ABSTRACT
Background: the International Continence Society [ICS] defined overactive bladder syndrome [OAB] as urinary urgency with or without urge incontinence, often accompanied by frequency and nocturia in absence of infection. Urinary urgency is the complaint of a sudden compelling desire to void which is difficult to defer with patients often suffering from anxiety due to fear of leakage. Urge urinary incontinence is defined as involuntary leakage of urine, accompanied or immediately preceded by urgency. Overactive bladder syndrome is a symptomatic diagnosis. On the other hand, detrusor overactivity [DO] is an urodynamic finding, characterized by involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked. These terms aren't interchangeable, as overactive bladder syndrome patients may not have detrusor activity on urodynamic testing
Aim of the Work: to determine the relation between clinical improvement and urodynamic based improvement in patients with overactive bladder syndrome receiving anticholinergic drugs
Patients and Methods: this study included thirty eight patients, who presented to the Outpatient Urology Clinic at Ahmed Maher Teaching Hospital with symptoms of OAB syndrome. This study design was prospective. Patients clinical histories were taken, they were examined thoroughly, and completed an IPSS questionnaire. This was followed by a urinalysis, free uroflowmetry and a pelvi-abdominal ultrasound
Results: this study included thirty eight patients who were divided into two groups. Group A included twenty one patients, fifteen females and six males with mean age of 48.2 years old [21-60], who did not have detrusor overactivity in the first urodynamic study. On the other hand, group B included seventeen patients, ten females and seven males with mean age of 43.7 years old [18-58], who had detrusor overactivity in the initial urodynamic study. Patients in both groups received Solifenacin 10 mg once daily for twelve weeks before completing another IPSS questionnaire and undergoing a follow up urodynamic study
Conclusion: in this study, we concluded that there was strong correlation between urodynamic and clinical improvement in OAB patients after Solifenacin treatment as patients who were improved urodynamicaly reported improvement of their symptoms while those with poor urodynamic response reported that their symptoms were either the same as before treatment or worse. We also concluded that Solifenacin 10 mg once daily led to significant improvement in IPSS results of OAB patients with significant increase in volume to first desire and maximum cystometric capacity
ABSTRACT
This open, prospective, randomized, comparative study evaluated clinical, metabolic, and histopathological aspects of cyclic, extended, and continuous use of a COC containing 30 micro g EE and 75 micro g gestodene [Gynera] in 245 women for 18 cycles. Continuous [82 women] and extended [80 women] pill users had significantly fewer bleeding days requiring sanitary protection than cyclic users [83 women]. Spotting increased initially in continuous and extended pill users but declined after the 4[th] cycle. Amenorrhea rates increased significantly after the 4[th] cycle reaching 85% and 71.4% in the last cycle in continuous and extended pill users, respectively. No significant changes in BP or weight as well as a significant increase in hemoglobin concentration were observed in all study groups. No significant changes in lipid profile were observed except a significant increase in HDL-cholesterol in the continuous group. Insulin levels increased significantly with no associated change in glucose levels in all study arms. A significant increase in both fibrinogen and PAI-1 and a significant reduction in PT without changes in other coagulation parameters were observed in all study arms. Continuous and extended COC pill use for 18 cycles was well tolerated with satisfactory clinical effects and good compliance without changes in BP or weight. The treatment was associated with high rates of amenorrhea after the 4[th] cycle, less severe adverse effects, and metabolic changes similar to those in cyclic users