We compared the serum cholinesterase (ChE) level and various parameters between patients with or without overactive bladder (OAB) and/or neurogenic bladder (NB). A total of 258 patients who met the following criteria were enrolled: the presence/absence of OAB and/or NB was documented, laboratory data were available, and liver and renal functions were normal. Patients were divided into the 3 groups: 1) a NB /OAB + group, a higher serum albumin or ChE level was associated with a better therapeutic outcome. These results suggest that a decrease of serum ChE level is related to the occurrence of OAB and the poor response to treatment in OAB patients without NB.The symptom of urinary urgency (usually combined with frequency and nocturia) with or without urge incontinence is characteristic of the overactive bladder (OAB) syndrome (1). OAB occurs in patients with neurogenic bladder (NB) caused by damage to the brain, spinal cord, or peripheral nerves, or in patients without neurogenic bladder, among whom it usually arises due to bladder outlet obstruction (BOO) secondary to conditions such as benign prostatic hyperplasia (BPH) and urethral stricture (2). Bladder smooth muscle cells undergo contraction when exposed to acetylcholine secreted from the parasympathetic nerve terminals, and the efficacy of anticholinergic agents is usually assessed on the basis of blocking the micturition reflex in animal studies. However, recent studies reported that acetylcholine is produced by the bladder epithelium as well as by nerve terminals (7, 23), and its production by the bladder epithelium increases after the occurrence of BOO (5,22). It has also been suggested that the bladder epithelium express receptors for various neurotransmitters, including adrenergic, nicotinic and muscarinic receptors, and release not only acetylcholine but also nitric oxide, prostaglandin and adenosine triphosphate (ATP), and that muscarinic mechanisms may also have a role in urothelial sensory function (9). Clinically, anticholinergic agents are the main type of drug used for the treatment of OAB because these agents can usually
The modulation of plasma adrenaline and serotonin levels by naftopidil in patients with increased sympathetic activity contributed to improvement of LUTS associated with BPH, in addition to its antagonistic effects of α1D/A -adrenergic receptor on the detrusor and prostatic urethral smooth muscle, the urothelium, and the central nervous system.
Administration of imidafenacin at 0.1-0.2 mg once daily before sleeping was safe and effective for the treatment of OAB with the main symptom of nocturia.
To date we have not armed any active procedure to control radiation-induced refractory hemorrhagic cystitis in terms of efficacy, invasiveness, and adverse effects. Therefore, in consideration of our clinical results, hyperbaric oxygen therapy appears to be useful for radiation cystitis.
To examine the efficacy of the melatonin receptor agonist ramelteon for nocturia, it was compared with zolpidem, a conventional non-benzodiazepine hypnotic. A total of 50 patients with nocturia (2 urinations/night) were enrolled. Subjects assigned odd numbers or even numbers were respectively prescribed 8 mg of ramelteon (n = 27; mean age: 75 years) or 5 mg of zolpidem (n = 23; mean age: 73 years) once a day before sleeping for 4 weeks. The daytime and nighttime frequencies of urination, as well as the results of global self-assessment by the patients, were compared between the two groups before and after 4 weeks of treatment. Both ramelteon and zolpidem caused a significant decrease of nocturia to about once per night after 4 weeks. The global self-assessment rating at 4 weeks was "good" or "fair" for more patients in the zolpidem group than in the ramelteon group, while the rating was "excellent" or "no change" for more patients in the ramelteon group. There were no serious adverse events in either group. Ramelteon was safe and effective for nocturia, achieving similar results to zolpidem. However, responders and non-responders to ramelteon were more clearly distinguished. Ramelteon might be effective for patients with sleep disturbance and nocturia because of low melatonin levels. Therefore, as diagnostic therapy for identification of nocturia caused by sleep disturbance and melatonin deficiency, ramelteon should be administered to patients who do not respond to alpha-1 antagonists and/or anticholinergic agents.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.