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At least 217 records · Page 12Linked to original sources
PubMed2003

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.

Algorithms↗
PubMed2006

Games as an innovative teaching strategy for overactive bladder and BPH.

A challenge for urologic nurses and nurse educators is how to present information to staff, students, and patients in a way that will capture their interest and engage them in the learning process. The use of adult-learning principles and innovative teaching strategies can make the learning experience dynamic, and encourage learners to take a more active role in their own learning. Games are a creative, fun, and interactive way to assist in the emphasis, review, reinforcement, and retention of information for urology nurses.

Humans↗
PubMedDate not supplied

Estimating the annual cost of overactive bladder in Indonesia.

AIM: to estimate the annual economic cost and quality of life related to OAB in Indonesia population by taking into account the direct cost, value of lost productivity and cost consequences associated with OAB. METHODS: cross sectional study was done in Geriatric Clinic and Urogynaecology Clinic in Dr. Cipto Mangunkusumo Hospital Jakarta from July 2005 to March 2006. Primary outcome of this study was annual cost of OAB, symptom and quality of life of OAB patients. Cost data related to personal routine care of OAB and transportation expenditures were obtained by using questionnaires modified from Dowell Bryant incontinence cost index validated questioner. Data related to quality of life were obtained by OAB-q questioner. Subjects included 30 male and female OAB patients aged 18-100 years. RESULTS: most of patients were female (96.7%). Median of age was 62.5 (30-93) years old, 56.7% patients were elderly (age more than 60 years). Median of total annual cost of OAB was Rp. 2,850,000,-. Median of total personal cost which consist of routine personal care costs and treatment costs were Rp. 2,850,000. Median of total cost which is expended by government for routine personal and treatment of OAB was Rp.2,500,000,- . Median score of symptom severity was 62.5. Quality of life score was divided into coping, concern, sleep, and social item. Median of coping score was 50.0, concern score was 43.1, sleep score was 50.8, and social score was 38.8. Median of total quality of life score was 44.7. Maximum score of symptom severity and quality of life should be 98.8. The higher the score, the more severe the symptom, but the better is the quality of life. CONCLUSION: total annual cost of OAB was Rp. 2,850,000, Quality of life of OAB patient was somewhat poor.

Adolescent↗
PubMed2006

[Chemical destruction of sacral nerve roots by alcohol injection for the treatment of overactive bladder].

INTRODUCTION: This study retrospectively reviewed the value of alcohol injection of sacral nerve roots after a lidocaine test in two indications: detrusor instability-detrusor hyperactivity syndrome and cystalgia. MATERIAL AND METHODS: Single-centre retrospective study from January 1992 to March 2003. Twenty-eight patients (1 man, 27 women) were admitted to the urology department for lidocaine test injection because of detrusor hyperactivity 24 cases (idiopathic = 13, neurological = 11), and cystalgia in another 4 cases. RESULTS: After the lidocaine test, infiltration of the sacral nerve roots (bilateral S3) by 70% alcohol was performed in 24/28 cases. The therapeutic effect was assessed at 1 month: 14 out of 24 patients reported that they were globally improved by the alcohol injection. The mean duration of the therapeutic effect was 3.8 months. In the longer term, only one of the 14 patients initially improved did not subsequently experience deterioration of the clinical features (with a follow-up of 8 months). A second alcohol injection was performed in 5/28 patients, with a positive result in only one case (4%). COMPLICATIONS: 6/24 (25%) patients developed lower limb pain that resolved over 2 to 3 months; 3/24 (12%) presented immediate postoperative urinary retention (that persisted in the long term in 1 case); 1/24 (4%) presented cicatricial anal incontinence. CONCLUSION: Alcohol injection of sacral nerve roots is a simple and inexpensive technique, but is associated with morbidity, and has inconstant and only transient effects. It can only be considered exceptionally in highly selected cases when no more effective treatments are available, such as botulinum toxin injection or sacral nerve root neuromodulation.

Adult↗
PubMed2001

The overactive bladder in children: a potential future indication for tolterodine.

OBJECTIVE: To determine the safety, efficacy and pharmacokinetics of tolterodine in children with an overactive bladder. PATIENTS AND METHODS: Thirty-three children (20 boys and 13 girls, aged 5-10 years) with an overactive bladder and symptoms of urgency, frequency and/or urge incontinence were enrolled in an open, dose-escalation study. Patients were treated with oral tolterodine 0.5 mg (n = 11), 1 mg (n = 10) or 2 mg (n = 12) twice daily for 14 days. The primary safety endpoint was the change in residual urinary volume, as determined by ultrasonography. In addition, voiding diary variables (frequency and incontinence episodes) and pharmacokinetics were evaluated. Other safety endpoints included laboratory variables, electrocardiogram recordings and reported adverse events. RESULTS: There were no safety concerns in terms of the change in residual urinary volume for any of the three dosage groups; values were comparable with baseline after 2 weeks of treatment for all three dosages. Adverse events were reported by 20 patients (six on 0.5 mg, five on 1 mg, and nine on 2 mg). Most adverse events were not considered to be drug-related; of the 13 possibly related events, 10 occurred in those taking 2 mg. Headache was the most commonly reported adverse event. No serious adverse events were reported and there were no general safety concerns. There was an improvement in voiding diary variables in all treatment groups after 2 weeks of treatment, although the efficacy was greatest in those taking 1 mg and 2 mg. Pharmacokinetic findings were consistent with dose linearity over the range 0.5-2 mg. CONCLUSION: The results support the use of 1 mg twice daily as the optimal dose of tolterodine for treating children aged 5-10 years with an overactive bladder.

Administration, Oral↗
PubMed2006

[Overactive bladder syndrome. Are there indications for surgical therapy?].

Conservative therapeutic options are considered the gold standard in therapy of overactive bladder syndrome. However, surgery may be beneficial in selected cases. Neuromodulation is well established in clinical practice. If conservative or minimally invasive therapy fails, augmentation techniques or urinary diversion may be considered. This review presents the current knowledge about surgical treatment options for idiopathic overactive bladder.

Cystectomy↗
PubMed2006

Effect of antimuscarinic drugs used for overactive bladder on learning in a rat passive avoidance response test.

Antimuscarinic drugs are used for the treatment of overactive bladder. One adverse effect associated with their use, however, is cognitive impairment arising from their anticholinergic action. Here, we examined the effects of antimuscarinic drugs on learning using a passive avoidance task in rats. Drugs were intravenously administered 10 min before an acquisition trial, followed 24 h later by measurement of latency time in the passive avoidance task in a retention trial. Oxybutynin (0.1-1 mg/kg i.v.), propiverine (1-10 mg/kg i.v.) and scopolamine (0.1-1 mg/kg i.v.) impaired learning at doses of 0.3 mg/kg i.v. or more, 10 mg/kg i.v., and 0.3 mg/kg i.v. or more, respectively. Tolterodine (0.1-1 mg/kg i.v.) tended to impair these functions at a dose of 1 mg/kg i.v. In contrast, darifenacin (0.1-1 mg/kg i.v.) and solifenacin (0.3-3 mg/kg i.v.) showed no impairment of these functions. We also examined the effects of antimuscarinic drugs on learning enhanced by the cholinesterase inhibitor donepezil at a dose of 0.1 mg/kg i.v. in scopolamine-treated rats. Oxybutynin (0.1-1 mg/kg i.v.) impaired these donepezil-enhanced functions, whereas solifenacin (0.3-3 mg/kg i.v.) produced no significant impairment. These results suggest that antimuscarinic drugs such as darifenacin, solifenacin and tolterodine may have less effect on cognitive function in the treatment of patients with overactive bladder.

Animals↗
PubMed2002

Tolterodine: as effective but better tolerated than oxybutynin in Asian patients with symptoms of overactive bladder.

BACKGROUND: This double-blind, multicenter study compared the efficacy and tolerability of tolterodine (Pharmacia, Los Angeles, USA) with that of oxybutynin (Alza, Palo Alto, USA) in Asian patients with overactive bladder. METHODS: Two-hundred-and-twenty-eight adults with overactive bladder symptoms were randomized to receive tolterodine 2 mg twice daily (bid) (n = 112) or oxybutynin 5 mg bid (n = 116). After 8 weeks' treatment, changes in micturition diary variables, patients' perception of treatment benefit, and tolerability endpoints were determined. RESULTS: The mean (+/- SD) number of micturitions/24 h decreased by 2.6 +/- 2.9 (-21%) with tolterodine and 1.8 +/- 4.2 (-15%) with oxybutynin (both P = 0.0001 vs baseline). The mean number of incontinence episodes/24 h decreased by 2.2 +/- 2.3 (-85%) in the tolterodine group and by 1.4 +/- 1.8 (-58%) in the oxybutynin group (both P = 0.0001 vs baseline). Patient perception of treatment benefit was over 70% in each treatment group. Adverse events were significantly lower in the tolterodine group compared with oxybutynin-treated patients (55% vs 82%; P = 0.001). Dry mouth was reported by significantly fewer patients on tolterodine, compared with oxybutynin (35% vs 63%; P = 0.001) and withdrawals due to adverse events were lower in the tolterodine group than with those treated with oxybutynin (10% vs 16%). There were no safety concerns. CONCLUSIONS: Tolterodine 2 mg bid is equally or more effective than oxybutynin 5 mg bid in the treatment of Asian patients with overactive bladder, and shows significantly better tolerability. This may enhance compliance during long-term treatment.

Adult↗