No abstract available.
Urinary Bladder, Overactive

No abstract available.
Urinary Bladder, Overactive* ; Duloxetine Hydrochloride

PURPOSE: We performed a meta-analysis to evaluate the efficacy and safety of mirabegron add-on therapy to solifenacin for patients with overactive bladder (OAB). METHODS: We conducted a systematic literature review to identify all randomized, double-blind, controlled trials (RCTs) of this combination (mirabegron and solifenacin) for OAB. Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched. A manual search was also performed to investigate relevant references from the retrieved studies. RESULTS: Four publications describing 5 RCTs that compared combination therapy with solifenacin, including a total of 3,309 patients, were analyzed. The mean number of micturitions per 24 hours (mean difference [MD], -0.45; 95% confidence interval [CI], -0.65 to -0.26; P < 0.00001), number of episodes of incontinence per 24 hours (MD, -0.71; 95% CI, -0.14 to -0.02; P=0.04), volume voided per micturition, and number of urgency episodes per 24 hours demonstrated that combination therapy was more effective than solifenacin therapy alone. Safety assessments, including common treatment-emergent adverse events (odds ratio, 1.09; 95% CI, 0.95–1.27; P=0.23) and discontinuations due to adverse events (P=0.30), demonstrated that the combination therapy was well tolerated. CONCLUSIONS: This meta-analysis suggests that mirabegron therapy as an add-on to solifenacin provides a satisfactory therapeutic effect for OAB symptoms with a low occurrence of side effects.
Humans ; Solifenacin Succinate* ; Urinary Bladder, Overactive* ; Urination

PURPOSE: We tried to discover the voiding patterns, which was diurnal & nocturnal urinary volume and voiding frequencies in women with overactive bladder (OAB). MATERIALS AND METHODS: All voided volumes, times and frequencies were recorded in 249 women with overactive bladder. The subjects age related changes in bladder capacity, urinary volume and frequency were evaluated. The causes of nocturnal urinary frequency and its increase with age in older women with OAB were evaluated using 3 days of voiding diaries. Nocturia was devided into three types: nocturnal polyuria, decreased nocturnal bladder capacity and mixed type. RESULTS: Total voided volume, daytime urine volume, functional bladder capacity were decreased with the age. Nocturnal urine volume and nocturnal urinary frequency were increased with age. Nocturnal polyuria was the major cause for nocturia, and mixed type was increased with age. CONCLUSIONS: Voiding symptoms as well as storage symptoms were increased with age in OAB female. In most cases, nocturia was caused by nocturnal polyuria.
Aging ; Female ; Humans ; Nocturia ; Polyuria ; Urinary Bladder ; Urinary Bladder, Overactive*

PURPOSE: To determine the relationship between the neurogenic bladder symptoms score (NBSS) and urodynamic examination in patients affected by multiple sclerosis (MS) and related lower urinary tract dysfunction (LUTD). METHODS: We recruited 122 consecutive patients with MS in remission and LUTD from January 2011 to September 2013 who underwent their first urodynamic examination. Neurological impairment was assessed using the Expanded Disability Status Scale (EDSS) and bladder symptoms were studied with the NBSS. RESULTS: Median NBSS was 20.0 (interquartile range, 12.75-31.0). Neurogenic detrusor overactivity (NDO) was discovered in 69 patients (56.6%). The concordance between patients with NDO and maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC)> or =20.0 cm H2O was 0.89 (kappa-Cohen; P<0.05). Patients with EDSS scores of > or =4.5 had a greater NBSS (25.41 vs. 20.19, P<0.05), NBSS-incontinence (8.73 vs. 4.71, P<0.05), NBSS-consequence (4.51 vs. 3.13, P<0.05) and NBSS-quality of life (2.14 vs. 1.65, P<0.05). The NBSS was not associated with PdetmaxIDC> or =20 cm H2O (P=0.77) but with maximum cystometric capacity<212 mL (odds ratio, 0.95; P<0.05). CONCLUSIONS: The NBSS cannot give adequate information the way urodynamic studies can, in patients with MS and LUTD.
Humans ; Multiple Sclerosis* ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Bladder, Overactive ; Urinary Tract* ; Urodynamics*

OBJECTIVE: To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility. METHODS: Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling. RESULTS: Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r2=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r2=0.529) during the first phase of filling cystometry. CONCLUSION: Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.
Compliance* ; Female ; Humans ; Male ; Spinal Cord Injuries ; Urinary Bladder* ; Urinary Bladder, Neurogenic* ; Urinary Bladder, Overactive ; Urodynamics

PURPOSE: After correction of stress incontinence, some patients experience the improvement of overactive bladder symptoms. During urodynamic study of some patients, the leak point pressure has a tendency to decrease at increasing vesical volumes. We evaluated the possibility of a correlation between stress incontinence parameters and bladder capacity or compliance. MATERIALS AND METHODS: 113 stress incontinence patients who received urodynamic study from February 2000 to August 2005, were reviewed retrospectively for this study. In these patients, urodynamic stress incontinence parameters(abdominal leak point pressure: ALPP, maximum urethral closure pressure: MUCP), Q-tip angle and Stamey symptom grade and age were analyzed for a correlation with urodynamic cystometric capacity or compliance. We also compared the cystometric capacity of each symptom grade group to assess the difference among the groups. RESULTS: The mean age of the patients was 49.5+/-10.4 years(29~75), symptom grade was I(37), II(27), III(19), Q-tip angle was 33.6+/-14.0 degrees(10~60), cystometric capacity was 390.2+/-109.7 ml(121~641), compliance was 51.6+/-30.4 ml/cmH2O(9.2~142.5), ALPP was 83.2+/-31.0 cmH2O(24~200), MUCP was 55.4+/-29.3 cmH2O(7~142). In the correlation analysis, cystometric capacity had a correlation of -0.207 with age (p=0.029) and -0.215 with symptom grade(p=0.031). However, bladder compliance had no significant correlation with any of the parameters studied. In each symptom grade, cystometric capacity was 407.0+/-103.1 cc(I), 395.8+/-103.0 cc(II), 324.5+/-124.0 cc(III)(p=0.04) and the age for each symptom grade was 48.5+/-9.7(I), 48.1+/-10.1 (II), 57.3+/-10.1(III)(p=0.005). CONCLUSION: As cystometric capacity decreased, symptom grade of stress incontinence increased and age also increased. However, there were no other correlations between cystometric capacity or compliance and stress incontinence parameters.
Compliance* ; Humans ; Retrospective Studies ; Urinary Bladder* ; Urinary Bladder, Overactive ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: Bladder wall thickness has been reported to be associated with overactive bladder (OAB) in women. Diabetic women have an increased risk for OAB syndrome and may have an increased risk for bladder wall thickness. METHODS: A total of 235 female patients aged 40 to 75 years were categorized into four groups. The first group consisted of women free of urgency or urge urinary incontinence. The second group included nondiabetic women with idiopathic OAB. The third group consisted of women with diabetes and clinical OAB, and women with diabetes but without OAB constituted the fourth group. Bladder wall thickness at the anterior wall was measured by ultrasound by the suprapubic approach with bladder filling over 250 mL. RESULTS: The diabetic (third group) and nondiabetic (second group) women with OAB had significantly greater bladder wall thickness at the anterior bladder wall than did the controls. However, the difference was not significant between the diabetic (third group) and the nondiabetic (second group) women with OAB. Women with diabetes but without OAB (fourth group) had greater bladder wall thickness than did the controls but this difference was not significant. Additionally, the difference in bladder wall thickness between diabetic women with (third group) and without (fourth group) OAB was not significant. CONCLUSIONS: This is the first study to show that bladder wall thickness is increased in diabetic women with and without OAB. Additionally, nondiabetic women with OAB had increased bladder wall thickness. Further studies may provide additional information for diabetic and nondiabetic women with OAB, in whom the etiopathogenesis of the disease may be similar.
Aged ; Diabetes Mellitus ; Female ; Humans ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence

Functional urinary incontinence, the absence of any neurologic or structural abnormality as a cause of urinary incontinence in children, is one of the most common clinical problems encountered in pediatric and urologic departments, and it can be socially and emotionally distressing for the affected children. The prevalence rates of functional urinary incontinence in school-aged children are not very high and differ between boys and girls. The underlying mechanisms of functional urinary incontinence are heterogenous and can be associated with the following dysfunctions of both the storage and voiding patterns of the bladder: overactive bladder, dysfunctional voiding, lazy bladder syndrome, HinmanAllen syndrome, giggle incontinence, and vaginal voiding. Treatment methods for urinary incontinence in children should be chosen according to these clinical conditions. Treatment modalities generally consist of the treatment of comorbid conditions such as urinary infection and constipation, behavior therapy to modify learned voiding patterns, and pharmacotherapy primarily with anticholinergics and alpha -adrenergic blockers. This review discusses the optimal treatment modalities, including treatment of the underlying voiding disorders, and diagnostic approaches related to functional urinary incontinence in children.
Behavior Therapy ; Child ; Cholinergic Antagonists ; Constipation ; Humans ; Prevalence ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence

PURPOSE: A videourodynamic study is useful for examining the functional and structural problems of the urinary tract simultaneously. Due to its invasiveness, however, it is important to obtain as much information as is possible as the study is being conducted. The purpose of this study was to evaluate the results of a repeated videourodynamic examination in spina bifida children. MATERIALS AND METHODS: Between January 2005 and July 2006, a total of 48 patients who were diagnosed with spina bifida and underwent repeated videourodynamic studies were enrolled in this study. We compared variables including compliance, involuntary detrusor contraction (IDC), cystometric bladder capacity (CBC), maximum detrusor pressure, and post-voiding residual urine (PVR) between the initial and repeated studies. RESULTS: During the repeated studies, cases of IDC decreased significantly (p<0.05) compared with the initial studies. No other significant differences were found in terms of compliance, CBC, maximum detrusor pressure, and PVR. CONCLUSIONS: There were no significant differences in terms of compliance, CBC, maximum detrusor pressure, and PVR between initial and repeated studies. However, the number of patients who had IDC decreased significantly in the second study. Nevertheless, we conclude that the first examination in this study was enough to evaluate the overall function and structure of the urinary tract. We believe that repeat studies are not necessary in children with spina bifida.
Child ; Compliance ; Contracts ; Humans ; Spinal Dysraphism ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Tract ; Urodynamics