Lower Urinary Tract Symptoms in a prospective cohort of COVID-19 survivors

ABSTRACT Purpose: To analyze the prevalence of lower urinary tract symptoms (LUTS) in patients who survived moderate and severe forms of COVID-19 and the risk factors for LUTS six months after hospitalization. Materials and Methods: In this prospective cohort study, patients were evaluated six months after hospitalization due to COVID-19. LUTS were assessed using the International Prostate Symptom Score. General health was assessed through the Hospital Anxiety and Depression Scale and the EQ5D-L5 scale, which evaluates mobility, ability to perform daily activities, pain and discomfort and completed a self-perception health evaluation. Results: Of 255 participants, 54.1% were men and the median age was 57.3 [44.3 - 66.6] years. Pre-existing comorbidities included diabetes (35.7%), hypertension (54.5%), obesity (30.2%) and physical inactivity (65.5%). One hundred and twenty-four patients (48.6%) had a hospital stay >15 days, 181 (71.0%) were admitted to an ICU and 124 (48.6%) needed mechanical ventilation. Median IPSS was 6 [3-11] and did not differ between genders. Moderate to severe LUTS affected 108 (42.4%) patients (40.6% men and 44.4% women; p=0.610). Nocturia (58.4%) and frequency (45.9%) were the most prevalent symptoms and urgency was the only symptom that affected men (29.0%) and women (44.4%) differently (p=0.013). LUTS impacted the quality of life of 60 (23.5%) patients with women more severely affected (p=0.004). Diabetes, hypertension, and self-perception of worse general health were associated with LUTS. Conclusions: LUTS are highly prevalent and bothersome six months after hospitalization due to COVID-19. Assessment of LUTS may help ensure appropriate diagnosis and treatment in these patients.

Influencing factors for over active bladder syndrome in patients with cerebral small vessel disease / 中华老年心脑血管病杂志

Objective To explore the influencing factors of over active bladder(OAB)in patients with cerebral small vessel disease(CSVD)and its correlation with CSVD imaging markers.Meth-ods A total of 163 elderly CSVD patients admitted in our hospital from January 2021 to Decem-ber 2022 were enrolled and divided into OAB group(37 cases)and non-OAB group(126 cases)based on the results of OAB rating scale.Mini-mental State Examination(MMSE)score,Fazekas scale score,and total CSVD burden score were recorded and compared between the two groups.Results The OAB group had older age,higher urinary frequency,larger proportions of nocturia,urgency,and urge incontinence ratio,increased Fazekas score,periventricular white matter hyper-intensity(PWMH)score and deep white matter hyperintensity(DWMH)score,and elevated total CSVD burden score and lower MMSE score than the non-OAB group(P＜0.05,P＜0.01).PWMH score and DWMH score were risk factors for the occurrence of OAB(P＜0.01).The OAB score was positively correlated with Fazekas score,PWMH score,and DWMH score in the CSVD patients(r=0.533,P=0.001;r=0.462,P=0.004;r=0.398,P=0.015).The occurrence of urgency urinary incontinence was positively correlated with Fazekas score and PWMH score in the CSVD patients(r=0.352,P=0.033;r=0.346,P=0.036).Conclusion PWMH and DWMH are risk factors for OAB occurrence in CSVD patients.

Comparative assessment of efficacy and safety of approved oral therapies for overactive bladder: a systematic review and network meta-analysis

ABSTRACT Purpose: To compare the effectiveness and safety of marketed oral drugs for overactive bladder based on a systematic review and network meta-analysis approach. Methods: Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022. Randomized controlled double-blind trials of oral medication for overactive bladder were screened against the protocol's entry criteria. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 software. Result: A total of 60 randomized controlled double-blind clinical trials were included involving 50,333 subjects. Solifenacin 10mg was the most effective in mean daily micturitions and incontinence episodes, solifenacin 5/10mg in mean daily urinary urgency episodes and nocturia episodes, fesoterodine 8mg in urgency incontinence episodes/d and oxybutynin 5mg in voided volume/micturition. In terms of safety, solifenacin 5mg, ER-tolterodine 4mg, mirabegron, vibegron and ER-oxybutynin 10mg all showed a better incidence of dry mouth, fesoterodine 4mg, ER-oxybutynin 10mg, tolterodine 2mg, and vibegron in the incidence of constipation. Compared to placebo, imidafenacin 0.1mg showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and darifenacin 15mg in headache. Conclusion: Solifenacin showed better efficacy. For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated. The choice of drugs should be tailored to the patient's specific situation to find the best balance between efficacy and safety.

Preliminary results of a trial on Mirabegron in combination with microecologics for the treatment of overactive bladder in elderly women / 中华老年医学杂志

Objective:To investigate the efficacy of Mirabegron plus microecologics for the treatment of overactive bladder(OAB)in elderly women.Methods:In this prospective study, 104 patients diagnosed with OAB in the urology department of our hospital between February 2020 and December 2021 were recruited.The participants were randomly divided into two groups, with 52 in each.Group I was treated with Mirabegron alone(50 mg, qd)and Group Ⅱ was treated with Mirabegron(50 mg, qd)plus probiotics(3.5 g, bid)for 12 weeks.The efficacy was evaluated based on results before and after treatment, using measurements including the daily frequencies of urinary urgency, nocturia, daytime urination, urge incontinence and bladder capacity.The overactive bladder symptom score(OABSS), the quality-of-life score, and the number of lower urinary tract infections during treatment were also collected.Results at different treatment stages(week 4 and week 12)were compared within each group and between the two groups by Dunnett's test.Results:The symptoms of OAB in both groups were significantly improved after 12 weeks' treatment.In the group(Group Ⅱ)receiving the combination of two drugs, results from four measurements, the frequency of 24-hour urination(6.6 ± 0.7 vs.7.1 ± 1.2), the frequency of 24-hour urinary urgency(0.6 ± 0.6 vs.1.1 ± 0.7), the frequency of daily nocturia(0.8 ± 0.7 vs.1.3 ± 0.6)and the quality-of-life score(1.2 ± 0.7 vs.2.3 ± 0.8), were all significantly more favorable than in the group(Group I)treated with Mirabegron( P<0.05).The incidence of lower urinary tract infections and constipation was significantly reduced in the group with drug combination treatment. Conclusions:The efficacy of Mirabegron combined with microecologics for the treatment of OAB is better than that of Mirabegron alone, and the incidence of adverse events such as infections and constipation is also lower.

Prevalence and risk factors of overactive bladder in elderly women with stress urinary incontinence / 中华老年医学杂志

Objective:To explore the risk factors of overactive bladder(OAB)syndrome in older women with stress urinary incontinence(SUI).Methods:In this cross-sectional study, 157 elderly women with SUI, aged 60-88(65.6±5.4)years, were recruited from Qingshan District Maternal and Child Health Hospital and areas serviced by Fozuling Community Service Center in Wuhan between October to November 2020.Data collection included a questionnaire covering general information, dietary habits, childbirth history, medical history, the urogenital distress inventory(UDI-6)and the overactive bladder symptom score(OABSS), and physical examinations on curvature of the spine, pelvic floor muscle strength and pelvic floor ultrasound imaging.Results:A total of 157 elderly women with SUI were included in the study and the prevalence of OAB was 17.2%(27 cases). The prevalence of OAB was 17.6%(25 cases)among 142 patients with mild SUI and 13.3%(2 cases)among 15 patients with moderate or severe SUI, but SUI severity was not correlated with the prevalence of OAB( χ2=0.003, P>0.05). The UDI-6 score was 2.39±2.04 and the OABSS score was 3.70±2.48, with a positive correlation between OABSS and UDI-6( r=0.254, P<0.01), suggesting that OAB had a negative effect on the quality of life of patients with SUI.Multivariate Logistic regression analysis on factors with P<0.3 in the univariate analysis showed that number of pregnancies( P<0.01), anterior vaginal wall prolapse( P<0.05), and abnormal inclination of the pelvis( P=0.05)were associated with the prevalence of OAB.Regarding the number of pregnancies, the risk of OAB increased with 2-3 pregnancies( OR=1.46, 95% CI: 0.25-8.56)and with 3 pregnancies or more( OR=4.29, 95% CI: 0.79-23.18), compared with the prevalence at no more than 1 pregnancy.Compared with patients without anterior vaginal wall prolapse, Ⅰ-Ⅱ degree prolapse increased the risk of OAB( OR=4.21, 95% CI: 1.40-12.63), and third-degree prolapse further increased the risk( OR=11.48, 95% CI: 1.37-96.17). Compared with patients with normal inclination of the pelvis, anterior or posterior pelvis inclination promoted the occurrence of OAB( OR=3.46, 95% CI: 1.23-9.73; OR=2.62, 95% CI: 0.54-12.71). Conclusions:OAB has a negative impact on the quality of life of elderly women with SUI.Pregnancy, anterior vaginal prolapse and abnormal inclination of the pelvis promote the occurrence of OAB.

Analysis of factors related to the efficacy of Tamsulosin monotherapy for overactive bladder symptoms in benign prostatic hyperplasia patients with the prostate volume <40 ml / 中华老年医学杂志

Objective:To assess the efficacy of Tamsulosin monotherapy for overactive bladder(OAB)symptoms in benign prostatic hyperplasia(BPH)patients with the prostate volume(PV)<40 ml, and to analyze related factors affecting the efficacy.Methods:300 BPH patients with OAB were enrolled, with an average age of(66.9±7.7)years and the PV<40 ml.Smoking, drinking and other living habits were investigated.Data on the Overactive Bladder Symptom Score(OABSS), International Prostate Symptom Score(IPSS)and Quality of Life Scale(QOLS)were collected before and after 4 weeks of treatment with Tamsulosin 0.2 mg QN.The maximum urine flow rate(Qmax)and bladder residual urine volume(PVR)were measured before and after treatment.OBASS was used as the main assessment parameter to analyze the correlation of efficacy with age, lifestyle, pre-treatment symptom scores, PV, Qmax and PVR.Results:257 patients completed the study, and 169 patients were treated effectively, with an overall effectiveness rate of 65.8%.The effectiveness rates of the mild, moderate and severe OAB groups were 83.6%, 62.4% and 38.5%, respectively, with statistical significance( χ2=13.037, P=0.001).3 patients showed adverse drug reactions, including 2 patients with mild dizziness and 1 patient with nausea.The baseline OABSS score, the proportion of smoking patients and the proportion of drinking patients in the effectively treated OAB group were significantly lower than those in the ineffectively treated group.Multivariate analysis showed that baseline OABSS score( OR=0.735, P<0.001)and smoking( OR=2.111, P=0.029)were correlated with tamsulosin's efficacy in treating BPH patients with OAB with PV<40 ml. Conclusions:The effectiveness rate of Tamsulosin for the treatment of BPH patients with mild OAB with PV<40 ml is high.The baseline OABSS score and smoking are factors affecting the efficacy of Tamsulosin on OAB symptoms in these patients.

Comparison of urodynamic changes in elderly patients with central neurogenic bladder and with peripheral neurogenic bladder / 中华老年医学杂志

Objective:To examine differences in urodynamic changes between central neurogenic bladder(CNB)and peripheral neurogenic bladder(PNB)in elderly patients.Methods:A total of 57 elderly patients over 60 years old with neurogenic bladder(NB)were divided into a CNB group and a PNB group based on the types of nerve injuries.Data on urodynamic parameters recorded for the two groups were compared and analyzed.Results:The rate of detrusor overactivity(DO)in the CNB group was significantly higher than that in the PNB group [66.7%(16/24)vs.36.4%(12/33), χ2=5.105, P=0.024]. There were significant differences between the two groups in maximum bladder capacity(MCC)[(277.8±101.1)in the CNB group vs.(481.4±110.2)ml in the PNB group, t=-7.149, P=0.001]and in safe bladder capacity(SBC)[(283.2±28.8)ml in the CNB group vs.(348.6±33.9)ml in the PNB group, t=-7.636, P=0.000]. There was no significant difference between the two groups in the maximum urine flow rate, residual urine volume, urination volume, leak point pressure, or detrusor pressure at the maximum urine flow rate(all P>0.05). In the CNB group, 8 patients had normal bladder sensation, 4 had disappeared bladder sensation, 10 had decreased sensation, and 2 had increased sensation.In the PNB group, 9 patients had normal bladder sensation, 4 had disappeared bladder sensation, 14 had decreased sensation, and 2 had increased sensation.There was no statistical significance in SBC between different sensation levels within each group( P>0.05). Conclusions:There are differences in urodynamic characteristics between the elderly patients with CNB and those with PNB.Decreases in MCC, SBC and DO are more likely to occur in CNB.

Urine virology and clinical characteristics of female patients with overactive bladder / 中华泌尿外科杂志

Objective:To investigate the urinary virology and clinical characteristics of female overactive bladder (OAB) patients.Methods:Catheterized urine samples were collected from 55 women with OAB and 18 control individuals between January 2021 and August 2021. Inclusion criteria were: female with age>18, diagnosed as OAB, OABSS total score≥3 and item Urgency score≥2, informed consent signed. Exclusion criteria were: Urine culture positive, urinary catheter indwelling status, antibiotic usage in recent 30 days, other disease leading to OAB-like symptoms, pelvic organ prolapse and current pregnancy, immunosuppressive therapy or status. Clinical characteristic and history were collected. OAB symptoms were assessed via both OABSS (overactive bladder symptom score) and OAB-V8 (8-item overactive bladder questionnaire). The urine specimens were analyzed using mNGS for identifying viral infections. The correlation between the disease and JC virus infection was analyzed by t test, chi-square test, binary logistic regression analysis and Spearman correlation matrix, and the Nomogram map for predicting the risk of viral infection was constructed. Results:In total, 55 women with OAB and 18 healthy controls were recruited in the study. There are significant difference in terms of UTI history, pelvic surgery history and the habit of holding urine [60.0%(n=33)to 16.7%(n=3), P=0.002; 43.6%(n=24)to 0.0%(n=0), P<0.01; 36.4%( n=20)to 5.6%( n=1), P=0.015]. Based on mNGS results, OAB patients were identified with more positive viral infection [47.3%(n=26)to 33.3%(n=6)] and more JC virus infection. In the OAB group, subtype 7B of JCV ( n=8) was identified, while in the control group, subtype 7A(n=2) was identified. Pairwise Spearman correlation analysis indicated high correlations between viral infection and OABSS ( r=0.58), age and pausimenia ( r=0.68), hypertension and age ( r=0.53), respectively. Estimates from binary logistic regression model indicated risk factors for virus infection in OAB patients including age ( OR=1.99, 95% CI 0.02-2.61), holding urine habit( OR=2.16, 95% CI 0.18-3.85) and pelvic surgery ( OR=2.53, 95% CI 0.54-4.27). Conclusions:Urinary viral infections appear to be associated with more severe OAB symptoms and JC virus may be a potential therapeutic target for OAB.

Meta-analysis of acupuncture-moxibustion treatment of overactive bladder in adults in the past decade / 针灸推拿医学（英文版）

Objective: To systematically assess the effectiveness and safety of using acupuncture-moxibustion therapy alone to treat adult overactive bladder (OAB) by taking oral Western medication solely as the control, and to provide evidence-based reference for acupuncture-moxibustion treatment of OAB. Methods: A systemic search was conducted through China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), China Biology Medicine Disc (CBM), PubMed, Cochrane Library, and Excerpta Medica Database (EMBASE). RevMan 5.3 was used for meta-analysis. Statistical descriptions were made using standardized mean difference (SMD), confidence interval (CI), and risk ratio (RR). Results: Eight randomized controlled studies were finally recruited and were analyzed after being grouped according to intervention methods. Regarding urinary symptoms, compared with sole use of oral Western medication, acupuncture plus moxibustion can more effectively reduce 24 h urinary frequency [P=0.01, SMD=-0.57, 95％CI (-1.02, -0.12)], 24 h nocturia frequency [P=0.03, SMD=0.49, 95％CI (0.05, 0.94)], and OAB syndrome score (OABSS) [P<0.001, SMD=-3.67, 95％CI (-4.48, -2.86)]. Acupuncture combined with moxibustion and oral Western medication work equivalently in comparing 24 h urinary urgency frequency [P=0.38, SMD=-0.17, 95％CI (-0.57, 0.22)], 24 h urgent incontinence frequency [P=0.25, SMD=0.26, 95％CI (-0.18, 0.70)], and single voiding volume [P=0.22, SMD=1.15, 95％CI (-0.70, 3.00)]. There were no significant differences between acupuncture/electroacupuncture and oral medication in comparing 24 h urinary frequency [P=0.46, SMD=0.07, 95％CI (-0.12, 0.26)], 24 h urinary urgency frequency [P=0.18, SMD=0.70, 95％CI (-1.71, 0.32)], 24 h nocturia frequency [P=0.46, SMD=-0.71, 95％CI (-2.60, 1.17)], 24 h urgent incontinence frequency [P=0.08, SMD=-0.22, 95％CI (-0.48, 0.03)], single voiding volume [P=0.09, SMD=0.17, 95％CI (-0.02, 0.36)], or OABSS [P=0.96, SMD=-0.07, 95％CI (-2.65, 2.52)]. Compared with oral Western medication, moxibustion can more effectively reduce 24 h urinary frequency [P<0.001, SMD=-6.53, 95％CI (-7.65, -5.44)] and 24 h urinary urgency frequency [P<0.001, SMD=-1.6, 95％CI (-2.85, -0.36)]. In comparing the adverse reaction rate, acupuncture-moxibustion was associated with a lower rate compared with oral medication [P=0.002, RR=0.07, 95％CI (0.01, 0.37)], but the difference was statistically insignificant between acupuncture/electroacupuncture and oral medication [P=0.40, RR=0.57, 95％CI (0.16, 2.12)]. Conclusion: Acupuncture-moxibustion is equivalent to the sole use of oral Western medication in improving urinary symptoms in OAB patients and has a higher safety rating.

Co-administration of sodium hydrosulfide and tadalafil modulates hypoxia and oxidative stress on bladder dysfunction in a rat model of bladder outlet obstruction

ABSTRACT Purpose: This study aimed to assess the possible healing effect of combination treatment with a hydrogen sulfide (H2S) donor, sodium hydrosulfide (NaHS) plus tadalafil on partial bladder outlet obstruction (PBOO)-induced bladder dysfunction. Materials and Methods: A total of 75 male Sprague-Dawley rats aged 10-wk and 300-350g were divided into five groups; control; PBOO; PBOO+NaHS (5.6mg/kg/day, i.p., 6-wk); PBOO+tadalafil (2mg/kg/day, oral, 6-wk) and PBOO+NaHS+tadalafil. PBOO was created by partial urethral ligation. 6 weeks after obstruction, the in vitro contractile responses of the detrusor muscle and Western blotting, H2S and malondialdehyde assay were performed in bladder tissues. Results: There was an increase in bladder weight(p<0.001) and a decrease in contractile responses to KCl (p<0.001), carbachol (p<0.01), electrical field stimulation (p<0.05) and ATP (p<0.001) in the detrusor smooth muscle of obstructed rats which was normalized after the combination treatment. Cystathionine γ-lyase and cystathionine β-synthase, and nuclear factor kappa B protein levels did not significantly differ among groups. The obstruction induced decrement in 3-mercaptopyruvate sulfur transferase protein expression(p<0.001) and H2S levels(p<0.01) as well as increment in protein expressions of neuronal nitric oxide synthase (NO, p<0.001), endothelial NOS (p<0.05), inducible NOS(p<0.001), hypoxia-inducible factor 1-alpha (p<0.01), and malondialdehyde levels (p<0.01), when combined treatment entirely normalized. Conclusions: Combination therapy has beneficial effects on bladder dysfunction via regulating both H2S and nitric oxide pathways as well as downregulation of oxidative stress and hypoxia. The synergistic effect of H2S and nitric oxide is likely to modulate bladder function, which supports the combined therapy for enhancing clinical outcomes in men with BPH/LUTS.

Efficacy of intravaginal electrical stimulation with different treatment frequency in women with refractory idiopathic overactive bladder

ABSTRACT Objective The aim of this study is to evaluate the effect of intravaginal electrical stimulation (IVES) therapies with different treatment frequencies (two or five days in a week) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with refractory idiopathic overactive bladder (OAB). Material and Methods Fifty-two women with refractory idiopathic OAB were randomized into two groups as follows: Group 1 (n:26) received BT and IVES, two times in a week, for 10 weeks and Group 2 (n:26) received BT and IVES five times in a week, for 4 weeks. IVES was performed 20 minutes in a day, a total of 20 sessions for both groups. Women were evaluated for incontinence severity (24h pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and the number of pads), symptom severity (OAB-V8), quality of life (IIQ-7), treatment success (positive response rate), cure/improvement rate and treatment satisfaction (Likert scale). Results There was no statistically significant differences in all parameters between the two groups at the end of the treatment. It was found that the treatment satisfaction scores, cure/improvement and positive response rates were not significantly different between two groups (p>0.05). Conclusion We concluded that the application of IVES twice a week or 5 times a week added to BT were both effective on incontinence-related QoL and clinical parameters in women with refractory idiopathic OAB. These two IVES frequencies had similar clinical efficacy and patient satisfaction with a slight difference between them; 5 times per week IVES has a shorter treatment duration.

Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with overactive bladder?

ABSTRACT Objective: Bladder wall thickness (BWTh) measurements and Nerve Growth Factor (NGF) /creatinine (Cr) values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). The goal of this research was to examine if bladder wall thickness together with urine NGF/Cr could be a clinical utility in treatment outcome of OAB in children. Patients and Methods: A total of 60 children with OAB, (Group 1; n=40) and healthy normal controls (Group 2; n=20), aged 6-14 years old were involved in this prospective study. Children were evaluated with detailed history and physical examination, including neurologic examination, and were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. Uroflowmetry was performed in all cases. Urinary nerve growth factor levels were measured by the ELISA and BWTh was measured trans-abdominally by one uro-radiologist specialized in pediatric ultrasonography. Urinary NGF levels were normalized by urinary creatinine levels and compared among all subgroups. Children with OAB received urotherapy as first line treatment at least for three months. 18 children refractory to urotherapy received anticholinergic therapy defined as group 3. Results: The median age of the study group was 10 (range 6 to 16). After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls. (2.75 ± 1.15; 2.40 ± 1.00 mm; p=0.86 and 1.02 ± 0.10; 0.78 ± 0.15; p=0.12, respectively). After anticholinergic treatment, BWTh levels (2.25 ± 0.90; 2.40 ± 1.00 mm; p=0.94) and NGF/Cr values (0.95 ± 0.10; 0.78 ± 0.15; p=0.42, respectively) had no significantly difference compared to controls (Group 2). In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% (3,20 AUC, 913; 95 %) and NGF/Cr had sensitivity of 90% and specificity of 92.1% (1,595; AUC, 947; 95 %) in predicting treatment outcome in children with OAB. Conclusions: Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder.

The effect of vitamin D deficiency in children with overactive bladder related urinary incontinence

ABSTRACT Purpose: Overactive bladder (OAB) is a common syndrome associated with lower urinary tract symptoms (LUTS), especially urinary incontinence in children, which may affect the patient's quality of life (QoL). Vitamin D deficiency has been shown to be associated with OAB syndrome. This study evaluated the relationship between vitamin D status and OAB-related symptoms and QoL in children. Materials and Methods: The study included 52 pediatric patients with OAB-related urinary incontinence and 41 healthy children. LUTS were assessed using the Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) questionnaire, and QoL was assessed using the Pediatric Incontinence Questionnaire (PINQ). Oral vitamin D supplementation was given to patients with OAB with vitamin D deficiency. Urinary symptoms and QoL were evaluated before and after vitamin D supplementation. Results: Vitamin D deficiency was more common in the OAB group (75%) than in the control group (36.6%). Logistic regression analysis revealed that vitamin D status (<20ng/mL) was a significant predictor of OAB. Both pre-treatment and post-treatment DVISS and PINQ scores showed a positive correlation. After vitamin D supplementation, 8 (23.5%) patients had a complete response and 19 (55.9%) patients had a partial response. Significant improvement in QoL was also achieved. Conclusions: Vitamin D deficiency is more common in children with urinary incontinence and OAB than in healthy children. Although vitamin D deficiency is not routinely evaluated for every patient, it should be evaluated in treatment-resistant OAB cases. Vitamin D supplementation may improve urinary symptoms and QoL in patients with OAB.

Risk factors for bladder spasms in elderly patients after minimally invasive surgery of the lower urinary tract / 中华老年医学杂志

Objective:To investigate the risk factors for bladder spasms in elderly patients after minimally invasive surgery of the lower urinary tract.Methods:Clinical data of elderly patients from 87 medical centers across the country who had received minimally invasive surgery of the bladder, prostate, or urethra from July 2016 to September 2016 were retrospectively analyzed.Based on the occurrence of bladder spasms, patients were divided into the spasm group and the control group.General information and clinical data were compared between the two groups, and potential risk factors for bladder spasms after surgery were analyzed.Results:A total of 1275 patients were enrolled, aged from 65 to 96 years, with an average age of(73.4±6.1). Bladder spasms occurred in 606(47.5%)of all patients.Univariate analysis showed that, compared with the control group, patients in the spasm group had statistically significant differences in gender, age, constipation, preoperative use of drugs, and surgical site(all P<0.05), while there were no significant differences between the two groups in ethnicity, body mass index(BMI), smoking, drinking, caffeine intake, and marital status(all P>0.05). Logistic regression analysis showed that advanced age( OR=1.310, P=0.007), male( OR=0.595, P=0.030), preoperative use of drugs( OR=0.510, P=0.002)affecting bladder function, and constipation( OR=0.627, P<0.001)were independent influencing factors for bladder spasms in elderly patients after minimally invasive surgery of the lower urinary tract( P<0.05). Conclusions:Old age, male, preoperative use of drugs affecting bladder function, and constipation are risk factors for bladder spasms after minimally invasive lower urinary tract surgery in elderly patients.These findings can be used for guiding clinicians to conduct targeted interventions before surgery to prevent bladder spasms.

Effect and safety of repeated trigone-including intradetrusor BTX-A injection with intermittent catheterization for male adults with NDO and urinary incontinence secondary to spinal cord injury / 中华泌尿外科杂志

Objective:To assess the clinical result of repeated combined detrusor-trigone botulinum toxin A(BTX-A)injection and intermittent catheterization(IC) for male adults with neurogenic detrusor overactivity (NDO) and urinary incontinence(UI) secondary to spinal cord injury(SCI).Methods:From January to August 2021, the data of 43 adult male patients with NDO and UI secondary to SCI who received repeated trigone-including intradetrusor BTX-A injection in Guangdong Provincial Work Injury Rehabilitation Hospital were retrospectively analyzed. The mean age of the patients was (29.1±10.7) years. The mean incontinence specific quality of life (I-QOL) was (39±4.8). The UI episodes was (11.9±2.6), mean voiding volume was (170.7±20.1)ml, mean maximum detrusor pressure at first NDO was (81.4±19.6) cmH 2O and mean volume at first NDO was (169.1±40.0)ml.All patients received trigone-including intradetrusor BTX-A (300 U, 30 sites) injection for four times and IC. Clinical data including I-QOL, bladder diary, video-urodynamic test and adverse events were recorded at baseline and 12 weeks after each injection. Results:Mean interval between four injections were (220.6±27.4), (222.8±24.1) and (224.4±39.0) d ( P=0.13). Compared with baseline data before first injection, mean I-QOL after the first, second, third and fourth injection increased to (54.9±9.1), (56.1±7.9), (61.7±9.1) and (68.8±8.9) (all P<0.001). The number of urinary incontinence cases decreased to 36, 35, 35 and 33 (all P<0.05). The mean urinary incontinence episodes per day decreased to (4.4±0.6), (3.8±0.4), (2.2±0.5) and (2.1±0.3)(all P<0.001). Mean voiding volume increased to (288.3±40.2), (300.0±38.6), (316.9±46.8) and (319.5±36.7) ml (all P<0.001). Mean maximum detrusor pressure at first NDO decreased to (29.4± 11.0), (26.1±8.7), (20.3±5.9) and (18.5±6.0) cmH 2O (all P<0.001) and mean volume at first NDO increased to (270.0±48.7), (284.9±51.3), (287.7±47.9) and (303.0±46.2) ml (all P<0.001), respectively. Compared with four injections, no difference in response was found in the mean I-QOL, the number of urinary incontinence cases, mean urinary incontinence episodes mean voiding volume, mean maximum detrusor pressure at first NDO and mean volume at first NDO (all P>0.05). No de novo VUR occurred and 2 cases of grade Ⅱ VUR at baseline had resolved after the first injection. 9 patients experienced serious gross hematuria within first week after injection, but the urine returned to clear by prolonging the catheter indwelling time or bladder irrigation. 12 patients with active urinary tract infection were treated with indwelling catheter and sensitive antibiotics. Patients continued IC when the symptoms, signs and laboratory examination were normal. Conclusions:Combined detrusor-trigone BTX-A injection and IC could help decrease detrusor pressure, restore some of the lower urinary tract function and improve the quality of life for male patients with NDO and UI secondary to SCI. Repeated injection is as effective and safe as the first injection.

Evaluation of sacral neuromodulation system with new six-contact points electrode for the treatment of bladder dysfunction / 中华泌尿外科杂志

Objective:To investigate the effects of sacral neuromodulation (SNM)using the new six-contact electrode vs. the four-contact electrode in patients with refractory overactive bladder.Methods:The clinical data of 29 patients underwent SNM testing therapy from January 2018 to January 2020 in China Rehabilitation Research Center were reviewed. In six-contact points electrode group 16 patients accepted SNM with new six-contact points electrode, while 13 patients in four-contact points electrode group accepted SNM with four-contact points electrode. There were no significant differences between the two group in age [(51.63±4.67) vs. (51.85±7.18) years], gender (male/female, 4/12 and 5/8), urination frequency [(22.10±9.05) vs. (21.79±8.05) times/24h], mean voided volume [(135.68±56.98) vs. (131.00±53.05) ml], and urgency score [(2.78±0.97) vs. (3.02±0.91)] (all P>0.05). The number of sensitive contact points, the ratio of reaction contact points, operation time of stage I and the success rate of two groups were calculated. Results:The mean number of sensitive points of six-contact points electrode group (3.31± 0.95) was significantly higher than that of the four-contact points electrode group (1.85± 0.38), ( P<0.05). There was no significant difference in the ratio of reaction contact points [ (96.87±6.71)% vs. (96.15± 9.39)%] and operation time of stage I [(71.25± 18.21)min vs.(68.85± 10.83)min]between six-contact points electrode group and four-contact points electrode group ( P<0.05). The contact E4 and E5 of six-contact electrodes had similar reaction voltage ( P>0.05). The implant rate of six-contact points electrode group was (14/16, 87.5%), which was higher than that of four-contact points electrode group (10/13, 76.9%), but there was no statistical difference ( P>0.05). Conclusions:This study showed that six-contact electrodes has more sensitive points compared with four-contact electrodes. Application of six contact electrodes, patients might get a higher implant rate.

Efficacy of intravaginal electrical stimulation added to bladder training in women with idiopathic overactive bladder: A prospective randomized controlled trial

ABSTRACT Purpose: To evaluate the efficacy of intravaginal electrical stimulation (IVES) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB). Materials and Methods: Sixty-two women with idiopathic OAB were randomized into two groups using the random numbers generator as follows: Group 1 received BT alone (n:31), and Group 2 received BT+IVES (n:31). IVES was performed for twenty minutes three days a week over a course of eight weeks for a total of 24 sessions. Patients were evaluated in terms of incontinence severity (24-hour pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes and number of pads), symptom severity (OAB-V8), incontinence-related QoL (IIQ-7), treatment success (positive response rate), cure/improvement rate and treatment satisfaction (Likert scale). Results: A statistically significant improvement was found in all parameters for all groups at the end of the treatment compared to the baseline values except pelvic floor muscles strength in Group 1 (p <0.05). At the end of treatment, incontinence severity, frequency of voiding, nocturia, incontinence episodes, number of pads, symptom severity, and QoL were significantly improved in Group 2 compared to Group 1 (p <0.05). Treatment satisfaction, cure/improvement, and positive response rates were significantly higher in group 2 compared to Group 1 (p <0.05). Conclusion: We conclude that BT+IVES were more effective than BT alone on both incontinence-related QoL and clinical parameters in women with idiopathic OAB.

Current pharmacotherapy of overactive bladder

ABSTRACT Overactive bladder is a symptom complex consisting of bothersome storage urinary symptoms that is highly prevalent among both sexes and has a significant impact on quality of life. Various antimuscarinic agents and the beta-3 agonists mirabegron and vibegron are currently available for the treatment of OAB. Each drug has specific pharmacologic properties, dosing schedule and tolerability profile, making it essential to individualize the medical treatment for the patient's characteristics and expectations. In this manuscript, we review the most important factors involved in the contemporary pharmacological treatment of OAB.

Evaluation of autonomic function in children and adolescents with overactive bladder

ABSTRACT Aims: To evaluate autonomic activity in children/adolescents with isolated overactive bladder. Materials and Methods: Descriptive, analytical, non-interventional, cross-sectional study conducted between February 2017 and January 2018 with individuals aged between 5 and 17 years old, with overactive bladder (OAB group) or asymptomatic (control). Neurological or anatomical abnormalities, diabetes mellitus and kidney failure constituted exclusion criteria. The DVSS and the Rome III questionnaire were applied, and heart rate variability (HRV) was assessed. The chi-square test, Student's t-test, ANOVA and the Mann Whitney U test were used in the statistical analysis. Results: 41 patients with OAB and 20 controls were included. In the OAB group, there were more girls (p=0.23), more overweight/obese and constipated patients. The DVSS score was higher in the OAB group. HRV showed a higher heart rate variability at the frequency domain and LF/HF variation in the control group (p=0.02 and p=0.05 respectively). In the intergroup evaluation, LF (Hz) was predominant in the control group at the post-voiding evaluation moment (p=0.03). Conclusion: The control group demonstrated a physiological heart rate variation during the voiding process, with a predominance of sympathetic activity during urinary storage.

Parasacral transcutaneous electrical nerve stimulation in children with overactive bladder: comparison between sessions administered two and three times weekly

ABSTRACT Purpose: This study compares the results achieved following parasacral TENS administered using two different weekly schedules. Materials and Methods: Children of at least four years of age with a diagnosis of pure overactive bladder were included in this randomized clinical trial and treated with parasacral TENS (2 versus 3 sessions per week). All the participants also underwent standard urotherapy. Results: Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group. There were no statistically significant differences between the two groups with respect to sex; however, there was a difference in age. There were no significant differences regarding complete resolution of urinary symptoms, with 8 children (50%) in the twice-weekly group and 11 children (61%) in the three times weekly group having their symptoms completely resolved (p=0.73). There was a significant difference in the DVSS score in both groups following TENS treatment compared to baseline (p=0.0001 for both groups), but not between groups. Evaluation of the bladder diary showed no difference between the groups before or after treatment. Conclusion: For children with overactive bladder who are unable to undergo parasacral TENS treatment three times weekly, the method can be administered successfully at twice-weekly sessions.