Validation of a simple patient questionnaire to assist self-detection of overactive bladder. A study in general practice

OBJECTIVE: To develop and validate a simple patient questionnaire for the detection of overactive bladder (OAB). DESIGN: An open, non-randomized multicentre study. SETTING: A pilot study (n = 133) was conducted to bring forward five questions from initially 14 questions, for detection of OAB. These five questions were subject to further validation in the main study (n =520). SUBJECTS: 531 adults responding to a newspaper advertisement regarding symptoms of OAB and patients seeing a physician for other reasons were attending 28 general practitioners. MAIN OUTCOME MEASURES: Agreement rate, sensitivity, and specificity. RESULTS: The agreement rate between the patients' own diagnosis based on the patient questionnaire, and the physicians' diagnosis based on medical history, urine analysis, and micturition chart, was 0.78 (kappa =0.89). Sensitivity and specificity were 0.98 and 0.90, respectively. CONCLUSION: The validated questionnaire may become a useful tool to decide whether a patient has overactive bladder. The questionnaire corresponds well with the physicians' diagnosis.     

Relationships between improvements in symptoms and patient assessments of bladder condition, symptom bother and health-related quality of life in patients with overactive bladder treated with tolterodine

Aims: Relationships were evaluated between treatment‐related improvements in overactive bladder (OAB) symptoms as recorded in bladder diaries and patient‐reported symptom bother, bladder‐related problems and health‐related quality of life (HRQL). Methods: A post hoc analysis was performed on data from patients with OAB (n = 863) enrolled in a 12‐week open‐label trial of tolterodine extended release (ER) in a primary care setting. At baseline and week 12, patients recorded every micturition, urgency episode and urgency urinary incontinence episode in 3‐day bladder diaries. Patients also completed the Overactive Bladder Questionnaire (OAB‐q) and Patient Perception of Bladder Condition (PPBC). Relationships between week 12 changes in bladder diary variables and OAB‐q and PPBC scores were evaluated using Spearman correlations. Results: By week 12, tolterodine ER‐related improvements in all bladder diary variables were significantly correlated with improvements on the PPBC (r = 0.26–0.36; p < 0.001), OAB‐q Symptom Bother scale (r = 0.30–0.51; p < 0.001), and all OAB‐q HRQL domains (r = ?0.24 to ?0.42; p < 0.001), although the correlations were generally small to moderate in size. Improvements on the PPBC were also significantly correlated with improvements on the OAB‐q Symptom Bother scale (r = 0.63; p < 0.001) and all HRQL domains (r = ?0.40 to ?0.59; p < 0.001). Conclusions: Tolterodine ER‐related improvements in OAB symptoms (assessed by diary variables) and patients’ perceptions of the changes in symptom bother, bladder‐related problems and HRQL (assessed by PPBC and OAB‐q) were significantly correlated. The OAB‐q and the PPBC provide a relevant and important patient perspective for OAB treatment evaluation.     

Coping strategies and health care-seeking behavior in a US national sample of adults with symptoms suggestive of overactive bladder

BACKGROUND: Although millions of individuals have symptoms suggestive of overactive bladder (OAB), few ever seek or receive medical treatment for their condition. Objective: The purpose of this study was to describe coping strategies and health care-seeking behavior in a community-based sample of adults with symptoms suggestive of OAB. METHODS: A cross-sectional household telephone survey of an age- and sex-stratified sample of adults was conducted. The survey consisted of general health-related questions as well as questions related to OAB symptoms. A total of 4896 adults completed the interview Respondents were considered to have OAB if they reported > or = 1 symptom of urinary urgency, frequency, or urge incontinence. A follow-up questionnaire was then mailed to a subsample of the telephone interview respondents. The mailed questionnaire contained questions related to type and severity of OAB symptoms, coping strategies, medical care/treatment, feelings/beliefs about OAB, and quality of life. Half of the phone respondents with urinary incontinence (n = 638) and a random sample of all other phone respondents received the mailed questionnaire (n = 873); 1,034 questionnaires were returned. RESULTS: Of the respondents with OAB, 69.6% tried > or = 1 nonmedical coping strategy. Respondents with incontinent OAB were significantly more likely than those with continent OAB or those with no OAB (controls) to use nonmedical coping strategies (incontinent OAB, 76.1%; continent OAB, 59.0%; controls, 31.9%; P < 0.001). Fewer than half of the respondents with OAB (43.5%) had spoken with a provider about OAB in the previous 12 months. Medical consultation was associated with sex, type and severity of OAB, number of nonmedical coping strategies tried, number of OAB information sources consulted, inclination to try new OAB medications, and feelings/beliefs about OAB. In 90% of patient-provider discussions about OAB, the patient initiated the topic. CONCLUSIONS: Individuals manage symptoms suggestive of OAB primarily by using nonmedical coping strategies rather than consulting health care providers. Results of this study support the need for improved clinical recognition of OAB and increased patient-provider communication about this condition.     

Validation of a 3-item OAB awareness tool

Aim: The purpose of this study was to validate a short awareness tool to assist patients in identifying if they have bothersome overactive bladder (OAB) symptoms. Methods: This secondary analysis study utilised data from a cross‐sectional study of adult patients presenting for primary care visits. Patients completed an 8‐item OAB screener. The clinician probed for urinary frequency, urgency, nocturia and urgency urinary incontinence. If the patient screened positive or reported the presence of at least one OAB symptom, additional questions were asked regarding lifestyle and coping issues. The clinician then diagnosed the patient as having No OAB, Possible OAB, or Probable OAB. Multivariate logistic regressions were performed to assess the feasibility of deriving a shorter screener to raise awareness of OAB among primary care patients. Results: The 1,260 patients in this study were 51.6 ± 17.0 years old; 62% were women; and most (89%) were Caucasian. Clinicians diagnosed 12.1% of patients with Probable OAB, 19.7% with Possible OAB and 68.3% with No OAB. The logistic regression models were performed with OAB clinical diagnosis as the dependent variable comparing No OAB versus Probable OAB. Three items which included the symptoms of urinary frequency, urinary urgency and urine loss associated with a strong desire to urinate performed well as an awareness tool. A cut‐point of four provided the most appropriate sensitivity (82%) and specificity (91%) when identifying Probable OAB and yielded adequate model fit. The final 3‐item OAB Awareness Tool (OAB‐V3) is gender neutral. Conclusion: The 3‐item OAB Awareness Tool (OAB‐V3) correctly identified patients with symptoms of OAB with high sensitivity and specificity and can be used as a conversation starter for patients with symptoms of OAB.     

Validation study of the Self‐Assessment Goal Achievement (SAGA) questionnaire for lower urinary tract symptoms

Background:  Patients’ treatment goals for overactive bladder (OAB) and other lower urinary tract symptoms (LUTS) may not be aligned with their healthcare provider’s goals. Successful management of OAB symptoms is improved by individualised treatment plans with attainable treatment goals. Goal attainment setting may facilitate patient–provider interaction and the development of a personalised treatment plan based on realistic, individual goals, thereby increasing patient satisfaction and therapeutic outcomes. The purpose of this study was to validate the utility of the Self‐Assessment Goal Achievement (SAGA) questionnaire for LUTS in helping patients identify and achieve realistic treatment goals. Methods:  The 2‐module SAGA questionnaire consists of nine prespecified (fixed) items and five open‐ended items for goal identification and ranking (baseline module) and goal achievement rating (follow‐up module). Adult patients in the United States (n = 104) seeking treatment for LUTS, including symptoms of OAB, completed the SAGA baseline module, micturition diary, other patient‐reported outcome measures (PROs), and discussed their urinary goals with a clinician at baseline. The SAGA follow‐up module was completed 2–4 months later. SAGA was validated based on analyses of face, concurrent, known‐groups, and convergent validity and item distribution. Results:  Among the nine fixed goals of SAGA, four were ranked as very important by > 50% of patients (i.e. reduce night‐time frequency, daytime frequency, urine leakage, urgency). Most patients did not change the importance level of their goals after discussion with their healthcare provider. Pearson correlations between SAGA, diary variables and PRO scores were generally of low to moderate strength. The global mean (SD) follow‐up SAGA T‐score was 32.54 (12.54), indicating that overall goal attainment was not achieved after 3 months. The goal attainment score was significantly different between groups differing in symptom severity, health‐related quality of life, bladder control and continence status. Conclusions:  The results support the validity of SAGA as a measure of patients’ goals and goal achievement for the treatment of LUTS, including symptoms of OAB. SAGA may improve healthcare provider–patient interactions and treatment outcomes in clinical practice.     

Symptom bother and health-related quality of life outcomes following solifenacin treatment for overactive bladder: the VESIcare Open-Label Trial (VOLT)

BACKGROUND: Most clinical trials designed to evaluate overactive bladder (OAB) syndrome treatments have focused on measuring micturition variables from bladder diaries. However, although diaries help physicians assess symptoms objectively, they lack information on patients' subjective experience of OAB symptoms and the effects of treatment. OBJECTIVE: The objective of this study was to assess patients' perceptions of improvements in symptom bother and health-related quality of life (HRQOL) with solifenacin succinate 5- and 10-mg treatments in patients with OAB. METHODS: VOLT (VESIcare Open-Label Trial) was a prospective, flexible-dosing trial performed at 207 centers in the United States. Ambulatory adult (aged > or = 18 years) men and women with an established diagnosis of OAB (urgency, urge urinary incontinence, frequency, and/or nocturia for > or = 3 months) and who provided a sterile urine sample received solifenacin QD for 12 weeks. Initially, all patients received 5 mg/d, with the option of adjustment to 10 mg/d at 4 and 8 weeks. Effectiveness was assessed using the Patient Perception of Bladder Condition (PPBC) scale, a visual analog scale (VAS) for the degree of bother caused by individual OAB symptoms, and the overactive bladder questionnaire (OAB-q). Assessments were performed at study initiation and study end or study termination. Adverse events (AEs) were assessed throughout. RESULTS: Patients (N = 2225) were enrolled between June 2004 and April 2005. Patients with baseline data (n = 2205) had a mean (SD) age of 59.7 (14.4) years; most patients were women (1813 [82.2%]) and white (1761 [79.9%]). Of the total patients enrolled, 1743 (78.3%) completed all 12 weeks of the study. After 12 weeks of solifenacin treatment, improvement was observed in the mean values of patient-reported perception of bladder condition. Significant change was observed on the PPBC scale from the mean baseline value to study end (4.4 vs 2.9; P < 0.001). All subscales of HRQOL significantly improved on the OAB-q score (mean changes, 14.7 to 29.6; all, P < 0.001). On the VAS, there was a significant reduction in the degree of bother associated with urgency, urge urinary incontinence, frequency, and/or nocturia (mean changes in VAS ratings, -36.7 to -41.8; all, P < 0.001 vs baseline). Solifenacin was well tolerated in most patients. Treatment-emergent AEs were reported by 1321 (59.4%) patients. Most reported AEs were anticholinergic in nature and of mild to moderate severity: dry mouth, 477 (21.4%); constipation, 295 (13.3%); headache, 76 (3.4%); blurred vision, 57 (2.6%); nausea, 39 (1.8%); dyspepsia, 34 (1.5%); and dry eye, 29 (1.3%). Two hundred sixteen (9.7%) patients discontinued treatment due to AEs. CONCLUSION: Flexibly dosed solifenacin 5 and 10 mg QD was associated with reductions in patient-reported OAB symptom bother and improvements in patients' perception of bladder condition and HRQOL.     

Botulinum toxin in urology: a review of clinical potential in the treatment of urologic and sexual conditions

Introduction: In recent years, there has been an increased interest in the use of botulinum neurotoxin (BoNT) to treat medical conditions refractory to conventional treatment. The following article provides an overview of the clinical use and efficacy of BoNT in the treatment of various urologic and sexual conditions.

Areas covered: BoNT has been accepted and/or explored as novel treatment for various lower urinary tract and sexual dysfunctions such as overactive bladder/detrusor overactivity (DO), detrusor-sphincter dyssynergia (DSD), benign prostatic hyperplasia, interstitial cystitis/painful bladder syndrome, chronic pelvic pain and more recently premature ejaculation. The following terms ‘botulinum toxin’, ‘BoNT’, ‘botulinum toxin A’, ‘Botox’, ‘Dysport’, ‘Xeomin’, ‘botulinum toxin B’, ‘Myobloc’, ‘OnabotulinumA’, ‘RimabotulinumA’, ‘IncobotulinumA’ and ‘AbobotulinumA’ were used to search several databases including MEDLINE, Pubmed, EMBASE, CINAHL and clinicaltrials.gov for inclusion in this review article. Only English language articles were considered and all studies were limited to BoNT therapy in urological conditions in the adult population.

Expert opinion: BoNT-A has received regulatory approval for use in neurogenic DO and overactive bladder, but its use remains unlicensed in other lower urinary tract conditions such as non-neurogenic lower urinary tract symptoms in men with benign prostatic hyperplasia, bladder pain syndrome and DSD. Published literature shows that BoNT can be effective in carefully selected patient groups, has minimal adverse event profile and is generally well tolerated by many patients. However, many questions remain unanswered and larger scale multi-institutional studies are required to determine the key factors in BoNT treatment success.     

生物反馈治疗联合康复训练在中年女性膀胱过度活动症患者中的应用效果

目的 探讨生物反馈治疗联合康复训练在中年女性膀胱过度活动症(OAB)患者中的应用效果.方法 选取医院2015年2月—2017年8月收治的中年女性OAB患者96例为研究对象,将患者按照组间年龄、病程、膀胱过度活动症患者症状评估表(OABSS)评分匹配的原则分为对照组和观察组,每组48例.对照组采取常规护理及药物治疗,观察...     

Relationships between symptoms, symptom bother, and health-related quality of life in patients with overactive bladder taking solifenacin or placebo in the VIBRANT study

Aims: Studies of antimuscarinics for overactive bladder (OAB) typically use objective and subjective measures to assess efficacy, as each provides unique information about patient outcome. We evaluated the relationships between changes in diary‐documented OAB symptoms and other patient‐reported outcome (PRO) measures. Methods: In VIBRANT, OAB patients received solifenacin (5/10 mg) or placebo for 12 weeks. During the study, patients completed 3‐day bladder diaries and other generic and disease‐specific PRO measures. Data from both treatment groups were combined (n = 738). Categorical changes in diary variables were compared with changes in PRO measures. Partial correlations controlling for treatment and Spearman correlations were also calculated. Results: Categorical improvements in diary variables were significantly associated with greater improvements in PRO measures. Pair‐wise comparisons showed that patients with major symptomatic improvements had significantly greater improvements on PROs vs. those with some or no improvement. Odds ratios ranged from 1.52 to 4.09 (p ≤ 0.002). Linear relationships between changes in PRO measures and diary variables were low to moderate but statistically significant (p < 0.001). Partial correlations were highest for diary variables and OAB‐Questionnaire Symptom Bother. Spearman correlations ranged from 0.170 to 0.450 (p < 0.001). Conclusions: In patients with OAB, changes in objectively measured symptoms of urgency, incontinence and frequency showed low‐to‐moderate correlations to changes in PRO measures. While providing evidence for similar change patterns in symptoms and patient perceptions, correlations were not high, lending support to the concept that in OAB clinical trials, both bladder diaries and PRO measures are important independent measures of efficacy.     

Baseline incontinence severity is predictive of the percentage of patients continent after receiving once‐daily trospium chloride extended release

Objective: It has been assumed that a patient’s underlying baseline overactive bladder (OAB) incontinence severity is predictive of the resulting efficacy of pharmacological treatment. The objective of this study was to stratify and analyse the effects of baseline incontinence disease severity on the treatment outcome of the percentage of patients continent (PPC) during treatment with once‐daily trospium chloride 60 mg extended release (XR). Methods: A post hoc analysis was conducted on pooled data from two 12‐week, randomised, double‐blind phase III studies in the USA in which 1165 patients with baseline urgency, and an average of ≥ 1 urge urinary incontinence (UUI) episode/day and ≥ 10 toilet voids/day on a 3‐day bladder diary, received once‐daily trospium chloride 60 mg XR (n = 578) or placebo (n = 587). Patients were stratified by the mean number of UUIs/day (1.0, > 1.0–2.0, > 2.0–5.0 or > 5.0) at baseline. The efficacy parameter that was analysed was complete continence (defined as no UUIs on a 3‐day bladder diary collected at week 12 of treatment). Results: Baseline UUI levels were inversely correlated with the week 12 PPC (p < 0.0001). Post‐treatment PPCs were higher with trospium chloride XR vs. placebo at all degrees of severity. Complete continence was achieved in 75% of trospium chloride XR recipients with 1.0 UUI/day at baseline and 48% of those with > 1.0–2.0 UUIs/day at baseline. Conclusions: These findings support the assumption that baseline incontinence severity affects the likelihood of achieving continence from OAB therapy, and that patients with less severe OAB (e.g. 1 UUI/day) can expect higher ‘dry rates’ following treatment (e.g. up to 75%) than those with more severe OAB. This information can provide a useful tool for the physician and patient in establishing expectations during therapy.     

膀胱过度活动症对跌倒发生的影响——一项针对社区40岁以上妇女的研究

目的针对市区及乡镇40岁以上女性,评估膀胱过度活动症对跌倒发生及对跌倒关注度(或对跌倒焦虑心理)的影响。方法采用基于人群的队列研究方法,用KHQ问卷(KHQ),国际跌倒效能量表(自评跌倒风险量表、自评跌倒关注程度量表)和一份跌倒相关问卷,调查对象为广东省深圳市40岁以上女性。514位应答者的数据用于分析。膀胱过度活动症被定义为在KHQ问卷(KHQ)中回答"中等"或"很多"尿急或急性尿失禁者。跌倒发生被定义为去年有过跌倒经历。高度跌倒恐惧定义为国际跌倒效能量表(FES-I)评分在24分或以上者。统计方法为χ2检验及t检验。多元回归分析用于检查膀胱过度活动症对跌倒及对跌倒关注度(或对跌倒焦虑心理)的影响。结果 514例应答者中,98例符合膀胱过度活动症诊断。89例(17.3%)去年有过跌倒:27例(27.5%)患有膀胱过度活动症,62例(14.9%)无膀胱过度活动症。跌倒和膀胱过度活动症呈显著相关[比值比(OR)=1.76;95%可信区间(CI)为1.00～3.08;P=0.048],跌倒恐惧心理和膀胱过度活动症显著相关(OR=2.72;95%CI为1.42～5.20;P=0.002)。结论尿急与急性尿失禁症状会增加40岁以上妇女发生跌倒的风险。早期诊断及适当治疗可以预防跌倒发生,提高膀胱过度活动症患者的生活质量。     

Quantitative analysis of the levels of expression of muscarinic receptor subtype RNA in the detrusor muscle of patients with overactive bladder.

INTRODUCTION: Antimuscarinic drugs have frequently been used for the treatment for patients with an overactive bladder (OAB) and there have been many studies on the distribution of muscarinic receptor subtypes in the bladder. However, the distribution of muscarinic receptor subtypes in OAB patients has not been well investigated. In this study we investigated the distribution of muscarinic receptor subtypes with mRNA and protein expressions in patients with and without OAB, and investigated both the dome and trigone area. METHODS: Samples of bladder smooth muscle were obtained from 10 individuals, five patients with OAB and a non-OAB group consisting of five patients who received radical cystectomy. RESULTS: The M2 receptor was predominant, but there was no significant difference in the level of M2 expression between the groups in the dome area. M5 expression in the dome area was significantly higher in the OAB group than in the non-OAB group. In the trigone area, the level of M2 mRNA expression was the highest in the non-OAB group, and was significantly lower in the OAB group. The levels of M1 and M5 mRNA expression were also observed in samples obtained from the trigone area. CONCLUSION: The multiformity of the muscarinic receptor subtypes in human bladder smooth muscle was confirmed, and our results suggest that the efficacy of a given pharmacologic therapy differs from patient to patient.     

Validation of an overactive bladder awareness tool for use in primary care settings

Overactive bladder (OAB)—a syndrome characterized by urinary urgency, with or without urge incontinence, urinary frequency and nocturia—is estimated to affect 10% to 20% of the US and European populations. This study was carried out to validate a patient-administered screening awareness tool to identify patients with bothersome OAB symptoms. Patients were recruited from 12 primary care and 1 gynecology practice during regularly scheduled appointments. Enrollees completed an 8-item questionnaire assessing the amount of “bother” they associated with OAB symptoms. Clinicians then asked the patients 4 questions regarding urinary frequency, urgency, nocturia, and incontinence. If the screening was positive for symptoms of OAB or if the patient provided positive responses to the urinary symptom questions, the clinician asked additional questions regarding lifestyle and coping behaviors. The clinician then diagnosed the patient, placing him or her in the “No OAB,” “Possible OAB,” or “Probable OAB” category. Multivariable logistic regressions controlling for age and sex were performed to assess the applicability of the tool for identifying patients with OAB. A total of 1299 patients were enrolled, and 1260 provided complete data. Patients were aged 51.6±17.0 years, 62% were female, most (89%) were Caucasian, 22% experienced urinary urgency, and 18% experienced urge incontinence. The prevalence of Probable OAB was 12%. The c-index of the model identifying patients with a diagnosis of Probable OAB was 0.96, with a sensitivity and specificity of 98.0 and 82.7. For OAB-V8 scores ≥8, the odds ratio for Probable OAB was 95.7 (95% Cl: 29.3; 312.4). The OAB-V8 performed well in helping clinicians identify patients with bothersome OAB symptoms in a primary care setting and will assist clinicians in identifying patients who may benefit from treatment.     

Patient-reported goal achievement after antimuscarinic treatment in patients with overactive bladder symptoms

Aim: Standardised traditional outcome measures may fail to address factors that are important to patients and address irrelevant factors. Aim of this study was to assess patient‐reported goals and goal achievement (GA) in the antimuscarinic treatment for overactive bladder (OAB) patients. Methods: Men and women aged ≥ 18 years with OAB symptoms were eligible for the study. Treatment began with a dose of 10 mg oxybutynin, to be increased if necessary to 30 mg. Before treatment, each patient’s primary treatment goal was identified. After 12‐week treatment, patients reported GA using a Likert scale from 0 (no achievement) to 5 (complete achievement). Successful achievement was defined as a score of 4 or 5. Traditional outcome measures including voiding diaries, the OAB questionnaire short form, patient perception of bladder condition, and treatment benefit and satisfaction were assessed. Baseline characteristics affecting GA and the correlation between GA and traditional outcome measures were evaluated. Results: A total of 303 goals were identified from 303 patients (51 men, 252 women). Of those, 72.3% addressed symptom relief and frequency as the most common target symptom. Other goals addressed were improving quality of life (13.5%) and eliminating coping behaviours (14.2%). After treatment, 42% had a successful GA with a median score of 3 (interquartile range; 2–4). Age had a negative effect on GA. Goal achievement was the outcome measure most correlated with treatment benefit and satisfaction. Discussion and Conclusions: Goal achievement can be a valuable outcome measure in OAB patients, addressing individual treatment goals and reflecting treatment benefit and patient satisfaction.     

The assessment of quality of life in female Turkish patients with overactive bladder

The objective of this study was to examine the quality of life in female Turkish patients with overactive bladder (OAB). The investigation was conducted as a cross-sectional study between January and April 2010. Two hundred eighty female patients responded to the Overactive Bladder Validated Eight-Question Screener, the OAB disease-specific health-related quality-of-life scale (OAB questionnaire (OAB-q)) and the general quality-of-life scale EuroQol Five-Dimensional Questionnaire (EQ-5D) for the study. Of the 280 patients, 38.9% was classified as having OAB. The mean age was 47.0 ± 8.7. All of the quality-of-life domains (coping, concern, sleep and social) and OAB-q total scores in women with OAB were significantly worse than in women without OAB (P < 0.001 for all). Similarly, the EQ-5D(index) and EQ-5D(VAS) scores for women with OAB were significantly worse than for women without OAB (P < 0.001 and P = 0.006, respectively). OAB-q and EQ-5D(index) scores in menopausal women were significantly lower than non-menopausal women (P < 0.05) in patients with OAB. In conclusion, OAB negatively affects quality of life in Turkish women. However, many women's quality of life can be improved if the patients seek medical treatment. Thus, nurses should encourage the patients to seek medical support in order to cope with health-related quality-of-life problems.     

Evaluating and understanding combination therapy decision drivers for the treatment of overactive bladder in the United States

ObjectiveTo understand factors guiding overactive bladder (OAB) therapy selection and experience with combination therapy (antimuscarinics and beta-3 agonists).MethodsCross-sectional surveys of OAB patients and OAB-treating physicians in the USA were conducted. Patients receiving monotherapy with antimuscarinics were categorized by OAB treatment history: monotherapy only; third-line procedures (e.g., onabotulinumtoxinA injections) and combination therapy; third-line therapy only; and combination therapy only. The patient survey assessed therapy choice drivers and barriers, treatment satisfaction and sociodemographic/clinical characteristics. The physician survey assessed drivers of and barriers to OAB treatment choices.ResultsOf 200 patients, 86.5% reported involvement in treatment decision-making; doctor’s recommendation was the most frequently considered factor (84.4%). Most patients (71%) were unaware of combination therapy. The primary reason why those patients aware of combination therapy had not used it (N = 43/200; 21%) was physician recommendation of other treatments (69.8%). For physicians (N = 50), the most frequently considered factors when prescribing OAB treatment were effectiveness (92.0%) and side effects (84.0%); 70% prescribed combination therapy, primarily for symptom severity (82.9%). The main reasons for not prescribing combination therapy were cost/insurance coverage (80%) and lack of information (53.3%).ConclusionsShared decision-making guided treatment decisions; the main considerations were treatment safety and efficacy.     

The mediating role of illness perceptions in psychological outcomes in overactive bladder

Overactive bladder (OAB) is condition, characterized by urinary urgency, frequency and incontinence, which has the potential to disrupt everyday life considerably. Although there is evidence that antimuscarinic treatment is effective at treating physical symptoms, there is currently no systematic exploration of psychological factors associated with OAB after treatment. This study aimed to examine the quality of life, relationships, sexual functioning, psychological wellbeing and illness perceptions of individuals with OAB after they have received treatment. And to determine whether an individual's psychological wellbeing is directly related to the severity of their symptoms, or whether their illness perceptions mediate this relationship. This study used a cross‐sectional, questionnaire‐based quantitative design with a secondary care outpatient sample who were diagnosed with OAB and had been either previously or currently prescribed drug treatment. Patients reported moderately severe OAB symptoms, with approximately a third reporting moderate/severe anxiety and 12% reporting severe depression. There was no direct relationship between symptom severity and psychological wellbeing (β = ?0·03, t(31) = ?0·96, p = 0·34; β = ?0·02, t(31) = ?0·41, p = 0·68) – this relationship was mediated by the patient's sense of personal control over their OAB (β = 0·03 (SE = 0·02), 95% CI [0·004, 0·09]; β = 0·02 (SE = 0·02), 95% CI [0·0008, 0·08]). Including interventions to improve personal control alongside drug treatment may improve treatment adherence and outcomes.     

Long‐term safety,tolerability and efficacy of fesoterodine treatment in subjects with overactive bladder symptoms

Aims: The aim of this study was to assess the long‐term safety, tolerability and efficacy of fesoterodine treatment in subjects with overactive bladder (OAB) symptoms. Methods: This was an open‐label extension study of a 12‐week, double‐blind fesoterodine study. During open‐label treatment, all subjects received fesoterodine 8 mg for an initial 4 weeks, after which subjects could elect dose reduction to 4 mg or subsequent reescalation to 8 mg during clinic visits (dose reduction and reescalation each permitted once annually). The maximum allowable duration of open‐label fesoterodine treatment ranged from 24 to 32 months across study sites. Safety and tolerability were evaluated via discontinuations, fesoterodine exposure, treatment‐emergent adverse events (TEAEs) and subject‐reported treatment tolerance. Three‐day bladder diaries and other patient‐reported outcomes (PROs) were assessed during the first 24 months of open‐label treatment. PROs included evaluations of health‐related quality of life [HRQL; King’s Health Questionnaire (KHQ), and International Consultation on Incontinence Questionnaire–Short Form (ICIQ‐SF)], severity of bladder‐related problems and treatment satisfaction. Subjects completed 3‐day diaries before open‐label baseline and months 1, 4, 8, 12 and 24; the ICIQ‐SF and measures of bladder‐related problems and treatment satisfaction at open‐label baseline and months 4, 12 and 24; and the KHQ at open‐label baseline and months 12 and 24. Results: Of the 417 eligible subjects who enrolled in the open‐label extension, 61% continued fesoterodine treatment for ≥ 24 months and 71% elected to maintain the fesoterodine 8‐mg dose throughout treatment. No unexpected safety signals were observed. Most subjects rated treatment tolerance as at least ‘good’ throughout the study (≥ 88%). Dry mouth was the most commonly reported TEAE (34%) during open‐label treatment, resulting in discontinuation in 2% of subjects (n = 8). Improvements from open‐label baseline in OAB symptoms, HRQL and bladder‐related problems were statistically significant at the earliest point measured and maintained through month 24. Treatment satisfaction rates were high throughout the study (≥ 84%). Conclusions: Long‐term fesoterodine treatment was well tolerated and associated with sustained improvements in OAB symptoms and HRQL.     

Intradetrusor onabotulinumtoxinA for overactive bladder

Introduction: Overactive bladder is a life-compromising disease that affects approximately 11.8% of all men and women, with increasing rates in the elderly. The mainstay of pharmacotherapy for this disease, anticholinergics, has up to a 71% discontinuation rate at 6 months. The emerging data of intradetrusor onabotulinumtoxinA (onabotA) use for treatment of idiopathic overactive bladder is showing to be an efficacious and well-tolerated alternative to the mainstay of therapy.

Areas covered: This study covers the use of onabotA and its use for idiopathic overactive bladder, stemming from its use in neurogenic detrusor overactivity, by evaluating the conclusions of current studies. A literature search and review was carried out for onabotA in treatment of overactive bladder using PubMed.

Expert opinion: Multiple randomized clinical trials have shown that intradetrusor injection with onabotA is effective in treating non-neurogenic bladder with promising efficacy in patients who have failed traditional pharmacotherapy. This treatment may be superior in certain patients due to its higher rate of compliance and higher rates of complete symptom resolution. Long-term studies are needed.