Current optimal pharmacologic therapies for overactive bladder

Jiang, Yuan-Hong; Kuo, Hann-Chorng

doi:10.1080/14656566.2023.2264183

Cited by 3 publications

(1 citation statement)

References 183 publications

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“…Patients with neurogenic lesions and voiding dysfunction often have a mix of storage and voiding symptoms. Moreover, ambulatory patients who wish to urinate voluntarily without catheterization may prefer resumption of voiding ability [ 39 93 94 95 ].…”

Section: P Harmacological Therapy and Botulinum Toxin A Ure...mentioning

confidence: 99%

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A

Kuo

2024

Tzu Chi Medical Journal

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Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with central nervous system (CNS) lesions. Cases of cerebrovascular accidents (CVA), Parkinson’s disease, dementia, and other intracranial lesions develop poor bladder control with or without urinary difficulty due to loss of cortical perception of bladder filling sensation and poor coordination of urethral sphincter relaxation during reflex micturition. Patients with CNS lesions usually have overactive bladder (OAB) symptoms, including urgency, frequency, incontinence, voiding symptoms of dysuria, large postvoid residual volume, and retention. In elderly patients with severe CNS disease the OAB symptoms are usually difficult to adequately relieve by medical treatment, and thus, their quality of life is greatly. Botulinum toxin A (BoNT-A) is currently licensed and has been applied in patients with idiopathic and neurogenic OAB due to spinal cord injury or multiple sclerosis. However, the application of BoNT-A in the treatment of urinary incontinence due to NLUTD in chronic CNS lesions has not been well-documented. Although cohort studies and case series support BoNT-A treatment for neurogenic OAB, chronic urine retention after intravesical BoNT-A injection for OAB and exacerbated urinary incontinence after urethral BoNT-A injection for voiding dysfunction have greatly limited its application among patients with NLUTD due to CNS lesions. This article reviews the pathophysiology and clinical characteristics of NLUTD in patients with CNS lesions and the clinical effects and adverse events of BoNT-A injection for patients with NLUTD. A flowchart was created to outline the patient selection and treatment strategy for neurogenic OAB.

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Section: P Harmacological Therapy and Botulinum Toxin A Ure...mentioning

confidence: 99%

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A

Kuo

2024

Tzu Chi Medical Journal

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Efficacy of the combination of transcutaneous tibial nerve stimulation(TTNS) and mirabegron in women with overactive bladder: a prospective randomized controlled trial

Xu,

Xiong,

Tian

et al. 2024

Preprint

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Objective: The management of overactive bladder (OAB) in women encompasses a range of strategies, from behavioral modifications to pharmacotherapy and nerve stimulation techniques. This prospective, randomized, controlled trial evaluates the efficacy of the combination of TTNS and mirabegron in symptom improvement over three months in women diagnosed with OAB. Patients and Methods: The study was designed as a randomized controlled trial. A total of 40 patients were prospectively randomized into two groups. Twenty patients in the combination group accepted TTNS and mirabegron therapy, and the other 20 patients as control only accepted mirabegron therapy. Primary outcomes were changes from baseline in the lower urinary tract symptoms. The severity of symptoms and quality of life (QoL) were assessed using the validated OAB questionnaire (OAB-q). Results: TTNS reduced the clinical symptoms of OAB, and the difference was statistically significant at all study sites (p<0.05). Regarding secondary outcomes, the OAB-q symptom bother score was lower in the combination group than in the mirabegron group (p<0.05). The OAB-q score in the combination group was statistically superior to that in the mirabegron group (p<0.05). The incidence of complications was not statistically significant between the two groups. Conclusion: The combination of TTNS and mirabegron represents a promising therapeutic strategy for women with overactive bladder, significantly improving symptoms and quality of life with a favorable safety profile. Further research with a larger sample size and long-term follow-up is warranted to confirm these findings and explore the underlying mechanisms of this combination therapy’s efficacy.

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Nocturia, nocturnal polyuria, and nocturnal enuresis in adults: What we know and what we do not know

Chang,

Kuo

2024

Tzu Chi Medical Journal

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Nocturia is defined as the nocturnal frequency of one or more voiding episodes per night. It increases with aging and has an impact on sleep quality and the risks of falling and mortality. Nocturia disorder involves nighttime frequency, nocturnal polyuria, and nocturnal enuresis. In older adults with nocturia disorder, multiple factors could contribute to nocturia severity and characteristics, including poor sleep quality, lower urinary tract dysfunction, and excessive fluid output. Several nonurological medical diseases have been found to result in nocturia, such as hypertension, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, metabolic syndrome, and diabetes. Urological and medical assessments should be performed to diagnose nocturia disorder. A frequency volume chart to evaluate the nocturnal polyuria index, functional bladder capacity, and urodynamic study can reveal the presence of nocturnal polyuria and lower urinary tract dysfunction. Treatment should be based on multiple nocturia etiologies, and a combination of multiple therapies for individual pathophysiology will achieve a better treatment outcome.

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Current optimal pharmacologic therapies for overactive bladder

Cited by 3 publications

References 183 publications

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A

Efficacy of the combination of transcutaneous tibial nerve stimulation(TTNS) and mirabegron in women with overactive bladder: a prospective randomized controlled trial

Nocturia, nocturnal polyuria, and nocturnal enuresis in adults: What we know and what we do not know

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