骶神经根磁刺激联合索利那新治疗女性难治性膀胱过度活动症的效果

目的 探讨骶神经根磁刺激联合索利那新治疗女性难治性膀胱过度活动症(OAB)的临床效果。方法 2017年1月至12月,120例难治性OAB患者随机分为骶神经根磁刺激组(n = 40)、索利那新组(n = 40)和联合治疗组(n = 40)。治疗前后分别评价三组排尿日记(日间排尿次数、夜间排尿次数、单次排尿量、尿急次数)、尿动力指标(初始尿意膀胱容量、最大膀胱容量)和膀胱过度活动症评分(OABSS)。结果 骶神经根磁刺激组2例、索利那新组1例、联合治疗组1例脱落。联合治疗组日间排尿次数、夜间排尿次数、单次排尿量、尿急次数、初始尿意膀胱容量、最大膀胱容量和OABSS评分均优于骶神经根磁刺激组和索利那新组(P < 0.05)。 结论 骶神经根磁刺激联合索利那新治疗女性难治性膀胱过度活动症效果优于单一疗法。     

尿动力学膀胱冷水反射试验在肉毒素治疗女性膀胱过度活动症效果评价中的应用价值

目的探析尿动力学膀胱冷水反射试验在肉毒素治疗女性膀胱过度活动症效果评价中的应用价值。方法选取我院2014年1月~2016年6月收治的70例女性OAB患者研究对象,给予A型肉毒素200IU+生理盐水30ml膀胱注射治疗。比较治疗前后临床症状(24h尿急次数、排尿次数、夜尿次数、平均每次排尿量)及OABSS评分变化,膀胱冷水反射试验检测治疗前后尿动力学指标变化。结果与治疗前比较,治疗后24h尿急次数、排尿次数、夜尿次数及OABSS评分显著降低,平均每次排尿量显著升高,差异均具有统计学意义(P0.05)。与治疗前比较,治疗后最大尿流率、初尿意膀胱容量、最大膀胱容量显著改善/降低,残余尿量显著升高,差异均具有统计学意义(P0.05)结论尿动力学膀胱冷水反射试验用于肉毒素治疗OAB的效果评价,能准确检验出患者的尿动力学数据,能够综合判定药物治疗效果,值得推广。     

骶神经根磁刺激联合行为治疗对脊髓损伤后 膀胱过度活动症的临床疗效观察

目的：观察骶神经根磁刺激联合行为治疗对脊髓损伤（SCI）后膀胱过度活动症(OAB)的临床疗效。方法：选取我科2017年12月至2018年12月期间收治的SCI后OAB患者33例,均采用行为治疗和骶神经根磁刺激治疗,共治疗4周。比较治疗前后排尿日记记录项目、膀胱过度活动症症状评分（OABSS）问卷评分、尿失禁问卷表简表（ICIQ-SF）评分及尿失禁生活质量量表(I-QOL)评分。结果：治疗后患者24 h平均排尿次数为（7.30±1.01）次、平均排尿量为（204.79±9.19）m L、平均尿急次数为（1.36±0.86）次、平均尿失禁次数为（0.58±0.50）次,OABSS总评分为（3.64±1.06）分,ICIQ-SF评分为（11.61±1.14）分,I-QOL评分为（70.39±2.77）分,与治疗前比较差异均具有统计学意义（均P<0.05）,治疗总有效率为75.76%。结论：骶神经根磁刺激联合行为治疗能够抑制SCI后膀胱过度活动,改善尿频、尿急、尿失禁,改善生活质量。     

罗西维林片联合缩泉胶囊治疗膀胱过度活动症的安全性和疗效

目的:探讨罗西维林片联合缩泉胶囊治疗膀胱过度活动症(overactive bladder,OAB)的疗效及安全性.方法:2011年10月-2012年10月就诊的89例OAB患者,均给予口服罗西维林片10 mg/次,每日3次;同时给予缩泉胶囊1.8 g/次,每日3次;疗程为4周.观察患者治疗前后主观指标[OAB症状评分(overactive bladder symptom score,OABSS)]及客观指标(24h排尿次数、尿急次数、尿失禁次数、夜尿次数、每次排尿量)的变化,评估治疗后患者OAB症状的改善情况及治疗安全性.结果:OAB患者的主观指标及客观指标治疗前后对比,差异均有统计学意义(P＜0.05).89例OAB患者的治愈率及总有效率分别为89.89％和94.38％,不良事件的发生率为5.6％,无严重不良事件的发生.结论:罗西维林片联合缩泉胶囊治疗膀胱过度活动症,临床治愈率和有效率高,安全可靠.     

男性肥胖膀胱过度活动症患者的行为疗法干预效果

目的探讨行为干预疗法在男性膀胱过度活动症(OAB)患者中应用效果。方法选取本院32例男性肥胖OAB患者为对照组,给予常规药物治疗、护理干预。选取另外34例男性肥胖OAB患者为观察组,在对照组基础上强化行为疗法。比较2组干预3个月后的排尿情况、症状变化、生活质量等。结果观察组干预3个月后的膀胱过度活动症状量表(OABSS)评分、排尿行为评分低于对照组(P 0. 05)。观察组干预3个月后体质量指数低于对照组,生活质量评分高于对照组,困扰量表评分低于对照组(P 0. 05)。结论行为疗法能够显著改善男性肥胖OAB者的排尿情况,缓解临床症状,提高生活质量。     

膀胱过度活动症的诊治

进修医生教授,首先请您谈谈膀胱过度活动症的一些基本情况好吗? 教授膀胱过度活动症(overactive bladder,OAB)是一种以尿急症状为特征的综合征,常伴有尿频和夜尿症状,可伴或不伴有急迫性尿失禁.OAB是一种以症状学诊断为基础的概念,它取代了以尿动力学诊断为基础的逼尿肌过度活动这一概念.OAB在尿动力学上既可表现为逼尿肌过度活动,也可表现为其他形式的尿道-膀胱功能障碍.OAB无明确的病因,它不包括由急性尿路感染或其他形式的膀胱尿道局部病变所致的尿频、尿急症状,可把它与伴有OAB症状的其它许多疾病区分开来.OAB与下尿路综合征(lower urinary tract symptoms,LUTS)的鉴别点在于:OAB仅包含有储尿期症状,而LUTS既包括储尿期症状,也包括排尿期症状,如排尿困难等.     

感觉相关的排尿日记在社区女性膀胱过度活动症中的应用研究

目的 应用感觉相关的排尿日记评价40岁及以上的社区女性的膀胱过度活动症(OAB)发病情况.方法 620例女性(平均58岁)完成了3 d的感觉相关的排尿日记.膀胱感觉的定义:0级=膀胱没有感觉,1级=膀胱有涨满的感觉,但没有排尿的愿望,2级=有排尿愿望,3级=有强烈的排尿愿望,4级=有非常紧迫的排尿愿望,但没有急迫性尿失禁,5级=出现因尿急引起的漏尿.结果 96例(15.5%)有OAB症状,包括74例(11.9%)没有急迫性尿失禁(即干性OAB)和22例(3.5%)伴有急迫性尿失禁(即湿性OAB).在全部的11 418次排尿中,随着膀胱感觉等级的增加,排尿量显著增加.干性OAB受试者的24 h排尿量显著高于正常受试者.湿性OAB受试者的平均排尿量显著低于干性OAB受试者和正常受试者.无尿急感觉的正常组的膀胱感觉3级时平均排尿量显著高于其他各组.湿性OAB组的膀胱感觉4级和5级时排尿量显著低于正常组和干性OAB组.结论 感觉相关的排尿日记能有效地评价排尿感觉、尿失禁和排尿模式.正常组、干性OAB组和湿性OAB组中引起诸如尿急或尿频等症状的原因可能不同.     

泌尿外科膀胱过度活动症患者的行为干预护理

目的探讨认知及行为干预护理对泌尿外科膀胱过度活动症(OAB)患者的护理效果。方法选择本院泌尿外科进行OAB诊断治疗的患者66例,随机分为观察组和对照组各33例。观察组治疗过程中除药物治疗外,还加入认知及行为干预,而对照组采取常规护理,比较2组临床疗效、排尿频率、尿急间隔频率和排尿量情况。结果观察组护理总有效率高于对照组(P 0. 05),观察组排尿频率和尿急间隔频率低于对照组(P 0. 05),排尿量多于对照组(P 0. 05)。结论认知及行为干预护理方式对于OAB患者,护理效果良好。     

热水坐浴应用于膀胱过度活动症的疗效分析

目的探讨热水坐浴应用于膀胱过度活动症(OAB)的治疗效果。方法对确诊为OAB的65例患者进行热水坐浴治疗,疗程8周,通过分别统计患者治疗前后的膀胱过度活动症症状评分(OABSS)来评价热水坐浴的治疗效果。结果治疗后患者尿频、尿急、夜尿及急迫性尿失禁等症状均有明显改善,OABSS分值较治疗前明显下降(P0.05)。结论热水坐浴可明显缓解OAB患者症状,该方法简单、实用、廉价,值得临床推广。     

女性膀胱过度活动症患者内源性硫化氢调控作用的研究

目的探讨女性膀胱过度活动症（overactive bladder,OAB）患者膀胱组织中内源性硫化氢（hydrogen sulfide,H2S）水平的变化及其与排尿功能障碍的关系。方法选取女性OAB患者（OAB组）及非OAB受试者（对照组）各50例,观察两组平均24h排尿次数、24h尿失禁次数、初始尿意容量（first desire to void,FDV）及最大尿意容量（maximal volume atmicturtion desire,MV）,评判最大尿流率（maximum urine streaming rate,Qmax）及排尿量（voiding volume,VV）,完成膀胱过度活动症评分（overactive bladder symptom score,OABSS）。两组入选对象均行膀胱镜检查,并于非膀胱三角区区域收集膀胱肌肉组织,应用敏感硫电极法测定膀胱肌肉组织匀浆中H：S含量。结果OAB组患者与对照组受试者膀胱组织中H2S水平差异有统计学意义（P〈0．05）。OAB组H2S水平与平均24h排尿次数及24h尿失禁次数呈正相关,与FDV、MV、VV、Qmax呈负相关。结论女性OAB患者膀胱组织内H2S水平较正常女性明显升高,H2S含量作为一种有效、客观的监测指标,对评价女性OAB患者排尿功能障碍的严重程度及治疗效果具有一定的临床意义。     

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.     

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.     

Satisfaction with tolterodine: assessing symptom-specific patient-reported goal achievement in the treatment of overactive bladder in female patients (STARGATE study)

AIMS: Open-label study to evaluate the effect of tolterodine extended-release (ER) on symptom-specific patient-reported goal achievement (PGA) of overactive bladder (OAB) symptoms in females. METHODS: Eligible patients who had frequency >or= 8 and urgency >or= 2 episodes per 24 h with or without urgency incontinence were treated with 12-week tolterodine ER (4 mg once daily). Primary end-point was the rate of PGA by a visual analogue scale compared with initial expectation with treatment. At baseline, patients were asked to set their personal goals for each OAB symptom with treatment. Secondary efficacy variables were changes in symptom severity, voiding diary and patient perception of bladder condition (PPBC), global impression of improvement (GII), and willingness to continue treatment. RESULTS: A total of 56 patients were entered. The median rate of symptom-specific PGA and reductions in symptom severity were for frequency (60%, 45%), episodes of urgency 60%, 55%), urge incontinence (80%, 71%), nocturia (50%, 52%) and tenesmus (30%, 26%) after 12 weeks treatment. There was a significant improvement in all OAB symptoms in voiding diary. Thirty-five patients (62.5%) experienced an improvement of >or= 2 points in PPBC. Thirty (53.6%) and 22 (39.3%) of patients reported much and little improvement of their symptoms in GII. A total of 41 (73.2%) patients wanted to continue taking the medication at the end of the study. CONCLUSIONS: Most OAB patients reported improvement of their OAB symptoms with 12-week tolterodine ER 4 mg treatment. There was a significant achievement of symptom-specific goal on the key OAB symptoms. But, PGA did not correlate with objective outcomes.     

The association between the self‐perception period of overactive bladder symptoms and overactive bladder symptom scores in a non‐treated population and related sociodemographic and lifestyle factors

Aims: To investigate the association between the self‐perception period of OAB symptoms (SP‐OAB) and the overactive bladder symptom score (OABSS), along with related sociodemographic and lifestyle factors. Methods: This was a cross‐sectional study comprised of 192 men aged 40 years and older who participated in a prostate examination survey between February and May 2009 and proved to have OAB. Survey questionnaires included items on the OABSS and the SP‐OAB assessed by the OABSS. Various sociodemographic and lifestyle factors were also included. Results: The average SP‐OAB period was 24.72 ± 45.75 months and became significantly longer as the severity of OAB increased in correlation analysis (coefficient = 0.501, p < 0.001). Age, education, income, regular check‐up, health maintenance and occupation were all risk factors in both OABSS and SP‐OAB in univariate analysis. Body mass index (BMI), family size and SP‐OAB were risk factors for OABSS in univariate analysis. Age and regular check‐ups were factors in both OABSS and SP‐OAB in multivariate analysis. BMI, income and SP‐OAB were risk factors for OABSS. Conclusion: These findings suggest that the SP‐OAB is an independent risk factor for OAB progression and that various sociodemographic and lifestyle factors affect OABSS. The self‐perception period should be considered in the treatment and prevention of OAB symptoms.     

Health‐related quality of life in people with overactive bladder symptoms: reliability and validity of the traditional Chinese version of the Kings' Health Questionnaire

Overactive bladder (OAB) is a common medical condition. A number of health‐related quality of life (HRQOL) measurements for OAB have been developed during recent years, including the linguistic validation of the traditional Chinese version of the Kings' Health Questionnaire (KHQ). However, limited studies are available for this version of KHQ. Hence, the aim of this study was to examine the reliability and discriminant validity of this traditional Chinese version within the communities of Taiwanese. A cross‐sectional and case–control study was designed. On the basis of a convenience sampling, participants were recruited at a community health center in Pingtung County, Taiwan from March to July 2010. The collected data included OAB symptoms assessed by the Overactive Bladder Symptom Score (OABSS), the HRQOL assessed by the traditional Chinese version of the KHQ and demographic characteristics. Subjects with urinary urgency at least once a week and a total score of OABSS ≥ 3 were assigned to the OAB group. Participants without OAB but with matched age and gender were selected as the control group. Internal consistency reliability was assessed using Cronbach's α, and discriminant validity was examined by Student's independent t‐test. A total of 173 pairs of observations were matched and analysed. The Cronbach's α value was above 0·80 for the traditional Chinese version of KHQ and all its subscales, suggesting a good internal consistency reliability for this measurement. The participants in OAB group showed poor quality of life than the controls (all p < 0·001), which display a good discriminant validity of traditional Chinese version of KHQ. Only 39·9% (n = 69) participants with OAB had discussed their symptoms with a doctor during the past year. As the HRQOL could be improved by medical help, health care providers should educate the public about OAB and encourage patients to seek medical attention.     

Solifenacin significantly improves all symptoms of overactive bladder syndrome

Overactive bladder syndrome (OAB) is a chronic condition characterised by urgency, with or without associated urge incontinence. Solifenacin succinate is a once daily, bladder selective antimuscarinic available in two doses (5 and 10 mg). The recommended dose is 5 mg once daily and can be increased to 10 mg once daily if 5 mg is well tolerated. This article presents pooled efficacy and safety data from four large, placebo-controlled, multinational phase III trials of solifenacin succinate with a total enrolment of over 2800 patients. Data from these trials show that solifenacin 5 and 10 mg once daily is significantly more effective than placebo at reducing urgency, incontinence, micturition frequency and nocturia and at increasing volume voided per micturition. Adverse events were mainly mild-to-moderate in all treatment groups. The results of these phase III trials support the use of solifenacin in the treatment of OAB.     

Symptom-specific efficacy of tolterodine extended release in patients with overactive bladder: the IMPACT trial

We evaluated the efficacy of tolterodine extended release (ER) for patients' most bothersome overactive bladder (OAB) symptom in a primary care setting. Patients with OAB symptoms for >or=3 months received tolterodine ER (4 mg q.d.) for 12 weeks. Among incontinent patients (n = 772), the most bothersome OAB symptoms were daytime frequency (28%), urgency urinary incontinence (UUI; 27%), nocturnal frequency (26%) and urgency (19%); among continent patients (n = 91), they were daytime frequency (47%), nocturnal frequency (42%) and urgency (10%). Sixty-nine per cent of patients had one or more comorbid conditions. By week 12, there were significant reductions in patients' most bothersome symptom: -80% for UUI, -78% for urgency episodes, -40% for nocturnal frequency and -30% for daytime frequency (p < 0.0001). The most common adverse events were dry mouth (10%) and constipation (4%). In primary care practice, bothersome OAB symptoms can be effectively and safely treated with tolterodine ER, even in patients with comorbid conditions.     

Group training for overactive bladder in female patients: a clinical,randomized, non‐blinded study

Bladder training (BT) given individually for overactive bladder symptoms (OAB) is time consuming, and patients tend to need reinforcement. We hypothesized that a specified BT programme for female OAB patients performed as group training would have the same effect as the identical programme used for individual training. A randomized, controlled, non‐blinded trial in six hospital‐situated clinics in Denmark. A total of 91 women were randomized to either individual BT or group BT (three–four patients in each group). In both settings BT was to be performed daily for a 2‐month period supported by a diary and with three training sessions at the hospital coached by a continence nurse. All analyses were performed as intention‐to‐treat. Main outcome measures were urgency episodes, urgency incontinence episodes and scores from a symptom‐specific visual analogue scale (VAS). A total of 38 women with individual BT and 41 with group BT were included in the analyses. No significant differences in urgency episodes, urgency incontinence episodes, voiding frequency between the two settings were observed after treatment. Neither did scores from the VAS scale differ. Median values showed a daily 50% reduction in urgency incontinence episodes. Daily voiding frequency of 8·5–10 was reduced to 7·5 voidings. Women were equally satisfied with the programme in both settings. Compliance in training was equal, and no serious adverse events were reported in either setting. This particular BT programme for female OAB patients showed no difference between group training and individual training with respect to clinical end points, patient satisfaction or compliance.     

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.