Overactive bladder syndrome treatment with ospemifene in menopausal patients with vulvovaginal atrophy: improvement of sexuality?

Schiavi, Michele Carlo; Sciuga, Valentina; Giannini, Andrea; Vena, Flaminia; D’Oria, Ottavia; Prata, Giovanni; Tucci, Chiara Di; Savone, Delia; Aleksa, Natalia; Capone, Carmela; Mascio, Daniele Di; Meggiorini, Maria Letizia; Monti, Marco; Zullo, Marzio Angelo; Muzii, Ludovico; Panici, Pierluigi Benedetti

doi:10.1080/09513590.2018.1441398

Cited by 36 publications

(20 citation statements)

References 27 publications

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“…It is well known that the lower urinary tract symptom is related to female sexual function. Females with an overactive bladder and urinary incontinence had a worsened sexual life, decreased sexual desire, and loss of arousal [ 39 , 40 ]. From previous literature, estrogen supply can not only improve the symptoms of an overactive bladder and urinary incontinence but also increase sexual life [ 40 – 42 ].…”

Section: Discussionmentioning

confidence: 99%

Low-Intensity Extracorporeal Shock Wave Therapy Ameliorates the Overactive Bladder: A Prospective Pilot Study

Chuang

Lin

Chen

et al. 2020

BioMed Research International

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Objective. In the present clinical trial, we evaluated the therapeutic effects of low-intensity extracorporeal shockwave therapy (LiESWT) on overactive bladder (OAB). Methods. Female subjects with ages of 20-75 years and who have been clinically diagnosed with OAB were included in the study. The LiESWT (DUOLITH SD1 T-TOP, AG) applicator was placed on the suprapubic skin area and applied with an intensity of 0.25 mJ/mm2, 3000 pulses, and 3 pulses/second. To assess the therapeutic efficacy, all subjects were required to complete the validated OAB symptoms and life bothersome questionnaires, 3-day urinary diary, uroflowmetry, and post-voided residual urine (PVR) measurement at 4 weeks of LiESWT (W4), 8 weeks of LiESWT (W8), 1-month follow-up (F1), and 3-month follow-up (F3) after LiESWT. Result. 82 subjects with the mean age of 56.5±1.2 years were enrolled. The questionnaire scores were significantly improved at W4, W8, F1, and F3 as compared to baseline data (W0). At W8, the mean values of functional bladder capacity were meaningfully increased. According to the 3-day urinary diary, daytime frequency, urgency, and nocturia were significantly decreased. The uroflowmetry results showed that the mean voided urine volume and the maximal flow rate (Qmax) were noticeably increased. PVR volume was also significantly decreased. Conclusions. The data demonstrated that 8-week LiESWT ameliorated the OAB symptoms, promoted the uroflow parameters, and improved the quality of life (QoL) in OAB patients, suggesting that LiESWT might serve as an alternative noninvasive therapy for OAB.

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Section: Discussionmentioning

confidence: 99%

Low-Intensity Extracorporeal Shock Wave Therapy Ameliorates the Overactive Bladder: A Prospective Pilot Study

Chuang

Lin

Chen

et al. 2020

BioMed Research International

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“…The authors concluded that Ospemifene is an effective therapy after MUSs in women with MUI, improving urgency symptoms and quality of life [18]. Another study, also published by Schiavi et al, demonstrated that Ospemifene is also an effective therapy for postmenopausal women with VVA affected by OAB, improving sexual function and quality of life [19].…”

Section: Local Estrogen In the Treatment Of Oab Syndromementioning

confidence: 96%

Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion

et al. 2019

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Introduction and hypothesis There is clear evidence of the presence of estradiol receptors (ERs) in the female lower urinary and genital tract. Furthermore, it is a fact that estrogen deficiency after menopause may cause atrophic changes of the urogenital tract as well as various urinary symptoms. Moreover, the effect of hormone replacement therapy (HRT) on urinary incontinence (UI) symptoms as well as pelvic organ prolapse (POP), anal incontinence (AI) and vulvovaginal symptoms (VVS) is still a matter of debate. This committee opinion paper summarizes the best evidence on influence of sex steroids as well as hormonal treatment (local and systemic) in postmenopausal women with pelvic floor disorders. Methods A working subcommittee from the International Urogynecology Association (IUGA) Research and Development Committee was formed. A thorough literature search was conducted and an opinion statement expressed. The literature regarding hormones and pelvic floor disorders was reviewed independently and summarized by the individual members of the subcommittee. Results The majority of studies reported that vaginal estrogen treatment when compared with placebo has more beneficial effects on symptoms and signs of vaginal atrophy including sensation of burning, dyspareunia and UI symptoms. Definitive evidence on local estrogen application and prolapse treatment or prevention is lacking. A statistically significant increase in risk of worsening of UI as well as development of de novo incontinence was observed with estrogen-only or combination systemic HRT. Conclusions In summary, local estrogen seems to be safe and effective in the treatment of VVS and can also improve urinary symptoms in postmenopausal patients with UI, but most of these recommendations correspond to evidence level 2C. The evidence in POP is still scarce but not in favor of benefit. Finally, the duration of local estrogen treatment (LET), optimal dosage, long-term effects and cost-effectiveness compared with current practice are still unknown.

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“…37 Pain at intercourse decreases, while desire and arousal increase. 39,40 Ospemifene vs Vaginal Oestrogens: Safety VVA is a chronic and progressive disease and it would require long-term therapy. Unfortunately, adherence to treatment is weak and many women discontinue vaginal therapy for perceived inefficacy, inconvenient administration or perceived risk.…”

Section: Ospemifene An Innovative Optionmentioning

confidence: 99%

<p>Ospemifene in the Management of Vulvar and Vaginal Atrophy: Focus on the Assessment of Patient Acceptability and Ease of Use</p>

Cagnacci¹,

Xholli²,

Venier³

2020

PPA

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Endocrinological changes that occur with menopause lead to a chronic and progressive condition named vulvar and vaginal atrophy (VVA). This disease is characterized by symptoms such as dryness, dyspareunia, itching, burning, and dysuria. According to recent epidemiological studies, VVA has a high prevalence and can also occur in younger women prior to the menopause, negatively affecting quality of life, sexual function, intimacy and relationship with the partner. Accordingly, therapy should be effective, initiated early and continued for as long as possible. Up to recent years, available therapeutic options have included over-the-counter lubricants and moisturizers, vaginal oestrogens and systemic hormones. These products are not indicated for all women. Hormones are mostly contraindicated in women with a history of hormone-sensitive cancer and are frequently not accepted even by women without contraindications. Local therapies are frequently considered uncomfortable, difficult to apply, and messy. Indeed, these treatments have a high spontaneous discontinuation rate, mostly due to dissatisfaction, safety concern, side effects and difficulty in vaginal placement. Recently, ospemifene, a new non-hormonal systemic remedy, was approved by FDA (Food and Drug Administration) and EMA (European Medicines Agency) for the treatment of the two most bothersome symptoms of VVA: dryness and dyspareunia. Because ospemifene is a selective estrogen receptor modulator (SERM), it can be administered also in women with a history of breast cancer, and this makes it more acceptable by any woman. In addition, its route of administration minimizes those bothersome side effects intrinsic to the vaginal route of administration. Available data indicate that women using ospemifene have higher adherence to treatment, higher persistence and lower discontinuation rate. Satisfaction is higher than with other local therapies and overall health care cost is lower.

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Overactive bladder syndrome treatment with ospemifene in menopausal patients with vulvovaginal atrophy: improvement of sexuality?

Cited by 36 publications

References 27 publications

Low-Intensity Extracorporeal Shock Wave Therapy Ameliorates the Overactive Bladder: A Prospective Pilot Study

Low-Intensity Extracorporeal Shock Wave Therapy Ameliorates the Overactive Bladder: A Prospective Pilot Study

Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion

<p>Ospemifene in the Management of Vulvar and Vaginal Atrophy: Focus on the Assessment of Patient Acceptability and Ease of Use</p>

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