Cryptorchidism and overactive bladder.
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Journal Article↗
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Results for “overactive bladder”
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What is the Effect of Overactive Bladder Medication on Sleep?
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Journal Article↗
Management of overactive bladder with transdermal oxybutynin.
In clinical trials, transdermal oxybutynin (OXY-TDS) has shown comparable efficacy and improved tolerability when compared with conventional pharmacotherapy. Systemic anticholinergic adverse effects are comparable to those with placebo, most likely owing to avoidance of first-pass hepatic metabolism and conversion of oxybutynin to N-desethyloxybutynin. OXY-TDS has predictable pharmacokinetic absorption and elimination parameters, as shown in both in vitro and in vivo studies. Consistent plasma concentrations of oxybutynin avoid labile peak and trough concentrations seen with immediate-release formulations, paralleling extended-release drug delivery. This novel drug delivery system has unique dermatologic skin application site reactions, including erythema and pruritus. Skin reactions are usually mild and can be minimized by varying the site of patch application. Most eczematous dermatologic reactions can be appropriately treated with a moderately potent topical corticosteroid cream. A small percentage of patients will discontinue therapy as a result of bothersome application site skin reactions.
Journal Article↗
Health care usage, botulinum toxin for overactive bladder.
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Journal Article↗
The Overactive Bladder: From Basic Science to Clinical Management Consensus Conference. Proceedings. London, England, June 29, 1997.
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Humans↗
Tolterodine for overactive bladder.
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Benzhydryl Compounds↗
Does anticholinergic medication have a role for men with lower urinary tract symptoms/benign prostatic hyperplasia either alone or in combination with other agents?
PURPOSE OF REVIEW: A substantial proportion of men with lower urinary tract symptoms have a combination of both 'storage' and 'voiding' symptoms, suggesting possible coexisting bladder outlet obstruction and bladder overactivity. Bladder overactivity is traditionally treated with anticholinergic drugs. However, guidelines from the European Association of Urologists make no mention of the possible therapeutic role of anticholinergic drugs for treating storage symptoms in such patients. It is a common perception that using an anticholinergic drug in men with bladder outlet obstruction runs the risk of inducing acute urinary retention, because of the inhibitory effect of anticholinergics on bladder contraction in the presence of outlet obstruction. This review focuses on recent data determining the efficacy of anticholinergic medication in men with lower urinary tract symptoms/benign prostatic hyperplasia and the associated risk of acute urinary retention. RECENT FINDINGS: One recent study in men with urodynamically confirmed obstruction supports the assertion that anticholinergic drugs are safe in men with bladder outlet obstruction. Safety data from larger studies using anticholinergics in patients with overactive bladders supports these findings. SUMMARY: Efficacy and safety studies of anticholinergic medication in men with lower urinary tract symptoms/benign prostatic hyperplasia are few and far between, but preliminary data suggests they are not associated with a substantial risk of urinary retention nor with a substantial increase in residual urine volume.
Aged↗
[Application of intraurethral catheter for geriatric male patients complaining of urethral obstruction due to malignancy--comparison with benign prostatic hypertrophy].
Intraurethral catheters (IUC) were used for elderly male patients with prostatic urethral obstruction (PUO) due to malignancy (MA) and benign prostatic hypertrophy (BPH). Thirty-three men complaining of urinary retention in spite of medical therapy at the risk for prostatic surgery underwent insertion of IUC (16Fr Puroflex, Angiomed Co., Ltd., Germany). Six of 33 were patients with PUO due to MA (5 prostatic cancer, and 1 urethral invasion of rectal cancer, mean 82.7 years old), and the other 27 were patients with BPH (average 80.1 years old). Follow-up period of the former ranged from 2 to 9 (mean 6.5) months, and that of the latter ranged from 6 to 23 months. Water filling cystometry (CMG) before the insertion of IUC and fluoroscopic voiding cystourethrography (VCU) just after insertion of IUC were performed. We defined normal CMG and normal VCU as normal bladder, overactive CMG and normal VCU as overactive bladder, and normal or poor sensitive CMG and underactive VCU as underactive bladder. Five of 27 BPH patients had previous prostatic operations (TUR-P, and/or balloon dilation), but 6 MA did not. All of MA (3 normal bladder, 2 overactive bladder, and 1 underactive bladder) voided satisfactorily, and average duration of IUC in place was 6.5 months without exchange of IUC. Although sixteen of 27 (59.3%) BPH patients voided satisfactorily, and average duration of IUC in place was 12.1 months without exchange of IUC, in the other 11 of these 27 BPH patients were removed IUC, and average duration of IUC in place was 4.7 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Nighttime dosing with tolterodine reduces overactive bladder-related nocturnal micturitions in patients with overactive bladder and nocturia.
OBJECTIVES: To evaluate the efficacy and tolerability of nighttime tolterodine dosing on urgency-related micturitions in patients with overactive bladder (OAB) and nocturia. METHODS: This was a 12-week randomized controlled study of 850 patients given 4 mg tolterodine extended release (TER) or placebo once daily 4 hours or less before bed. Patients with eight or more micturitions/24 hours and a mean of 2.5 episodes/night or more were included. Changes in the number of nighttime and 24-hour micturitions were analyzed by urgency rating per micturition. The urgency per micturition was recorded in 7-day diaries using a 5-point rating scale (score 1 to 5). Each micturition was classified according to the following urgency rating categories: total (1 to 5), non-OAB (1 to 2), or OAB (3 to 5). OAB-related micturitions were further classified as nonsevere (score 3) and severe (score 4 to 5). RESULTS: TER reduced the total number of nocturnal micturitions, but, compared with placebo, this difference was not statistically significant. However, TER did significantly reduce OAB-related and severe OAB-related nocturnal micturitions compared with placebo. TER had no effect on non-OAB micturitions. TER significantly reduced the total, OAB, and severe OAB micturitions during 24-hour and daytime intervals compared with placebo. Significantly more TER-treated than placebo-treated patients reported a treatment benefit and willingness to continue treatment. Adverse events associated with nighttime dosing of TER versus placebo were few. CONCLUSIONS: TER significantly reduced OAB-related micturitions during 24-hour, daytime, and nighttime intervals. TER did not affect normal (non-OAB) micturitions. Nighttime dosing with TER was associated with few adverse events and adverse event-related withdrawals. The 24-hour efficacy of TER was maintained with nighttime dosing.
Benzhydryl Compounds↗
Treatment of nocturia in the elderly.
The aging process, behavioural habits and a multitude of pathological conditions are the main contributors to the development of nocturia in the elderly. Age-related physiological changes can alter the regular pattern of urine excretion and lead to increased nocturnal frequency of voiding. In addition, aging is associated with anatomical and physiological changes of the urinary tract itself that predispose to increased urinary frequency without affecting urine volume. Several urinary and extra-urinary tract conditions may have nocturia as a prominent symptom. These conditions can be grouped as those associated with bladder overactivity, bladder outlet obstruction, bladder hypotonicity and an increased urine volume. A detailed assessment that gathers clues from the medical history, physical examination and laboratory is of utmost importance in identifying the specific causes. Overactive bladder can be idiopathic or associated with different triggers such as UTI, bladder stones, bladder tumours and CNS diseases that disrupt the normal inhibitory signals to the bladder. It may be cured by the successful elimination of the trigger conditions. Therapeutic modalities include behavioural therapies with scheduled voiding, anticholinergic drugs and in women the use of transvaginal electrical stimulation. Benign prostatic hyperplasia is the most common cause of bladder outlet obstruction in men. Different drug classes (e.g. peripheral alpha-adrenoceptor blockers and 5 alpha-reductase inhibitors) are now available for the treatment of mild to moderate symptoms. Surgery is reserved for patients with severe symptoms or with complications, with new and less invasive surgical techniques being preferred. Bladder hypotonicity is usually caused by peripheral neuropathies, spinal cord lesions and the indiscriminate use of drugs with anticholinergic actions. Treatment involves discontinuation of implicated drugs, short term use of cholinergic drugs and urinary catheterisation. Increased urine volumes and nocturia are frequently seen in hyperosmolar and oedematous states. Excessive ingestion of fluids, caffeinated or alcoholic beverages are habits that commonly produce nocturia. Although more definitive studies are awaited, low dose loop diuretics given a few hours prior to bedtime and desmopressin nasal spray or tablets may be useful alternatives for the control of nocturic symptoms in elderly patients with nocturnal polyuria syndrome. Whenever nocturia is present, clinicians should try to identify its causes by means of a thorough history, physical examination and pertinent complimentary tests. Once the specific cause or causes are found, most cases can be satisfactorily managed with behavioural, pharmacological or surgical therapies.
Aged↗
[Trospium chloride in the treatment of idiopathic and neurogenic detrusor overactivity].
The aim of the study was to investigate safety and efficacy of spasmex (trospium chloride) in patients with idiopathic and neurogenic detrusor overactivity. The study included 66 patients with idiopathic and neurogenic detrusor overactivity. The diagnostic scheme consisted of voiding dairy for 72 hours, laboratory tests, ultrasound investigation with measurement of residual urine volume, urodynamic investigation and neurologic examination. The patients were divided into 4 groups: 15 patients with idiopathic detrusor overactivity (DOA), 16 with neurogenic DOA, 23 with combination of DOA with benign prostatic hyperplasia, 12 with overactive bladder without DOA. Initial trospium chloride dose of 15 mg/day (5 mg 3 times a day) followed by dose titration to obtain clinical efficacy was used under residual urine volume control every week. The maximal dose was 45 mg. After 12 weeks reduction of micturation frequency was registered in all the groups. Administration of small dose trospium chloride (15 mg) resulted in subjective improvement in 63 (94.5%) patients. Only 3 patients persisted with the symptoms in whom the dose was raised to 30 mg and then to 45 mg/day. Thus, spasmex demonstrated high efficacy in patients with bladder overactivity. High efficacy and safety with low cost make spasmex a drug of choice in the majority of patients with overactive bladder symptoms.
Adolescent↗
Effect of the ATP-sensitive potassium channel opener ZM226600 on cystometric parameters in rats with ligature-intact, partial urethral obstruction.
The activity of a recent K(ATP) channel opener, the N-(4-Phenylsulfonylphenyl)-3,3,3-trifluoro-2-hydroxy-2-methylpropionamide (ZM226600) was investigated on a female rat model of overactive bladder with outlet obstruction. Both ZM226600 and pinacidil instilled into the bladder (10(-7) M, 30 min) or following systemic administration (10, 100 nmol/kg e.v.) almost completely abolished bladder overactivity and improved residual volume and frequency of micturition. However, pinacidil affected arterial pressure. Oxybutynin instilled into the bladder (10(-7), 10(-6), 10(-5) M, 30 min) decreased detrusor overactivity by about 16%, 25% and 46% respectively, but also blocked micturition reflexes at highest doses tested. Oxybutynin reduced detrusor overactivity by about 50% and 80%, after systemic administration (10, 100 nmol/kg e.v.), but also blocked micturition reflexes at the highest dose tested. In conclusion, ZM226600 is more active than oxybutynin in reducing bladder overactivity, and it is devoid of vascular side effects observed with pinacidil. Its short duration of action (about 1 h) is probably the main problem to solve, in order to consider this compound a valid alternative to antimuscarinics in the therapy of bladder overactivity.
Adenosine Triphosphate↗
The overactive bladder-symptom composite score: a composite symptom score of toilet voids, urgency severity and urge urinary incontinence in patients with overactive bladder.
PURPOSE: To our knowledge there is no index in urology that yields a single, quantifiable and clinically interpretable measure of overactive bladder (OAB) symptoms, including urgency, 24-hour voiding frequency and urge urinary incontinence (UUI). Urgency is the most difficult of these symptoms to measure. The Indevus Urgency Severity Scale (Indevus Pharmaceuticals, Lexington, Massachusetts) was recently developed and validated to capture urgency severity per toilet void. The scale has been combined with 24-hour frequency and UUI episodes to create the OAB Symptom Composite Score (OAB-SCS). We present this composite score. MATERIALS AND METHODS: Two multicenter trials were performed to determine the effects of trospium chloride given as 20 mg tablets vs placebo. A total of 1,157 patients, including 581 who received placebo and 576 who received trospium, were randomly assigned to treatment. Daily OAB-SCS totals were obtained for each patient for each day during the 7-day diary collection period for every visit. RESULTS: The average baseline OAB-SCS value was 36. The mean change from baseline in the trospium and placebo groups was 5 and 1 OAB-SCS points in patients with mild OAB, 10 and 5 in patients with moderate OAB, and 13 and 9 in patients with severe OAB, respectively. CONCLUSIONS: The OAB-SCS discriminated between placebo and pharmacologically treated (trospium chloride) patients with OAB in this study. The OAB-SCS is an improvement over individual symptoms alone. It is easy to implement and interpret and it will prove to be a clinically relevant tool in clinical trials in which patient diary data are captured.
Benzilates↗
Capsaicin receptor VR1 and ATP-gated ion channel P2X3 in human urinary bladder.
OBJECTIVES: To determine the presence, distribution and molecular forms of the vanilloid receptor VR1, and confirm the presence and distribution of the ATP-gated ion channel P2X3 in the human urinary bladder. Materials and methods Normal urinary bladder tissues were obtained at postmortem from four subjects. Eight urinary bladder biopsies were also taken from patients with detrusor hyper-reflexia treated with intravesical resiniferatoxin. The specimens were studied using affinity-purified specific antibodies to VR1 and P2X3 by Western blotting and immunocytochemistry, and compared with immunostaining using antibodies to the pan-neuronal marker PGP 9.5 and Schwann cell marker S-100. RESULTS: VR1- and P2X3-immunoreactive fine nerve fibres were scattered throughout the suburothelium of the normal bladder and cystoscopic biopsies, and traversed the muscle layer. They had a similar distribution to PGP 9.5-immunoreactive fibres, but there were fewer, suggesting localization in subsets of axons. Western blot studies showed an expected 100-kDa VR1 protein and a P2X3-immunoreactive 66-kDa protein. Conclusion VR1 and P2X3 are present in the human urinary bladder and may contribute to distinct pathophysiological states of bladder overactivity, in accord with their differential expression in sensory neurones. Intravesical vanilloids act via VR1 and are effective in the treatment of detrusor hyper-reflexia. P2X3 may represent a selective therapeutic target for other causes of overactive bladder.
Adenosine Triphosphate↗
[Spasmex treatment of patients with hyperactive urinary bladder].
Overactive urinary bladder (HAUB) is encountered in 16-20% patients with various voiding disorders. Etiologically, detrusor hyperactivity can be neurogenic and idiopathic. We studied efficacy of the antimuscarine drug spasmex in patients with imperative voiding disorders and compared its efficacy and tolerance with those of driptan and detrusitol. 193 female patients with imperative voiding disorders were examined. Spasmex given in a dose of 5 mg 3 times a day for 12 weeks produced a good effect in 56 patients: increased the effective capacity of the urinary bladder, reduced the number of voidings and episodes of incontinence for a day. A 3-month course of spasmex proved highly effective as shown by the patients' subjective response and positive changes in objective evidence. Being equally effective with detrusitol and driptan, spasmex is much superior to oxibutynin in safety.
Benzhydryl Compounds↗
Increased leukotriene and prostaglandin release, and overactivity in the chronically ischemic bladder.
PURPOSE: Chronic ischemia has been shown to alter bladder contractility. We studied the roles of cyclooxygenase (COX) and lipoxygenase products in ischemia induced bladder overactivity in the rabbit. MATERIALS AND METHODS: A total of 28 male New Zealand White rabbits were divided into 2 groups. In group 1 atherosclerotic occlusion of the iliac arteries was induced by balloon endothelial injury, followed by a short period of a high cholesterol diet. Group 2 received a regular diet alone. After 12 weeks blood flow measurements and cystometry were performed. Bladder tissues were processed for enzyme immunoassay of leukotrienes and prostaglandins (PGs), Western blotting of COX and lipoxygenase, isometric tension measurement and histology. RESULTS: Atherosclerotic occlusion of the iliac arteries significantly decreased bladder blood flow. Moderate ischemia caused bladder overactivity, while severe ischemia inhibited bladder contractions. Ischemia increased leukotriene B4, E4 and C4 release by 141%, 132% and 254%, and increased PG F2alpha and thromboxane A2 release by 95% and 93%, respectively, although it did not alter PG E2 release. Western blotting showed increased 5-lipoxygenase, COX-1 and COX-2 protein levels in ischemic bladder tissues. Moderate ischemia increased bladder smooth muscle contraction in response to carbachol and electrical field stimulation. Tissue treatment with the COX inhibitor indomethacin significantly increased control tissue contraction but had no effect on ischemic tissues. Treatment with the 5-lipoxygenase inhibitor REV5901 abolished this effect of indomethacin in control tissues. Treatment with REV5901 significantly decreased the contraction of ischemic tissues but had no significant effect on control tissues. The effect of indomethacin plus REV5901 was similar to the effect of REV5901 alone. Histology showed urothelial thickening and mild fibrosis in the moderately ischemic bladder. CONCLUSIONS: Chronic ischemia increased bladder 5-lipoxygenase, and COX-1 and COX-2 protein expression, and altered leukotriene and PG production. Treatment with COX and lipoxygenase inhibitors produced completely different effects in the ischemic bladder compared with the control bladder. Functional changes in the ischemic bladder were concurrent with structural changes in the urothelium. PGs modulate smooth muscle contractility in the healthy bladder. However, under ischemic conditions leukotrienes dominate bladder tone and appear to have a leading role in increased smooth muscle contraction and bladder overactivity.
Animals↗
Long-term efficacy and predictive factors of full spectrum therapy for nocturnal enuresis.
PURPOSE: We determine the effect and predictive factors of relapse 1 year after combination therapy of an enuresis alarm, bladder training, motivational therapy and retention control training for nocturnal enuresis. MATERIALS AND METHODS: In 68 of 77 children the relapse rate 1 year after full spectrum therapy for nocturnal enuresis was investigated. Gender, age, sleep arousal, family history, monosymptomatic, bladder capacity, overactive bladder, nighttime polyuria, duration of treatment, over learning and psychosocial factors were investigated. RESULTS: The relapse rate during the whole year was 50%, with 33.8% of subjects being dry and 16.2% sometimes wet. The relapse rate after 1 year was 16%. Nine patients could not be reached and, thus, were considered dropouts. Only overactive bladder and psychosocial problems were significantly related to relapse. CONCLUSIONS: The relapse rate during the year was high while the relapse rate after 1 year was low. Psychosocial problems and overactive bladder were the only 2 predictive factors for relapse.
Adolescent↗
Nonpharmacologic treatments for overactive bladder-pelvic floor exercises.
The theory behind the use of physical therapies (electrical stimulation or pelvic floor muscle [PFM] training with or without biofeedback) for overactive bladder is to (1) inhibit detrusor muscle contraction by voluntary contraction of the PFMs at the same time as the urge to void; and (2) prevent sudden falls in urethral pressure by a change in PFM morphology, position, and neuromuscular function. Few trials have evaluated the effect of PFM training on symptoms of overactive bladder. Most studies are flawed because they include several diagnoses and treatment modalities in the same intervention. Because of the lack of evidence, no firm conclusion can be drawn on the effect of PFM exercise on overactive bladder. There are some initially promising results, but there is still a need for high-quality, randomized controlled trials on the effect of PFM training on the inhibition of detrusor contraction in human beings. The efficacy of PFM training in combination with other treatments, such as pharmacotherapy, also requires investigation.
Exercise Therapy↗