Overactive Bladder or Anxiety: Which Came First?

OBJECTIVE: Although available diagnostic criteria are intelligible, combination of OAB and anxiety in the same patient presents a perfect example of medical causality dilemma, commonly stated as the question: "which came first: the chicken or the egg?". The aim of this review article is to address available insights in bidirectional association between OAB and anxiety. METHODS: In this review article, we included different types of studies whose results are presented as relative risk (RR) or odds ratio (OR) with a 95% accuracy. A literature search was conducted with the use of the PubMed and EMBASE electronic databases focusing on identifying articles published in English between 1990 and 2020. RESULTS: The electronic searches, after duplicate records removal, provided a total of 126 citations. Of these, 107 were excluded after title/abstract screening (not relevant to the review). We examined the full text of 19 publications remaining to summarize possible mechanisms between OAB and anxiety. According to examined literature, our result synthesis provides insight in epidemiology, pathophysiology, diagnostic and therapeutic approach of both conditions. CONCLUSION: Temporal relationship between OAB and anxiety is not very well documented because available longitudinal cohort studies are limited. The limitation of the published literature is that most were population-based symptom studies demonstrating high risk of bias. Although data from analysed studies suggest that anxiety and OAB and anxiety might be casually related, studies provided on clinical population are warranted. In addition to the traditional urologic factors, we recommend that psychosocial factors such as anxiety should be assessed routinely in patients with OAB.

Perinatal outcome in primiparous women aged 35 and older: a case-control study.

UNLABELLED: Women who delay childbearing are at increased risk for complications in pregnancy and delivery. AIM: The aim of this study was to determine whether primiparas > or = 35 have worse perinatal outcome compared to primiparas aged 20-27. PATIENTS AND METHODS: The perinatal outcome of 240 primiparas who gave singleton birth at Mostar Clinical Hospital between January 1, 2002 and December 31, 2004 was analyzed. Observed group was formed by 120 primiparas aged > or = 35. The control group was formed in the manner that each primipara from the observed group was assigned the first primipara younger than 35 with a singleton gestation who was subsequently entered in the delivery room record book. The data were collected from the maternal and newborn medical records at Mostar Clinical Hospital within the observed period. RESULTS: Significantly higher occurrence of cesarean section (p < 0.001; OR = 2.6; 95% CI 2.32-2.90), preterm delivery (p < 0.001; OR = 4.8; 95% CI 4.51-5.09), newborn of low birth weight < 2500 g (p < 0.034; OR = 2.6; 95% CI 2.34-2.92) and neonatal intensive care unit admission (OR = 2.7; 95% CI 2.47-3.05) were observed in primiparas aged > or = 35. The perinatal mortality was also significantly higher in the group of the older primiparas (p = 0.020; OR = 7.8; 95% CI 7.55-8.13). CONCLUSION: The overall results and a significantly higher number of perinatal deaths in particular present a significant concern because of growing number of older primiparas over the last decades.