OBJECTIVE: To evaluate the quality of life of patients with interstitial cystitis/bladder pain syndrome (IC/BPS), to compare the difference between IC/BPS and overactive bladder (OAB) pain syndrome, and to explore the related factors affecting the quality of life of IC/BPS patients. METHODS: The demographic data of female outpatients with IC/BPS in Beijing Hospital and other medical centers in China were collected. The quality of life of the patients was investigated by multi-angle questionnaires and compared with the data of OAB patients. According to the influence degree of quality of life, the patients with IC/BPS were divided into mild-moderate group and severe group. RESULTS: In this study, 109 patients with IC/BPS were included. The average age was (46.4±14.3) years and the average course of disease was (39.4±51.6) months. Compared with the OAB patients, the patients in IC/BPS group had a longer average course of disease (P=0.008), a lower proportion of the patients of first visit for the disease (P < 0.001), a higher score of the American Urological Association symptom index (AUA-SI) (P < 0.001), a lower body mass index (BMI) ratio (P=0.016), and a lower incidence of constipation (P=0.006). IC/BPS had the greatest impact on family life, followed by social activity. The score of IC/BPS related symptoms on family life was significantly higher than that of the OAB group (P=0.003). The top three symptoms of the IC/BPS patients were pain (45%), frequency (28%) and urgency (17%). The score of quality of life in the IC/BPS patients was significantly higher than that in the OAB patients (P < 0.001). Caffeine intake (P=0.034) and constipation (P=0.003) might be the factors influencing the quality of life of the patients with IC/BPS. CONCLUSION IC/BPS has a great influence on the quality of life of patients. Caffeine intake and constipation may be related factors affecting the quality of life of patients with IC/BPS. Urologists should recommend changes in diet and lifestyle to reduce symptoms and improve the patients' quality of life.
Adult ; Cystitis, Interstitial/epidemiology* ; Female ; Humans ; Middle Aged ; Pain ; Quality of Life ; Surveys and Questionnaires ; Urinary Bladder, Overactive/epidemiology*

OBJECTIVE: To introduce a urodynamic classification of male patients with symptoms of overactive bladder (OAB) and discuss its clinical significance in practice. METHODS: From January 2015 to January 2017, there were 181 male patients from Peking University People's Hospital who were diagnosed clinically with OAB and underwent preoperative urodynamic test. Finally 126 male patients were enrolled in the research. Male OAB patients could be stratified into four groups based on the chief complaints (whether or not presenting urgency) and the results of urodynamic test (whether or not presenting detrusor overactivity and the ability to stop the involuntary contraction). The contents of this follow-up study included the basic information, the preoperative and postoperative scores of the OAB symptom score (OABSS), the preoperative and postoperative scores of the international prostate symptom score (IPSS), and the amount of the concomitant diseases. RESULTS: According to the classification, the amounts of the four types of OAB patients were 32 (25.40%) for type I, 27 (21.43%) for type II, 59 (46.83%) for type III, and 8 (6.35%) for type IV, respectively. The data of their heights showed no statistical significance (P>0.05). The ages, weights and the amount of the concomitant diseases of type IV were obviously higher than those of the other three types (P<0.05). And the ages, weights and the amount of the concomitant diseases of the other three types had shown no statistical significance (P>0.05). The improvement of the OABSS and IPSS scores of the type IV were obviously inferior to the other three types (P<0.05). The improvements of the OABSS and IPSS scores of type III were obviously higher than those of the other three (P<0.05). The discrepancy of the OABSS and IPSS scores of type I and type II had shown no statistical significance (P>0.05). CONCLUSION Type IV has the worst outcome and type III has the best among the four types of OAB. And this classification system will certainly have a profound significance in guiding and directing our clinical diagnosis and treatments, and evaluating the prognosis of the patients with OAB.
Follow-Up Studies ; Humans ; Male ; Urinary Bladder, Overactive ; Urodynamics

PURPOSE: To evaluate seasonal variations of overactive bladder (OAB) symptoms in women who visited hospital clinics.METHODS: Medical records of female patients treated for OAB symptoms from January 2011 to December 2017 were retrospectively reviewed. Patients with pyuria at the first visit, those who did not complete the questionnaire, and those with <3 overactive bladder symptom scores (OABSS) were excluded. Uroflowmetric parameters, 3-day micturition diary, and OABSS were analyzed.RESULTS: A total of 582 patients with OAB symptoms who visited the hospital were enrolled in this study. Patients were grouped into 1 of the 3 season groups (cold, intermediate, and hot) depending on the average temperature of the month that the patient first visited the urologic department outpatient clinic. The total OABSS was significantly different between the 3 season groups (cold [7.25±3.20] vs. intermediate [6.24±3.40] vs. hot [5.51±3.20], P=0.001). The proportion of patients who had moderate OAB symptoms (6≤OABSS) was higher in the cold season group (56.2%) than in the other season groups (intermediate, 42.1%; hot, 31.8%; P=0.002). Differences in the number of micturitions (12.12±4.56 vs. 10.95±4.39, P=0.021) and number of urgent urinary incontinence episodes (2.06±0.94 vs. 2.48±0.87, P=0.001) between the cold and hot season groups were also significant. However, differences in the nocturia episode, total daytime voided volume, and mean voided volume between season groups were not significant.CONCLUSIONS: Different urinary symptoms and uroflowmetric parameters were correlated with seasonal variation. OAB symptoms might be worse in cold season than in other seasons.
Ambulatory Care Facilities ; Female ; Humans ; Medical Records ; Nocturia ; Pyuria ; Retrospective Studies ; Seasons ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urination

PURPOSE: Providing practitioners with an adjunctive guide that will aid implanters in the ability to predict and, immediately recognize, what suboptimal needle placement looks like (based on visualization of needle/lead placement and the patient's sensory and motor responses), allow cultivation of a more complete and comprehensive level of understanding of the sacral neuromodulation procedure as a whole, and inversely provide a guide for what true optimal needle/lead placement should currently demonstrate (based on current International Continence Society guidelines).METHODS: More than 400 patients underwent sacral neuromodulation procedures from 2011–2018 by a practitioner who is in the top 5% of implanting physicians in the United States. Common stimulation patterns with motor and sensory responses were observed in patients with suboptimal needle placement intraoperatively.RESULTS: Reproducible stimulation patterns were observed with common suboptimal needle placement intraoperatively. This allowed the implanting practitioner to immediately identify and correct the needle placement intraoperatively to achieve optimal needle placement and optimal motor and sensory responses for the patients.CONCLUSIONS: By considering the 3-dimensional spatial trajectory of the S3 nerve, and following this presented guide, the most optimal lead placement with consistently reproducible outcomes that include S3 motor and sensory response on all 4 leads at less than, or equal to, 2 volts can be achieved and can potentially maximize the life of the device while potentially affording patients a more successful outcome.
Fecal Incontinence ; Humans ; Needles ; United States ; Urinary Bladder, Overactive

PURPOSE: To evaluate the outcomes of sacral neuromodulation (SNM) after failure of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with overactive bladder (OAB).METHODS: A retrospective study was conducted in 3 university hospitals and included all patients with OAB and treated with SNM after TPTNS had been tried between October 2008 and May 2018. The primary endpoint was the proportion of definitive SNM device implantation in patients with 50% objective and/or subjective improvement after a test period (stage 1). The secondary outcomes of interest were changes of the number of diurnal voids and nocturia episodes per 24 hours between the end of TPTNS and the end of stage 1.RESULTS: Overall, 28 of the 43 patients included achieved at least 50% objective and/or subjective improvement during stage 1 and underwent an Interstim II implantation (65.1%). The mean daytime frequency decreased significantly from 10.3/day at the end of TPTNS to 7.8 diurnal voids/day at the end of SNM stage 1 (P=0.01). The mean number of nocturia episodes decreased from 2.5/night at the end of TPTNS to 2.1/night at the end of stage 1, but this did not reach statistical significance (P=0.18). There was no other parameter significantly associated with response to SNMCONCLUSIONS: SNM might improve OAB symptoms in most patients who experienced no or poor efficacy with TPTNS. History of failed TPTNS should not preclude the use of SNM in OAB patients.
Hospitals, University ; Humans ; Nocturia ; Retrospective Studies ; Tibial Nerve ; Urinary Bladder, Overactive

Aged ; Biomarkers ; metabolism ; Brain-Derived Neurotrophic Factor ; metabolism ; Female ; Humans ; Incidence ; Middle Aged ; Nerve Growth Factor ; metabolism ; Quality of Life ; Surveys and Questionnaires ; Urinary Bladder, Overactive ; metabolism

PURPOSE: To identify factors predicting the presence of overactive bladder syndrome (OAB)-wet, compared with OAB-dry. METHODS: Between September 2007 and September 2013, the medical records of 623 women with OAB who completed a 3-day bladder diary and underwent urodynamic studies in a medical center were retrospectively reviewed. OAB-wet was diagnosed in patients who complained of at least one episode of urgency incontinence in the previous month; otherwise, OAB-dry was diagnosed. Multivariable logistic regression analysis was used to predict the presence of OAB-wet. RESULTS: Age (odds ratio [OR], 1.05; P<0.001), maximal flow rate (Qmax) (OR,1.06; P<0.001), voided volume (OR, 0.996; P=0.001), detrusor pressure at maximal flow rate (PdetQmax) (OR, 1.02; P=0.003), urgency episodes (OR, 1.04; P<0.001) and urodynamic stress incontinence (OR,1.78; P=0.01) were independent predictors for the presence of OAB-wet vs. OAB-dry. If we use bladder contractility index as a variable for multivariable logistic regression analysis, bladder contractility index (OR, 1.012; P<0.001) become an independent predictor for OAB-wet. CONCLUSIONS: A smaller bladder capacity and more frequent urgency episodes were predictors of OAB-wet, and the above findings indicate that OAB-wet and OAB-dry might be a continuum of OAB. Old age, high Qmax, high PdetQmax and urodynamic stress incontinence were also predictors for OAB-wet, and the above results reveal that OAB-wet and OAB-dry have partially different clinical and urodynamic features. Further studies might be performed to elucidate whether different treatment strategies between OAB-dry and OAB-wet can improve treatment efficacy.
Female ; Humans ; Logistic Models ; Medical Records ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder ; Urinary Bladder, Overactive ; Urodynamics

PURPOSE: OnabotulinumtoxinA has demonstrated efficacy and safety in the treatment of urinary incontinence (UI) associated with neurogenic detrusor overactivity (NDO) and idiopathic overactive bladder (OAB); however, real-world evidence is limited. This postmarketing surveillance study aimed to assess the effectiveness and safety of onabotulinumtoxinA in Korean patients with UI associated with NDO or OAB with an inadequate response or intolerance to anticholinergics. METHODS: Patients received 200 U (NDO) or 100 U (OAB) of onabotulinumtoxinA. Effectiveness (assessed using the validated International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]) and safety were assessed for 1–4 months after onabotulinumtoxinA administration. RESULTS: Overall, 686 patients (NDO, 161; OAB, 525) comprised the safety population; of these, 612 patients were analyzed for effectiveness. There was a significant decrease (P<0.0001) in the mean (standard deviation) ICIQ-SF scores in the NDO (–6.8±5.5) and OAB (–6.0±6.4) groups after onabotulinumtoxinA administration. A decrease of >5 points from baseline in the ICIQ-SF score was observed in 64.9% and 47.3% of patients in the NDO and OAB groups, respectively. Following treatment, 59.9% in the NDO group and 43.0% in the OAB group were dry. There was no effect of age on effectiveness in either group. Only 10 adverse drug reactions (ADRs) were reported in 5.6% of NDO patients and 20 ADRs in 3.2% of OAB patients. Most ADRs in both groups were related to the lower urinary tract such as dysuria (NDO, 1.2%; OAB, 0.6%) and urinary retention (NDO, 0.6%; OAB, 1.5%). CONCLUSIONS: Effectiveness and safety of onabotulinumtoxinA in Korea in a real-world setting was demonstrated.
Cholinergic Antagonists ; Drug-Related Side Effects and Adverse Reactions ; Dysuria ; Humans ; Korea ; Outcome Assessment (Health Care) ; Urinary Bladder, Neurogenic ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urinary Retention ; Urinary Tract

PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P<0.05). During AA infusion, SNM at 64 μsec, 204 μsec, and 624 μsec increased the bladder capacity to 126.1%±6.9%, 129.5%±7.3%, and 140.1%±7.6% of the AA control level (P<0.05). No significant differences were found among the results obtained using pulse widths of 64 μsec, 204 μsec, and 624 μsec (P>0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P<0.05). No significant differences were found among the T visual for pulse widths of 204 μsec and 624 μsec (P>0.05). CONCLUSIONS: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.
Acetic Acid ; Humans ; Reflex ; Spinal Nerves ; Swine ; Tail ; Urinary Bladder ; Urinary Bladder, Overactive ; Urination

PURPOSE: Intradetrusor onabotulinum toxin A (BTXA) and sacral neuromodulation (SNM) are effective third-line therapies for overactive bladder (OAB). We aimed to measure the outcomes of BTXA for treatment of OAB refractory to initial SNM and identify patient characteristics associated with these outcomes. METHODS: This retrospective cohort study included patients who failed to respond to initial SNM treatment for OAB and subsequently received BTXA at a single provider’s clinic between January 2013 and December 2016. Treatment successes were defined as patients willing to continue BTXA or who found symptom relief whereas treatment failures discontinued BTXA due to adverse effects or lack of symptom relief. Symptoms and patient-reported outcomes on validated questionnaires were compared before the initial BTXA trial to 2 months after the last BTXA treatment. The SNM failure BTXA groups were also compared to BTXA SNM naïve groups. RESULTS: Of 18 patients who received BTXA after failed SNM treatment, 7 (39%) achieved treatment success. Successfully treated patients demonstrated decreased urinary frequency from a median 11 voids/day pre-BTXA to 8 voids/day with BTXA (P=0.042). Patients whose treatment failed reported increased complaints of a weak urinary stream (P=0.03) and higher frequency of straining to urinate (P=0.016) than the successful treatment group pre-BTXA. Compared to BTXA patients without prior SNM, the odds of failing BTXA after initial SNM were 3.6 times higher (P=0.016). CONCLUSIONS: BTXA appears effective for OAB refractory to SNM, although the success rate is lower compared to BTXA patients without SNM exposure.
Cohort Studies ; Humans ; Retrospective Studies ; Rivers ; Treatment Failure ; Urinary Bladder, Overactive