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PubMed2005

[Increase in number of operations for stress urinary incontinence].

Since the introduction of the minimally invasive tension-free vaginal tape (TVT) the number of operations performed for treatment of stress urinary incontinence has increased dramatically from over 1600 in 1999 to more than 4200 in 2003. Both gynaecologists and urologists now perform more TVTs and fewer Burch colposuspensions and Marshall-Marchetti-Krantz operations. This increase was apparent before data from proper studies on the effectiveness of the TVT were available. With the increasing popularity of a new and more easily performed variant of the TVT, the transobturator tape, the number of operations is likely to increase further. Gynaecologists and urologists must remain critical in the recommendation of these operations, since complications such as urinary retention and overactive-bladder syndrome with urgency or urge incontinence are well known and difficult to treat. Pelvic-floor physiotherapy, which is accepted by gynaecologists, urologists and general practitioners, should remain the first-line treatment for stress urinary incontinence.

Female↗

PubMed2004

[Comparative study of tension-free vaginal tape and fascia lata for stress urinary incontinence].

OBJECTIVE: To compare the efficacy of surgically managing stress urinary incontinence (SUI) with tension-free vaginal tape (TVT) and autologous fascia lata pubovaginal sling (Lata). METHODS: Sixty-seven patients suffering from SUI entered this prospective study. The patients were divided into two groups randomly, 48 in TVT group and 19 in Lata group. The average follow-up time post-operation was 20 months in TVT group and 37 months in Lata group. RESULTS: The operating time was (27 +/- 5) min in TVT and (125 +/- 13) min in Lata. The volume of blood loss during surgery was: (27 +/- 6) ml in TVT and (67 +/- 11) ml in Lata. The post-operative recovery period in the hospital was: TVT, 1.8 days and Lata, 7.2 days. The differences between the two groups for these three parameters were statistically significant (P < 0.01). The 3-month cure rate post-operations was 94% (45/48) for TVT and 95% (18/19) for Lata. The surgical complications included 1 case of vesical perforation and 2 cases of overactive bladder in TVT group. CONCLUSIONS: TVT and Lata are both effective and safe surgical treatments for stress urinary incontinence. TVT has the benefits of being minimally invasive with a shorter operating time and a quicker recovery for the patients. A disadvantage is that the tape used in TVT is expensive, making the operation rather costly. Lata on the other hand is cheaper and may result in fewer complications, but the operation is not as easy for the patient.

Aged↗

PubMed2006

Nocturia in adults: draft New Zealand guidelines for its assessment and management in primary care.

Nocturia is a common bothersome condition. An ad hoc group of interested clinicians from a variety of backgrounds has developed draft guidelines for the assessment and management of this condition in primary care in New Zealand. The guidelines propose four steps in the assessment and management: clinical evaluation; simple investigations; assignment of a provisional diagnosis; and management based on the provisional diagnosis. For nocturnal polyuria-associated nocturia, the draft guidelines recommend that: lifestyle measures should be used as part of the management; if a patient complaining of nocturia has other features of overactive bladder, then bladder retraining and/or anticholinergics can be used; hypnosedatives should not be used to treat nocturia in older adults because of the increased risk of falls; loop diuretics given in the afternoon should be considered for the treatment; and desmopressin can be considered in the management of nocturnal polyuria associated nocturia but that it should be used cautiously in people aged over 65 because of the risk of hyponatraemia. A draft algorithm based on international guidelines is presented.

Adolescent↗

PubMed2006

[Vaginal prolapse and stress urinary incontinence: combined treatment by a single prosthesis].

OBJECTIVES: To evaluate the efficacy and possible short-term and medium-term complications of vaginal prosthetic surgery with transobturator fixation to treat prolapse and stress urinary incontinence (SUI) that are often associated in a single operation. MATERIAL AND METHOD: From February 2002 to August 2004, 45 patients with a mean age of 66 +/- 11 years presenting essentially stage 3 or 4 cystocele associated with SUI (documented for 40 cases and revealed by reduction of the prolapse for the other five) were operated according to the transobturator infracoccygeal sling technique. RESULTS: With a mean follow-up of 31 +/- 9 months, the success rate of the technique was estimated to be 98% anatomically (only one failure) and 91% in terms of urinary symptoms (73% of patients were cured, 18% were improved and 9% failed). No cases of urinary retention were observed, except for one patient with a secondarily infected pelvic haematoma requiring evacuation and the partial removal of the prosthesis. The mean residual urine on discharge was 83 ml. Two patients developed de novo overactive bladder The prostheses exposure rate was 18%. CONCLUSION: Combined treatment of vaginal prolapse and associated urinary incontinence is possible by the use of a single transvaginal prosthesis. The medium-term anatomical results are very good. The results on continence are good and a subsequent specific procedure is always possible in the case of failure or insufficient improvement. The prostheses exposure rate is similar to that observed with synthetic transvaginal prostheses.

Adult↗

PubMed2006

Pharmacology down under in 2005--focus on targets.

At the joint meeting of the Australasian Society of Clinical and Experimental Pharmacology and the Australasian Pharmaceutical Sciences Association, held December 4-7, 2005, in Melbourne, Australia, and other select meetings, drugs for the treatment of the overactive bladder, benign prostatic hyperplasia, cancer, stroke, pain, malaria and cardiovascular disease were discussed. During these discussions, the following possible drug targets were considered: urothelium-derived inhibitory factor, muscarinic receptors in the bladder, purinergic signaling, pacemaking cells in the urogenital tract, cannabinoid receptors in the prostate, vascular endothelial growth factor in cancer, the nonselective cation channel TPRV1 in pain, and angiotensin receptors, Rho kinase, connective tissue growth factor and NADPH oxidase in cardiovascular disease.

Asia↗

PubMed2006

[News in the pharmacological treatment of female urinary incontinence].

The article addresses the issue of pharmacological treatment of female urinary incontinence. It summarizes the two types of incontinence, i.e. stress urinary incontinence (SUI) and urgency incontinence, or even just urgency symptoms (overactive bladder--OAB). It focuses on the role of urethra in maintaining continence for women. The article covers new possibilities of pharmacological treatment of SUI with detailed analysis of the effects of a new drug--duloxetine (YENTREVE). In the second part, the article outlines the drugs most frequently used in the treatment of urgency incontinence or just urgency symptoms, mentioning new preparations and new forms of preparations already in use. It analyzes the effects of tolterodine (DETRUSITOL), oxybutinine (UROXAL) and solifenacine (VESICARE).

Female↗

PubMed2001

Future trends in the treatment of urinary incontinence.

Anticholinergic drugs act on efferent nerves to counteract overactive bladder (OAB) after it occurs. To prevent the occurrence of OAB, therapies should be directed at blocking the afferent nerves that control the bladder. Tachykinin-receptor antagonists hold great promise in this regard, since they can be administered orally and do not increase the risk of urinary retention that occurs with anticholinergics. Advanced drug delivery systems, such as controlled-release oral oxybutynin (oxybutynin-XL) can reduce the incidence of anticholinergic side effects. In a similar manner intravesical therapy for OAB is site specific, and thus also reduces the occurrence of adverse events. Moreover, the difficulties of intravesical therapy may now be overcome with advanced delivery techniques such as an implantable, long-acting drug-delivery pump. Another intravesical therapy that has met with great acceptance and success is the administration of chili pepper extracts, especially resiniferitoxin, which may be effective for up to 3 months with one application. Finally, gene therapy holds great promise for OAB, because it is possible to access all of the genitourinary organs via endoscopy and other minimally invasive techniques that are ideally suited for gene therapy.

Journal Article↗

PubMed2002

Interventions for detrusor overactivity: the case for multimodal therapy.

Viable therapeutic alternatives for the management of overactive bladder (OAB) have recently evolved that provide satisfactory symptomatic control for the majority of patients. However, the presupposition that interventions exist as stand-alone entities is not representative of experience in unique populations with the therapeutic benefit of combination therapy, using components drawn from behavioral, physiotherapeutic, neuromodulatory, and, if necessary, surgical alternatives. Even in populations relatively refractory to therapy, the use of multimodal therapy yields additive benefits for patients with OAB symptoms. Herein is detailed the evidence supporting the concept that multimodal therapy provides optimal benefit to patients suffering from this symptom complex.

Journal Article↗

PubMedDate not supplied

Urinary incontinence in women.

NICE guidance has been issued to help health professionals diagnose and manage urinary incontinence in women. The problem is common but under-reported as women are often too embarrassed to seek help. This report outlines assessment, diagnosis and treatment options for women with stress, urge or mixed urinary incontinence and overactive bladder syndrome.

Exercise Therapy↗

PubMed1990

[The use of viloxazine in the treatment of primary enuresis].

The use of Viloxazine (a non tricyclic antidepressant) could be a less toxic alternative to Imipramine (cardiotoxic tricyclic antidepressant) in the treatment of childhood primary enuresis. Bladder overactivity, infection or psychological disturbances should be excluded before start of treatment, the drug seems to have a good efficacy in cases of "heavy sleepers".

Child↗

PubMed1998

Biotransformation of tolterodine, a new muscarinic receptor antagonist, in mice, rats, and dogs.

Tolterodine is a new muscarinic receptor antagonist intended for the treatment of urinary urge incontinence and other symptoms associated with an overactive bladder. The in vivo metabolism of 14C-labeled tolterodine was investigated in rats, mice, and dogs by analysis of blood and urine samples, whereas in vitro metabolism studies were performed by incubation of [14C]tolterodine with mouse, rat, dog, and human liver microsomes in the presence of NADPH. Tolterodine was extensively metabolized in vivo. Mice and dogs showed similar metabolite patterns, which correlated well with that observed in humans. In these species, tolterodine was metabolized along two different pathways, with the more important being the stepwise oxidation of the 5-methyl group to yield the 5-hydroxymethyl metabolite of tolterodine and then, via the aldehyde, the 5-carboxylic acid metabolite. The other pathway involved dealkylation of the nitrogen. In the subsequent phase II metabolism, tolterodine and the metabolites were conjugated with glucuronic acid to various degrees. Rats exhibited more extensive metabolism and a markedly different metabolite pattern, with metabolites also being formed by hydroxylation of the unsubstituted benzene ring. In addition, a gender difference was observed, with male rats showing more extensive metabolism than females. Incubation of [14C]tolterodine with liver microsomes yielded a total of five metabolites with rat liver microsomes and three with mouse, dog, and human liver microsomes. The 5-hydroxymethyl metabolite of tolterodine and N-dealkylated tolterodine were major metabolites in all incubations, representing 83-99% of total metabolism. Although the extent of metabolism varied among species, the metabolic profiles were similar. However, rat liver microsomes also formed metabolites hydroxylated in the unsubstituted benzene ring. These results show that the metabolism of tolterodine in mice and dogs corresponds to that observed in humans, whereas rats exhibit a different metabolite pattern.

Animals↗

PubMed2006

Sacral neuromodulation in women with idiopathic detrusor overactivity incontinence: decreased overactivity but unchanged bladder contraction strength and urethral resistance during voiding.

PURPOSE: We evaluated the effect of sacral (S3) nerve neuromodulation on voiding in women with idiopathic detrusor overactivity incontinence. MATERIALS AND METHODS: Urodynamic measurements in all patients implanted in 1990 to 2003 were reconsidered. Patients were included if these measurements, which were done at baseline and after 6 months, could be analyzed completely and reliably. Maximum detrusor pressure, amplitude of the highest involuntary detrusor contraction and end fill volume were used as parameters characterizing the degree of detrusor overactivity. Urethral resistance and bladder contraction strength during voiding were characterized by the bladder outlet obstruction index, the urethral resistance factor, average pressure, the slope of the low pressure side of the pressure flow plot, the bladder contractility index and the bladder contraction strength parameter. RESULTS: A total of 33 women were included. Detrusor overactivity parameters were significantly improved at followup. In addition, the supine position of the patient during filling in followup measurements proved less provocative with respect to overactivity than the standing position in the majority of measurements at baseline. Consequently bladder volumes at which voiding was initiated were considerably higher at followup. Changes in the parameters characterizing urethral resistance and bladder contraction strength during voiding were not unambiguous. However, exactly those parameters that appeared volume independent in a previous study were not significantly different. CONCLUSIONS: Our study confirmed the depressant effect of sacral (S3) nerve neuromodulation on detrusor overactivity. No effect on urethral resistance and bladder contraction strength during voiding could be demonstrated using volume independent parameters.

Adult↗

PubMed1988

[Bladder deformity in traumatic spinal cord injury patients].

Fifty-nine patients with traumatic spinal cord injury were subjected for the analysis of bladder deformity. Bladder deformity means bladder trabeculation and deformity of bladder shape such as pine tree shape. We classified bladder deformity into grade 0 (none), grade I (mild), grade II (moderate) and grade III (severe). Upper urinary tract deterioration was found in 0% of grade 0 (16 pts.), 32% of grade I (22 pts.), 80% of grade II (10 pts.) and 82% of grade III (11 pts.). We suggested that bladder deformity was one of the risk factors of upper urinary tract deterioration. High grade (greater than grade II) bladder deformity was found more frequently in complete injury than in incomplete injury. There was no differentiation between overactive bladder-overactive sphincter and underactive bladder-overactive sphincter. All patients with low compliance bladder had a high grade bladder deformity. There was a significant relationship between severity of urinary tract infection and severity of bladder deformity. Intermittent catheterization program was effective for preventing bladder deformity.

Adolescent↗

PubMedDate not supplied

The lazy bladder syndrome: a possible urodynamic evolution in patients with idiopatic detrusor and pelvic floor overactivity.

OBJECTIVE: To correlate the urge syndrome due to bladder overactivity and the lazy bladder syndrome, demonstrating that, at least in some cases, the lazy bladder may be the final stage of the evolution of an overactive bladder when associated with overactivity of the pelvic floor during micturition. PATIENTS AND METHODS: From January 1998 to December 1999, 38 children, 30 females and 8 males, 5 to 16 yrs. old (median 7.4 yrs), presenting with urge symptoms and never treated before, have been evaluated with repeated urodynamic investigations. At presentation all the patients underwent complete baseline urodynamics including evaluation of free flow, EMG, cystometrogram, subtracted detrusor pressure and flow/pressure studies. Flow/EMG was repeated every four months during the treatment period and full urodynamic investigation every year. RESULTS: The first urodynamic study showed that 17 patients were affected by pure detrusor overactivity with good detrusor-sphincter co-ordination, while 21 presented both detrusor and pelvic floor muscles overactivity. All the patients have been treated with oxibutinin (0.3-0.5 mg/Kg. in 3 divided doses) and a timed voiding program with the help of a frequency-volume chart. At the end of the study 16 out of the 17 children with pure overactive bladder were cured (94%), while only 12 of the 21 patients with both bladder and sphincter overactivity were clinically and urodinamically normal Nine girls showed a progressive shift towards the development of a lazy bladder syndrome (capacious, hypocontractile bladder with large post-voiding residual and a non relaxing sphincter during micturition). Clinically this shift was signalled by recurrent urinary tract infections. CONCLUSIONS: The transition from an overactive bladder to a hypocontractile one has been reported previously, but it has not been extensively investigated in children and its causes are largely hypothetical. In our cases this phenomenon occurred only in girls that, initially showed both detrusor urethral sphincter overactivity, therefore we can reasonably conceive that, at least in some cases, the lazy bladder syndrome may be due to prolonged and repeated high pressure bladder contractions opposed by a non relaxing sphincter that may lead to a progressive loss of the contractile properties of detrusor muscle fibres. The rather rapid shift observed in our patients might have been favoured by the use of anticholinergic medications.

Adolescent↗

PubMed2006

Histologic features in the urinary bladder wall affected from neurogenic overactivity--a comparison of inflammation, oedema and fibrosis with and without injection of botulinum toxin type A.

OBJECTIVES: To study histological features and morphological differences in bladder wall specimen from patients with and without botulinum toxin A injections and to compare those issues in responders and non-responders to the toxin therapy. MATERIAL AND METHODS: Bladder wall specimen obtained from cystectomy in 45 patients with neurogenic overactive bladders with and without injection of botulinum toxin A into the detrusor muscle for treatment of neurogenic incontinence were evaluated concerning the histological criteria inflammation, oedema and fibrosis of the bladder wall. RESULTS: Bladder wall specimen obtained from patients suffering from neurogenic detrusor overactivity showed important histological alterations. Generally, inflammatory infiltration, oedema and fibrosis of the bladder wall were frequently observed. When comparing specimen from patients who had received botulinum toxin injection to those from patients who had not, there was no difference concerning inflammation and oedema. However, patients who had received botulinum toxin injection showed significantly less fibrosis of the bladder wall than those who had not received the toxin injection (p<0.00073). When comparing specimen from responders and non-responders to the botulinum toxin therapy, there was no difference in inflammation. Although not significant, a trend was observed that responder to the toxin therapy had less fibrosis and oedema of the bladder wall than non-responder. CONCLUSION: In our study injection of botulinum toxin into the detrusor muscle did not lead to increased fibrotic activity within the bladder wall, on the contrary patients with previous botulinum toxin injection revealed significant less fibrosis than patients without toxin injection.

Adult↗

PubMed2006

Suppression of detrusor overactivity in rats with bladder outlet obstruction by a type 4 phosphodiesterase inhibitor.

OBJECTIVE: To investigate the effects of a selective type 4 cyclic nucleotide phosphodiesterase (PDE4) inhibitor, IC486051, on bladder activity in normal rats and those with and bladder outlet obstruction (BOO), as inhibition of PDE4 leads to elevation of intracellular cAMP levels and relaxation of smooth muscle. MATERIALS AND METHODS: BOO was induced in female Sprague-Dawley rats by tying a silk ligature around the urethra. At 4 or 6 weeks after inducing BOO, conscious rats were assessed by cystometry with the urethral ligature intact. In unobstructed rats, blood pressure was also measured. RESULTS: In unobstructed rats, IC486051 (0.1 mg/kg intravenously) produced no significant changes in cystometric variables, while at a dose of 0.5 mg/kg maximum voiding pressure was reduced by 34%. At both doses, there was a small, transient increase in blood pressure. In both 4- and 6-week BOO rats IC486051 dose-dependently decreased the number and amplitude of non-voiding bladder contractions by up to 80%, relative to pre-treatment values. At doses of 0.1 and 0.5 mg/kg IC486051 had no significant effect on voiding variables. In the 4-week BOO rats, a dose of 1.0 mg/kg decreased bladder capacity, voided volume and residual volume by 21%, 32% and 18%, respectively. In 6-week BOO rats, a dose of 1.0 mg/kg decreased maximal voiding pressure by 17% and pressure threshold for voiding by 28%. In both groups of rats with BOO, voiding efficiency was unchanged. CONCLUSIONS: A selective PDE4 inhibitor can effectively suppress detrusor overactivity in rats with BOO, at doses that have no effect on voiding bladder contractions. Thus, selective PDE4 inhibitors should be considered for the treatment of overactive bladder in patients with BOO.

3',5'-Cyclic-AMP Phosphodiesterases↗

PubMed2006

Treatment-resistant detrusor overactivity--underlying pharmacology and potential mechanisms.

Bladder function during filling and micturition is regulated by peripheral and central nervous and hormonal control systems. Micturition occurs in response to afferent signals from the lower urinary tract, and distention of the bladder wall is the primary stimulus. In the animal and human bladder, efferent adrenergic, cholinergic and nonadrenergic, noncholinergic (NANC) neurotransmission has been demonstrated. The most important receptors for activation of contraction are muscarinic (M3) and purinergic receptors (P2X1), however, the contribution of these receptors to contraction may differ between species, and may be changed in bladder dysfunction associated with detrusor overactivity (DO) and/or the overactive bladder (OAB) syndrome, such as outflow obstruction, neurogenic bladders, idiopathic DO and diabetes. The NANC component of the nerve-induced response in such disorders may be responsible for up to 40-50% of the total bladder contraction. Whether this in vitro'atropine-resistance' corresponds to DO/OAB seen in patients not responding to antimuscarinic treatment is not known. Afferent signalling from the urothelium may be involved in both normal bladder function and in DO/OAB, but its role in antimuscarinic-refractory patients remains to be established. Several central nervous system (CNS) transmitters/transmitter systems, including gamma aminobutyric acid (GABA), opioid, serotonin, noradrenaline, dopamine or glutamatergic receptors and mechanisms are known to be involved in micturition control. The contribution of these receptors and mechanisms in DO/OAB resistant to treatment with antimuscarinics is not known, but drugs acting at these sites may offer future treatment possibilities.

Animals↗

PubMed2006

Is sensory urgency part of the same spectrum of bladder dysfunction as detrusor overactivity?

It has been suggested that the urogynecological diagnosis of sensory urgency is an early form of detrusor overactivity and may be just earlier in the spectrum of disease. The former term is generally defined as increased perceived bladder sensation during filling, a low first desire to void and low bladder capacity in the absence of recorded urinary tract infection (UTI) or detrusor overactivity. The aims of this study are to determine the prevalence and associations of sensory urgency in comparison with detrusor overactivity, and whether sensory urgency is shown to be in the same spectrum of bladder dysfunction as detrusor overactivity. Five hundred and ninety-two women attending for an initial urogynecological/urodynamic assessment took part in this prospective study. In addition to a full clinical assessment, all women underwent free uroflowmetry, residual urine volume measurement (by vaginal ultrasound) and multichannel filling and voiding cystometry. Data were separated into those having (1) sensory urgency or (2) detrusor overactivity. Apart from prevalence figures, comparative associations were sought for (3) age; (4) parity; (5) presenting symptoms; (6) presence of at least one (medically) documented UTI in the previous 12 months; (7) two or more (recurrent) documented UTIs in the previous 12 months; (8) prior hysterectomy; (9) prior continence surgery; (10) menopause; (11) menopause and HRT use; (12) sign of clinical stress leakage; (13) retroverted uterus; (14) anterior vaginal wall prolapse; (15) uterine prolapse; (16) posterior vaginal wall prolapse; (17) apical vaginal prolapse; (18, 19) maximum, average urine flow rate (MUFR, AUFR) centiles, Liverpool Nomograms; (20) median residual urine volume (RUV) in milliliters; (21, 22) voiding difficulty: VD1,VD2 (MUFR, AUFR under 10th centile Liverpool Nomogram and/or RUV >30 ml); (23) diagnosis of urodynamic stress incontinence and (24) diagnosis of uterine and/or vaginal prolapse (grade >0). The prevalence of sensory urgency was 13%. The only differences in the clinical and urodynamic profiles of it and detrusor overactivity were (1) significantly increased prevalence of the symptom of urge incontinence and (2) (by definition) abnormal detrusor contractions during filling cystometry in women with detrusor overactivity. Overall, sensory urgency and detrusor overactivity appear to be part of the same spectrum of bladder dysfunction.

Adolescent↗