OAB Publications

Neurourol Urodyn. 2024 Feb;43(2):396-406. doi: 10.1002/nau.25370. Epub 2023 Dec 27.

Real-world onabotulinumtoxinA treatment patterns in patients with overactive bladder.

Chughtai B(1), Ricker CN(2), Boldt RJ(2), Elterman D(3).

Author information:

(1)Department of Urology, Weill Cornell Medicine, New York, New York, USA.

(2)Medtronic Plc, Minneapolis, Minnesota, USA.

(3)Division of Urology, University of Toronto, Toronto, Ontario, Canada.

PURPOSE: Utilization patterns of third-line onabotulinumtoxinA for overactive bladder (OAB) symptoms-including discontinuation and use of other therapeutic options during or after treatment-are not well understood. This retrospective analysis of administrative claims was designed to characterize the unmet need for OAB treatment.

MATERIALS AND METHODS: A retrospective claims analysis of Optum’s deidentified Clinformatics® Data Mart Database (2009-2021) was performed among patients with diagnosis of OAB newly starting onabotulinumtoxinA injection (2015-2017). Study measures were evaluated during an 18-month pretreatment baseline and over a minimum of 36 months of follow-up. These included number of injections, days between injections, other measures of onabotulinumtoxinA utilization, use of second-line pharmacologic treatments, use of device and surgical treatment options, and complications.

RESULTS: Of 2505 eligible patients, 535 (21.4%; 66.8 ± 13.3 y, 87.3% females) continued onabotulinumtoxinA throughout the study. The remaining 1970 (78.6%; 71.4 ± 11.6 y, 79.1% females) were considered discontinuers. Of continuers, 57% received ≥5 treatments. Of discontinuers, 84% received ≤2 treatments. Anticholinergics and β3-adrenoceptor agonist medication use declined in all

patients from baseline to follow-up; however, the absolute reduction in the proportion with any medication fill was similar across continuers versus discontinuers (21% vs. 18%, p < 0.0001). Sacral neuromodulation was initiated by 15/535 (3%) of continuers and 137/1970 (7%) of discontinuers (p < 0.0001). No patients initiated percutaneous tibial neuromodulation.

CONCLUSIONS: Early discontinuation of onabotulinumtoxinA therapy for OAB is common and most discontinuers do not receive alternative treatments. Providers have the opportunity to educate OAB patients with un- or undertreated symptoms regarding alternative options.

LLC.

DOI: 10.1002/nau.25370

PMID: 38149719 [Indexed for MEDLINE]

Can Urol Assoc J. 2024 Feb;18(2):12-16. doi: 10.5489/cuaj.8421.

Sacral neuromodulation in the golden years: Treatment outcomes in elderly 75 years and older.

Ferreira R(1), Otis-Chapados S(2), Alwashmi E(2)(3), Bhojani N(4), Zorn KC(4), Chughtai B(5), Elterman DS(2).

Author information:

(1)Department of Health Research Methods, Evidence, and Impact, McMaster

University, Hamilton, ON, Canada.

(2)Division of Urology, University Health Network, Toronto, ON, Canada.

(3)Department of Surgery, College of Medicine, Qassim University, Qassim, Saudi

Arabia.

(4)University of Montreal Hospital Center, Université de Montréal, Montreal, QC,

Canada.

(5)New York Presbyterian Hospital-Weill Cornell, New York, NY, United States.

INTRODUCTION: Despite high prevalence and increased severity and burden of overactive bladder (OAB) and fecal incontinence (FI) in the elderly, sacral neuromodulation (SNM) is often overlooked as a potential treatment option for this demographic. In this study, we report the outcomes of SNM in patients aged 75 years or older at the time of surgery.

METHODS: We conducted a retrospective cohort study of patients who underwent SNM implantation between 2013 and 2022 performed by a single, high-volume urologist at a tertiary center. Success, complication, and adjunct therapy rates were analyzed by Fisher’s or Wilcox rank-sum test as appropriate. We compared outcomes between patients aged 75-79 years and octogenarians.

RESULTS: Of 632 patients, 50 were ≥75 years. Patients had a mean age of 78.4±2.6 years and were predominantly female (84%). The indications for SNM were 66% OAB, 16% FI, 16% non-obstructive urinary retention, and 4% pelvic pain. Within the first year, 94% of patients reported satisfaction and improvement in symptoms, while 76% continued to experience improvement beyond one year. SNM insertion led to reduced oral medication use from 68% to 24% (p<0.0001). The complication rate was 16% and mostly included device pain. No significant difference was observed in treatment success, complication, or adjunct therapy rate between age groups.

CONCLUSIONS: SNM is a safe and effective option in well-selected patients over the age of 75 years. Treatment success rate is comparable to younger cohorts. Advanced age should not preclude third-line therapy options in this population.

DOI: 10.5489/cuaj.8421

PMCID: PMC10841569

PMID: 37931277

Conflict of interest statement: COMPETING INTERESTS: Dr. Bhojani is a consultant/investigator for Boston Scientific, Procept BioRobotics, and Olympus. Dr. Zorn is a consultant/investigator for Boston Scientific and Procept BioRobotics. Dr. Chughtai is a consultant for Boston Scientific, Olympus,

Procept, and Prodeon. Dr. Elterman is a consultant/investigator for Boston Scientific, Procept Biorobotics, Olympus, Urotronic, Prodeon, and Zenflow. All other authors do not report any competing personal or financial interests related to this work.

Neurourol Urodyn. 2024 Jan;43(1):52-62. doi: 10.1002/nau.25276. Epub 2023 Sep 4.

Systematic review and meta-analysis of urinary incontinence prevalence and population estimates.

Sadri H(1), Oliaei A(2), Sadri S(3), Pezeshki P(4), Chughtai B(5), Elterman D(6).

Author information:

(1)Department of Health Economics and Outcomes Research, Toronto, Ontario,

Canada.

(2)Department of Interdisciplinary Studies, Hamilton University, Hamilton,

Ontario, Canada.

(3)Department of Law, University of Toronto, Toronto, Ontario, Canada.

(4)Department of Clinical and Medical Affairs, Toronto, Ontario, Canada.

(5)Department of Urology, Weill Cornell Medical College, New York, New York,

USA.

(6)Department of Urology, University of Toronto, Toronto, Ontario, Canada.

INTRODUCTION: Incontinence impacts the quality-of-life of people suffering from the disease. However, there is limited information on the prevalence of incontinence due to the stigma, lack of awareness, and underdiagnosis.

OBJECTIVE: This study aims to conduct a systematic review and meta-analysis of overactive bladder (OAB) and nonobstructive urinary retention (NOUR).

METHODS: The authors conducted a systematic review following the PRISMA guidelines using Embase, MEDLINE, and PubMed databases to identify the relevant publications in the English language. Two reviewers independently assessed the articles and extracted the data. Review papers were assessed for content and references. A meta-analysis of proportions was conducted using the RStudio software. To address the age heterogeneity, a subanalysis was conducted. Pooled data were overlayed on the Canadian population and a sample of 10 populous countries to estimate the number of people suffering from incontinence.

RESULTS: Twenty-eight and eight articles were selected for OAB and NOUR, respectively. The pooled prevalence of OAB in men and women was 12% (95% CI: 9%-16%) and 15% (95% CI: 12%-18%), respectively. The estimated prevalence of NOUR was 15.6%-26.1% of men over 60 and 9.3%-20% of women over 60. The subanalysis pooled prevalence of OAB in men and women was 11% (95% CI: 8%-15%) and 12% (95% CI: 9%-16%), respectively. We estimated that 1.4-2.5 million women

and 1.3-2.2 million men suffer from OAB in Canada.

CONCLUSION: Urinary incontinence is an under-reported and underdiagnosed prevalent condition that requires appropriate treatment to improve a patient’s quality-of-life.

DOI: 10.1002/nau.25276

PMID: 37661792 [Indexed for MEDLINE]

Female Pelvic Med Reconstr Surg. 2022 Jul 1;28(7):429-435. doi: 10.1097/SPV.0000000000001190. Epub 2022 May 17.

Adverse Events for Overactive Bladder Medications From a Public Federal Database.

Sze C(1), Drangsholt S(2), Stoddard MD(3), Singh Z(4), Sansone S(1), Bhojani N(5), Zorn K(5), Elterman D(6), Chughtai B(1).

Author information:

(1)From the Weill Cornell Medicine/New York Presbyterian Hospital.

(2)Department of Urology, Westchester Medical Center Health Network, New York,

NY.

(3)University of Texas Health, San Antonio, San Antonia, TX.

(4)Department of Urology, Albany Medical Center, Albany, NY.

(5)Division of Urology, Department of Surgery, University of Toronto, Toronto,

Canada.

(6)Department of Surgery, University of Montreal (CHUM), Montreal, Canada.

IMPORTANCE: Clinical data on the use of overactive bladder (OAB) medications are limited by the physician interpretation of adverse effects rather than those that are patient reported.

OBJECTIVE: The aim of the study was to evaluate the association between OAB medications and adverse drug events (ADEs) through the self-reporting U.S. Food and Drug Administration Adverse Event Report System database.

STUDY DESIGN: The U.S. Food and Drug Administration Adverse Event Report System (FAERS) database was queried from 2004 to 2019. Adverse drug events were recategorized. Disproportionality analysis was used to detect the risk signals for each OAB medication and ADEs. χ 2 values were calculated to assess the association between ADEs and dosage.

RESULTS: A total number of 14,102 reports were identified. The most frequently reported OAB medications were mirabegron (35%), transdermal oxybutynin (27%), and solifenacin (25%). Neuropsychiatric (NP) ADEs were highest with tolterodine and fesoterodine usage (16% and 15.6%, respectively) and transdermal oxybutynin had the lowest (6.5%). Increasing the dose of tolterodine or fesoterodine was not associated with increased NP ADEs. Oxybutynin had the highest risk of affect/mood disorder, agitation, and balance/movement disorder; however, it had the lowest risk of headache/migraine compared with all OAB medications. Mirabegron compared with all other OAB medications had the lowest risk of affect/mood disorder and agitation; however, it had the highest risk of headache and migraines.

CONCLUSIONS: The FAERS database not only is a repository of ADEs but also may represent evolving prescribing habits for OAB medications. Transdermal oxybutynin had the lowest NP ADEs and may be appropriate for selected individuals.

DOI: 10.1097/SPV.0000000000001190

PMID: 35536677 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared they have no conflicts of interest.

Urol Int. 2022;106(7):664-671. doi: 10.1159/000522646. Epub 2022 Mar 23.

A Community-Based Education Program for Overactive Bladder in a Predominantly Minority Older Female Population: A Pilot Study.

Martinez Díaz S(1), Pierce H(2), Lee JR(3), Asfaw T(4), Abram A(2), Bhojani N(5), Elterman D(6), Zorn K(5), Chughtai B(2).

Author information:

(1)Department of Urology, Weill Cornell Medical College-New York Presbyterian,

New York, New York, USA, sum4002@med.cornell.edu.

(2)Department of Urology, Weill Cornell Medical College-New York Presbyterian,

New York, New York, USA.

(3)Division of Nephrology and Hypertension, Department of Medicine, New York

Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA.

(4)Department of Obstetrics and Gynecology, Weill Cornell Medical College-New

York Presbyterian, New York, New York, USA.

(5)Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM),

Université de Montréal, Montreal, Québec, Canada.

(6)Division of Urology, University Health Network (UHN), University of Toronto,

Toronto, Ontario, Canada.

INTRODUCTION: Knowledge gaps regarding available treatment and social stigmatization are barriers to care in patients with overactive bladder (OAB). We assessed the feasibility of an OAB education program targeting older community-dwelling females.

METHODS: Community-dwelling women over 55 years old were recruited. Eligible participants underwent an education program covering continence-promotion strategies. The Overactive Bladder Questionnaire-Short Form and Short Form-12 were completed at baseline, 1 week, 3 months, and 6 months post-intervention to measure symptom bother and condition-specific and general quality of life (QoL). Data were analyzed using a linear mixed-effects model for repeated measures.

RESULTS: Thirty-seven female patients with OAB symptoms at baseline were assessed with the majority from Latino/Hispanic or Black/African American ethnic/racial backgrounds. For our youngest subgroup (≤68 years old), significant improvements were observed at 3 and 6 months compared to 1 week

post-intervention for symptom bother (3 months, -22.75, p = 0.006; 6 months, -25.76; p = 0.001) and condition-specific and health-related QoL subscale scores for concern (3 months, +23.76, p = 0.006; 6 months, +22.15, p = 0.011) and social interaction (3 months, +21.11, p = 0.017; 6 months, +20.51; p = 0.021). For all age subgroups, improvements in general QoL measures for mental health were seen at 3 and 6 months compared to baseline (3 months, +7.57, p = 0.02; 6 months, +6.70; p = 0.048).

CONCLUSIONS: Statistically significant improvements in symptom bother, condition-specific, and general QoL measures were observed following an OAB education program pilot study in a predominantly minority female population. Further studies are needed to support efficacy and optimize program design.

DOI: 10.1159/000522646

PMCID: PMC9393838

PMID: 35320799 [Indexed for MEDLINE]

Conflict of interest statement: John Richard Lee, MD, receives research support under an investigator-initiated research grant from BioFire Diagnostics, LLC, and holds patent US-2020-0048713-A1 titled “Methods of Detecting Cell-Free DNA in Biological Samples.” Bilal Chughtai, MD, and Dean Elterman, MD, are consultants for Medi-Tate Ltd., Olympus, Boston Scientific, and MedeonBio. The other author has no conflicts of interests to disclose. The other authors have no conflicts of interested to declare.

Int Urogynecol J. 2022 May;33(5):1157-1164. doi: 10.1007/s00192-022-05127-3.

Epub 2022 Mar 2.

The gut, vaginal, and urine microbiome in overactive bladder: a systematic review.

Sze C(#)(1), Pressler M(#)(2), Lee JR(3), Chughtai B(4).

Author information:

(1)Department of Urology, New York Presbyterian Hospital, New York, NY, USA.

(2)New York Medical College, New York, NY, USA.

(3)Division of Nephrology and Hypertension, Department of Medicine, Weill

Cornell Medicine, New York, NY, USA.

(4)Department of Urology, Weill Cornell Medicine/New York Presbyterian Hospital,

525 E. 68th Street, New York, NY, 10021, USA. bic9008@med.cornell.edu.

(#)Contributed equally

INTRODUCTION AND HYPOTHESIS: The objective was to systemically review the current literature on the association of gut, vaginal, and urinary dysbiosis in female patients with overactive bladder (OAB).

METHODS: We performed a comprehensive literature search following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols for systematic reviews. In the EMBASE, CINAHL, and Medline databases, a search was conducted using key words such as “microbiome,” “microbiota,” “microflora,” “overactive bladder,” “urge,” “gut,” “vaginal.” Articles were screened using the online tool www.covidence.org . Two independent reviewers screened studies at each stage and resolved conflicts together. We excluded papers that discussed pediatric patients and animal studies. In total, 13 articles met this criterion, which included 6 abstracts.

RESULTS: After identifying 817 unique references, 13 articles met the criteria for data extraction. Articles were published from 2017 to 2021. No study reported the same microbiota abundance, even in healthy individuals. Overall, there was a loss of bacterial diversity in OAB patients compared with controls. Additionally, the bacterial composition of the controls and OAB patients was not significantly different, especially if the urine was collected midstream. Overall, the composition of the microbiome is dependent on the specimen collection methodology, and the metagenomic sequencing technique utilized. OAB urine microbiome is more predisposed to alteration from the gut or vaginal influences than in controls.

CONCLUSIONS: Current evidence suggested a potential relationship among gut, vaginal, and urinary microbiome in OAB patients, but there are very limited studies.

DOI: 10.1007/s00192-022-05127-3

PMID: 35237854 [Indexed for MEDLINE]

Eur Urol Focus. 2022 Sep;8(5):1415-1423. doi: 10.1016/j.euf.2021.12.016. Epub 2022 Jan 14.

The Prevalence of Nocturnal Polyuria in the United States: Results from the Epidemiology of Nocturnal Polyuria Study.

Weiss JP(1), Bosch JLHR(2), Chapple CR(3), Bacci ED(4), Simeone JC(5), Rosenberg

MT(6), Mueller ER(7), Andersson FL(8), Juul K(8), Chughtai B(9), Coyne KS(10).

Author information:

(1)SUNY Downstate Health Sciences University, Brooklyn, NY, USA.

(2)Franciscus G&V Hospital, Rotterdam, The Netherlands.

(3)University of Sheffield, Sheffield, UK.

(4)Evidera, Seattle, WA, USA.

(5)Formerly with Evidera, Waltham, MA, USA.

(6)Mid Michigan Health Center, Jackson, MI, USA.

(7)Loyola University Medical Center, Maywood, IL, USA.

(8)Ferring Pharmaceuticals, Copenhagen, Denmark.

(9)Weill Cornell Medicine, New York, NY, USA.

(10)Evidera, Bethesda, MD, USA. Electronic address: Karin.Coyne@evidera.com.

Comment in

J Urol. 2022 Sep;208(3):740-743. doi: 10.1097/JU.0000000000002821.

BACKGROUND: The prevalence of nocturnal polyuria (NP), which is passing large volumes of urine during the main sleep period, has been investigated primarily in middle-aged to older men. There is thus a gap in the NP evidence base for women and for younger individuals.

OBJECTIVE: To estimate the prevalence of nocturia due to NP in the USA.

DESIGN, SETTING, AND PARTICIPANTS: This large epidemiologic study used a US population-representative sample of men and women aged ≥30 yr to assess the prevalence of NP (NCT04125186).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Consenting participants completed an online survey (Lower Urinary Tract Symptoms Tool and comorbidities). All who reported two or more voids per night and 100 random respondents each reporting no or one void per night were asked to complete a 3-d bladder diary. Two NP definitions were used: nocturnal urine production >90 ml/h (NUP90) and Nocturnal Polyuria Index >0.33 (NPI33). Crude and population-adjusted prevalence results were calculated from completed diaries for the following subgroups by sex and age: idiopathic NP; NP with overactive bladder (NP-OAB) or bladder outlet obstruction (NP-BOO; men only); NP associated with other comorbidities; and no NP (did not meet the NPI33 or NUP90 definition).

RESULTS AND LIMITATIONS: Among the 10,190 respondents who completed the survey, the mean age was 54.4 yr (range 30-95); 3,339 reported two or more nocturnal voids and 1,763 completed the 3-d diary (response rate 49.3%). The adjusted overall NP prevalence was 31.5% among men and 38.5% among women using the NPI33 definition, and 23.8% among men and 18.1% among women using NUP90. The adjusted idiopathic NP prevalence was lower among men (NPI33: 5.2%; NUP90: 1.4%) than among women (NPI33: 9.8%; NUP90: 4.0%). The prevalence of idiopathic NP decreased with age as NP associated with other possible causes increased with age in men (most common, BOO) and women (most common, OAB).

CONCLUSIONS: This is the first population-based study of NP prevalence to include men, women, and young adults. NP is common; a multifactorial etiology should be considered, particularly as age increases.

PATIENT SUMMARY: In this population-based US study, we examined the frequency of nighttime urination among men and women aged ≥30 y and older. We found that nighttime urination is common among men and women. Many conditions can lead to increased nighttime urination as people age.

DOI: 10.1016/j.euf.2021.12.016

PMID: 35039242 [Indexed for MEDLINE]

Curr Urol Rep. 2021 Jun 11;22(8):40. doi: 10.1007/s11934-021-01054-w.

How I Handle Retreatment of LUTS Following a Failed MIST.

Te AE(1), Cho A(2), Chughtai BI(2).

Author information:

(1)Department of Urology, Weill Cornell Medical College of Cornell University,

425 East 61st street, 12th floor, New York, NY, 10065, USA.

aet2005@med.cornell.edu.

(2)Department of Urology, Weill Cornell Medical College of Cornell University,

425 East 61st street, 12th floor, New York, NY, 10065, USA.

PURPOSE OF REVIEW: The goal of this paper is to review retreatment management after failed minimally invasive treatment (MIST) of various technologies.

RECENT FINDINGS: A failed MIST can be defined by the return, persistence, or worsening of LUTS, as documented by symptom scores. Persistence, development, or recurrence of comorbidities such as recurrent urinary tract infection (UTI), retention, stones, hematuria, and incontinence can also signal a failed MIST. The common etiology for MIST failure is the preoperative consequence of long-term bladder outlet obstruction (BOO) on the bladder function. Close monitoring of therapies with antimuscarinics or beta-agonists can be empirically utilized if post-void bladder residual (PVR) is low. If there is a high PVR, urodynamic studies and cystoscopy can be used to determine overactive bladder

(OAB), BOO, or necrosis. Depending on the timing of the observed BOO/OAB, subsequent retreatments involving transurethral debridement, medical and behavioral therapies, or repeat surgical debulking can be employed.

DOI: 10.1007/s11934-021-01054-w

PMID: 34115242 [Indexed for MEDLINE]

Expert Opin Emerg Drugs. 2017 Sep;22(3):201-212. doi:

10.1080/14728214.2017.1369953. Epub 2017 Aug 30.

Emerging drugs for the treatment of benign prostatic hyperplasia.

Thomas D(1), Chughtai B(1), Kini M(1), Te A(1).

Author information:

(1)a Department of Urology , Weill Cornell Medicine-New York Presbyterian , New

York , NY , USA.

Benign prostatic hyperplasia (BPH) is a common condition affecting over 50% of men as they reach their 5th decade of life. This leads to a number of sequelae such as lower urinary tract symptoms, urinary retention and a decrease in quality of life. Currently, the available treatments for BPH are alpha blockers

and 5-alpha reductase inhibitors. Clinical studies have demonstrated these medical options are effective in alleviating a patient’s symptoms, however there are a number of side effects. There is a paucity of information regarding long-term use of these medications. The purpose of this review is to identify potential and emerging medications for the treatment of BPH. Areas covered: Articles used in this review were retrieved from Pubmed, Google and through searching the PharmaProjects database over the last 10 years, giving the reader an in-depth knowledge about the current pharmacological agents available and

other potential treatments for BPH. Expert opinion: The new paradigm of BPH treatment depends on addressing a patient’s specific constellation of symptoms. This allows to tailor therapy of increasing efficacy and reduce adverse events that our patients have by increasing dosage.

DOI: 10.1080/14728214.2017.1369953

PMID: 28829208 [Indexed for MEDLINE]

Female Pelvic Med Reconstr Surg. 2018 Jul/Aug;24(4):264-266. doi:

10.1097/SPV.0000000000000449.

Trends and Clinical Practice Patterns of Sacral Neuromodulation for Overactive Bladder.

Elterman DS, Chughtai B(1), Vertosick E(2), Thomas D(1), Eastham J(2), Sandhu J(2).

Author information:

(1)Department of Urology, Weill Cornell Medical College.

(2)Urology Section, Department of Surgery, Memorial Sloan Kettering Cancer

Center, New York, NY.

OBJECTIVES: The aim of this study was to investigate surgical practice patterns of American urologists treating refractory overactive bladder (OAB) over the past decade. Refractory OAB remains a management challenge to urologists. When multiple medical therapies have failed, treatment options may include sacral neuromodulation (SNM) or surgery such as augmentation cystoplasty (AC).

METHODS: Data on SNM and AC performed between 2003 and 2012 by certifying and recertifying urologists were obtained in the form of annualized case logs from the American Board of Urology (ABU). Associations between surgeon characteristics (type of certification, annual volume, practice type, and location) and these procedures were evaluated.

RESULTS: Over the past decade, 756 of 6355 urologists certified with the ABU performed SNM or AC for the treatment of refractory OAB. Forty-five (6%) of these surgeons completed fellowships in female urology and 71 surgeons (9%) completed another type of fellowship program. Surgeons recertifying with ABU performed 76% of all SNM procedures. Although SNM and AC have increased from 64 to 2086 between 2003 and 2012, however, this is mainly driven by the increase of SNM from 48 to 2068 cases. Rates of AC have remained stable with 14 to 38 cases reported annually. However, they have declined relative to the total, from 25% in 2003 to less than 1% in 2012.

CONCLUSIONS: Sacral neuromodulation has increased dramatically over the past decade in surgeons certified with the ABU. This is in contrast to AC, which while remaining stable in number of procedures.

DOI: 10.1097/SPV.0000000000000449

PMCID: PMC8162039

PMID: 28658001 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Statement: The authors have

no conflict of interests to disclose.

Post Reprod Health. 2016 Mar;22(1):34-40. doi: 10.1177/2053369116633017. Epub

2016 Feb 16.

The concomitant use of fesoterodine and topical vaginal estrogen in the management of overactive bladder and sexual dysfunction in postmenopausal women.

Chughtai B(1), Forde JC(2), Buck J(2), Asfaw T(3), Lee R(2), Te AE(2), Kaplan

SA(2).

Author information:

(1)Department of Urology, Weill Cornell Medical College/New York Presbyterian

Hospital, NY, USA bic9008@med.cornell.edu.

(2)Department of Urology, Weill Cornell Medical College/New York Presbyterian

Hospital, NY, USA.

(3)Department of Obstetrics and Gynecology, Weill Cornell Medical College/New

York Presbyterian Hospital, NY, USA.

OBJECTIVE: The objective of this study is to investigate the combination effect of anti-muscarinic medication and topical vaginal estrogen in the treatment of overactive bladder (OAB) and female sexual dysfunction in postmenopausal women.

STUDY DESIGN: After IRB approval, 23 female subjects who met the entry criteria were randomized into two groups: (1) fesoterodine (Toviaz®, Pfizer, NY) with topical vaginal estrogen (Premarin®, Pfizer, NY) once daily or (2) fesoterodine once daily alone. If 4 mg fesoterodine was tolerated at 1-week, the dose was increased to 8 mg.

MAIN OUTCOME MEASURES: Primary endpoints were improvement in OAB symptom severity (Overactive Bladder Questionnaire, OAB-Q SF), improvement in OAB health-related quality of life (HRQL) (OAB-Q SF), and sexual function (Sexual Quality of Life-Female, SQOL-F) after 12 weeks. Secondary endpoint was change in total number of micturitions.

RESULTS: After 12-weeks, the combination group had a significant improvement in OAB symptom severity (p = 0.006), HRQL (p = 0.029), and SQOL-F (0.0003). The fesoterodine alone group also had significant improvement in OAB symptom severity (p < 0.0001), HRQL (p = 0.0002), and SQOL-F (p = 0.02). When compared directly to the fesoterodine alone group, the combination group after 12-weeks

had a reduced OAB symptom severity (10 versus 23.3; p = 0.35), higher HRQL (96.9 versus 84.6; p = 0.75), and higher SQOL-F (99 versus 81; p = 0.098). The total number of micturitions over 3 d was significantly reduced in the combination group (45-26, p = 0.03) between baseline and 12-weeks.

CONCLUSIONS: The combined effect of fesoterodine and topical vaginal estrogen improved OAB symptoms and sexual function in postmenopausal women.

DOI: 10.1177/2053369116633017

PMID: 26883688 [Indexed for MEDLINE]

Int Urogynecol J. 2016 Nov;27(11):1645-1651. doi: 10.1007/s00192-015-2935-y. Epub 2016 Jan 6.

The role of acupuncture in managing overactive bladder; a review of the literature.

Forde JC(1), Jaffe E(1), Stone BV(1), Te AE(1), Espinosa G(1), Chughtai B(2).

Author information:

(1)Department of Urology, Weill Cornell Medical College, 425 East 61st Street,

12th Floor, New York, NY, USA.

(2)Department of Urology, Weill Cornell Medical College, 425 East 61st Street,

12th Floor, New York, NY, USA. bic9008@med.cornell.edu.

Comment in

Aktuelle Urol. 2016 Aug;47(4):305-9. doi: 10.1055/s-0042-103985.

J Urol. 2017 Sep;198(3):490-492. doi: 10.1016/j.juro.2017.06.053.

INTRODUCTION AND HYPOTHESIS: Overactive bladder (OAB) affects a considerable proportion of men and women in the United States and is associated with significant costs and quality of life (QoL) reduction. While medication remains a mainstay of treatment, there is increasing interest in the use of alternative medicine in the form of acupuncture. We reviewed the literature on the role of acupuncture in managing OAB.

METHODS: A narrative review was compiled after searching electronic databases (PubMed, MEDLINE, Scopus, and EMBASE) for clinical studies involving acupuncture in treating OAB. Databases were searched from the time of inception through September 2015 by a clinician for articles reporting the results related to the use of acupuncture in OAB. Key search terms were acupuncture, overactive bladder, bladder instability, urgency, urinary incontinence. Articles in English or translated into English were included.

RESULTS: Initial animal studies suggest several biochemical mechanisms of action underlying the effect of acupuncture on OAB suppression. The experience in humans includes two case series and six comparative trials. All studies demonstrated subjective improvement in OAB symptoms, and some reported objective improvement in urodynamic studies. Notably, some comparative trials showed the benefit of acupuncture to be comparable with antimuscarinic treatment.

CONCLUSION: Despite their limitations, existing studies serve as a promising foundation for suggesting a role for acupuncture as an alternative therapy for OAB. Further well-designed studies are required to investigate optimal technique and their outcomes.

DOI: 10.1007/s00192-015-2935-y

PMID: 26740199 [Indexed for MEDLINE]

Asian J Urol. 2015 Jan;2(1):33-37. doi: 10.1016/j.ajur.2015.04.014. Epub 2015 Apr 16.

Effect of phosphodiesterase inhibitors in the bladder.

Chughtai B(1), Ali A(1), Dunphy C(1), Kaplan SA(1).

Author information:

(1)Weill Cornell Medical College, New York City, NY, USA.

Many aging men will experience lower urinary tract symptoms (LUTS). Phosphodiesterase type 5 (PDE5) inhibitors have shown promise in treating LUTS in these patients. PDE5 inhibitors mediate their effects through several pathways including cAMP, NO/cGMP, K-channel modulated pathways, and the l-cysteine/H2S pathway. PDE5 inhibitors exert their effect in muscle cells, nerve fibers, and interstitial cells (ICs). The use of PDE5 inhibitors led to improvement in LUTS. This included urodynamic parameters. PDE5 inhibitors may play a significant role in LUTS due to their effect on the bladder rather than the prostate.

DOI: 10.1016/j.ajur.2015.04.014

PMCID: PMC5730687

PMID: 29264117

Can J Urol. 2014 Apr;21(2):7217-21.

Randomized, double-blind, placebo controlled pilot study of intradetrusor injections of onabotulinumtoxinA for the treatment of refractory overactive bladder persisting following surgical management of benign prostatic hyperplasia.

Chughtai B(1), Dunphy C, Lee R, Lee D, Sheth S, Marks L, Kaplan SA, Te AE.

Author information:

(1)Weill Cornell Medical College, New York, New York, USA.

INTRODUCTION: We assessed the efficacy of onabotulinumtoxinA (BOTOX, Allergan Inc., Irvine, CA, USA) in patients with refractory overactive bladder (OAB) after treatment for benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS: This was a two-center, randomized, double-blinded pilot study conducted in patients with OAB secondary to bladder outlet obstruction (BOO), refractory to anticholinergic medication and persistent for greater than 3 months after surgical intervention to relieve obstruction, with an International Prostate Symptom Score (IPSS) > 12. Patients were randomized in

1:1 fashion to either 200 units of onabotulinumtoxinA versus placebo. Fifteen patients received onabotulinumtoxinA versus 13 who received placebo. Follow up was performed at 1 week and then 1, 3, 6, and 9 months. The primary endpoint was reduction in the frequency of micturition per 24 hours by 3-day voiding diary. Secondary endpoints were maximum flow rate (Qmax), post-void residual (PVR), and IPSS scores.

RESULTS: Patients receiving onabotulinumtoxinA demonstrated significantly improved quality of life scores at 180 and 270 days after treatment (p = 0.02 and 0.03, respectively) as well as significantly lower International Consultation on Incontinence Questionnaire (ICIQ) scores (p < 0.05). Baseline urinary frequency was 10.5 versus 11.0 voids/day (p = 0.47). Frequency episodes improved from 11 episodes per day to 8 episodes per day in the treatment arm. The placebo arm did not have a decrease in frequency episodes. This response was durable up to 90 days, although this was not statistically significant. IPSS,

PVR, and urgency were unchanged postoperatively in both groups.

CONCLUSIONS: OnabotulinumtoxinA was safe in patients with refractory irritative lower urinary tracts symptoms after surgical treatment of BPH. There were improvements in daily frequency, although the results were not statistically significant. Larger trials are needed to help characterize the utility of onabotulinumtoxinA in the treatment of OAB secondary to BPH.

PMID: 24775575 [Indexed for MEDLINE]

Rev Urol. 2013;15(3):93-6.

Use of herbal supplements for overactive bladder.

Chughtai B(1), Kavaler E, Lee R, Te A, Kaplan SA, Lowe F.

Author information:

(1)Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College New York, NY.

Anticholinergics, specifically antimuscarinic agents, are the most common medications prescribed for overactive bladder (OAB). The most common side effects of these agents are dry mouth and constipation, although other more concerning effects include changes in blood pressure, pulse rate, or heart rhythm when treatment is initiated. Herbal treatments are an increasingly popular alternative for treating OAB. A 2002 survey of US adults aged ≥ 18 years conducted by the Centers for Disease Control and Prevention indicated that 74.6% of those with OAB had used some form of complementary and alternative medicine. The World Health Organization estimates that 80% of the world’s population presently uses herbal medicine for some aspect of primary health care. Women were more likely than men to use complementary and alternative medicine. The authors review the most commonly used herbal medications for OAB.

PMCID: PMC3821987

PMID: 24223020

Expert Opin Pharmacother. 2013 Oct;14(14):1987-91. doi:

10.1517/14656566.2013.823158. Epub 2013 Jul 26.

Tolterodine for the treatment of urge urinary incontinence.

Elterman DS(1), Chughtai B, Kaplan SA, Barkin J.

Author information:

(1)Weill Cornell Medical College of Cornell University, James Buchanan Brady Department of Urology , 425 East 61st Street, 12th floor, New York, NY 10065 , USA.

INTRODUCTION: Overactive bladder (OAB) and its resultant urge urinary incontinence (UUI) are significant problems that medically, psychologically and financially affect people. The constellation of symptoms comprising OAB affects ∼ 16% of the adult population and its prevalence increases with aging. The typical class of medications used to treat OAB is antimuscarinics.

AREAS COVERED: OAB medications, with a focus on tolterodine for the treatment of UUI are reviewed. A thorough review of English language literature using EMBASE/Medline and PubMed has been performed.

EXPERT OPINION: Tolterodine provides a reasonable starting point when treating patients with OAB and UUI. Efficacy and tolerability are generally comparable between tolterodine and other newer antimuscarinics. Tolterodine is a good option as part of the algorithm in the treatment of OAB and UUI.

DOI: 10.1517/14656566.2013.823158

PMID: 23885788 [Indexed for MEDLINE]

Clin Interv Aging. 2008;3(3):503-9. doi: 10.2147/cia.s3414.

Choice of antimuscarinic agents for overactive bladder in the older patient: focus on darifenacin.

Chughtai B(1), Levin R, De E.

Author information:

(1)Albany Medical College, Division of Urology, Albany, NY, USA.

Overactive bladder (OAB) is a difficult condition to live with and is very costly to the community. OAB affects 16% of the adult population and rises with increasing age. We describe the necessary steps in evaluation and behavioral therapy prior to initiating medical therapy. There are several medications that

have been used for the treatment of patients who suffer from OAB. This manuscript discusses the popular agents used for OAB, with a focus on the recent clinical trials on darifenacin.

DOI: 10.2147/cia.s3414

PMCID: PMC2682382

PMID: 18982920 [Indexed for MEDLINE]

Arrange a visit now