דו״ח מאומת

Up to 40% of men older than 50 years have lower urinary tract symptoms, including urinary urgency, nocturia, and weak urinary stream, due to disorders of the bladder and prostate. These symptoms negatively affect quality of life and may be associated with urinary retention, which can cause kidney insufficiency, bladder calculi, hematuria, and urinary tract infections. In men, lower urinary tract symptoms can be caused by bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), an overactive bladder detrusor (a syndrome of urinary urgency and frequency), or both. Behavioral therapy, including pelvic floor physical therapy, timed voiding (voiding at specific intervals), and fluid restriction, can improve symptoms. Medications including α-blockers (such as tamsulosin), 5α-reductase inhibitors (such as finasteride), and phosphodiesterase 5 inhibitors (such as tadalafil) improve lower urinary tract symptoms (mean improvement, 3-10 points on the International Prostate Symptom Score [IPSS], which ranges from 0-35, with higher scores indicating greater severity) and can prevent symptom worsening measured by increased IPSS greater than or equal to 4 points or development of secondary sequelae, such as urinary retention. Combination therapies are more effective than monotherapy. For example, α-blockade (eg, tamsulosin) combined with 5α-reductase inhibition (eg, finasteride) lowers progression risk to less than 10% compared with 10% to 15% with monotherapy. Treatment for overactive bladder detrusor muscle, including anticholinergics (eg, trospium) and β3 agonists (eg, mirabegron), reduces voiding frequency by 2 to 4 times per day and reduces episodes of urinary incontinence by 10 to 20 times per week. Surgery (eg, transurethral resection of the prostate, holmium laser enucleation of the prostate) and minimally invasive surgery are highly effective for refractory or complicated cases of BPH, defined as persistent symptoms despite behavioral and pharmacologic therapy, and these therapies can improve IPSS by 10 to 15 points. Minimally invasive procedures, such as water vapor therapy (endoscopic injection of steam into BPH tissue) and prostatic urethral lift (endoscopic insertion of nonabsorbable suture implants that mechanically open the urethra), have lower complication rates of incontinence (0%-8%), erectile dysfunction (0%-3%), and retrograde ejaculation (0%-3%) but are associated with increased need for surgical retreatment (3.4%-21%) compared with transurethral resection of the prostate (5%) and holmium laser enucleation of the prostate (3.3%). Lower urinary tract symptoms, defined as urinary urgency, nocturia, or weak stream, are common among men and are usually caused by BPH, overactive bladder detrusor, or both. First-line therapy consists of behavioral interventions, such as pelvic floor physical therapy and timed voiding, as well as pharmacologic therapy, including α-adrenergic blockers (tamsulosin), 5α-reductase inhibitors (finasteride), phosphodiesterase inhibitors (tadalafil), anticholinergics (trospium), and β3 agonists (mirabegron).…

PMID: 40658396

Overactive bladder is a condition whose prevalence increases with ageing, and which can substantially impair quality of life. It is defined by presence of urinary urgency, in the absence of other causes of similar problems. The underlying mechanisms are incompletely understood, but may include increased excitability of smooth muscle, abnormal spread of excitation through the bladder wall, increased sensory nerve activity, and altered processing of information in the central nervous system. Clinical assessment requires evaluation of symptoms and their impact, and exclusion of confounding co-morbidities. Initial treatment comprises fluid advice and bladder training, followed by drug prescription. Antimuscarinic drugs can improve symptom severity and quality of life, but adverse effects include dry mouth, constipation and cognitive impairment; a minority of patients persist with these drugs in the longer term. Optimising medical management requires tailoring drugs according to efficacy and adverse effects, and also checking compliance. Refractory bothersome symptoms merit secondary care input, usually with urodynamic evaluation to define underlying mechanisms. Neuromodulatory techniques (sacral or tibial nerve stimulation) and reconstructive surgery (augmentation cystoplasty, detrusor myectomy or urinary diversion) can be offered in severe cases, but can have inadequate outcomes and significant implications. Newer approaches under investigation include pharmaceutical interventions to reduce cellular excitability or generation of sensory nerve activity; potential targets include beta-3 adrenergic receptors, Transient Receptor Potential (TRP) channels and surface ion channels. Intravesical botulinum injections are an unlicensed approach which may achieve reduced contractility and sensory nerve activity, but voiding dysfunction is common and long-term effects uncertain.…

PMID: 20399043

Overactive bladder (OAB) is a condition that has physical, social, psychosocial, and financial impacts. Transcutaneous tibial nerve stimulation (TTNS) is a modality that stimulates the nerve root fibers of L5-S3, the same spinal segments of the parasympathetic nervous system as the bladder. This scoping review aims to identify current literature available on the feasibility and outcomes of TTNS as a first-line treatment option for OAB. A scoping review of six electronic data bases was performed to identify full-text articles from 2015 that explored the impact of TTNS on OAB and bladder dysfunction in people aged >18 years. A total of 15 articles met the inclusion criteria. TTNS was compared with sham treatment, parasacral stimulation, pelvic floor muscle training (PFMT), anticholinergic medication, and percutaneous tibial nerve stimulation (PTNS). Heterogeneity in treatment application and parameters existed, with variations in treatment duration, frequency of use, and treatment settings such as pulse width (μs) and frequency (Hz). Results indicated that TTNS has efficacy equal to PFMT and PTNS in the management of OAB; however, it is not as efficacious as anticholinergic medication. TTNS is a promising first-line management option for people with OAB, particularly in the older population and for those with neurogenic bladder. It can provide symptomatic relief from urinary incontinence, frequency, urgency, and nocturia, while avoiding the bothersome side effects of more invasive or pharmaceutical therapies. Heterogeneity in treatment parameters limits generalizability and translation of the most appropriate clinical application and should be considered in future trials.…

PMID: 35688702

The functions of the lower urinary tract, to store and periodically release urine, are dependent on the activity of smooth and striated muscles in the urinary bladder, urethra, and external urethral sphincter. This activity is in turn controlled by neural circuits in the brain, spinal cord, and peripheral ganglia. This paper will review recent advances in our understanding of the pathophysiology of voiding disorders, especially focusing on the central nervous system. Various neurotransmitters, including acetylcholine, norepinephrine, dopamine, serotonin, excitatory and inhibitory amino acids, adenosine triphosphate, nitric oxide, and neuropeptides, have been implicated in the neural regulation of the lower urinary tract. Injuries or diseases of the nervous system, as well as drugs and disorders of the peripheral organs, can produce voiding dysfunctions such as urinary frequency, urgency, or incontinence. We discuss the potential targets in the central nervous system and new modalities for the treatment of voiding dysfunction.…

PMID: 23832777

Overactive bladder is a condition whose prevalence increases with ageing, and which can substantially impair quality of life. It is defined by presence of urinary urgency, in the absence of other causes of similar problems. The underlying mechanisms are incompletely understood, but may include increased excitability of smooth muscle, abnormal spread of excitation through the bladder wall, increased sensory nerve activity, and altered processing of information in the central nervous system. Clinical assessment requires evaluation of symptoms and their impact, and exclusion of confounding co-morbidities. Initial treatment comprises fluid advice and bladder training, followed by drug prescription. Antimuscarinic drugs can improve symptom severity and quality of life, but adverse effects include dry mouth, constipation and cognitive impairment; a minority of patients persist with these drugs in the longer term. Optimising medical management requires tailoring drugs according to efficacy and adverse effects, and also checking compliance. Refractory bothersome symptoms merit secondary care input, usually with urodynamic evaluation to define underlying mechanisms. Neuromodulatory techniques (sacral or tibial nerve stimulation) and reconstructive surgery (augmentation cystoplasty, detrusor myectomy or urinary diversion) can be offered in severe cases, but can have inadequate outcomes and significant implications. Newer approaches under investigation include pharmaceutical interventions to reduce cellular excitability or generation of sensory nerve activity; potential targets include beta-3 adrenergic receptors, Transient Receptor Potential (TRP) channels and surface ion channels. Intravesical botulinum injections are an unlicensed approach which may achieve reduced contractility and sensory nerve activity, but voiding dysfunction is common and long-term effects uncertain.…

PMID: 20399043

Complex organization of CNS and PNS pathways is necessary for the coordinated and reciprocal functions of the urinary bladder, urethra and urethral sphincters. Injury, inflammation, psychogenic stress or diseases that affect these nerve pathways and target organs can produce lower urinary tract (LUT) dysfunction. Numerous neuropeptide/receptor systems are expressed in the neural pathways of the LUT and non-neural components of the LUT (e.g., urothelium) also express peptides. One such neuropeptide receptor system, pituitary adenylate cyclase-activating polypeptide (PACAP;…

PMID: 29255407

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic inflammatory disease of the urinary bladder, characterized by chronic pain, increased urinary frequency, urgency, and nocturia. Currently, no therapeutic option consistently provides long-term relief for all IC/BPS patients, likely due to the largely unknown mechanisms underlying the disease's development and progression. IC/BPS is considered a multifactorial disorder with a complex pathobiology that ultimately leads to unresolved inflammation, bladder dysfunction, and pain. Recent research has highlighted chronic inflammation and oxidative stress, resulting from either increased production of reactive oxygen species or their inadequate elimination, as a significant feature of IC/BPS. The frequent co-occurrence of IC/BPS with other chronic diseases characterized by prolonged oxidative stress and subtle chronic inflammation, such as autoimmune diseases, chronic psychological stress, fibromyalgia, and irritable bowel syndrome, suggests a common underlying pathogenic pathway. In this review, we summarize key findings suggesting that oxidative stress and chronic inflammation play a part in the onset and progression of IC/BPS. We explore how oxidative stress contributes to IC/BPS through various mechanisms, including damage to bladder urothelial cells and mitochondria, the activation of innate immune signaling pathways, which together create a self-perpetuating cycle of inflammation. Additionally, we discuss potential therapeutic options and novel drug candidates with anti-inflammatory and antioxidant properties, which could modulate regulatory pathways involved in disease development and provide long-term efficacy in IC/BPS.…

PMID: 40570823

Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by bladder and/or pelvic pain, increased urinary urgency and frequency and nocturia. The pathophysiology of IC/BPS is poorly understood, and theories include chronic inflammation, autoimmune dysregulation, bacterial cystitis, urothelial dysfunction, deficiency of the glycosaminoglycan (GAG) barrier and urine cytotoxicity. Multiple treatment options exist, including behavioural interventions, oral medications, intravesical instillations and procedures such as hydrodistension; however, many clinical trials fail, and patients experience an unsatisfactory treatment response, likely owing to IC/BPS phenotype heterogeneity and the use of non-targeted interventions. Oxidative stress is implicated in the pathogenesis of IC/BPS as reactive oxygen species impair bladder function via their involvement in multiple molecular mechanisms. Kinase signalling pathways, nociceptive receptors, mast-cell activation, urothelial dysregulation and circadian rhythm disturbance have all been linked to reactive oxygen species and IC/BPS. However, further research is necessary to fully uncover the role of oxidative stress in the pathways driving IC/BPS pathogenesis. The development of new models in which these pathways can be manipulated will aid this research and enable further investigation of promising therapeutic targets.…

PMID: 38326514

Overactive bladder (OAB) is a significant public health issue that adversely affects the quality of life of patients and imposes a significant socioeconomic burden, with varying prevalence rates across study populations in Chinese women. A systematic review and meta-analysis were conducted to estimate the prevalence of OAB in Chinese women. Relevant published articles on the prevalence of OAB in Chinese women were searched through July 21, 2022, using PubMed, EMbase, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data, and VIP databases. After the independent screening of articles, data extraction, and quality assessment of included studies by two investigators, a meta-analysis was performed using Stata 16.0 software, and the prevalence was determined using a random-effects model. To identify potential sources of heterogeneity, subgroup analyses were conducted with subgroup categories including age, Body Mass Index (BMI), region, and survey year. Publication bias was assessed by visually examining the funnel plot and Egger's test. Twenty studies were included in this meta-analysis. The results of the random-effects model indicated that the prevalence of OAB in Chinese women was 14% (95% Confidence Interval: 9%-18%). The prevalence increased significantly in the past decade (from 8% in pre-2006 to 18% in 2016-2021). A prevalence (18%) was observed among women aged 31-40 compared with other age groups. The BMI range of 24-27.9 (18%) was higher than the other groups. Additionally, the prevalence of this BMI range was comparatively higher in North China and Southwest China (21%) than in Central China and East China. In addition, publication bias was observed. OAB incidence has increased in Chinese women over the last two decades, affecting more than 20% of women aged 31-40 years and above. With the increasing prevalence of OAB, greater emphasis has been placed on implementing preventative and control measures.…

PMID: 38127870

This study aims to systematically estimate the global prevalence of overactive bladder (OAB), identify demographic and regional factors contributing to prevalence variations, and assess trends in prevalence over the past two decades. This cross-sectional study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. From inception to April 2024, computerized searches for OAB prevalence-related literature were conducted on PubMed, Embase, Web of Science, and Cochrane. Studies of OAB prevalence in the general population were included. Two independent researchers conducted the screening, data extraction, and quality assessment of the included studies. A total of 53 studies, encompassing 610,438 participants, were ultimately included in the analysis. The meta-analysis determined the global prevalence of OAB to be 20% (95% CI 0.18-0.21). Over the past 20 years, there has been an increase in OAB prevalence, rising from 18.1% (95% CI 0.13-0.23) to 23.9% (95% CI 0.19-0.29). Among women, the prevalence of OAB was 21.9% (95% CI 0.20-0.24), indicating higher rates compared to men (OR = 16.1, 95% CI 0.15-0.18). The study also found higher prevalence rates among overweight and obese individuals (OR = 18.6, 95% CI 0.13-0.24) and those aged 60 years and above (OR = 28.3, 95% CI 0.24-0.33). Middle-income countries exhibited higher prevalence rates compared to high-income countries. The study highlights higher risks of OAB among obese individuals, women, and the elderly. OAB prevalence has shown an increasing trend over the past 20 years.…

PMID: 39951109

: Overactive bladder is a term used to describe a group of lower urinary tract symptoms that are prevalent in women, particularly as they age. Those with overactive bladder often experience related physical and psychological symptoms or conditions and report a poorer quality of life than other women. Many factors that increase the risk of developing overactive bladder are modifiable; therefore, lifestyle and behavioral interventions are first-line treatments. More treatment options are becoming available to women as research provides new information about the underlying pathophysiology of overactive bladder. Nurses play a major role in its screening, assessment, and management in women, many of whom do not seek help and try to self-manage symptoms, leading to a continuing cycle of unpredictable urgency and incontinence.…

PMID: 28282306