Understanding Clinic Options for Overactive Bladder
TL;DR: Treatment options focusing on behavioral modification, medical therapy, and neuromodulation are reviewed, remembering that more than one may be needed and can be used concomitantly.
Abstract: Overactive bladder (OAB) is a symptom complex of urinary frequency, nocturia and urgency with or without urgency incontinence that adversely impacts patient’s quality of life. Conservative management begins in the outpatient clinic, often with significant improvement and patient satisfaction. In this review we will discuss the evaluation of OAB and review treatment options focusing on behavioral modification, medical therapy, and neuromodulation. These treatment options are offered in a stepwise fashion, remembering that more than one may be needed and can be used concomitantly.
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TL;DR: The aim of this review is to inform clinicians regarding OAB management in order to improve patient counseling and care.
Abstract: Overactive bladder (OAB) is a common condition affecting millions of men and women worldwide. It is an embarrassing condition with far-reaching consequences. Although many treatment options exist, no single treatment has been proven to be most effective. Often a combination of therapy is required to successfully manage OAB symptoms. In this review, we provide an overview of OAB, including risk factors for development of OAB; keys to diagnosis; therapeutic options including conservative and medical management, as well as treatments for refractory OAB; when to consider referral to a specialist; and resources for clinicians and patients. The aim of this review is to inform clinicians regarding OAB management in order to improve patient counseling and care.
48 citations
Cites methods from "Understanding Clinic Options for Ov..."
...These questionnaires can also be used to track improvement and to objectively assess the effectiveness of various treatment modalities.(27) For more complicated or refractory patients, including patients with prior pelvic reconstructive surgery or those without symptom improvement with first- and second-line therapies, additional testing, including urodynamic evaluation, cystoscopy, and/or upper genitourinary tract imaging, can be used to differentiate between OAB and other etiologies....
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Patent•
30 May 2014
TL;DR: A topical nerve stimulator patch and system comprising a dermal patch, an electrical signal generator associated with the patch, a signal receiver to activate the generator, and a power source for the generator are described in this paper.
Abstract: A topical nerve stimulator patch and system are provided comprising a dermal patch; an electrical signal generator associated with the patch; a signal receiver to activate the electrical signal generator; a power source for the electrical signal generator associated with the patch; an electrical signal activation device; and a nerve feedback sensor.
33 citations
TL;DR: It is demonstrated that transcutaneous spinal cord stimulation (TSCS), a non-invasive intervention, applied over the thoracolumbar spine in neurologically intact rhesus macaques can activate the LUT, including activation of the bladder detrusor muscle, the urethral sphincter and pelvic floor muscles, and enable voiding in select neurological conditions.
20 citations
Cites background from "Understanding Clinic Options for Ov..."
...For instance, electrical stimulation of sacral nerve roots, pudendal nerve, or tibial nerve may modulate micturition reflexes, suppress urgency, and augment LUT function in patients with an overactive bladder (Bartley et al., 2013; Brindley et al., 1982; Lordêlo et al., 2010; Peters et al., 2010; Staskin et al., 2012)....
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TL;DR: Combination treatment did not have any additional benefits in relation to reducing nocturnal voids in patients with NPU; however, combination therapy is helpful because it increases the maximal bladder capacity and decreases the NPI.
Abstract: Purpose
The aims of this study were to investigate the efficacy of combining the systematized behavioral modification program (SBMP) with desmopressin therapy and to compare this with desmopressin monotherapy in the treatment of nocturnal polyuria (NPU).
17 citations
Cites background from "Understanding Clinic Options for Ov..."
...Behavioral therapy and medication are the initial treatment options for patients with overactive bladders [5]....
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...Although behavioral modification therapy and medication are initial treatment options for patients with overactive bladders [5,10], behavioral modification therapy has not been widely used in routine clinical practice in patients with nocturia....
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...First, the authors have previously demonstrated the efficacy of the SBMP after reinforcement SBMP education, if the latter was required [5]....
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TL;DR: The aim of this short commentary is to provide an overview of the effectiveness of neuromodulation therapies and of their impact on quality of life, body image, sexual function, and emotional well-being in patients with OAB.
Abstract: Overactive bladder syndrome (OAB) is defined by the presence of urinary urgency, with or without urge incontinence, usually accompanied by an increase in urinary frequency and nocturia in the absence of urinary tract infections (UTI) or other diseases. The overall prevalence of OAB symptoms in the female population is reported to be 16.6% and increases with advancing age and menopause. The aetiology of OAB is not fully understood and is likely to affect a heterogeneous population of patients due to changes to their central and peripheral nervous systems. Although OAB is frequently associated with female sexual dysfunction (FSD), its real impact on sexual function in women has been evaluated only in a few studies. The first line of treatment for OAB includes behavioural modification and physical therapy, either as monotherapies or in combination. Many patients who have not had success in managing their symptoms with more conservative therapies may decide to resort to third-line treatments for refractory OAB. These treatments include neuromodulation therapies, particularly transvaginal electrical stimulation (TES) and sacral neuromodulation (SN). The aim of this short commentary is to provide an overview of the effectiveness of these treatments and of their impact on quality of life, body image, sexual function, and emotional well-being.
14 citations
Cites background from "Understanding Clinic Options for Ov..."
...First-line medical therapies are usually associated with a secondline of treatment of anticholinergics and β-3 agonists, before potentially considering invasive surgical treatments such as urinary diversion [66]....
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...The first line of treatment for OAB includes behavioural modification and physical therapy, either as monotherapies or in combination [65, 66]....
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References
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TL;DR: Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female‐specific approach and clinically based consensus report.
Abstract: Introduction and hypothesis Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. Methods This report combines the input of members of the Standardization and Terminology Committees of two Inter
2,500 citations
"Understanding Clinic Options for Ov..." refers background in this paper
...Overactive bladder is defined by the International Continence Society (ICS) as the presence of urinary urgency, typically accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection (UTI) or other obvious pathology [1]....
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TL;DR: The EPIC study is the largest population-based survey to assess prevalence rates of OAB, UI, and other LUTS in five countries and is the first study to evaluate these symptoms simultaneously using the 2002 ICS definitions.
2,275 citations
TL;DR: The NOBLE studies do not support the commonly held notion that women are considerably more likely than men to have urgency-related bladder control problems, and overactive bladder, with and without urge incontinence, has a clinically significant impact on quality-of-life, quality- of-sleep, and mental health, in both men and women.
Abstract: Context: the National Overactive BLadder Evaluation (NOBLE) Program was initiated to better understand the prevalence and burden of overactive bladder in a broad spectrum of the United States population. Objective: to estimate the prevalence of overactive bladder with and without urge incontinence in the US, assess variation in prevalence by sex and other factors, and measure individual burden. Design: US national telephone survey using a clinically validated interview and a follow-up nested study comparing overactive bladder cases to sex- and age-matched controls. Setting: noninstitutionalized US adult population. Participants: a sample of 5,204 adults ≥18 years of age and representative of the US population by sex, age, and geographical region. Main outcome measures: prevalence of overactive bladder with and without urge incontinence and risk factors for overactive bladder in the US. In the nested case-control study, SF-36, CES-D, and MOS sleep scores were used to assess impact. Results: the overall prevalence of overactive bladder was similar between men (16.0%) and women (16.9%), but sex-specific prevalence differed substantially by severity of symptoms. In women, prevalence of urge incontinence increased with age from 2.0% to 19% with a marked increase after 44 years of age, and in men, increased with age from 0.3% to 8.9% with a marked increase after 64 years of age. Across all age groups, overactive bladder without urge incontinence was more common in men than in women. Overactive bladder with and without urge incontinence was associated with clinically and significantly lower SF-36 quality-of-life scores, higher CES-D depression scores, and poorer quality of sleep than matched controls. Conclusions: the NOBLE studies do not support the commonly held notion that women are considerably more likely than men to have urgency-related bladder control problems. The overall prevalence of overactive bladder does not differ by sex; however, the severity and nature of symptom expression does differ. Sex-specific anatomic differences may increase the probability that overactive bladder is expressed as urge incontinence among women compared with men. Nonetheless, overactive bladder, with and without incontinence, has a clinically significant impact on quality-of-life, quality-of-sleep, and mental health, in both men and women.
2,017 citations
"Understanding Clinic Options for Ov..." refers background or result in this paper
...Some studies have estimated rates to be higher in women than men [2], while others suggest similar rates between the sexes [5]....
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...OAB symptoms have a significant negative impact on patients, reflected in their low quality-of-life scores, high depression scores, low work productivity, decreased sexual satisfaction, poor quality of sleep and low levels of overall health [5, 9]....
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TL;DR: A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
Abstract: Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six 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 female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible. A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
1,646 citations
TL;DR: The prevalence of chronic and debilitating symptoms of the overactive bladder are determined 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.
Abstract: 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.
1,544 citations