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Management of Refractory OAB in the Non-Neurogenic Patient

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)
  • Published:
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Abstract

Overactive bladder (OAB) is one of the most common bothersome urological diseases. It also has a negative economic impact. Pathophysiology entails changes in neurogenic and myogenic factors, as well as urinary biomarkers such as nerve growth factor (NGF) and prostaglandins (PGs). With symptoms from OAB-Dry to OAB-Wet, the urodynamic pattern of OAB bladder is often characterized by idiopathic detrusor overactivity with lower threshold of sensation, diminished compliance and capacity. Treatment ranges from a combination of behavioral modifications (BM)/ pelvic floor muscle training (PFMT) to combinations of antimuscarinics, Botox injection, nerve stimulation and augmentation cystoplasty. Herein, a contemporary review on the different aspects of management of refractory OAB in patients without neuropathic disorders is presented.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kobelt G, Kirchberger I, Malone-Lee J. Review. Quality-of-life aspects of the overactive bladder and the effect of treatment with tolterodine. BJU Int. 1999;83:583–90.

    Article  CAS  PubMed  Google Scholar 

  2. Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Economic burden of urgency urinary incontinence in the United States: a systematic review. J Manag Care Pharm. 2014;20:130–40.

    PubMed  Google Scholar 

  3. Goldman HB, Wyndaele JJ, Kaplan SA, Wang JT, Ntanios F. Defining response and non-response to treatment in patients with overactive bladder: a systematic review. Curr Med Res Opin. 2014;30:509–26. A very good review on how success/failure is defined in the literature regarding the response to various remedies of OAB. The article shows that the literature is lacking a clear, standardized form of treatment response.

    Article  CAS  PubMed  Google Scholar 

  4. Robinson D, Giarenis I, Cardozo L. The medical management of refractory Overactive Bladder. Maturitas. 2013;74:386–90. This manuscript is an overview for pharmacotherapy of OAB. It can also serve as baseline knowledge for the reader on the subject of evaluation.

    Article  PubMed  Google Scholar 

  5. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61:37–49.

    Article  PubMed  Google Scholar 

  6. Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ. Global prevalence and economic burden of urgency urinary incontinence: a systematic review. Eur Urol. 2014;65:79–95.

    Article  PubMed  Google Scholar 

  7. Jeong SJ, Lee SC, Jeong CW, Hong SK, Byun SS, Lee SE. Clinical and urodynamic differences among women with overactive bladder according to the presence of detrusor overactivity. Int Urogynecol J. 2013;24:255–61.

    Article  PubMed  Google Scholar 

  8. Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline. J Urol. 2012;188:2455–63. An updated and comprehensive guideline, noteworthy for any urologist.

  9. Yamauchi H, Akino H, Ito H, Aoki Y, Nomura T, Yokoyama O. Urinary prostaglandin E2 was increased in patients with suprapontine brain diseases, and associated with overactive bladder syndrome. Urology. 2010;76:1267. E 13–9.

  10. Seth JH, Sahai A, Khan MS, van der Aa F, de Ridder D, Panicker JN, et al. Nerve growth factor (NGF): a potential urinary biomarker for overactive bladder syndrome (OAB)? BJU Int. 2013;111:372–80.

    Article  CAS  PubMed  Google Scholar 

  11. Cho KJ, Kim HS, Koh JS, Kim JC. Changes in urinary nerve growth factor and prostaglandin E2 in women with overactive bladder after anticholinergics. Int Urogynecol J. 2013;24:325–30.

    Article  PubMed  Google Scholar 

  12. Rubio-Diaz DE, Pozza ME, Dimitrakov J, et al. A candidate serum biomarker for bladder pain syndrome/interstitial cystitis. Analyst. 2009;134:1133–7.

    Article  CAS  PubMed  Google Scholar 

  13. Andersson KE, Chapple CR, Cardozo L, et al. Pharmacological treatment of urinary incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 4th ed. Paris: Health Publication Ltd; 2009. p. 631–700. Editions 21.

    Google Scholar 

  14. Armstrong EP, Malone DC, Bui CN. Cost-effectiveness analysis of anti-muscarinic agents for the treatment of overactive bladder. J Med Econ. 2012;15(Supp 1):35–44.

    Article  PubMed  Google Scholar 

  15. Bolduc S, Moore K, Lebel S, Lamontagne P, Hamel M. Double anticholinergic therapy for refractory overactive bladder. J Urol. 2009;182:2033–9.

    Article  CAS  PubMed  Google Scholar 

  16. Natalin R, Oliveira Reis L, Alpendre C, Ikari L, Prudente A, D’Ancona C. Triple therapy in refractory detrusor overactivity: a preliminary study. World J Urol. 2010;28:79–85.

    Article  PubMed  Google Scholar 

  17. Rai BP, Cody JD, Alhasso A, Stewart L. Anticholinergic drugs versus non-drug active therapies for non-neurogenic overactive bladder syndrome in adults. Cochrane Database of Syst Rev. 2012;Issue 12. Art. No.: CD003193. Important review outlines different comparisons of antimuscarnincs vs. anything else.

  18. Ansari MS, Bharti A, Kumar R, Ranjan P, Srivastava S, Kapoor R. Gabapentin: a novel drug as add-on therapy in cases of refractory overactive bladder in children. J Pediatr Urol. 2013;9:17–22.

    Article  CAS  PubMed  Google Scholar 

  19. Schmidt RA, Tanagho EA. Feasibility of controlled micturition through electric stimulation. Urol Int. 1979;34:199–230.

    Article  CAS  PubMed  Google Scholar 

  20. Thüroff JW, Bazeed MA, Schmidt RA, Wiggin DM, Tanagho EA. Functional pattern of sacral root stimulation in dogs. I Micturition. J Urol. 1982;127:1031–3.

    PubMed  Google Scholar 

  21. Thüroff JW, Bazeed MA, Schmidt RA, Wiggin DM, Tanagho EA. Functional pattern of sacral root stimulation in dogs. II. Urethral closure. J Urol. 1982;127:1034–8.

    PubMed  Google Scholar 

  22. Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol. 1988;140:1331–9.

    CAS  PubMed  Google Scholar 

  23. Schmidt RA, Jonas U, Oleson KA, et al. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group. J Urol. 1999;162:352–7.

    Article  CAS  PubMed  Google Scholar 

  24. Siegel S, Noblett K, Mangel J, Griebling TL, Sutherland SE, Bird ET, et al. Results of a prospective, randomized, multicenter study evaluating sacral neuromodulation with InterStim therapy compared to standard medical therapy at 6-months in subjects with mild symptoms of overactive bladder. Neurourol Urodyn. 2014. doi:10.1002/nau.22544.

    Google Scholar 

  25. Govier FE, Litwiller S, Nitti V, Kreder Jr KJ, Rosenblatt P. Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol. 2001;165:1193–8.

    Article  CAS  PubMed  Google Scholar 

  26. Burton C, Sajja A, Latthe PM. Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis. Neurourol Urodyn. 2012;31:1206–16.

    Article  CAS  PubMed  Google Scholar 

  27. Ammi M, Chautard D, Brassart E, Culty T, Azzouzi A, Bigot P. Transcutaneous posterior tibial nerve stimulation: evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder. Int Urogynecol J. 2014. doi:10.1007/s00192-014-2359-0.

    PubMed  Google Scholar 

  28. Peters K, Carrico D, Burks F. Validation of a sham for Percutaneous Tibial Nerve Stimulation (PTNS). Neurourol Urodyn. 2009;28:58–61.

    Article  PubMed  Google Scholar 

  29. Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183:1438–43.

    Article  PubMed  Google Scholar 

  30. Tellenbach M, Schneider M, Mordasini L, Thalmann GN, Kessler TM. Transcutaneous electrical nerve stimulation: an effective treatment for refractory non-neurogenic overactive bladder syndrome? World J Urol. 2013;31:1205–10.

    Article  PubMed  Google Scholar 

  31. Schurch B, Stohrer M, Kramer G, et al. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol. 2000;164:692–7.

    Article  CAS  PubMed  Google Scholar 

  32. Schmid DM, Sauermann P, Werner M, et al. Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics. J Urol. 2006;176:177–85.

    Article  CAS  PubMed  Google Scholar 

  33. Okamura K, Nojiri Y, Ameda K, Namima T, Suzuki M, Inoue K, et al. Botulinum toxin A submucosal injection for refractory non-neurogenic overactive bladder: early outcomes. Int J Urol. 2011;18:483–7.

    PubMed  Google Scholar 

  34. Makovey I, Davis T, Guralnick ML, O’Connor RC. Botulinum toxin outcomes for idiopathic overactive bladder stratified by indication: lack of anticholinergic efficacy versus intolerability. Neurourol Urodyn. 2011;30:1538–40.

    Article  PubMed  Google Scholar 

  35. Mangera A, Andersson KE, Apostolidis A, et al. Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA). Eur Urol. 2011;60:784–95.

    Article  CAS  PubMed  Google Scholar 

  36. Dowson C, Watkins J, Khan MS, Dasgupta P, Sahai A. Repeated botulinum toxin type a injections for refractory overactive bladder: medium-term outcomes, safety profile, and discontinuation rates. Eur Urol. 2012;61:834–9.

    Article  CAS  PubMed  Google Scholar 

  37. Dmochowski R, Chapple C, Nitti VW, Chancellor M, Everaert K, Thompson C, et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol. 2010;184:2416–22.

    Article  CAS  PubMed  Google Scholar 

  38. Wein A. Diagnosis and treatment of the overactive bladder. Urology. 2003;62(Supple. 5B):20–7.

    Article  PubMed  Google Scholar 

  39. Reyblat P, Ginsberg DA. Augmentation enterocystoplasty in overactive bladder: is there still a role? Curr Urol Rep. 2010;11:432–9.

    Article  PubMed  Google Scholar 

  40. Greenwell TJ, Venn SN, Mundy AR. Augmentation cystoplasty. BJU Int. 2001;88:511–25

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Dr. Bassem S. Wadie reports received honorarium from NIDDK/NIH.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Voiding Dysfunction and Female Urology, Urology& Nephrology Center, Mansoura University, Mansoura, Egypt

    Bassem S. Wadie

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  1. Bassem S. Wadie
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Correspondence to Bassem S. Wadie.

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This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

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Wadie, B.S. Management of Refractory OAB in the Non-Neurogenic Patient. Curr Urol Rep 15, 438 (2014). https://doi.org/10.1007/s11934-014-0438-x

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  • DOI: https://doi.org/10.1007/s11934-014-0438-x

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