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Bladder Health COE

  • Is Overactive Bladder in the Female Surgically Curable by Ligament Repair?

    Introduction
    The existing framework for the management of over-active bladder symptoms (OAB) (urge, frequency, nocturia) is essentially what has been defined and recommended by the ICS (International Continence Society)1. OAB symptoms in women are said to be associated with chronic pelvic pain (CPP), bowel dysfunction and organ prolapse, but no numerical relationship has been stated 1. The pathogenesis of OAB is not stated by ICS. However, the 5th International Consultation 2 states that “OAB (symptomatic diagnosis) is often assumed to be caused by detrusor overactivity (DO; urodynamic diagnosis), even if this does not always seem to be the case”. Regarding the treatment of OAB, the Consultation states, “Many drugs have been tried, but the results are often disappointing, partly due to poor treatment efficacy and/or side effects” 2. No surgical treatment for OAB is mentioned in the Incontinence 5th International Consultation Paris Feb 2012.
    Published November 13, 2018
  • SUFU 2018: Management of Stress Urinary Incontinence in the Female Underactive Bladder

    Austin, TX (UroToday.com) A Point-Counterpoint panel on the topic of the management of stress urinary incontinence in the female underactive bladder was held at SUFU 2018 in Austin, Texas. This session was moderated by Dr. Rosenblum.  She presented a difficult case to each of the experts.  Dr. Elise J.B. De took the stance of “treat the outlet," while  Dr. Philippe E. Zimmern took the position of “treat the bladder.” 
    Published March 2, 2018
  • Association of Pharmacologic Treatment of Urgency Urinary Incontinence With Sleep Quality and Daytime Sleepiness.

    To evaluate the association between pharmacologic therapy for urgency urinary incontinence (UUI) and sleep quality.

    We conducted a planned secondary data analysis of sleep outcomes in a previously conducted multicenter, double-blind, 12-week randomized trial of pharmacologic therapy for urgency-predominant incontinence among community-dwelling women self-diagnosed using the 3-Incontinence Questions questionnaire.

    Published January 15, 2018
  • AUA 2017: Does treating nocturia lead to better sleep? Results from REDUCE

    Boston, MA (UroToday.com) Older men have been commonly presenting with nocturia, the frequency of having to urinate during the night, which has led to complaints of lack of sleep and not feeling well rested when waking up in the mornings.
    Published May 13, 2017
  • AUA 2017: Female Pelvic Health Panel Investigates a Medication for HSDD, Low Serum Testosterone’s Association with SUI and Issues Surrounding Transvaginal and Vaginal Mesh

    Boston, MA, May 14, 2017 (UroToday.com) Four studies examining female pelvic and sexual health, show promising results for women with hypoactive sexual desire disorder (HSDD), an association between low testosterone levels and incontinence and refutes theories linking synthetic mesh and autoimmune disease and cancer. All four studies will be presented at the 112th Annual Scientific Meeting of the American Urological Association (AUA) during a joint press conference at the Boston Convention and Exhibition Center, Boston, MA on Sunday, May 14 at 7:30 a.m.
    Published May 17, 2017
  • AUA 2017: For Adults with Nocturia, A Significant Advance in a Potential New Treatment

    Boston, MA, May 12, 2017—Active surveillance in men under 60, use of telemedicine in the management of prostate cancer and physicians’ personal prostate cancer screening preferences will be highlighted today in a special press conference during the 112th Annual Scientific Meeting of the American Urological Association (AUA) at the Boston Convention & Exhibition Center. This press session will be moderated by Stacy Loeb, MD, assistant professor of urology and population health at New York University and AUA spokesperson.
    Published May 17, 2017
  • AUA 2018: A Prospective Study to Evaluate Efficacy with the Nuro™ Percutaneous Tibial Neuromodulation System in Drug Naïve Patients with Overactive Bladder Syndrome

    San Francisco, CA (UroToday.com) Overactive bladder (OAB) syndrome is a common phenomenon in both men and women, yet there are many challenges in effectively treating both urinary urgency and urgency urinary incontinence (UUI). Consequently, many advances to broaden management options for patients are underway. 
    Published May 21, 2018
  • AUA 2018: Advances in Diagnosis & Management in Nocturia

    San Francisco, CA (UroToday.com) In this instructional course, Dr. Wein and Dr. Weiss presented a framework for the assessment of patients with nocturia. Instructors argued that cause of disease is multifactorial, and it’s crucial to consider various diagnostic tools in order to address multiple risk factors and morbidities associated with disease occurrence. Primary learning objectives included evaluation of disease etiology in relation to morbidity, mortality and economic costs; analysis of current data regarding medication use for the treatment of the disease; classification of nocturia and corresponding medical conditions based on the analysis of the voiding diary; and concurrent review of actual case studies.
    Published May 19, 2018
  • AUA 2018: Association Between Overactive Bladder Severity and Bold fMRI Brain Activity

    San Francisco, CA (UroToday.com) Overactive bladder (OAB) is a common urological condition characterized by the sense of urinary urgency and has been shown to detrimentally affect quality of life. Prior studies using functional magnetic resonance imaging (fMRI) have demonstrated altered patterns of brain activity in women with OAB compared to healthy controls. Steven Weissbart, MD of Stony Brook University Hospital presented his research at the University of Pennsylvania to assess whether brain activity patterns are further altered with increased severity of OAB symptoms.
    Published May 21, 2018
  • AUA 2018: Clinical Evaluation and Treatment of Nocturia is Modest at Best

    San Francisco, CA (UroToday.com)  According to Dr. Drangsholt, nocturia was defined as one or more voids at night. Primary purpose of the study was to analyze diagnostic processes and effectiveness of clinical treatment options available.   Researchers conducted a chart review of patients with a new diagnosis of nocturia from 2010 to 2016. Data on all eligible subjects were collected within a year after the first encounter. Out of all patients who were considered eligible for the study, 52% of individuals have reported previous pharmacotherapy. Voiding diary (FVC) was prescribed to half of the study participants, but patient compliance with the FVC was only at 63%.  

    Published May 19, 2018
  • AUA 2018: Noctiva: Addressing a Nighttime Condition with Daytime Consequences

    San Francisco, CA (UroToday.com) The purpose of this presentation was to introduce Noctiva as an only FDA-approved treatment option available for patients with diagnosed polyuria, educate healthcare specialists on use of medication, and review concurrent case studies of individuals who were prescribed this medication.
    Published May 20, 2018
  • AUA 2018: What’s Keeping You Up at Night? Nocturia as a Primary Complaint

    San Francisco, CA (UroToday.com) In this presentation, Lindsey Kerr, MD, provided an overview of nocturia in men and women, described disease prevalence and its’ consequences, and introduced current treatment methods including pharmacotherapy and behavioral modifications. Nocturia was defined as waking up at night one or more times to void. This condition is associated with decreased quality of life and increased chance of developing comorbidities, which makes diagnosis even more challenging.
    Published May 19, 2018
  • ICS 2018: Efficacy of AV002, an Emulsified Microdose Vasopressin Analog for Rapid Nocturia

    Philadelphia, PA (UroToday.com) Diane K. Newman and colleagues assessed the effect of the first dose of AV002 on the number of NOV and FUSP in patients in two Phase 3 randomized, double-blind pivotal studies.

    Patients ≥50 years old with a history of ≥2 NOVs per night for ≥6 months (n=1333) were randomized to AV002 1.66mcg, AV002 0.83mcg, or placebo and treated for 12 weeks. After the first dose, the number of NOV and FUSP were measured. Safety evaluations included adverse events (AEs) and incidence of hyponatremia (moderate: 126-129 mmol/L; severe: ≤125 mmol/L).
    Published August 30, 2018
  • ICS 2018: What is the Evidence-base for Treatment of Recurrent UTIs in Women?

    Philadelphia, PA (UroToday.com) The purpose of this presentation was to assess diversity and effectiveness of available treatments for the recurrent urinary tract infections (rUTIs) in females. According to the presenters, rUTIs are highly prevalent in all ages and socioeconomic groups, but there is no universal treatment framework to guide healthcare providers. An antibiotic prescription is one of the primary therapies, but type, dosage, and length of administration vary across practices.
    Published August 31, 2018
  • Management of Nocturia | SUFU 2018

    Austin, TX (UroToday.com) A panel discussion on the management of nocturia, A Nocturia Clinical Pathway was held and Dr. Tamsin J. Greenwell began by addressing medical risk factors for nocturia.  He states the most important thing is to try and address the etiology of the nocturia.  The clinician should make note of the patient’s fluid intake, especially alcohol and caffeine.  Assess the patients sleep using the Epworth Sleepiness Scale (ESS).  Assess cardiovascular function, as well as BMI and hip to waist ratio, as these may be risk factors for obstructive sleep apnea.  Obtain a frequency volume chart.  Finally, obtain baseline labs: a urinalysis to exclude DM, UTI, or hematuria.  Obtain renal function, hemoglobin A1c, liver function tests, lipid profile, and PSA, if indicated.  

    Published March 2, 2018
  • New Data Demonstrating Enobosarm’s Potential to Treat Stress Urinary Incontinence -Presented at SUFU 2018.

      -- MRI results show increases in pelvic floor muscle and urethral muscle diameter supporting enobosarm’s mechanism of action --

      -- Additional positive results in subset of postmenopausal women suggest dual treatment effect on urge incontinence and stress urinary incontinence --

    TRUCKEE, California.--(UroToday)--Additional results from a Phase 2 proof-of-concept clinical trial of 3 mg enobosarm administered orally in postmenopausal women with stress urinary incontinence (SUI), including magnetic resonance imaging (MRI) results from patients’ pelvic floor muscle. 
    Published March 11, 2018
  • NSAUA 2018: Evaluation and Management of Women with Recurrent Stress Urinary Incontinence

    Toronto, Ontario (UroToday.com) The topic of recurrent stress urinary incontinence after initial surgical therapy in women was discussed in this talk by E. Ann Gormley, MD. In recurrent stress urinary incontinence (SUI) the severity of the incontinence occurring following a failed surgery can either be the same or might even be worse. This entity of recurrent SUI after initial failed surgical therapy can be divided into several entities:
    Published October 13, 2018
  • Sleep Quality and Daytime Sleepiness Among Women With Urgency Predominant Urinary Incontinence.

    The objective of this study was to examine the strength and direction of the association between urinary symptoms and both poor quality sleep and daytime sleepiness among women with urgency urinary incontinence.

    Published January 7, 2018
  • SUFU 2018: 5 Year Results of The Prostatic Urethral LIFT Pivotal Study

    Austin, TX (UroToday.com) Dr. Michael Trotter and colleagues presented the 5 year results from the LIFT pivotal trial.  This is a prospective, randomized study looking at the treatment of BPH using the Prostatic Urethral Lift (PUL).  This technique uses small transurethral implants to retract obstructing lateral lobes of the prostate.  206 patients at 19 centers were randomized to PUL (n=140) or sham control (n=66).  Inclusion criteria included age >= 50 years, International Prostate Symptom Score (IPSS) >= 13, peak flow rate <= 12 mL/s and prostate volume 30-80 cc. 
    Published March 2, 2018
  • SUFU 2018: A Novel Sacral Neuromodulation Infection Protocol is Associated with Reduction in Device Infection

    Austin, TX (UroToday.com) Dr. Colin Murrah Goudelocke and colleagues  presented a prospective study of 468 sacral neuromodulation procedures performed on 288 patients, from 2014 to 2017.  The authors designed an infection protocol in order to try and decrease SNM device infections, mainly due to staphylococcus aureus colonization. 108 procedures on 80 patients were performed prior to protocol implementation and 360 procedures on 208 patients were performed after the protocol.
    Published March 3, 2018
  • SUFU 2018: AUA/SUFU SUI Guidelines

    Austin, TX (UroToday.com) This is the third guideline for female stress urinary incontinence (SUI) by SUFU/AUA. As therapeutic options continues to evolve, more updated guidelines are expected in the future.  The guidelines are based on a comprehensive literature review by ECRI institute and recommendations based on benefits and risk. Papers were graded but he following scale.
    Published March 1, 2018
  • SUFU 2018: Clinical Experience with Posterior Tibial Nerve Stimulation in the Elderly

    Austin, TX (UroToday.com) Dr. Cristina Palmer and colleagues presented a retrospective study of 53 patients, aged 65 or older, undergoing percutaneous tibial nerve stimulation (PTNS) from 2011 to 2017 at the University of California Irvine.  They examined variables including age, BMI, number of comorbidities, and alternate and additional treatments used, in addition to PTNS.
    Published March 2, 2018
  • SUFU 2018: Effect of Age on Outcomes Of Transvaginal Native Tissue Repairs for Apical Vaginal Prolapse

    Austin, TX (UroToday.com) Dr. Lindsay Martin Kissane and colleagues presented a retrospective study of post-operative symptom severity, quality of life (QoL), overall symptomatic improvement, surgical complications, and retreatment in older compared to younger female patients (<70 years old). They used mailed and validated questionnaires to 641 patients with comparable response rate ( younger= 49% vs older= 56%). 
    Published March 1, 2018
  • SUFU 2018: Management of LUTS in the Male Underactive Bladder

    Austin, TX (UroToday.com) A point-counterpoint panel discussion on the topic of the management of lower urinary tract symptoms (LUTS) in the male underactive bladder was held at SUFU 2018 in Austin, Texas.  The moderator, Dr. Gousse, presented two difficult cases from his practice. The most recent definition of underactive bladder (UAB) states, “UAB is characterized by a slow urinary stream, hesitancy, and straining to void with or without a feeling of incomplete bladder emptying, sometimes with storage symptoms.”   We believe that the prevalence of UAB is 11-44%, but the true prevalence is really unknown. 
    Published March 2, 2018
  • SUFU 2018: Oral Enobosarm Shows Promising Activity in Post-Menopausal Women with Stress Urinary Incontinence: Results of a Phase 2 Study

    Austin, TX (UroToday.com) Dr. Kenneth M Peters and colleagues presented the results from the single-arm, open-label Phase 2 clinical trial evaluating enobosarm in postmenopausal women with stress urinary incontinence (SUI). The first clinical trial to evaluate an orally-administered selective androgen receptor modulator (SARM) for SUI.  Enobosarm, which is an oral selective androgen receptor modulator, given as an androgenic agent to modulate the pelvic floor and urinary sphincter was given to 17 post-menopausal women with stress predominant urinary incontinence were given the drug for 12 weeks.  The primary endpoint was the number of stress incontinence episodes per day on the 3−day voiding diary. Secondary endpoints include pad weights, BST, and quality of life (QOL) instruments (MESA, PGI−S, PGI−I, UDI−6, IIQ−7, and FSFI). Follow up was up to 40 weeks. 
    Published March 4, 2018
  • SUFU 2018: Pathophysiology of Nocturia

    Austin, TX (UroToday.com) Jeffrey P. Weiss, MD gave a State of the Art lecture on the pathophysiology of nocturia.   He describes the most important step to the evaluation of nocturia is a 24 hour voiding diary. 

    Published March 2, 2018
  • SUFU 2018: Randomized Controlled Trial of Group-Administered Behavioral Treatment in Reducing Urinary Incontinence in Adult Women

    Austin, TX (UroToday.com) Dr. Diane Newman and colleagues presented a randomized controlled trial of 463 women ages 55 and older, to determine the effectiveness of Group Behavioral Therapy (GBT) versus no treatment in adult women with no prior treatments, with stress, urgency, or mixed urinary incontinence.  The patients were randomized to a GBT group and a no treatment group.  The authors looked at the results of the ICIQ UI-SF scores, as well as a 3-day voiding diary, paper towel test, 24-hr pad weight, Brink test, Incontinence Quality of Life Questionnaire (I-QOL) and Patient Global Impression of Improvement (PGI-I).  The women undergoing GBT attended a one time 2 hour bladder health class, both groups received a behavioral education brochure.  The follow ups were every 3 months for 1 year, with clinic visits at months 3 and 12, with mailed questionnaires at months 6 and 9.
    Published March 4, 2018
  • SUFU 2018: Safety and Efficacy of Onabotulinumtoxina Injections in Octo and Nonagenarians

    Austin, TX (UroToday.com) Dr. Patricia Zahner presented a retrospective case series comparing patients undergoing intravesical botox injections (BTX-A) for the treatment of overactive bladder (OAB). 62 patients were ages 80-94 years versus 68 patients ages 50-70.  They examined demographics, complications, and clinical characteristics of the two groups.
    Published March 2, 2018
  • SUFU 2018: The Effects of Augmentation Cystoplasty and Botulinum Toxin Use on Patient Reported Bladder Function

    Austin, TX (UroToday.com) Dr. Jeremy Myers and colleagues presented a study of 846 spinal cord injury (SCI) patients who perform clean intermittent catheterization (CIC) for bladder management, identified from the Neurogenic Bladder Research Group (NBRG) registry. The study sought to examine the effects of augmentation cystoplasty and botulinum toxin use on patient reported bladder function and interventions, such as intravesical botox injections and augmentation cystoplasty, to determine if these interventions can improve satisfaction among individuals with spinal cord injury performing intermittent catheterization, an attempt to decrease rates of CIC discontinuation.
    Published March 4, 2018
  • SUFU 2018: The Pathophysiology and Future of Underactive Bladder

    Austin, TX (UroToday.com) A panel on underactive bladder (UAB) was held, moderated by Dr. Brian J. Flynn, MD.  Michael B. Chancellor, MD presents on Pathophysiology of UAB and the Future of UAB was presented by Alan J. Wein, MD, Ph.D. (hon), FACS.
    Published March 2, 2018
  • The Relationship Between Uterosacral Ligament Laxity, OAB , Chronic Pain and Bowel Dysfunction - Expert Commentary

    This commentary outlines the anatomical basis for surgical cure of OAB as reported by Liedl et al., in a multicentre study (n=611) in the Central European Journal of Urology1. This is the first substantive study aimed to challenge the Integral Theory’s predictions that OAB and other pelvic symptoms are mainly caused by loose suspensory ligaments2, are a consequence of deficient collagen/elastin within them, and are potentially curable surgically, Table1, by use of a polypropylene tape to create a collagenous neoligament 3. The first application of this neoligament methodology 3 was reinforcement of damaged pubourethral ligaments 4 as part of the midurethral sling operation, ‘TVT’ 4 for cure of urinary stress incontinence.
    Published November 14, 2018
  • Velicept Therapeutics Initiates First of Two Phase 2b Dose-Ranging Studies of Solabegron in Patients with Overactive Bladder; Finalizes Novel, Once Daily Formulation; and Receives U.S. Patent Covering OAB

    Truckee, CA (UroToday.com) Velicept Therapeutics, a privately-held specialty pharmaceutical company dedicated to the development of best-in-class compounds for the treatment of urological and gastrointestinal disorders, announced the initiation of the first of two Phase 2b clinical studies. The first study (VEL2002) will evaluate two doses of solabegron dosed twice daily in patients with overactive bladder (OAB). The primary objective of the study is to evaluate the mean change in number of micturitions per day as measured by patients in an e-diary.
    Published March 19, 2018
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