Objective To determine the prevalence of chronic and debilitating symptoms of the overactive bladder, defined here as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions.

Subjects and methods Data were collected using a population-based survey (conducted by telephone or direct interview) of men and women aged  40 years, selected from the general population in France, Germany, Italy, Spain, Sweden and the United Kingdom, using a random stratified approach. The main outcome measures were: prevalence of urinary frequency (> 8 micturitions/24 h), urgency and urge incontinence; the proportion of participants who had sought medical advice for symptoms of an overactive bladder; and current or previous therapy received for these symptoms.

Results In all, 16 776 interviews were conducted in the six European countries. The overall prevalence of overactive bladder symptoms in individuals aged  40 years was 16.6%. Frequency (85%) was the most commonly reported symptom, followed by urgency (54%) and urge incontinence (36%). The prevalence of overactive bladder symptoms increased with advancing age. Overall, 60% of respondents with symptoms had consulted a doctor but only 27% were currently receiving treatment.

Conclusion Symptoms of an overactive bladder, of which frequency and urgency are as bothersome as urge incontinence, are highly prevalent in the general population. However, only a few affected individuals currently receive treatment. Taken together, such findings indicate that there is considerable scope for improvement in terms of how physicians diagnose and treat this condition.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410x.2001.02228.x

How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study.

This review comprises the pharmacokinetics and pharmacodynamics of natural and synthetic estrogens and progestogens used in contraception and therapy, with special consideration of hormone replacement therapy. The paper describes the mechanisms of action, the relation between structure and hormonal activity, differences in hormonal pattern and potency, peculiarities in the properties of certain steroids, tissue-specific effects, and the metabolism of the available estrogens and progestogens. The influence of the route of administration on pharmacokinetics, hormonal activity and metabolism is presented, and the effects of oral and transdermal treatment with estrogens on tissues, clinical and serum parameters are compared. The effects of oral, transdermal (patch and gel), intranasal, sublingual, buccal, vaginal, subcutaneous and intramuscular administration of estrogens, as well as of oral, vaginal, transdermal, intranasal, buccal, intramuscular and intrauterine application of progestogens are discussed. The various types of progestogens, their receptor interaction, hormonal pattern and the hormonal activity of certain metabolites are described in detail. The structural formulae, serum concentrations, binding affinities to steroid receptors and serum binding globulins, and the relative potencies of the available estrogens and progestins are presented. Differences in the tissue-specific effects of the various compounds and regimens and their potential implications with the risks and benefits of hormone replacement therapy are discussed.

https://www.hormonebalance.org/images/documents/Kuhl%2005%20%20Pharm%20Estro%20Progest%20Climacteric.pdf

Pharmacology of estrogens and progestogens: influence of different routes of administration.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(06)67925-7.pdf

Urinary incontinence in women

Metabolism classified as disturbances of storage or of emptying. Excretion Failure to store urine may lead to various forms of Physiological Animal models incontinence (mainly urge and stress incontinence), and Clinical phase I failure to empty can lead to urinary retention, which Clinical Trials may result in overflow incontinence. Theoretically, a ‘practice’ disturbed storage function can be improved by agents that decrease detrusor activity, increase bladder capacity and/or increase outlet resistance. Many drugs have been Bladder contraction tried, but the results are often disappointing, partly through poor treatment eBcacy and side-eCects [3]. The Normal bladder contraction in humans is mediated development of pharmacological treatment has been mainly through stimulation of muscarinic receptors in slow, and the use of some of the currently prescribed the detrusor muscle. Atropine resistance, i.e. contraction agents is founded more on tradition than on evidence of isolated bladder muscle in response to electrical nerve based on results from controlled clinical trials [4–8]. stimulation after pretreatment with atropine, has been In the present review of drugs in current use for the shown in most animal species, but seems to be of little treatment of urinary incontinence, agents specifically importance in normal human bladder muscle [1]. used to treat urinary tract infections and interstitial However, atropine-resistant (nonadrenergic, noncholcystitis have not been included. The currently used inergic, NANC) contractions have been reported in terminology conforms with the recommendations of the normal human detrusor and may be caused by ATP ICS. Drugs have been evaluated using diCerent types of [9–11]. A significant degree of atropine resistance may evidence (Table 1). Evidence of pharmacological and/or exist in morphologically and/or functionally changed physiological eBcacy means that a drug has been shown bladders, and has been reported to occur in hypertrophic to have desired eCects in relevant preclinical experiments bladders [12,13], interstitial cystitis [14], and in neuroor in healthy volunteers (or in experimental situations genic bladders [15]. The importance of the NANC compoin patients); the present clinical drug recommendations nent to detrusor contraction in vivo, normally, and in are based on evaluations made using a modification of diCerent micturition disorders, remains to be established. the grading of evidence found in the Agency for Health Care Policy and Research (AHCPR) guidelines (Table 2). Drugs used to treat bladder hyperactivity

The pharmacological treatment of urinary incontinence

Introduction In the development of terminology of the lower urinary tract, due to its increasing complexity, the terminology for male lower urinary tract and pelvic floor symptoms and dysfunction needs to be updated using a male-specific approach and via a clinically-based consensus report. Methods This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 22 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Results A Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction, encompassing around 390 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in male lower urinary tract and pelvic floor dysfunction. Male-specific imaging (ultrasound, radiology, CT, and MRI) has been a major addition whilst appropriate figures have been included to supplement and help clarify the text. Conclusions A consensus-based Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction.

BACKGROUND: The aims of this population-based study were to compare the quality of life (QoL) in; (a) women with urinary incontinence (UI) and women without urinary incontinence (wUI) in relation to age, (b) women with stress incontinence and women with urge incontinence, and (c) women who had, vs. women who had not, consulted a health care service because of UI. METHODS: Totally, 787 women who reported symptoms of UI and 787 women who did not report symptoms of UI, aged 18-72 years, were mailed the Short Form-36 QoL questionnaire (SF-36) and a question concerning professional consultation. They were also mailed the Detrusor Instability Score questionnaire, which was used to clarify the women as being stress vs. urge incontinent. RESULTS: Women with UI had significantly lower scores on all eight dimensions of the SF-36. There were low correlations between age and the QoL scores in women with or without UI. Both women with stress incontinence and women with urge incontinence had significantly lower scores on all eight QoL dimensions compared with the women without UI. However, the absolute difference was smaller for women with stress incontinence. Women with urge incontinence consult health care service more often than women with stress incontinence. Women with UI who had consulted health care had significantly lower QoL scores than women with UI who had not consulted health care in seven out of eight dimensions. CONCLUSIONS: The QoL, in this female general population, is more affected by women with urge incontinence than women with stress incontinence. Help seeking is associated with substantially lower QoL scores and with urge incontinence.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1034/j.1600-0412.2001.801117.x

Quality of life and seeking help in women with urinary incontinence.

The aims of this study were to investigate the reasons why some women with long-term urinary incontinence (UI) seek professional help whereas others do not, their experiences and satisfactions with the healthcare services, and how women deal with their incontinence. In total, 95 women aged 23–51 years with persistent UI (median 10 years, range 6–20 years) were included in this telephone interview survey. Seventy-four percent of the women with long-term UI had not sought help. The most common reason given was that the disorder was considered a minor problem, which they felt they could cope with on their own. When women did consult professional help they did so because they were afraid of the odor of urine and that they perceived the leakage as shameful and embarrassing. These women felt that the healthcare service offered appropriate care for their condition. Pelvic floor exercises were the most commonly used management methods for all participants.

Reasons why women with long-term urinary incontinence do not seek professional help: a cross-sectional population-based cohort study.

OBJECTIVES:
To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been ...

Changes in urinary incontinence and quality of life after four years. A population-based study of women aged 22-50 years.

This study was done to evaluate the use of the frequency/volume chart in patients with motor urgency. Pretreatment data from a study of the effects of terodiline in women with motor urgency incontinence were used and compared with the findings of an investigation of healthy female volunteers. The relation of the values from the frequency/volume chart to cystometric data in the group of motor urgency patients were also studied. In spite of the statistically significant differences between the two groups in the parameters of the frequency/volume chart, it is concluded that the overlap between the groups limits the use of the chart for diagnostic purposes at this stage. The mean voided volume (total voided volume/frequency) is considered a reliable measure of the severity of motor urgency. No correlation was found between the data of the frequency/volume chart and cystometry. It is suggested that cystometry mainly gives a qualitative measure of motor urgency, whereas the frequency/volume chart offers objective and reliable quantitative information of the symptoms, and thus supplements the cystometric evaluation.

The frequency/volume chart in detrusor instability

Urethral injection is a convenient, minimally invasive means of treating stress urinary incontinence (SUI). We present long-term follow-up data from 20 patients originally recruited in 1994-95 (mean age 67 years) to receive urethral injection with dextranomer/hyaluronic acid (Dx/HA) copolymer. The majority of patients had failed previous therapy for SUI. If the first injection was unsuccessful, up to two further injections were offered. Only 3 patients (15%) failed to show a response to treatment. Sixteen women were reassessed during 2001 (4 had died of causes unrelated to the study treatment). A sustained response throughout the follow-up period was reported in 9/16 patients (57%), with incontinence recurring in just 4 (25%). None of the 7 patients with persistent or recurrent incontinence were cured by subsequent treatments, including surgery. In conclusion, urethral injection with Dx/HA copolymer offers promising long-term efficacy in the treatment of SUI, regardless of old age or failure to respond to previous therapy.

Gregor Larsson

Papers

Quality of life and seeking help in women with urinary incontinence.

Reasons why women with long-term urinary incontinence do not seek professional help: a cross-sectional population-based cohort study.

Changes in urinary incontinence and quality of life after four years. A population-based study of women aged 22-50 years.

The frequency/volume chart in detrusor instability

Urethral injection for stress urinary incontinence: long-term results with dextranomer/hyaluronic acid copolymer.