Chung-Cheng Wang

Higher glycosylated hemoglobin levels increase the risk of overactive bladder syndrome in patients with type 2 diabetes mellitus

Objectives:  To assess overactive bladder and its component symptoms among patients with type 2 diabetes mellitus and to explore whether higher glycosylated hemoglobin and other factors increase the risk of overactive bladder symptoms.

High Classification of Chronic Heart Failure Increases Risk of Overactive Bladder Syndrome and Lower Urinary Tract Symptoms

OBJECTIVE To assess the urologic symptoms among patients with chronic heart failure (CHF) and to explore whether a higher classification of CHF increases the risk associated with overactive bladder syndrome (OAB) and lower urinary tract symptoms. METHODS A total of 214 ambulatory patients with CHF (129 men and 85 women) and 378 age-matched subjects (222 men and 156 women) were enrolled in the present study. The urologic symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS) from January to June 2010. RESULTS Compared with the controls, the patients with CHF had a significantly greater mean OABSS (4.6±3.6 vs 3.4±3.1, P<.001), total IPSS (8.3±6.9 vs 6.9±7.6, P=.021), and storage IPSS (4.8±3.5 vs 3.7±3.3, P<.001). Of the patients with CHF, 34.1% had moderate/severe OAB symptoms (OABSS≥6), and 43.5% had moderate/severe lower urinary tract symptoms (IPSS≥8). Compared with patients who had New York Heart Association (NYHA) class I CHF, the patients with NYHA class III CHF had a significantly greater OABSS and total, storage, and voiding IPSSs. Patients with NYHA class II CHF did not. A greater body mass index and stroke were significantly associated with the OABSS and storage IPSS, and pulmonary disease was significantly associated with the voiding IPSS. CONCLUSION The patients with CHF had more storage urinary symptoms suggestive of OAB than did the age-matched controls. Among the patients with CHF, greater NYHA class heart function was significantly associated with OAB and lower urinary tract symptoms.

Intravesical OnabotulinumtoxinA Injection for Overactive Bladder Patients with Frailty, Medical Comorbidities or Prior Lower Urinary Tract Surgery

Overactive bladder (OAB) symptoms increase with age and involve several comorbidities. OnabotulinumtoxinA (BoNT-A) intravesical injection is a treatment choice for patients who are intolerant of or refractory to antimuscarinics. However, the increased risk of urinary tract infection and elevated post-void residual (PVR) volume post-treatment require resolution. Male sex, baseline PVR > 100 mL, and comorbidities are independent risk factors of adverse events (AEs) such as acute urinary retention (AUR). Intravesical BoNT-A injection is safe and effective for OAB patients with frailty, medical comorbidities such as Parkinson’s disease (PD), chronic cerebrovascular accidents (CVA), dementia, or diabetes, or a history of prior lower urinary tract surgery (prostate or transvaginal sling surgery). Post-treatment, 60% of frail elderly patients had a PVR volume > 150 mL and 11% had AUR. Although intravesical BoNT-A injection is safe for PD patients, CVA patients had higher strain voiding rates. Diabetic patients were at increased risk of large PVR urine volume and general weakness post-treatment. Treatment results were similar between patients with and without a history of prostate or transvaginal sling surgery. Possible AEs and bladder management strategies should be conveyed to patients before treatment. Careful patient selection is important, and therapeutic safety and efficacy should be carefully balanced.

MP65-16 PREDICTOR FACTORS FOR SUCCESSFUL TREATMENT OF SOLIFENACIN IN PATIENTS WITH OVERACTIVE BLADDER

INTRODUCTION AND OBJECTIVES: The impact of delivery mode and number of deliveries on urinary incontinence (UI) has been debated, and vaginal delivery has been suggested as a risk factor for female UI. Other potential factors include age, body mass index (BMI), parity, smoking, diabetes mellitus, and hysterectomy. We investigated whether delivery mode and number of deliveries is associated with UI among Japanese women. METHODS: We investigated 514 women recruited from outpatient departments (except the departments of pediatrics, psychiatry and ophthalmology) at our university hospital, regardless of the reason for visiting, during a 2-week period (from August 6 to August 17, 2007). All participants were asked to answer a standardized self-reported questionnaire. Using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), overactive bladder symptom score (OABSS), and an original questionnaire, we evaluated urinary symptoms and delivery mode history. We analyzed the impact of mode and number of deliveries on UI. The chi-square test and logistic regression modeling were used for statistical analyses. Values of P<0.05 were considered statistically significant. RESULTS: A total of 429 individuals completed the questionnaire (response rate, 83.5%). The mean age of respondents was 51.3 years (range, 23-83 years). The prevalence of each disorder was as follows: stress UI (SUI), 38.5%; urgency UI (UUI), 23.5%. The prevalence of UI tended to increase with age. The mean number of deliveries was 2 (range, 0-6). The prevalence of delivery mode was as follows: vaginal, 76%; caesarean (and/or vaginal), 12%; and no deliveries, 12%. Univariate analysis revealed a significant association between number of deliveries and SUI. Age and BMI were also associated with SUI and UUI. In multivariate analysis, the independent risk factors for SUI were age, BMI and number of deliveries (odds ratios (ORs), 1.03, 1.06, and 1.40, respectively). On the other hand, type of delivery was not a risk factor for SUI (Table). For UUI, only age was identified as an independent risk factor (OR, 1.05; p<0.05). CONCLUSIONS: This study revealed the number of deliveries as an independent risk factor for SUI, but showed no significant relationship between UI and delivery mode among Japanese women.