Article

Does the Imprecise Definition of Overactive Bladder Serve Commercial Rather than Patient Interests?

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
European Urology (Impact Factor: 10.48). 04/2012; 61(4):746-8; discussion 749-50. DOI: 10.1016/j.eururo.2011.12.013
Source: PubMed
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    ABSTRACT: Family studies and twin studies demonstrate that lower urinary tract symptoms and pelvic organ prolapse are heritable. This review aimed to identify genetic polymorphisms tested for an association with lower urinary tract symptoms or prolapse, and to assess the strength, consistency, and risk of bias among reported associations. PubMed and HuGE Navigator were searched up to May 1st 2014, using a combination of genetic and phenotype keywords, including nocturia, incontinence, overactive bladder, prolapse and enuresis. Major genetics, urology and gynecology conference abstracts were searched from 2005-2013. We screened 889 abstracts, and retrieved 78 full texts. 27 published and 7 unpublished studies provided data on polymorphisms in or near 32 different genes. Fixed and random effects meta-analyses were conducted using co-dominant models of inheritance. We assessed the credibility of pooled associations using the interim Venice criteria. In pooled analysis, the rs4994 polymorphism of the ADRB3 gene was associated with overactive bladder (OR 2.5, 95%CI 1.7-3.6, n=419). The rs1800012 polymorphism of the COL1A1 gene was associated with prolapse (OR 1.3, 95%CI 1.0-1.7, n=838) and stress urinary incontinence (OR 2.1, 95%CI 1.4-3.2, n=190). Other meta-analyses, including those for polymorphisms of COL3A1, LAMC1, MMP1, MMP3 and MMP9 did not show significant effects. Many studies were at high risk of bias from genotyping error or population stratification. In conclusion, these meta-analyses provide moderate epidemiological credibility for associations of variation in ADRB3 with overactive bladder, and variation of COL1A1 with prolapse. Clinical testing for any of these polymorphisms cannot be recommended based on current evidence.
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    ABSTRACT: Objectives The overactive bladder syndrome (OAB) is a highly prevalent and bothersome symptom complex. We review contemporary reports to provide an update of the key aspects of its pathogenesis and the therapeutic approaches. Methods The PUBMED database was searched for relevant publications in the period from 1 January 1985 to 1 May 2013, using the keywords ‘overactive bladder’, ‘anti-muscarinics’, ‘β-3 agonists’, ‘intravesical botulinum toxin’, ‘tibial nerve stimulation and ‘sacral neuromodulation’. Results In all, 33 articles were selected for this review. OAB is very common, affecting 10–20% of the population. It is often bothersome and frequently affects the quality of life. The current definition of OAB remains a source of controversy. Anti-muscarinic agents remain the mainstay of pharmacotherapy. The new β-3 agonists have some efficacy whilst avoiding anti-cholinergic effects, and so might benefit patients who are unable to tolerate anti-muscarinic agents. Intravesical botulinum toxin is recommended for patients in whom oral pharmacotherapy fails, although the optimal parameters in terms of dosing, number of injections and injection site are yet to be fully established. Sacral neuromodulation is another option that has a good response in about half of patients. Conclusions OAB remains an incompletely understood problem that presents a significant management challenge. A range of therapeutic options is now available for clinicians managing this problem.
    12/2013; 11(4):313–318. DOI:10.1016/j.aju.2013.07.006
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    ABSTRACT: No study has compared the bothersomeness of all lower urinary tract symptoms (LUTS) using a population-based sample of adults. Despite this lack of evidence, investigators have often cited their LUTS of interest as the "most bothersome" or "one of the most bothersome." To compare the population- and individual-level burden of LUTS in men and women. In this population-based cross-sectional study, questionnaires were mailed to 6000 individuals (18-79 yr of age) randomly identified from the Finnish Population Register. The validated Danish Prostatic Symptom Score questionnaire was used for assessment of bother of 12 different LUTS. The age-standardized prevalence of at least moderate bother was calculated for each symptom (population-level burden). Among symptomatic individuals, the proportion of affected individuals with at least moderate bother was calculated for each symptom (individual-level bother). A total of 3727 individuals (62.4%) participated (53.7% female). The LUTS with the greatest population-level burden were urgency (7.9% with at least moderate bother), stress urinary incontinence (SUI) (6.5%), nocturia (6.0%), postmicturition dribble (5.8%), and urgency urinary incontinence (UUI) (5.0%). Burden from incontinence symptoms was higher in women than men, and the opposite was true for voiding and postmicturition symptoms. At the individual level, UUI was the most bothersome for both genders. Although the response proportion was high, approximately a third did not participate. Both men and women with UUI report moderate or major bother more frequently than individuals with other LUTS. At the population level, the most prevalent bothersome symptoms are urgency, SUI, and nocturia. Urinary urgency was the most common troubling symptom in a large population-based study; however, for individuals, urgency incontinence was the most likely to be rated as bothersome.
    European Urology 01/2014; 65(6). DOI:10.1016/j.eururo.2014.01.019 · 10.48 Impact Factor

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