PURPOSE: The aim of this study was to evaluate the effects of the single administration of the anticholonergics, trospium chloride, in the nocturic patients without bladder outlet obstruction for mid-term. MATERIALS AND METHODS: We included the 22 male and 102 female patients with nocturia over 3 times and without bladder outlet obstruction. Exclusion criteria was under 15 ml/sec in maximal flow rate, over 30 ml in post-void residual urine, nocturnal polyuria and medication affecting lower urinary tract symptoms including alpha-blockers, sedatives, muscle relaxants. Based on voiding diary for 3 days, frequency of the nocturia, daytime frequency and frequency of the urgency and urge incontinence were measured at pretreatment, post-treatment 1st month, 3rd month and 6th month. Additionally maximal flow rate and post-void residual urine were also recorded at the same periods. Anticholinergics was administered in flexible dose. RESULTS: In frequency of nocturia, single administration of the anticholonergics improved significantly at post-treatment 1st, 3rd and 6th month compared to pre-treatment level. The more severe the frequency of the nocturia was, the more it was improved by medication but there is no significant difference. Daytime frequency is significantly improved 3 month and 6 month after medication. In urgency and urge incontinence, the significant improvement was also observed at post-treatment 3rd month and 6th month. The significant differences between pre-treatment and post-treatment were not demonstrated in maximal flow rate and post-void residual urine. Dry mouth was the most common side effect but mild and tolerable. CONCLUSION: The single administration of the trospium chloride demonstrated a clinically significant improvement in nocturia as well as symptoms of the overactive bladder and did not affect negatively on bladder contractility.
Cholinergic Antagonists ; Female ; Humans ; Hypnotics and Sedatives ; Lower Urinary Tract Symptoms ; Male ; Mouth ; Nocturia* ; Polyuria ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge

Lower urinary tract symptoms (LUTS) are classified into three groups: storage, voiding, and post-micturition symptoms. The most popular causes of LUTS are benign prostatic hyperplasia (BPH) and overactive bladder (OAB). Although BPH is a pathologic term, clinically, we use this when patients have LUTS due to benign prostatic enlargement and obstruction. OAB is defined as urgency, with or without urge incontinence, usually with frequency and nocturia. Currently alpha1-adrenoceptor antagonists are the most common drug treatment for BPH, and are thought to act by relaxing the prostatic smooth muscle. They are all effective for the treatment of LUTS/BPH. 5alpha-reductase inhibitors, such as fiansteride and dutasteride, are another treatment option for BPH symptoms, which reduce the prostatic volume by inducing epithelial atrophy. Long-term combination therapy with alpha-1-blockers and 5alpha-reductase inhibitors reduces the risk of the overall clinical progression of BPH significantly more than does treatment with either drug alone. Antimuscarinics are the mainstay for the treatment of OAB. Antimuscarinics competitively block muscarinic receptors of all subtypes but with variations in selectivity for the different subtypes. When they are used for the treatment of OAB, they are active during the storage phase of the bladder, with little or no effect on voiding contractions. Desmopressin acetate is a synthetic analogue of Arginin vasopressin, which has been proven effective for the treatment of nocturnal polyuria in LUTS.
Atrophy ; Azasteroids ; Contracts ; Deamino Arginine Vasopressin ; Dutasteride ; Humans ; Lower Urinary Tract Symptoms ; Muscarinic Antagonists ; Muscle, Smooth ; Nocturia ; Polyuria ; Prostatic Hyperplasia ; Receptors, Muscarinic ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge ; Vasopressins

Purpose: A video-urodynamic study is known as the most accurate test to differentiate between benign prostatic hyperplasia (BPH) with overactive bladder and detrusor instability but requires expensive equipment and an expert technique, so is not commonly available. We performed a video- urodynamic study and ice-water test which is easily performed for the diagnosis of a neurogenic bladder in the patients with symptomatic BPH associated with overactive bladder and compared the results. Materials and Methods: The video-urodynamic study using a 10-Fr triple lumen urodynamic catheter was performed in 36 patients with symptomatic BPH associated with overactive bladder that had frequency, weak stream, nocturia, urgency, urge incontinence, dysuria and no clinical neurogenic defect. After the video-urodynamic study, the ice-water test was performed by instilling 4degreesC sterilized water through a catheter at 200ml/ min in the supine position. The volume instilled was about 30% of the bladder capacity. The ice-water test was positive if there was an efflux of water around the catheter during or after water instillation. Results: Thirty two of the 36 symptomatic BPH patients with an overactive bladder were negative on the ice-water test. All 32 patients who had a negative ice-water test were BPH with overactive bladder on the video- urodynamic study. Four of the 36 symptomatic BPH patients with an overactive bladder were positive on the ice-water test. Two of the 4 patients who had a positive ice-water test were BPH with overactive bladder and the other two were detrusor instability on the video-urodynamic study. Conclusions: Therefore, in case of a positive ice water test, a video-urodynamic study is needed to differentiate between BPH with overactive bladder and detrusor instability in patients with symptomatic BPH associated with overactive bladder.
Catheters ; Diagnosis ; Dysuria ; Humans ; Ice ; Nocturia ; Prostatic Hyperplasia* ; Rivers ; Supine Position ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics ; Water

PURPOSE: This study aimed to evaluate the relationship between pressure-flow parameters and urethral pressure in women with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Urodynamic traces of women with stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and detrusor overactivity (DO) were retrospectively studied. The urodynamic parameters such as detrusor opening pressure (DOP), detrusor pressure at maximum flow rate (PdetQmax), maximum flow rate (Qmax), detrusor closing pressure (DCP), and maximal urethral closing pressure (MUCP) were measured and compared. The relationship between pressure-flow parameters and MUCP were evaluated as well as the differences between each urodynamic group. RESULTS: One hundred fifty-one women were investigated between June 2004 and May 2008. One hundred twenty-one (80%) women had good-quality urodynamic studies and were included in the present study. The mean age was 56 years (range, 32-77). Women with DO had higher DOP, PdetQmax, and MUCP than did women with SUI (p<0.05). Qmax was significantly greater in women with SUI than in women who had DO (p<0.05). Women with MUI had DOP, PdetQmax, and Qmax that were intermediate between women with SUI and those with DO. There was a significant positive correlation between DOP, PdetQmax, DCP, and MUCP measurements and a significant negative correlation between Qmax and MUCP measurements (p<0.01). CONCLUSIONS: Pressure-flow parameters are reliable surrogates of urethral pressure. Therefore, an accurate evaluation of the pressure-flow parameters might give important information in the assessment of urethral and detrusor function in women with LUTS. Further study is needed to confirm our results.
Female ; Humans ; Lower Urinary Tract Symptoms ; Retrospective Studies ; Urinary Incontinence ; Urodynamics ; Urological Manifestations

PURPOSE: We evaluated the changes of storage symptoms after tension-free vaginal tape(TVT) procedures in stress urinary incontinence(SUI) patients, and we investigated the factors predicting the changes of storage symptoms. MATERIALS AND METHODS: From January 2000 to August 2003, 713 patients with SUI were operated on with using suburethral sling procedures(TVT). A follow-up study was conducted for over a one year period with 495 patients. We analyzed the one year outcomes of TVT surgeries and the changes of storage symptoms after TVT. RESULTS: The rates of cure and improvements at one year after TVT were 80.8% and 12.3%, respectively. At one month after TVT, 59 of 180(33%) patients with urgency before TVT were improved, and 60 of 72(83.6%) patients with urgency incontinence before TVT were improved. In 86 of 180(47.8%) patients, the urgency is improved, and in 65 of 72(90.1%) patients, the urgency incontinence disappeared at one year after TVT procedure. Urgency developed in 65 of the 243(26.9%) patients who had no urgency before TVT, but after 1 year, only 28(10.2%, 25/243) these 243 patients had urgency. 102(31.6%) of the patients with frequency before TVT were improved after TVT. Of the 92 patients with nocturia, 22 (23.4%) patients were improved. There were no statically significant factors predicting the changes of the storage symptoms. CONCLUSIONS: The total improvement rate (cure+improvements) of stress urinary incontinence was 93.1% at one year. We can expect the improvement of urgency(47.1%) and urgency incontinence(90.1%) after TVT procedures, but not improvement of the frequency and nocturia.
Follow-Up Studies ; Humans ; Nocturia ; Suburethral Slings* ; Urinary Bladder, Overactive ; Urinary Incontinence* ; Urinary Incontinence, Urge

PURPOSE: The aim of this study was to describe lower urinary tract symptoms in neuromyelitis optica (NMO), and to compare these data with urinary disorders observed in multiple sclerosis (MS) patients. METHODS: Retrospective study of data collected from January 1997 to July 2017 using the database from a Neuro-Urology Department of a university hospital. NMO and MS patients were matched for sex, age, and Expanded Disability Status Scale (EDSS) RESULTS: Twenty-six patients with NMO were included and compared with 33 MS patients. Mean age was 41.6 years (standard deviation [SD], 14,8), mostly female patients (24 vs. 2 males). Mean EDSS was 4.6 (SD, 1.8) in the 2 groups. In NMO group, 57% of the patients (n=15) had overactive bladder with urgency and urge incontinence and 38.5% (n=10) of them had nocturia. Voiding symptoms was observed in 69.2% of the patients (n=18); 42.3% of NMO patients performed self-intermittent catheterization versus 12.1% in MS patients (P=0.012). Low bladder compliance and severe urinary tract infections (pyelonephritis) were more frequent in NMO than in MS patients (respectively 15% vs. 0%, P=0.016 and 42% vs. 12%, P=0.024). CONCLUSIONS: Lower urinary tract symptoms, especially overactive bladder and urinary retention, are frequent in NMO. Low bladder compliance, serious urinary infections, and high prevalence of urinary retention requiring self-intermittent catheterization are the main symptoms significantly more frequent than in MS.
Catheterization ; Catheters ; Compliance ; Female ; Humans ; Lower Urinary Tract Symptoms* ; Multiple Sclerosis* ; Neuromyelitis Optica* ; Nocturia ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity* ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge ; Urinary Retention ; Urinary Tract Infections

PURPOSE: The aim of this study was to evaluate the efficacy of functional magnetic stimulation (FMS) therapy on the lower urinary tract symptoms (LUTSs) and sexual function in female patients with stress urinary incontinence (SUI). MATERIALS AND METHODS: 39 sexually active women, with SUI treated by FMS therapy, were studied. Before treatment, female bladder questionnaires and a visual analog scale test (VAT) were used to acquire information relating to LUTS. Questions were asked about sexual function using the female sexual function index (FSFI). Treatments were performed for 20 minutes, twice a week, for 6 weeks. After treatment, the same questionnaires were repeated at 3, 6 and 12 months. The patients were divided into two groups: those with cured or improved SUI symptoms were defined as the success group, with the remainder defined as the failure group. The VAT scores of LUTSs, the domain scores and full scale scores of FSFI were analyzed. RESULTS: The success and failure groups comprised of 25 (64%) and 14 (36%) patients, respectively. In both groups, the frequency, urge incontinence and dysuria were improved. The VAT score for the overall satisfaction was significantly decreased in the success group only (p<0.05). In the success group, the domain score for 'satisfaction' in the FSFI was significantly increased (p<0.05). The full scale scores of the FSFI were significantly increased in the success group only (p<0.05). CONCLUSIONS: These results show that FMS therapy improves some LUTSs and sexual functions, with the correction of SUI symptom. Therefore, FMS therapy could be considered as a primary therapy in SUI women with LUTSs and sexual impairment.
Dysuria ; Female* ; Humans ; Lower Urinary Tract Symptoms* ; Magnetic Field Therapy* ; Surveys and Questionnaires ; Sexual Dysfunctions, Psychological ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urination Disorders ; Visual Analog Scale

Overactive bladder (OAB) is defined as urgency, usually with frequency and nocturia, and with or without urge incontinence. Duloxetine, an antidepressant that inhibits reuptake of serotonin and norepinephrine, is indicated for the treatment of stress urinary incontinence in Europe. In this paper, we present a case of a 17-year-old female patient with OAB and depressive symptoms who was successfully treated with duloxetine. This case suggests duloxetine can be an option for patient with OAB, and it also highlights the need for further studies of duloxetine's use in the treatment of OAB.
Adolescent* ; Depression ; Europe ; Female* ; Humans ; Nocturia ; Norepinephrine ; Serotonin ; Urinary Bladder, Overactive* ; Urinary Incontinence ; Urinary Incontinence, Urge ; Duloxetine Hydrochloride

The availability of new urologic medications has made it possible to manage a variety of urologic disorders successfully in a primary care setting. As a result, primary care physicians(PCPs) need to be familiar with the terminology and screening instruments used by urologists to decipher and categorize urologic symptoms. PCPs are often responsible for the treatment of lower urinary tract symptoms and benign prostatic hyperplasia(BPH). Evolving strategies of management include utilization of both symptom-modifying treatment and disease-modifying treatment. Alphablockers excellently provide symptomatic treatment, but do not alter long-term disease progression. 5-alpha reductase inhibitors can reduce the need for surgical intervention and the incidence of acute urinary retention. The combination of alphablockers and 5-alpha reductase inhibitors would be the choice of therapy in some patients, typically those with large prostate glands indicative of disease progression. Overactive bladder(OAB) is defined as urinary urgency with or without urge incontinence, usually with frequency and nocturia, in the absence of a pathologic or metabolic condition that can explain these symptoms. The diagnosis of OAB should be made after a careful history taking, physical examination, laboratory evaluation, and use of tools such as voiding diaries. Anticholinergic agents are the first choice for drug therapy. Treatment that couples drug therapy with behavioral techniques aimed at modifying abnormal voiding patterns may provide the best outcomes in many patients with OAB. There are situations for referring patients to urologists for more detailed evaluation and management, including when the PCP has a lack of interest in or sufficient knowledge about lower urinary tract symptoms and if the patient shows a poor response to prior noninvasive therapy, requiring in-depth investigation.
5-alpha Reductase Inhibitors ; Cholinergic Antagonists ; Diagnosis ; Disease Progression ; Drug Therapy ; Family Characteristics ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Mass Screening ; Nocturia ; Physical Examination ; Primary Health Care* ; Prostate ; Prostatic Hyperplasia ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge ; Urinary Retention

PURPOSE: To prospectively investigated the symptom changes in women with an overactive bladder (OAB) after discontinuation of 3 months of successful treatment with antimuscarinics and the pre-treatment factors that contributed to retreatment. MATERIALS AND METHODS: Sixty-eight women (mean age 51.4 years) with improvement in the symptoms of OAB after 4 weeks of treatment with propiverine hydrochloride (20mg/day) were prospectively enrolled in a protocol consisting of 8 further weeks of medication and a 4-week period of discontinuation. The frequency-volume charts were assessed before treatment, after the 12 weeks of therapy, and 4 weeks the end of the therapy. Changes in the frequencies, nocturia, urgency scores and urge incontinence at 12 and 16 weeks were evaluated. RESULTS: All of the OAB symptoms 4 weeks after discontinuation of medication remained improved compared to those initially recorded, but then deteriorated during further medication. At the baseline, and 12 and 16 weeks, the mean frequencies, nocturia and urgency scores per day were 11.2, 7.3 and 8.3, 1.6, 0.4 and 0.8, and 1.7, 0.6 and 1.2, respectively. The retreatment rate was 35.3%. Patients in the retreatment group were older (58.8 vs. 47.3 years, p<0.001) and had higher initial urgency scores (1.9 vs. 1.6, p=0.034). In an urodynamic study of 23 patients, those without detrusor overactivity (DO) maintained a significantly improved frequency after cessation of mediation, whereas those with DO (60.9%) did not. The retreatment rate was higher in patients with DO, but the difference was not significant. CONCLUSIONS: Three months of antimuscarinic therapy for OAB may not be sufficient. Older patients, or those with severe urgency, may be more likely to return to treatment.
Female ; Humans ; Muscarinic Antagonists ; Negotiating ; Nocturia ; Prospective Studies* ; Retreatment ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics