Overactive bladder: an update

PURPOSE OF REVIEW: Overactive bladder is an important lower urinary tract syndrome that negatively affects the quality of life of millions of people worldwide. Both sexes and all age groups may be affected; therefore many specialists, including urologists, gynaecologists, geriatricians, paediatricians, physiotherapists and continence advisors, are involved in the management of patients with overactive bladder. RECENT FINDINGS: There is ongoing research, both basic science and clinical trials, to establish the cause of overactive bladder and to determine the best method of managing patients who suffer from this syndrome. New theories and modified definitions of overactive bladder have been proposed, structured evidence-based management guidelines have been established, more prevalence studies have been conducted and new treatment strategies have emerged. SUMMARY: Overactive bladder is now recognized as a chronic debilitating condition that costs millions of dollars. With an ageing population these costs will increase, and it is necessary that health systems around the world recognize this. Further research into the basic science of the condition is required to identify the true cause of overactive bladder, allowing new targeted treatments to be established.     

Abnormalities of bladder innervation in diabetes mellitus

Electrophysiologic evaluation of the neural pathways involved in bladder and urethral function is described in 30 patients with diabetes mellitus. The study showed decreased conduction velocities in patients with the detrusor reflex as well as in detrusor areflexia. The findings indicated that diabetic vesical dysfunction is principally the result of segmental demyelination in the peripheral nerve supply to the detrusor muscle and urethra.     

Overactive bladder: prevalence and implications in Brazil

OBJECTIVES: To assess overactive bladder (OAB) prevalence, associated factors and implications in a young population. METHODS: An independent population-based study was carried out. A self-applicative questionnaire covering urinary symptoms, coping strategies, quality of life and treatment seeking behavior was developed. RESULTS: A total of 848 subjects between 15 and 55 years completed the questionnaire. The overall prevalence of OAB was 18.9%. Women were significantly more affected than men (p = 0.001). All age groups were equally affected (p = 0.152). Subjects with OAB reported significant impairment on household chores (p = 0.009), physical activities (p = 0.016), sleep (p < 0.001), work (p < 0.001), social life (p < 0.001) and sexual life (p < 0.001). In addition, OAB individuals present higher prevalence of depression (p = 0.036), anxiety (p < 0.001), shame (p < 0.001) and tiredness (p < 0.001) OAB was independently associated to sexual life impairment (OR = 3.36, 95% CI=1.20-9.39). Only 27.5% of OAB subjects sought for medical counseling. CONCLUSIONS: OAB is a highly prevalent condition, even in such a young population. It affects both genders, yet it is more frequently observed in women. OAB is an important health condition, with serious impact on quality of life and sexual function. A large percentual of individuals remain unrecognized, under treated and consequently suffer for long periods of time.     

Overactive bladder in cervical spondylotic myelopathy

Background

Overactive bladder (OAB) is a new disease concept defined by the International Continence Society in 2002. There have been no reports of OAB among patients with cervical spondylotic myelopathy assessed on the basis of symptom questionnaires.

Methods

One-hundred-and-six patients diagnosed with cervical spondylotic myelopathy and treated by use of laminoplasty were examined. The patients were classified into two groups, those identified as having OAB (OAB group) and those identified as not having OAB (non-OAB group), by use of the Overactive Bladder Symptom Score collected before and 1 year after surgery. The clinical results for the two groups were assessed. OAB symptom prevalence and post-operative symptom improvement were investigated 1 year postoperatively.

Results

Of the 106 patients, 50 were identified as having OAB (symptom prevalence 47.2 %). Of these 50 patients, symptom improvement was observed for only 14 (28 %) 1 year after surgery. For both groups good improvement on the basis of the Japanese Orthopedic Association score was observed 1 year postoperatively, but there were no significant differences between them.

Conclusions

Post-operative improvement of OAB symptoms in cervical spondylotic myelopathy patients was low, which indicated that OAB was most frequently attributable to non-neurogenic and idiopathic, but not neurogenic, causes. It is considered necessary to tell patients with cervical spondylotic myelopathy that the possibility of post-operative OAB symptom improvement is not high when the explanation for informed consent is given before the operation.     

Overactive bladder syndrome in older people

The overactive bladder symptom complex (OAB) is the commonest cause of urinary incontinence in older people, and is usually due to underlying detrusor overactivity, and as such is a treatable condition. Older people are a heterogeneous group, which includes fit community-dwelling individuals and those with significant medical comorbidity; thus the requirements of care for this group are many and varied. The International Continence Society definition of the frail elderly, those aged >65 years with continence problems, who by virtue of comorbidity are house-bound or living in an institution, is clearly not applicable to all. However, many conditions begin to appear in later life and practitioners need to be aware of the need to manage these, and their treatment, when dealing with older people. Studies of medication for OAB have included the elderly and there is evidence of an equivalent benefit in younger people. The impact of treatment on the cognitively impaired and those receiving acetylcholinesterase inhibitors is discussed.     

Decreased urinary bladder apoptosis in a rabbit model of diabetes mellitus

Urinary bladder dysfunction is a recognised complication of diabetes mellitus (DM). This is thought to be partly related to altered bladder morphology as DM is associated with increased bladder weight. In DM, increased cellular proliferation is well established. However, there is evidence that in other pathological states affecting the urinary tract, altered apoptosis may also play a role. We therefore used a rabbit model to investigate whether there are any changes in bladder apoptosis with DM. Diabetes was induced in adult New Zealand white rabbits. Age-matched controls were also used. After 6 months, the bladders were excised and weighed. The TUNEL technique was used to detect and quantify apoptosis in both DM and age-matched control bladders. Diabetes was confirmed as this group had significantly (P<0.001) elevated serum glucose-compared to controls. The bladder weights were also significantly (P<0.001) greater in the DM rabbits. Apoptosis was significantly (P<0.001) decreased in the urothelial cells of the DM bladders. Our results confirm previous findings that DM is associated with increased bladder weight. Although this is associated with increased cellular proliferation, we have demonstrated that decreased apoptosis may also play an important role. Therefore, decreased apoptosis may be important in the pathophysiology of DM cystopathy.     

糖尿病患者膀胱功能改变的临床研究

目的 :探讨糖尿病患者膀胱功能变化及其机制。方法 :将 70例糖尿病患者按照病程分为早期组和进展期组 ,分别对其初尿意的膀胱容量、最大膀胱容量、最大自由尿流率、最大尿流时的逼尿肌压力 (PQmax)、剩余尿量进行分析。结果 :早期组糖尿病患者产生初尿意的膀胱容量增大至 (15 1.6 7± 2 4 .0 7)ml,进展期糖尿病患者初尿意的膀胱容量进一步增大至 (2 6 8.16± 13.90 )ml,最大膀胱容量增大至 (5 92 .97± 2 5 2 .5 1)ml,最大自由尿流率降低至 (8.6 1± 2 .0 4 )ml/min ,PQmax降低 (3.2 5± 1.94 )kPa ,剩余尿量增加至 (16 9.0 3± 137.2 5 )ml。结论 :早期糖尿病患者膀胱感觉减退可能是逼尿肌兴奋性降低的缘故 ;进展期糖尿病患者的一系列尿动力学改变 ,可能是在逼尿肌兴奋性改变的基础上出现逼尿肌收缩力降低的结果。     

Overactive bladder: treatment options in primary care medicine

Overactive bladder is a highly prevalent condition, affecting approximately 33 million adults in the United States. Despite the considerable impact this condition has on patients' quality of life, overactive bladder remains underrecognized and undertreated as a result of patient embarrassment and reluctance to seek medical help, as well as a lack of proactive questioning by physicians. The present article encourages physicians to initiate a dialogue with patients regarding urinary control and, specifically, overactive bladder. Treatment options for overactive bladder recommended in the current article include both nonpharmacologic and pharmacologic therapies. Properties of antimuscarinic agents, including three new drug therapies, are reviewed and provided for physicians to optimize therapy options, particularly among elderly patients.     

Overactive bladder and men: Indications for anticholinergics

Similar to bladder outlet obstruction (BOO), overactive bladder (OAB) symptoms are very common and increase in prevalence as men age. Whether or not OAB symptoms are thought to be secondary to BOO, the goal of treatment of symptoms should result in an improved quality of life and ultimately prevent clinical deterioration. A common dilemma when treating men with obstruction and OAB is the risk of acute urinary retention or morbidities related to increasing postvoid residuals. In this article, the relationship of OAB to BOO is examined and the role of urodynamics and data on the use of anticholinergics in men with OAB and obstruction are reviewed. An algorithm for managing men with OAB also is proposed. In men with OAB without evidence of obstruction (including OAB after treatment for BOO), first-line medical therapy with anticholinergics is indicated. However, in men with OAB and concomitant BOO, nomogram has been developed to assist in the management of patients at risk for urinary retention. Men with significant obstruction should be appropriately treated to decrease bladder outlet resistance before adding anticholinergics for the treatment of OAB.     

Overactive bladder in female and new strategy

In 2002, the International Continence Society (ICS) derived a consensus symptomatic definition of overactive bladder (OAB) as urinary urgency, with or without urge incontinence usually with urinary frequency and nocturia, in the absence of pathologic or metabolic factors that would explain these symptoms. OAB is a highly prevalent disorder that increases with age in both sexes and that has a profound impact on quality of life. Although the prevalence of OAB in men and women is similar in Japan, help-seeking in women has been reported to be lower than that in men. One reason is most women with OAB consider it not a serious disease, and another reason is they hesitate to consult a doctor, especially a urologist, because they feel ashamed. On the other hand, the pathophysiology of OAB remains poorly understand. We have demonstrated that Kit-positive interstitial cells in the suburothelial layer and smooth muscle layer played an important role in the mechanism for maintaining bladder function and pathophysiology of OAB. In addition, we showed the effects of Glivec, a c-Kit tyrosine kinase inhibitor, reduced spontaneous action potential in detrusor smooth muscle. Glivec may prove useful for the treatment of OAB in the future.     

2型糖尿病患者膀胱过度活动症患病现状及影响因素分析

目的了解2型糖尿病患者膀胱过度活动症(OAB)患病现状,并探讨影响因素。方法采用方便抽样法抽取1 103例2型糖尿病患者,使用一般资料调查表、OAB症状评分量表、Charlson合并症指数进行调查,并测量腰臀比及记录糖化血红蛋白水平。结果 2型糖尿病患者OAB患病率为13.6%。Logistic回归分析显示,年龄、性别、糖化血红蛋白、腰臀比、Charlson合并症指数是OAB的影响因素(P0.05,P0.01)。结论糖尿病患者是OAB的高危人群,尤其是血糖水平控制欠佳、年长、男性、肥胖、合并其他慢性病的患者。应加强对OAB预防知识的健康教育,并在糖尿病治疗过程中关注OAB患病情况,及早干预和治疗,以控制或延缓OAB病情进展。     

Impact of diabetes mellitus on recurrence and progression in patients with non-muscle invasive bladder carcinoma: a retrospective cohort study

Objective: The aim of the present study was to investigate the relationship between diabetes mellitus (DM) and tumor features in patients with non‐muscle invasive bladder cancer (NMIBC). Methods: Data from 251 patients who underwent transurethral resection (TUR) for NMIBC from January 2000 to June 2010 were analyzed retrospectively. Patients were divided into two groups: Group I, 159 patients (63%) who did not have DM at the time of surgery; and (ii) Group II, 92 patients (37%) who had DM at the time of surgery. Recurrence‐ and progression‐free survival was assessed in both groups. Preoperative HbA1c levels, as parameter of glycemic control, were determined in Group II patients, with patients divided into two subgroups: (i) HbA1c ≥7.0%; and (ii) HbA1c <7.0%. The clinical features of the bladder tumor were compared in these two subgroups. Results: Compared with Group I, Group II patients were older and had a higher rate of hypertension, recurrence, and progression (P < 0.05). Univariate survival analysis showed that gender, DM, smoking, and serum creatinine were associated with recurrence‐free survival (P < 0.05), whereas DM, stage, grade, intravesical instillation, and serum creatinine were associated with progression‐free survival. In multivariate survival analysis, DM was found to be an independent factor for recurrence‐ (hazard ratio [HR] 2.11; 95% confidence interval [CI] 1.4–3.2; P = 0.001) and progression‐free survival (HR 9.35; 95% CI 3.1–28.6; P = 0.001). Furthermore, patients with HbA1c ≥7.0% exhibited a significantly higher rate of multiplicity (P = 0.001), tumor grade (P = 0.03), and intravesical treatment (P = 0.04). Conclusions: In conclusion, DM seems to be an independent predictor of recurrence‐ and progression‐free survival in NMIBC patients. Further prospective studies are needed to establish the prognostic significance of postoperative glycemic control in this patient population.