[Show abstract][Hide abstract] ABSTRACT: Dry mouth is among the most common side effects of antimuscarinic therapy. This study evaluated the drug-related change in dry mouth after the solifenacin treatment and the impact of dry mouth on the drug efficacy against overactive bladder syndrome (OAB).
OAB patients (n = 331) were enrolled in a prospective, multicenter, 8-week observational study of solifenacin treatment. Participants were >20 years of age and presented with OAB symptoms for ≥3 months, a total overactive bladder symptom score (OABSS) of ≥3, and an urgency score of ≥2. Primary endpoints were changes in dry mouth according to baseline dry mouth status using Xerostomia Inventory (XI) and the effect of dry mouth to the drug efficacy according to improvements in the OABSS.
Three hundred and thirty-three patients were initially screened for the study, with 331 actually enrolled. One hundred and ninety-four patients completed the study. Mean total XI scores increased by 2.8 points in the entire patient population, with larger increases for patients stratified into the non-dry mouth group (NDG) versus the dry mouth group (DG) (4.0 vs. 1.9, p = 0.015) at study baseline. Mean total OABSSs decreased by 3.2 points, with no significant differences between the NDG and the DG (-3.4 vs. -3.0 points, p = 0.578). The dry mouth aggravated in 71 patients (29.2 %) (NDG 30.1 % and DG 27.1 %), but only 10/331 individuals (3.0 %) stopped medication due to xerostomia. Dry mouth progressed in approximately 30 % of the OAB patients, regardless of its presence before solifenacin treatment. However, OAB symptoms were well relieved by solifenacin, and the adverse influence of dry mouth on drug persistence was low.
International Urology and Nephrology 12/2014; 47(2). DOI:10.1007/s11255-014-0892-x · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to investigate the efficacy of combining the systematized behavioral modification program (SBMP) with desmopressin therapy and to compare this with desmopressin monotherapy in the treatment of nocturnal polyuria (NPU).
Patients were randomized at 8 centers to receive desmopressin monotherapy (group A) or combination therapy, comprising desmopressin and the SBMP (group B). Nocturia was defined as an average of 2 or more nightly voids. The primary endpoint was a change in the mean number of nocturnal voids from baseline during the 3-month treatment period. The secondary endpoints were changes in the bladder diary parameters and questionnaires scores, and improvements in self-perception for nocturia.
A total of 200 patients were screened and 76 were excluded from the study, because they failed the screening process. A total of 124 patients were randomized to receive treatment, with group A comprising 68 patients and group B comprising 56 patients. The patients' characteristics were similar between the groups. Nocturnal voids showed a greater decline in group B (-1.5) compared with group A (-1.2), a difference that was not statistically significant. Significant differences were observed between groups A and B with respect to the NPU index (0.37 vs. 0.29, P=0.028), the change in the maximal bladder capacity (-41.3 mL vs. 13.3 mL, P<0.001), and the rate of patients lost to follow up (10.3% [7/68] vs. 0% [0/56], P=0.016). Self-perception for nocturia significantly improved in both groups.
Combination treatment did not have any additional benefits in relation to reducing nocturnal voids in patients with NPU; however, combination therapy is helpful because it increases the maximal bladder capacity and decreases the NPI. Furthermore, combination therapy increased the persistence of desmopressin in patients with NPU.
International neurourology journal 12/2014; 18(4):213-20. DOI:10.5213/inj.2014.18.4.213
[Show abstract][Hide abstract] ABSTRACT: We thank Agilli et al.  for their discussion of the restricted exclusion criteria in our study and possible effects of systemic conditions, including neuropsychiatric diseases and diabetes, on urinary nerve growth factor (NGF) . NGF messenger RNA (mRNA) expression and protein production was described in various cells, including smooth muscle cells, urothelial cells, mast cells, and adipocytes. Raised circulating levels of NGF were known to be associated with several inflammation-related diseases, including metabolic syndrome, diabetes, and overactive bladder (OAB) .As Agilli et al. pointed out, several medical conditions, including neuropsychiatric diseases, diabetes, and metabolic disorders, could affect the level of NGF. However, to our knowledge, most reported evidence involved serum or tissue, not urinary, NGF. Furthermore, some reports were demonstrated only in experimental animal studies. Also, association between medications, such as corticosteroids and herbal formulas ...
International Urogynecology Journal 10/2014; 26(3). DOI:10.1007/s00192-014-2533-4 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Urinary nerve-growth-factor (NGF) level reflected the severity of urgency in patients with lower urinary tract symptoms (LUTS) and pain in patients with Bladder pain syndrome/interstitial cystitis (BPS/IC). The aim of this study was to investigate the levels of biomarkers, nerve growth factor (NGF), and prostaglandin E2 (PGE(2)) among disease groups sharing similar urinary symptoms and to elucidate which symptoms are related to individual biomarker levels. We studied 83 patients with LUTS who visited our outpatient clinic from May 2011 to December 2012. On the basis of clinical symptoms and a 3-day voiding diary, patients were classified into three groups: those with frequency (n = 13), overactive bladder (OAB) (n = 35), and BPS/IC (n = 35). Patients with stress urinary incontinence (SUI) or microscopic hematuria served as controls (n = 24). Storage symptoms were evaluated based on OAB symptom score (OAB-SS). Mean patient age was 62.08 +/- 11.47 (range, 23-84). Urinary NGF and creatinine-normalized NGF levels were significantly increased in those with OAB (201.90 and 4.08, respectively) and BPS/IC (173.71 and 2.72) compared with controls (77.77 and 1.29) and those with frequency (67.76 and 1.23). Neither value significantly differed between OAB and BPS/IC patients or between controls and frequency patients. Urinary PGE(2) and creatinine-normalized PGE(2) levels were not significantly different among groups. On linear regression analysis, urinary NGF levels were significantly correlated with urgency severity overall (R = 0.222) and also pain in BPS/IC patients (R = 0.409). The levels of urinary NGF were elevated in patients with OAB and BPS/IC but not those with frequency and reflected the severity of urgency. In BPS/IC patients, urinary NGF increased with pain severity.
International Urogynecology Journal 05/2014; 25(11). DOI:10.1007/s00192-014-2424-8 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To show the noninferiority of silodosin 8-mg once-daily (QD) to 4-mg twice-daily (BID) in efficacy and safety in patients with lower urinary tract symptoms or benign prostatic hyperplasia in the Korean population.
A prospective, multicenter, double-blind, randomized, comparative study was conducted. A total of 532 male patients aged ≥50 years with lower urinary tract symptoms or benign prostatic hyperplasia were included. All patients received silodosin QD or BID for 12 weeks. The primary end point was the change from baseline in total International Prostate Symptom Score (IPSS) at 12 weeks. Adverse drug reactions, vital signs, and laboratory tests were recorded.
A total of 424 patients were randomized to the silodosin QD or BID groups. These groups were not significantly different in baseline characteristics. The mean total IPSS change in QD group was not inferior to that in BID group (−6.70 and −6.94, respectively; 95% confidence interval, −0.88 to 1.36). The QD and BID groups did not significantly differ in the following: percentages of patients with ≥25% (63.41% and 67.82%, respectively; P = .349) or ≥4-point improvement in total IPSS (65.85% and 69.31%, respectively; P = .457), maximum urinary flow rate improvement ≥30% (47.32% and 40.59%, respectively; P = .172), changes in IPSS voiding subscore (−4.42 ± 4.93 and −4.65 ± 4.77; P = .641), IPSS storage subscore (−2.05 ± 3.07 and −2.52 ± 2.97; P = .117), quality of life (−1.19 ± 1.49 and −1.40 ± 1.42; P = .136), maximum urinary flow rate (3.55 ± 5.93 and 3.74 ± 6.79 mL/s; P = .768), International Continence Society male questionnaire score, Patient Goal Achievement Score, or Treatment Satisfaction Question. The 2 groups had similar frequencies of adverse drug reactions.
QD administration of silodosin was not inferior to BID in efficacy. The 2 groups had similar adverse drug reaction profiles.
[Show abstract][Hide abstract] ABSTRACT: Objective
To investigate the associations between prostate elasticity and lower urinary tract symptoms (LUTS).
From August 2009 to December 2009, 48 patients with no history of neoadjuvant therapy or previous prostate surgery who underwent robot-assisted radical prostatectomy were included in this study. A novel palpation system was used to measure the tissue elasticity of the prostate specimens. The elasticity of the prostate was defined as the mean elastic modulus (kilopascals [kPa]) of 21 sites from the posterior surface of prostate. All patients completed an International Prostate Symptoms Score questionnaire before surgery, and LUTS was defined as an International Prostate Symptoms Score total of ≥8. Significant voiding symptoms were identified by a score of ≥5 on the basis of patient responses to 4 questions (Q1, Q3, Q5, and Q6), and storage symptoms were identified by a score ≥4 on the basis of patient responses to 3 questions (Q2, Q4, and Q7).
The median elastic modulus of the prostate was 20.8 kPa (interquartile range 15.6-22.9), and the LUTS incidences and voiding symptoms were significantly higher in patients with an elastic modulus >20 kPa. The multivariate logistic regression results indicated that a higher elastic modulus (as a continuous variable) was independently associated with voiding symptoms (odds ratio 1.18, P = .038) after controlling for age and prostate volume. However, the elastic modulus was not independently associated with LUTS or storage symptoms.
Patients with greater prostate stiffness are more likely to develop LUTS. Specifically, prostate elasticity was independently associated with voiding symptoms.
[Show abstract][Hide abstract] ABSTRACT: Purpose
These are the clinical experiences of Korean incidental prostate cancer patients detected by transurethral resection of the prostate according to initial treatment: active surveillance (AS), radical prostatectomy (RP) and hormone therapy (HT).
Materials and Methods
We retrospectively reviewed the records of 156 incidental prostate cancer patients between 2001 and 2012. The clinicopathologic outcomes were reviewed and follow-up results were obtained.
Among 156 patients, 97 (62.2%) had T1a and 59 (37.8%) had T1b. Forty-six (29.5%) received AS, 67 (42.9%) underwent RP, 34 (21.8%) received HT, 4 (2.6%) received radiotherapy, and 5 (3.2%) chose watchful waiting. Of 46 patients on AS, prostate-specific antigen (PSA) progression occurred in 12 (26.1%) patients. Among them, 3 patients refused treatment despite PSA progression. Five patients, who underwent RP as an intervention, all had organ-confined Gleason score ≤6 disease. In 67 patients who underwent RP, 50 (74.6%) patients had insignificant prostate cancer and 8 (11.9%) patients showed unfavorable features. During follow-up, biochemical recurrence occurred in 2 patients. Among 34 patients who received HT, 3 (8.8%) patients had PSA progression. Among 156 patients, 6 patients died due to other causes during follow-up. There were no patients who died due to prostate cancer.
The clinical outcomes of incidental prostate cancer were satisfactory regardless of the initial treatment. However, according to recent researches and guidelines, immediate definite therapy should be avoided without a careful assessment. We also believe that improved clinical staging is needed for these patients.
Yonsei medical journal 01/2014; 55(1):78-83. DOI:10.3349/ymj.2014.55.1.78 · 1.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
To evaluate the efficacy and safety of sacral neuromodulation for treating patients with refractory overactive bladder based on urodynamic data. Methods
Patients older than 18 years of age, with overactive bladder symptoms refractory to conventional therapies were eligible. Patients with more than a 50% reduction in frequency, urgency, or urge incontinence symptoms during a 2-week test stimulation period retained the sacral neuromodulation. Voiding diaries, overactive bladder questionnaires, and urodynamic studies were performed before and 1 year after sacral neuromodulation. ResultsForty patients received sacral neuromodulation and 31 patients of those were followed more than 1 year. The mean age of the 31 patients was 54.2 ± 15.4 (range, 30–76) years, and the mean duration of symptoms was 4.4 ± 5.7 (range, 1–31) years. After 12 months of sacral neuromodulation, significant decreases in the episodes of daily urgency (from 20.2 to 5.7, P < 0.001), urgency incontinence (from 7.3 to 0.2; P = 0.011), day time micturition (from 21.8 to 9.9; P < 0.001), night time micturition (from 3.2 to 1.2; P = 0.006) and in severity of urgency episodes (from 3.8 to 2.7; P = 0.015) were observed compared to baseline. Significant increases occurred in bladder volume at the first unstable contraction (from 182.4 ± 92.7 to 216.8 ± 115.6 mL), bladder volume at first desire to void (from 150.5 ± 90.8 to 167.8 ± 81.5 mL), maximal cystometric capacity (from 260.7 ± 120.4 to 291.7 ± 124.3 mL) and bladder volume at urgency sensation (from 182.4 ± 92.7 to 208.2 ± 106.6 mL) (all P < 0.05). Conclusions
Sacral neuromodulation is an effective and safe treatment for refractory overactive bladder.
[Show abstract][Hide abstract] ABSTRACT: The ankle foot orthosis (AFO) has been used for control of ankle motion in stroke patients for a long time. However, studies on the materials used in construction of AFOs have been limited. In this study, the authors attempted to investigate the effect of a hybrid AFO made with polypropylene and fabric in comparison with a conventional plastic AFO in terms of convenience and effect in patients with chronic hemiparetic stroke.
Seventeen patients with chronic hemiparetic stroke who have used plastic AFOs were recruited for this study. Two types of AFOs were used: plastic AFO made with polypropylene and hybrid AFO made with polypropylene covered with canvas fabric, which were individually molded and fitted. Convenience was evaluated using a self-developed questionnaire on patients' satisfaction and weights of AFO, and effect was evaluated using gait analysis.
On the satisfaction questionnaire, satisfaction was greater for the hybrid AFO, and it was lighter in weight than the plastic AFO (P < 0.05). In gait analysis, faster walking speed, larger mean and peak ankle dorsiflexion angles, and ankle dorsiflexion angles at heel strike and toe off were observed for the hybrid and plastic AFOs compared with barefoot (P < 0.05). No significant difference was observed between the two orthoses, except for ankle dorsiflexion angle at heel strike, in which the plastic AFO showed higher ankle dorsiflexion angle than did the hybrid AFO.
According to the results of this study, the hybrid AFO showed a similar effect in function, except for ankle dorsiflexion angle at heel strike, and was superior with regard to convenience compared with the conventional plastic AFO in chronic hemiparetic stroke patients. Therefore, it seems that, in general, the hybrid AFO can be recommended for hemiparetic stroke patients who require an AFO.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 10/2013; 93(2). DOI:10.1097/PHM.0b013e3182a92f85 · 2.01 Impact Factor