received intradetrusor onabotulinumtoxinA injections in the previous 12 months. The primary outcome was pain measured by a 100-mm visual analog scale. Demographic characteristics and overall satisfaction with the procedure were also recorded. Providers answered questions about cystoscopic visualization, ease of procedure, and perception of participant comfort. Prespecified noninferiority margin was set to equal the anticipated minimum clinically important difference of 14 mm. A planned sample of 100 participants, 50 in each treatment arm, provided 80% power to detect noninferiority at a significance level of.05. We performed a modified intention-to-treat analysis and compared variables with the t test or the Fisher exact test.
A total of 111 participants were enrolled, and complete data were obtained for 100 participants; 47 participants were randomized to phenazopyridine and 53 to lidocaine. Baseline characteristics did not differ between groups. There were 19.6% and 20.8% of participants in the phenazopyridine and lidocaine groups, respectively, who previously underwent intradetrusor onabotulinumtoxinA injections. The mean postprocedure pain was 2.7 mm lower in the phenazopyridine group than in the lidocaine group (95% confidence interval, −11.3 to 10.7), demonstrating noninferiority. More than 90% of participants in both groups stated that the pain was tolerable. Slightly more participants reported being “very satisfied” in the lidocaine group, although this was not statistically significant (50.0% vs 40.4%; P=.34). Providers reported clear visualization in 89.4% of participants in the phenazopyridine group and in 100% of participants in the lidocaine group (P=.02). Provider perception of participant comfort and overall ease of procedure were not different between groups. Length of time in the exam room was significantly shorter in the phenazopyridine than in the lidocaine group (44.4 vs 57.5 minutes; P=.0003).
In women receiving intradetrusor onabotulinumtoxinA injections for idiopathic overactive bladder, oral phenazopyridine was noninferior to intravesical lidocaine for procedural pain control. Phenazopyridine is well-tolerated by participants, allows for the procedure to be performed with similar ease, and is associated with shorter appointment times.
Mirabegron is an established treatment alternative to antimuscarinic therapy for patients with overactive bladder (OAB), as shown by efficacy and tolerability data from phase III trials.
To assess ...efficacy and tolerability of mirabegron 50mg versus antimuscarinic monotherapies and combination therapies.
Systematic literature review and network meta-analysis of randomised controlled trials (2000–2017) assessing eligible treatments for OAB.
Efficacy assessments included micturition frequency, urgency urinary incontinence, dry rate, and 50% reduction in incontinence. Tolerability assessments included dry mouth, constipation, blurred vision, and hypertension.
A total of 64 studies (n=46 666) were included in the network meta-analysis. Mirabegron 50mg was significantly more efficacious than placebo for all efficacy endpoints. Comparable overall efficacy was observed for mirabegron 50mg versus most active treatments, but solifenacin 10mg monotherapy and solifenacin 5mg plus mirabegron 25 or 50mg in combination were more efficacious for some/all outcomes. Mirabegron 50mg was significantly better tolerated regarding dry mouth, constipation, and urinary retention than 21/22, 9/20, and 7/10 active comparators, respectively; similar overall tolerability was observed between mirabegron 50mg and all treatments (including placebo) for the remaining endpoints. Limitations of the study included between-trial variations in the definition of certain endpoints and heterogeneity of the available data (eg, number of studies and patients assessed) for comparator treatments across different endpoints.
The relief of key OAB symptoms produced by mirabegron 50mg is significantly better than placebo, and similar to a range of common antimuscarinics, with the benefit of significantly fewer bothersome anticholinergic side effects such as dry mouth. Combination treatment of solifenacin 5mg plus mirabegron 25 or 50mg appears to provide an efficacy benefit compared with mirabegron 50mg, with the expected side effects of individual antimuscarinics.
This study assessed the efficacy and tolerability of different drug treatments for OAB. Mirabegron 50mg was as effective as antimuscarinic therapy, with fewer common, bothersome side effects such as dry mouth, constipation, and urinary retention. Combination treatment of solifenacin 5mg plus mirabegron 25 or 50mg was more effective than mirabegron 50mg alone, but with more anticholinergic side effects.
This network meta-analysis showed that mirabegron 50mg provides similar overall efficacy and improved tolerability compared with antimuscarinics in patients with overactive bladder. Solifenacin/mirabegron combination therapy further improves efficacy compared with mirabegron 50mg, with the expected side effects of individual antimuscarinics.
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