Effectiveness and durability of solifenacin versus percutaneous tibial nerve stimulation versus their combination for the treatment of women with overactive bladder syndrome: a randomized controlled study with a follow-up of ten months

ABSTRACT Purpose To assess effectiveness and durability of Solifenacin (SS) versus tibial nerve stimulation (PTNS) versus combination therapy (PTNS + SS) in women with overactive bladder syndrome (OAB). Materials and Methods 105 women with OAB were divided randomly into three groups of 35 patients each. In group A women received SS, in group B women underwent PTNS, in group C women underwent combination of PTNS + SS. Improvements in OAB symptoms were assessed with OABSS questionnaire; patients' quality of life was assessed with OAB-q SF questionnaire. Evaluation of effectiveness of treatments was performed with PGI-I questionnaire. OABSS and PGI-I were also assessed monthly for ten months. Results All treatments were effective on symptoms. PTNS showed a greater effectiveness than SS, but PTNS + SS was more effective than SS and PTNS. Furthermore, PTNS + SS showed a greater duration of effectiveness than PTNS and SS. Conclusions Combination of PTNS with SS showed more effectiveness and more durability than PTNS and SS alone.

Effectiveness and durability of solifenacin versus percutaneous tibial nerve stimulation versus their combination for the treatment of women with overactive bladder syndrome: a randomized controlled study with a follow-up of ten months.

PURPOSE: To assess effectiveness and durability of Solifenacin (SS) versus tibial nerve stimulation (PTNS) versus combination therapy (PTNS + SS) in women with overactive bladder syndrome (OAB). MATERIALS AND METHODS: 105 women with OAB were divided randomly into three groups of 35 patients each. In group A women received SS, in group B women underwent PTNS, in group C women underwent combination of PTNS + SS. Improvements in OAB symptoms were assessed with OABSS questionnaire; patients' quality of life was assessed with OAB-q SF questionnaire. Evaluation of effectiveness of treatments was performed with PGI-I questionnaire. OABSS and PGI-I were also assessed monthly for ten months. RESULTS: All treatments were effective on symptoms. PTNS showed a greater effectiveness than SS, but PTNS + SS was more effective than SS and PTNS. Furthermore, PTNS + SS showed a greater duration of effectiveness than PTNS and SS. CONCLUSIONS: Combination of PTNS with SS showed more effectiveness and more durability than PTNS and SS alone.

A randomized, multicenter, controlled study, comparing efficacy and safety of a new complementary and alternative medicine (CAM) versus Solifenacin Succinate in women with overactive bladder syndrome.

INTRODUCTION: To assess efficacy and tolerability of a new complementary and alternative medicine (CAM) consisting of vitamins (C and D), herbal products (cucurbita maxima, capsicum annum, polygonum capsicatum) and amino acid L-Glutammina, in the treatment of female Overactive Bladder syndrome (OAB). MATERIALS AND METHODS: 90 consecutive women with OAB symptoms were enrolled in this prospective, randomized, controlled study. Women were divided randomly into two groups of 45 patients each. In group A, women received Solifenacin Succinate (SS), 5 mg. once a day for 12 weeks. In group B, women received CAM, 930 mg, twice daily for 12 weeks. Women were assessed with 3-day micturition diary, Patient Perception of Intensity of Urgency Scale (PPIUS), Overactive Bladder questionnaire Short Form (OAB-q SF) and Patient Global Impression of Improvement questionnaire (PGI-I). RESULTS: 8 patients in group A and 1 patient in group B dropped out from therapy because of side effects. A reduction in the number of daily micturitions, nocturia and episodes of urge incontinence was present with both SS and CAM with statistically highly significant differences, but CAM was significantly more effective than SS. PPIUS and OAB-q SF showed improvements with both SS and CAM with a more significant efficacy of CAM. PGI-I, demonstrated improvements in the two groups of patients with a greater satisfaction expressed by patients treated with CAM. CONCLUSIONS: the small number of patients does not permit definitive conclusions; however, the results of the research showed the greater effectiveness and tolerability of CAM.

The degree of satisfaction of women undergoing surgical repair of prolapse, compared with clinical and urodynamic findings.

OBIECTIVE: To assess the degree of satisfaction of women undergoing surgical repair of prolapse, compared with the clinical and urodynamic findings. MATERIALS AND METHODS: 72 women hospitalized for pelvic organ prolapse (POP) were enrolled in this prospective study. Patients underwent clinical evaluation and urodynamic study before and 4 months after POP repair. Women were assessed for urinary symptoms by micturition diary and patient perception of intensity of urgency scale. Women were also questioned about defecation and sexual life. POP repair was performed in all cases without the use of a mesh. Subjective evaluation was performed by patient global impression of improvement questionnaire. RESULTS: 56 women were evaluable. Improvements were found in all micturition symptoms and in particular in voiding symptoms. Feeling of vaginal bulging disappeared in all patients. A slight improvement was found in constipation; 62% of patients had a normal sexual life but 27% refrained from sexual activity. Judgement of patients was between "much improved" and "very much improved". CONCLUSIONS: Disappearance of the feeling of vaginal bulging was by far the best result. Improvements were found in most of the symptoms particularly in voiding symptoms and urodynamic findings.

Comparison of Therapeutic Efficacy and Urodynamic Findings of Solifenacin Succinate versus Mirabegron in Women with Overactive Bladder Syndrome: Results of a Randomized Controlled Study.

INTRODUCTION: We assessed clinical and urodynamic effects of solifenacin versus mirabegron in women with overactive bladder (OAB) syndrome. MATERIAL AND METHODS: Eighty women with OAB were randomized into 2 groups. In group A, the patients received solifenacin 5 mg once a day for 12 weeks; in group B, the patients received mirabegron 50 mg once a day for 12 weeks. Symptoms were assessed with OAB Symptom Score (OABSS). Patients underwent urodynamic investigation with pressure flow study. OABSS and urodynamic study were performed before and after treatment. RESULTS: Both solifenacin and mirabegron were effective in improving OAB symptoms. Mirabegron showed greater tolerability with fewer patients discontinuing therapy because of side effects. Both solifenacin and mirabegron were effective in improving the storage function in the pressure flow study, but solifenacin showed a significant reduction of the detrusor pressure in the voiding phase with an increase in the postvoid residual urine volume. CONCLUSIONS: Mirabegron has shown to be a drug with the better balance between efficacy and tolerability in women with OAB.

Effect of Surgical Therapy on Urinary Symptoms and Urodynamic Findings in Patients with Uterine Myoma.

OBJECTIVE: To assess the relationship between uterine myomas, urinary symptoms, and urodynamic findings. STUDY DESIGN: A total of 49 women hospitalized for uterine myoma were eval- uated in this prospective study. Patients underwent- a detailed clinical evaluation and ukodynamic study. Uri- nary symptoms were as- sessed using 3-day micturi- tion diary and Patient Perception of Intensity of Urgency scale questionnaire. The dimensions of fibroma- tous uterus and single large myomas were evaluated by both transabdominal and transvaginal ultrasound. Urodynamic parameters and urinary symptoms were assessed before and 4 months after surgery. RESULTS: A total of 44 patients were evaluable at the end of the study: 32 out of 44 (72.8%) had urinary symptoms; 26 women underwent hysterectomy, and 18 had abdominal myomectomy. After surgery 87.5% of women were asymptomatic or showed improvement in urinary symptoms. Improvements were also seen in urodynamic parameters. CONCLUSION: Uterine myomas often result in uri- nary symptoms. Surgical therapy can result in signifi- cant improvements in symptoms as well as urodynamic findings.

Polyacrylamide hydrogel (bulkamid®) in female patients of 80 or more years with urinary incontinence.

INTRODUCTION: To assess the effectiveness of polyacrylamide hydrogel (Bulkamid®) in injection therapy for urinary incontinence in women of 80 or more years. MATERIALS AND METHODS: Twenty consecutive women mean age 84.5 (range 80-87) with stress or mixed urinary incontinence were enrolled in this prospective study. All subjects were evaluated at baseline and re-evaluated 7 days, 6,12,18 and 24 months after treatment. A detailed clinical evaluation, physical examination, daily pad count, urodynamic investigation and evaluation of urethral mobility by trans-labial ultrasound were performed. RESULTS: A statistically significant decrease in the number of pads was observed in the follow-up (p = 0.0002 after 24 months). Physical examination showed a statistically significant lack or reduced lost of urine with stress test (p = 0.0163 after 24 months). Urodynamic findings showed an increase of Valsalva leak point pressure, maximum urethral closure pressure and functional length. Maximum flow and post void residual were respectively observed to be significantly reduced and increased only after 7 days from injection therapy. Quality of life (QoL) assessed with the Incontinence Impact questionnaire short form (IIQ-7) showed a statistically significant improvement (p = 0.0001 after 24 months). Patient satisfaction assessed with the Visual Analogue Scale and Patient Global Impression of Improvement questionnaire respectively produced evaluation of ″satisfied″ and "much improved" even after 24 months. CONCLUSIONS: Polyacrylamide hydrogel (Bulkamid®) is an effective treatment with low morbility in patients of 80 or more years.

Polyacrylamide Hydrogel (Bulkamid) in Female Patients of 80 or More Years with Urinary Incontinence

Introduction: To assess the effectiveness of polyacrylamide hydrogel (Bulkamid ®) in injection therapy for urinary incontinence in women of 80 or more years. Materials and Methods: Twenty consecutive women mean age 84.5 (range 80-87) with stress or mixed urinary incontinence were enrolled in this prospective study. All subjects were evaluated at baseline and re-evaluated 7 days, 6,12,18 and 24 months after treatment. A detailed clinical evaluation, physical examination, daily pad count, urodynamic investigation and evaluation of urethral mobility by trans-labial ultrasound were performed. Results: A statistically significant decrease in the number of pads was observed in the follow-up (p = 0.0002 after 24 months). Physical examination showed a statistically significant lack or reduced lost of urine with stress test (p = 0.0163 after 24 months). Urodynamic findings showed an increase of Valsalva leak point pressure, maximum urethral closure pressure and functional length. Maximum flow and post void residual were respectively observed to be significantly reduced and increased only after 7 days from injection therapy. Quality of life (QoL) assessed with the Incontinence Impact questionnaire short form (IIQ-7) showed a statistically significant improvement (p = 0.0001 after 24 months). Patient satisfaction assessed with the Visual Analogue Scale and Patient Global Impression of Improvement questionnaire respectively produced evaluation of “satisfied” and “much improved” even after 24 months. Conclusions: Polyacrylamide hydrogel (Bulkamid®) is an effective treatment with low morbility in patients of 80 or more years. .

Solifenacin succinate versus percutaneous tibial nerve stimulation in women with overactive bladder syndrome: results of a randomized controlled crossover study.

AIMS: This study compared the effectiveness of solifenacin succinate (SS) versus percutaneous tibial nerve stimulation (PTNS) in women with overactive bladder syndrome (OABS). METHODS: A randomized controlled crossover study of 40 women with OABS was performed. Patients were randomized into two groups. In group A, patients received SS and then PTNS. In group B, patients underwent PTNS and then SS. Voiding diaries, quality of life surveys and patient perception of intensity of urgency questionnaire were performed before and after each treatment. The global impression of improvement questionnaire was performed at the end of the study. RESULTS: A reduction in the number of daily micturitions, episodes of nocturia and urge incontinence were found with both SS and PTNS in all groups, but PTNS showed a greater effectiveness than SS. There was an increase in voided volume in all groups with both SS and PTNS, but patients treated with PTNS had a greater increase. PTNS showed greater effectiveness in patient perception of urgency and quality of life. CONCLUSION: This study demonstrates the effectiveness of SS and PTNS In women with overactive bladder symptoms. However, greater improvements were found with PTNS.

Has the cost of anti-muscarinic a key role in the success rate of patients diagnosed with overactive bladder syndrome?

INTRODUCTION: Overactive bladder syndrome (OAB) is a chronic disease, the prevalence in the general population is reported to be 14-16%. Anti-muscarinic agents are considered the first-line pharmacological treatment for the management of OAB; although a long lasting therapy is indicated to reach a better control of OAB symptoms an high percentage of patients discontinue the cure after a brief period. Our attempt is to investigate whether the cost of solifenacin succinate may influence the long lasting regimen and patients' drug efficacy. MATERIALS AND METHODS: 70 consecutive women, with symptoms of OAB were enrolled in this randomized controlled study. In group A, all patients received solifenacin 5 mg by the urologist, without any cost; they were instructed to get the drug once daily for 4 months, differently, in group B, patients need to buy the drug which was administered as in the group A. Frequency, nocturia, incontinence, voided volume, were evaluated by a 3-day micturition diary. Overactive Bladder Questionnaire Short Form (OAB-qSF) was used to assess the impact of OAB symptoms on patients' quality of life (QoL). Urgency was assessed by patient's perception of intensity of urgency scale (PPIUS). Micturition-diary, OAB-qSF, PPIUS, were completed at baseline and after four months. RESULTS: A greater number of patients discontinued solifenacin in the group B who need to buy the drug. We observed significant differences in groups A and B in relation to frequency, nocturia, urge incontinence and voided volume comparing the pre and post treatment symptoms. The patients' perceptions of intensity of urgency and the PGI-I scale showed a significant improvement greater in group A in respect with group B. CONCLUSIONS: The cost of anticholinergic may be responsible for both early discontinuation of treatment and incomplete adherence to therapy with unsatisfactory results on symptoms and an incorrect assessment of the effectiveness of the drug by the urologist.

Effect of aging on urinary incontinence in woman.

OBJECTIVE: The aim of the study was to evaluate, in a group of female patients with urinary incontinence (UI), the effect of aging on: a) urodynamic findings; b) incidence of detrusor overactivity; c) types of urinary incontinence; d) pelvic organ prolapse; e) body mass index; f) anorectal disorders. MATERIAL AND METHODS: Eighty four consecutive patients with urinary incontinence were enrolled in this study. Patients were divided into two groups according to their age: group A: patients with age < or = 65 years, group B: patients with age > 65 years. Patients underwent a full urogynaecological workup with a clinical evaluation and urodynamic study. RESULTS: In older patients urge and mixed urinary incontinence were the most prevalent type of (UI). In these patients an increase of the bladder sensation with a decrease of the bladder capacity, an increase of detrusor overactivity and a reduction of the maximum urethral closure pressure were found. Furthermore, a higher body mass index was observed in older patients. CONCLUSIONS: The results of this study show an age-associated correlation of types of urinary incontinence, urodynamic findings, body mass index and incidence of detrusor overactivity.

Ultrasound in acute urinary retention by mechanical obstruction in woman.

We referred our experience about ultrasound in the diagnosis of the acute urinary retention by mechanical obstruction in woman. We believe ultrasound has a very important role in imaging of the lower urinary tract because it simplicity and no jonizing radiation used. Anatomical pathologies of the bladder neck and urethra can be detected and documented in order to make the right therapy decision.

Urethral and vaginal infections, age of patients and state of the pelvic floor in the aetiology of the irritative symptoms of the lower urinary tract in women.

OBJECTIVES: The aim of this study was to evaluate the importance of a) urethral and/or vaginal infections caused by common germs or Mycoplasmas, Chlamydia, Candida; b) age of patients; c) pelvic floor disorders in the development of irritative urinary symptoms in women. METHODS: 77 consecutive abacteriuric symptomatic female patients were compared with 55 asymptomatic women. A detailed micturition history and a genitourinary physical examination were performed. Urine samples as well as vaginal and urethral swabs were taken for cultures. RESULTS: No statistical difference was found between the two groups regarding both urethral and/or vaginal infections and pelvic floor disorders. Whereas a significant statistical difference was found in the age of the patients. In the symptomatic group the women were older than in the asymptomatic group. CONCLUSIONS: The results of this study confirm that ageing is a very important cause in the development of the lower urinary tract symptoms in women.

Urodynamic findings in female patients with urinary incontinence with intrinsic sphincteric deficiency.

BACKGROUND: The aim of the study was to evaluate differences in urodynamic findings in women with urinary incontinence between subjects with or without intrinsic sphincter deficiency (ISD). MATERIAL/METHODS: Sixty consecutive female patients with a history and urodynamically confirmed diagnosis of pure urinary incontinence were evaluated. Patients were divided into two groups according to their abdominal Valsalva leak-point pressure (AVLPP) values using a cutoff of 60 cm H(2)O: group A patients with AVLPP 60 cm H(2)O. RESULTS: Qmax and Qave in group A were higher than in group B; flow time was significantly shorter in group A than in group B. PVR in group A was lower than in group B. In pressure flow study, all detrusor findings in group A had a pressure value lower than in group B. MUCP in patients with AVLPP

Acute urinary retention in a young woman by parameatal urethral cyst.

Parameatal urethral cysts are a rare pathology reported both in male and in female. The aethiology is not completely understood. Urography, urethroscopy and urethrography were described to diagnose parameatal urethral cysts. The treatment of choice is the complete excision of the cyst. A rare case of acute urinary retention in a 17-year-old woman by a parameatal urethral cyst is presented.

Urethral and vaginal infections, age of patients and state of the pelvis floor in the aetiology of the irritative symptoms of the lower urinary tract in women

OBJETIVO: El objetivo del estudio es la evaluación de la importancia de a) las infecciones uretrales y/o vaginales producidas por gérmenes comunes o micoplasmas, clamidias y cándidas; b) la edad de las pacientes; y c) las alteraciones del suelo pélvico, en el desarrollo de síntomas urinarios irritativos en mujeres. MÉTODOS: Se compararon 77 pacientes sintomáticas sin bacteriuria con cincuenta y cinco pacientes asintomáticas. Se realizaron historia clínica del componente miccional y exploración física genitourinaria. Se tomaron muestras de orina, uretra y vagina para cultivo. RESULTADOS: No se encontraron diferencias estadísticas entre los grupos ni en infecciones uretrales y/o vaginales ni en alteraciones del suelo pélvico. Sin embargo se encontró una diferencia estadísticamente significativa en la edad. En el grupo sintomático las pacientes eran más mayores que en el grupo ha sintomático. CONCLUSIONES: Los resultados de este estudio confirman que el envejecimiento es una causa muy importante de desarrollo de síntomas del tracto urinario inferior en la mujer

OBJECTIVES: The aim of this study was to evaluate the importance of a) urethral and/or vaginal infections caused by common germs or Mycoplasmas, Chlamydia, Candida; b) age of patients; c) pelvic floor disorders in the development of irritative urinary symptoms in women. METHODS: 77 consecutive abacteriuric symptomatic female patients were compared with 55 asymptomatic women. A detailed micturition history and a genitourinary physical examination were performed. Urine samples as well as vaginal and urethral swabs were taken for cultures. RESULTS: No statistical difference was found between the two groups regarding both urethral and/or vaginal infections and pelvic floor disorders. Whereas a significant statistical difference was found in the age of the patients. In the symptomatic group the women were older than in the asymptomatic group CONCLUSIONS: The results of this study confirm that ageing is a very important cause in the development of the lower urinary tract symptoms in women

Relation between volume of residual urine and urodynamic findings in women with cystourethrocele.

OBJECTIVE: To evaluate the relation between post-voiding residual urine (PVR) and urodynamic findings, voiding patterns, and the degree of prolapse in women with cystourethrocele. PATIENTS AND METHODS: According to the average PVR value measured by means of catheterization after three separate and spontaneous micturitions, 73 women with minimal urethral hypermobility (n = 8) or colpocystocele (n = 65) were subdivided into 3 groups: group 1 = patients with a PVR of < or =50 ml; group 2 = patients with a PVR of >50 ml and < or =150 ml, and group 3 = patients with a PVR of >150 ml and < or =500 ml. The patients underwent a thorough physical examination, and prolapse was evaluated and graded. The women then underwent a complete urodynamic investigation. The 3 groups of patients were statistically correlated according to the urodynamic findings, voiding patterns and degree of prolapse. RESULTS: A large PVR in women with cystourethrocele was often associated with poor maximum flow rate, intermittent flow and with the highest degree of prolapse. CONCLUSION: The present study suggests that uroflowmetry is a very simple, noninvasive, but also essential method of investigation in evaluating female patients with cystourethrocele, particularly when a large PVR is suspected.