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Michael L. Guralnick Gwen Grimsby Michael Liss Aniko Szabo R. Corey O’Connor 《International urogynecology journal》2010,21(3):325-329
Introduction and hypothesis
This paper aims to determine if there are differences between female overactive bladder (OAB) patients with and without urodynamic detrusor overactivity (DO). 相似文献3.
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NORITOSHI SEKIDO SHIRO HINOTSU KOJI KAWAI TORU SHIMAZUI HIDEYUKI AKAZA 《International journal of urology》2006,13(10):1276-1279
OBJECTIVE: We retrospectively evaluated the incidence of detrusor overactivity (DO) in uncomplicated overactive bladder syndrome (OAB) patients. METHODS: From December 1993 to October 2003, 139 adult patients were referred to an urodynamic clinic for urodynamic evaluation of frequency and/or urinary incontinence. Of these, 50 patients (12 males and 38 females) with urgency, without any overt pathological conditions, were retrospectively evaluated in regard to patient age, storage symptoms, urodynamic parameters, and the presence or absence of DO (DO patients or no DO patients, respectively). RESULTS: The overall incidence of DO was 75% (nine of 12 patients) and 36.8% (14 of 38 patients) in male and female patients, respectively. Two of nine male DO patients and five of 14 female DO patients revealed DO after provocative maneuvers. In male patients, all DO patients were OAB wet. In female patients, 13 of 14 DO patients were OAB wet (92.9%), whereas 17 of 24 no DO patients were also OAB wet (70.8%). Compared with no DO patients, female DO patients revealed statistically significant lower maximum cystometric capacity (P = 0.0139) and lower vesical compliance (P = 0.0002). Although aged 60 years or more was associated with DO in univariate analysis in female patients, any symptoms, even incontinence, were not associated with DO in both sexes. CONCLUSION: It is supposed that, in contrast to male OAB, DO might not be a major underlying cause of uncomplicated female OAB. 相似文献
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Study Type – Therapy (RCT)Level of Evidence 1b
OBJECTIVE
To determine whether the presence of detrusor overactivity (DO) in patients with overactive bladder (OAB) and urgency urinary incontinence (UUI) is a predictor of the response to treatment with fesoterodine.PATIENTS AND METHODS
This phase 2 randomized, multicentre, placebo‐controlled trial consisted of a 1‐week placebo run‐in phase followed by an 8‐week double‐blind period. Eligible for the study were men and women aged 18–78 years with symptoms or signs of OAB with UUI; they were stratified into two balanced strata depending on the outcome of a baseline urodynamic assessment. By using this particular study design it was possible to investigate whether there were differences between the strata. The primary endpoint was the change from baseline to week 8 in mean voids/24 h. Secondary endpoints were the changes in UUI episodes/week, and for those patients with DO at baseline, the mean changes in volume at first involuntary contraction associated with a feeling of urgency, first desire to void, and strong desire to void, and change in maximum cystometric capacity. Because there were few patients the secondary analyses were considered exploratory.RESULTS
Overall, there were linear dose‐response relationships for placebo and the fesoterodine groups for the reduction in the number of voids/24 h and UUI episodes/week. Compared with the placebo group, the least squares mean changes from baseline to week 8 in both variables were significantly improved in patients receiving fesoterodine 4 mg (P = 0.045 and 0.040, respectively), 8 mg (P < 0.001 for both), and 12 mg (P < 0.001 for both). There were no significant differences in treatment responses, as measured by both variables between patients with and without DO. For patients with DO, the mean volume at the first desire to void improved in all fesoterodine treatment groups and worsened in the placebo group.CONCLUSIONS
Regardless of the presence of DO, the response to fesoterodine treatment was dose‐proportional and associated with significant improvements in OAB symptoms, indicating that the response to OAB pharmacotherapy in patients with UUI was independent of the urodynamic diagnosis of DO. 相似文献6.
Tincello DG 《World journal of urology》2012,30(4):451-456
Objectives
To review the evidence in support of botulinum toxin (BoNT-A) for overactive bladder and detrusor overactivity in adults.Methods
A search of Medline and Pubmed was undertaken using the search terms ‘botulinum toxin’ with ‘overactive bladder’, ‘detrusor overactivity’, ‘randomised trial’ and ‘trial’. A narrative review was undertaken based on the papers identified.Results
Only four randomised trials reporting the effects of botulinum toxin in this group of patients exist, alongside three systematic reviews and numerous uncontrolled series. Overall, BoNT-A appears an effective treatment modality, with significant and clinically meaningful reductions in urinary symptoms. Urgency and urgency incontinence episodes appear more responsive than absolute frequency. The side effect profile can be predicted from the mode of action of BoNT-A and includes voiding difficulty and urinary tract infection. Few data exist comparing the efficacy and safety of different doses, nor directly comparing the two common preparations, onabotulintum toxin A with apobotulinum toxin A. The cost-effectiveness of BoNT-A remains to be fully evaluated.Conclusions
BoNT-A is an emerging treatment for overactive bladder and detrusor overactivity. The data available to date are of moderate quality with few large randomised trials. However, the drug appears to be effective and safe, although further work is required to identify the most cost-effective dose and treatment interval for maximum benefit. 相似文献7.
《British journal of medical & surgical urology》2012,5(4):169-173
ObjectiveTo report our experience of intravesical botulinum toxin for idiopathic overactive bladder syndrome (OAB) without detrusor overactivity (DOA) on urodynamic assessment.Patients and methodsData regarding presentation, diagnosis, urodynamic findings, date and dose of treatment, and outcomes were recorded prospectively for 94 patients undergoing intravesical botulinum toxin injection for idiopathic overactive bladder syndrome at our institution. The cohort included 19 patients without DOA on urodynamics. A positive response to treatment was defined as patient-reported improvement without the need for further treatment. ICIQ-OAB and UI scores, and bladder diary parameters were also recorded. Rates of urinary retention requiring intermittent or indwelling catheterisation were noted.ResultsThe overall response rate to treatment was 82% (n = 94). Patients without DOA (n = 19) had a response rate of 89%, which compared favourably with a response rate of 81% in patients with DOA (n = 75).Overall, 29% of patients who were voiding normally prior to treatment required intermittent self-catheterisation after the procedure. The requirement for self-catheterisation did not appear to be influenced by urodynamic findings.ConclusionThese preliminary, non-randomised data suggest that intravesical botulinum toxin injection may be efficacious in patients with OAB symptoms without DOA. Further evaluation by means of a randomised, controlled trial is suggested. 相似文献
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Introduction and hypothesis The aim of this study was to assess whether prolapse repair affects voiding and whether this results in the resolution of
overactive bladder syndrome (OAB).
Methods Forty women with OAB and detrusor overactivity together with anterior wall prolapse who underwent a repair between 2003 and
2007 were studied. Each woman was assessed pre-operatively and post-operatively with a clinical assessment and cystometry.
Patients were divided into those who experienced resolution of their OAB symptoms and those with persistent OAB symptoms.
Wilcoxon matched pairs signed rank test was used to assess any change in flow rates between these groups.
Results Resolution of OAB was associated with a significant increase (p = 0.049) in the maximum flow rate.
Conclusion Improvement in voiding function may be important in symptom resolution in women with OAB and prolapse.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
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Stephen Garnett Lucy Swithinbank Julie Ellis‐Jones Paul Abrams 《BJU international》2009,104(7):948-953
OBJECTIVES
To assess the long‐term natural history of overactive bladder (OAB) symptoms due to idiopathic detrusor overactivity (IDO) in women.PATIENTS AND METHODS
Original urodynamic traces were reviewed and women who were referred with OAB symptoms and found to have IDO on investigation in our urodynamic unit ≥10 years previously were invited for a repeat urodynamic and symptomatic assessment.RESULTS
In all, 174 women were identified and invited to participate; 53 had repeat urodynamics, another 32 attended the unit for symptom assessment and a further 23 completed postal questionnaires. There were no significant symptomatic or urodynamic differences between these groups at baseline. Of the 53 who had repeat urodynamics, 46 (88%) had persistent symptomatic IDO.CONCLUSIONS
OAB symptoms have a significant effect on the quality of life of those affected. OAB symptoms due to IDO in women are persistent, lasting for ≥10 years in 88% of this study population. This information might affect the treatment choices made by patients and their doctors in the management of this condition. 相似文献12.
Vírseda Chamorro M Salinas-Casado J Zarza-Luciañez D Méndez-Rubio S Pelaquim H Esteban-Fuertes M 《Actas urologicas espa?olas》2012,36(1):37-41
ObjectivesThe functional symptoms of the filling phase and detrusor overactivity are two inter-related dysfunctions of the lower urinary tract. We have aimed to study the participation of the lesion of the pudendal nerve in both urinary dysfunctions.Material and methodsA cross-sectional cutoff study in a series of 108 women was carried out. The study consisted in the questioning on the presence of functional symptoms of the lower urinary tract, cystomanometry and determination of peripheral pudendal nerve latency time, selective electromyography of the external anal sphincter and determination of the sacral reflex latency time.ResultsA tendency was observed towards significance between the presence of pollakiuria amplitude of motor unit potentials (greater in presence of pollakiuria) and the presence of urgency-incontinence and time of sacral latency (greater in the presence of urge incontinence) and a significant relation between the score on the King's Health Questionnaire and peripheral pudendal nerve latency time. Regarding detrusor hyperactivity, greater sacral latency time was observed in patients with overactivity with tendency towards significance.ConclusionsThere is a relation between pudendal innervation alterations and presence of symptoms in the filling phase and detrusor overactivity. This relation would explain the therapeutic action of the perineal rehabilitation on these dysfunctions. 相似文献
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目的探讨终末型逼尿肌过度活跃患者的尿动力学表现。方法回顾性分析73例尿动力学检查证实为逼尿肌过度活跃患者的尿动力学检查结果,男57例,女16例,平均(51±29)岁,包括梗阻性期相型组(OPDO)18例、神经性期相型(NPDO)组17例、梗阻性终末型(OTDO)组23例和神经性终末型(NTDO)组15例。10例因上尿路疾病需要手术治疗而下尿路功能正常患者[男7例,女3例,平均(45±18)岁]为对照组。结果逼尿肌过度活跃各组最大膀胱压测定容量均显著低于对照组(480±120)ml,OTDO组(214±105)ml,显著低于OPDO组(354±146)ml,NTDO组(191±89)ml,显著低于NPDO组(328±155)ml。逼尿肌过度活跃各组膀胱顺应性显著低于对照组(35±19)ml/cmH2O,NTDO组(19±10.8)ml/cmH2O,显著高于NPDO组(12±6.7)ml/cmH2O。排尿前最大逼尿肌压力OTDO组(13±9)cmH2O,显著低于OPDO组(32±19)cmH2O,NTDO组(12±8)cmH2O,显著低于NPDO组(38±19)cmH2O。NTDO组上尿路扩张发生率(1/15)显著低于NPDO(7/17)组。梗阻性和神经性终末型逼尿肌过度活跃患者最大逼尿肌排尿压,最大尿流率时逼尿肌压力与对照组差异无统计学意义,但膀胱多不能完全排空,OTDO组排空效率在70%左右,显著低于NTDO组。结论终末型逼尿肌过度活跃患者膀胱多高度敏感,其无抑制逼尿肌收缩力接近于正常 相似文献
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A review of detrusor overactivity and the overactive bladder after radical prostate cancer treatment
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Nikesh Thiruchelvam Francesco Cruz Mike Kirby Andrea Tubaro Christopher R. Chapple Karl‐Dietrich Sievert 《BJU international》2015,116(6):853-861
There are various forms of treatment for prostate cancer. In addition to oncologic outcomes, physicians, and increasingly patients, are focusing on functional and adverse outcomes. Symptoms of overactive bladder (OAB), including urinary frequency, urgency and incontinence, can occur regardless of treatment modality. This article examines the prevalence, pathophysiology and options for treating OAB after radical prostate cancer treatment. OAB seems to be more common and severe after radiation therapy than after surgical therapy and even persisted longer with complications, suggesting an advantage for surgery over radiotherapy. Because OAB that occurs after radical prostate surgery or radiotherapy can be difficult to treat, it is important that patients are made aware of the potential development of OAB during counselling before decisions regarding treatment choice are made. To ensure a successful outcome of both treatments, it is imperative that clinicians and non‐specialists enquire about and document pretreatment urinary symptoms and carefully evaluate post‐treatment symptoms. 相似文献
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Insight into new potential targets for the treatment of overactive bladder and detrusor overactivity
Cerruto MA Asimakopoulos AD Artibani W Del Popolo G La Martina M Carone R Finazzi-Agrò E 《Urologia internationalis》2012,89(1):1-8
Although overactive bladder (OAB) and detrusor overactivity (DO) are not synonyms, they share therapeutic options and partially underlying physiopathological mechanisms. The aim of this overview is to give insight into new potential targets for the treatment of OAB and DO. A narrative review was done in order to reach this goal. Ageing, pelvic floor disorders, hypersensitivity disorders, morphologic bladder changes, neurological diseases, local inflammations, infections, tumors and bladder outlet obstruction may alter the normal voluntary control of micturition, leading to OAB and DO. The main aim of pharmacotherapy is to restore normal control of micturition, inhibiting the emerging pathological involuntary reflex mechanism. Therapeutic targets can be found at the levels of the urothelium, detrusor muscles, autonomic and afferent pathways, spinal cord and brain. Increased expression and/or sensitivity of urothelial-sensory molecules that lead to afferent sensitization have been documented as a possible pathogenesis of OAB. Targeting afferent pathways and/or bladder smooth muscles by modulating activity of ligand receptors and ion channels could be effective to suppress OAB. 相似文献
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Kanagarajah P Ayyathurai R Caruso DJ Gomez C Gousse AE 《International urology and nephrology》2012,44(1):91-97
Background
To evaluate the efficacy of intradetrusor botulinum toxin-A (BTX-A) in idiopathic overactive bladder patients (OAB) refractory to anti-muscarinic therapy, without detrusor overactivity (DOA) on urodynamics. 相似文献18.
Shiu‐Dong Chung Bin Chiu Hann‐Chorng Kuo Yao‐Chi Chuang Chung‐Cheng Wang Zhonghong Guan Michael B. Chancellor 《BJU international》2010,105(5):668-672
Study Type – Diagnostic (case series)Level of Evidence 4
OBJECTIVE
To determine the clinical usefulness of measuring detrusor wall thickness (DWT) as a noninvasive test in women with overactive bladder (OAB).PATIENTS, SUBJECTS AND METHODS
We prospectively enrolled 122 women with dry OAB, wet OAB, and women with no OAB symptoms (control group). A 3‐day voiding diary was used to differentiate between wet and dry OAB. Transabdominal ultrasonography (TAUS) measurements of DWT were taken at bladder volumes of 250–300 mL and the maximal bladder capacity by both catheter‐ and natural‐filling. Video‐urodynamic studies (VUDS) were used to classify bladder dysfunction in 88 of the women.RESULTS
The mean (range) age of the women was 58 (20–94) years. There were 39 ‘normal’ controls, 44 women had dry OAB, and 39 had wet OAB. Of the 88 women who had VUDS, 28 had a ‘normal’ test, 30 had increased bladder sensation (IBS), and 30 had detrusor overactivity (DO). The mean DWT at 250–300 mL among three symptomatic subgroups or urodynamic subgroups showed no significant difference by either catheter‐ or natural‐filling methods. The women with wet OAB had significantly greater DWTs than the controls at maximal bladder volume. The maximal bladder capacity was significantly greater in ‘normal’ women than in those with OAB. If we corrected maximal bladder volume to 250 mL, DWT at corrected 250 mL showed no significant difference among three symptomatic subgroups.CONCLUSIONS
DWT measured by TAUS in women with OAB and without OAB was not different and did not differ with urodynamic status. Thus, TAUS measurement of DWT is not recommended as a useful diagnostic test for DO in women with OAB. 相似文献19.
PURPOSE: The overactive bladder is a widespread medical condition with significant impact on quality of life. We review the existing evidence about the prevalence, impact and long-term followup of the overactive bladder. We also summarize the new International Continence Society terminology associated with the overactive bladder. MATERIALS AND METHODS: A MEDLINE search of all available literature regarding the epidemiology and long-term followup or outcome of the overactive bladder was performed. All articles and relevant resources cited in those articles were reviewed. RESULTS: The new International Continence Society terminology and definitions will allow greater consistency in future research. Two large, recently published surveys of the prevalence of overactive bladder give new insight into the widespread nature of the problem and its significant impact on quality of life. There is little good quality evidence currently available on the long-term outcome of overactive bladder. CONCLUSIONS: There is little published evidence regarding the natural history of overactive bladder. While recent studies have improved understanding the prevalence of the condition, we still know little about long-term outcome. The few published studies suggest that it is a chronic condition that persists urodynamically and symptomatically. 相似文献
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Eric Rovner Roger Dmochowski Christopher Chapple Catherine Thompson Wayne Lam Cornelia Haag‐Molkenteller 《Neurourology and urodynamics》2013,32(8):1109-1115