Definition and epidemiology of overactive bladder

doi:10.1016/S0090-4295(02)01784-3

Urology

Volume 60, Issue 5, Supplement 1, November 2002, Pages 7-12

https://doi.org/10.1016/S0090-4295(02)01784-3 Get rights and content

Abstract

The Standardisation Subcommittee of the International Continence Society (ICS) now recognizes overactive bladder (OAB) as a “symptom syndrome suggestive of lower urinary tract dysfunction.” It is specifically defined as “urgency, with or without urge incontinence, usually with frequency and nocturia.” The ICS definition was not formulated until January 2001 and was not formally approved until September 2001. Therefore, collection and discussion of the epidemiologic characteristics of OAB are somewhat hampered by the different definitions of this condition used by different investigators. Most communications that appeared before 2000 more often described characteristics of incontinence rather than OAB, and the estimates of OAB prevalence within those studies varied significantly. Until recently, little definite epidemiologic information was available on the prevalence and comorbidities of OAB. An important challenge in treating OAB is to increase awareness of this significant problem worldwide and to impress on other specialists and primary care physicians the importance of identifying this clinical problem and managing it in a way that will maximize quality-of-life improvement while minimizing morbidity.

Section snippets

Past definition

It is interesting that, although much argument was engendered by the use of the term OAB, this term was never actually defined or described by the ICS in any prior terminology reports. Overactive detrusor function (generally shortened to overactive detrusor) does appear,1 and this term is defined as a condition characterized by involuntary detrusor contractions during the filling phase of cystometry, which may be spontaneous or provoked. Overactive detrusor function was then divided into

Epidemiology: prevalence

Little definite epidemiologic information was available on the prevalence of OAB until very recently. Nearly all epidemiologic studies in this area have focused on urinary incontinence. The prevailing method for estimating the prevalence of OAB seems to have been to take the prevalence of urinary urge incontinence (including mixed incontinence) and multiply by 3, estimating that approximately 33% of patients with OAB had urinary urge incontinence. The remaining patients did not, complaining

Epidemiology: quality of life and comorbidities

In the study by Milsom et al.,10 65% of men and 67% of women with OAB reported that their symptoms had an effect on daily living, and 60% of those with symptoms found them bothersome enough to consult a medical practitioner. Frequency and urgency alone (59%) were almost as common as urge incontinence (66%) as reasons for seeking help. Of those who sought medical care, only 27% were receiving medication for symptoms at the time of the interview. Of those who were not taking medication, 27% had

Associated costs

In this area, as in many others, analyses of the economic implications of OAB, separate from incontinence, are essentially nonexistent. Wagner and Hu17 reported the total costs of urinary incontinence in the United States in 1995 to be $26,292,400,000. Of these, direct costs accounted for $25.6 billion and indirect costs for $700 million. It is imperative that a similar analysis be performed for patients with OAB, including those with OAB wet and OAB dry. Only by quantification of the total

Conclusion

OAB is a highly prevalent disorder that affects the lives of millions of people worldwide. The importance of OAB as a term has been recognized by the ICS, which now incorporates this term in its lexicon as a symptom syndrome. Prevalence of OAB, as distinct from urinary incontinence, is now the subject of some well-performed surveys, and, through these, we are beginning to be able to characterize the disorder in terms of various demographic features. Data on the effects on quality of life and

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Conventional treatments for alleviating the symptoms of Overactive bladder (OAB) have been reported to have limited efficacy and a high rate of side effects. Traditional Chinese medicine (TCM) has been used in Asia countries because of its low side effects and being easy to operate. To confirm the efficacy of acupoint application treatment for alleviating OAB symptoms, a randomized and placebo-controlled pilot trial was conducted in this study.
All participants were randomly allocated into a treatment group or control group, receiving either a “Dinggui” acupoint application or placebo treatment for 4 weeks. The outcome measures were OAB symptom scores (OABSS), OAB questionnaire (OAB-q) scores, and TCM syndrome scores. Urine nerve growth factor (NGF) level, NGF normalized to urine creatinine (NGF/Cr), and maximum flow rate (Q_max) were also measured to evaluate the OAB symptoms.
In total, 69 participants were included with 34 in the treatment group and 35 in the placebo-treated group. Treatment with “Dinggui” acupoint application showed a statistically significant decrease in OABSS scores (8.10±1.54 to 3.67±1.77), OAB-q scores (61.43±13.93 to 38.13±15.42), and TCM syndrome scores (15.60±5.98 to 9.20±4.82). The NGF and NGF/Cr were also observed meaningful changes in a decrease from 379.68 to 136.17 pg/ml and from 0.30 to 0.16 pg/mg, respectively. The Q_max value showed a significant increase from 14.40 to 24.05 ml/s.
Treatment with “Dinggui” acupoint application could be considered an effective and alternative therapy for OAB management. Further studies with larger sample sizes and longer treatment periods are needed to investigate.
Efficacy of various forms of acupuncture for the treatment of urinary incontinence in women: A systematic review and meta-analysis
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Citation Excerpt :
SUI is highly prevalent among women older than 18 years and greatly influences general health, overall well-being, and quality of life.2 In addition to SUI, overactive bladder (OAB) is also prevalent among women and is defined by the ICS as urgency, with or without urge UI, often accompanied by urinary frequency and nocturia.3 Population-based survey studies have reported that the prevalence of SUI ranges from 5 to 70%,4 whereas the prevalence of OAB ranges from 11 to 32.6%.5,6
Evidence regarding the efficacy of various forms of acupuncture for the treatment of urinary incontinence (UI) in women is outdated and inconclusive. This review aims to determine the efficacy of different forms of acupuncture for the treatment of UI in women.
Multiple databases were searched from inception to June 2020. Randomized controlled trials that compared various forms of acupuncture to control were included.
Ten trials were included in this review. The pooled analysis demonstrated that an increased proportion of women with stress UI (SUI) reported fewer UI episodes (1.73 [95% CI 1.46, 2.04]; p < 0.00001) in the electroacupuncture group than in the sham group. The meta-analysis also revealed a significantly increased number of women who reported the complete cure of SUI in the electroacupuncture combined with pelvic floor muscle training group than in the medication group (RR 2.67 [95% CI 1.51, 4.71]; p = 0.0007). Body and laser acupuncture caused significant decreases in the number of urge accidents (-2.70 [95% CI -4.86, -0.54]; p = 0.01) and the occurrence of urgency symptoms (-3.60[95% CI -5.34, -1.86]; p < 0.0001), compared with sham acupuncture.
Based on the findings of this review, electroacupuncture may be able to improve SUI in women in clinical settings. This review also identified evidence supporting the use of body, electro,- and laser acupuncture for the treatment of urge UI; however, these results were obtained from single studies, and further research remains necessary to confirm the effects of these interventions on the treatment of urge UI in women.
Cervicosacropexy or vaginosacropexy for urinary incontinence and apical prolapse: A systematic review
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Several anatomic theories suggest that lax uterosacral ligaments may result in apical prolapse and urinary incontinence. Therefore, prolapse repair such as cervicosacropexy or vaginosacropexy, may resolve urinary incontinence. Shortcomings in current treatment options endorse further exploration of the potential benefit of a surgical alternative.
This systematically review of the literature aimed to summarize the evidence on the efficacy and safety of cervicosacropexy and vaginosacropexy as alternative surgical treatment options for urge and/or mixed urinary incontinence and apical prolapse. The PRISMA 2020 statement was followed and the review protocol was registered with PROSPERO (CRD42021267941). Studies from inception to 9/2021 were systematically reviewed and included. Data collection, risk of bias, and certainty of evidence were assessed using the standard Cochrane methods. The primary outcome measures were improvements in prolapse and urinary symptoms. Secondary outcomes included surgical safety and reintervention rates for complications and recurrence.
The included studies showed a moderate-to-high risk of bias and low certainty of evidence. Owing to their heterogeneity, no meta-analysis was performed. Cure rates for mixed and urge urinary incontinence and apical prolapse were 47.5 % (CI95%:42.4–52.6), 73.8 % (CI95%:61.9–85.7) and 97–100 % respectively, at a mean follow-up of 9.7 ± 7.3 months. Additional incontinence surgery in 38.9 % (216/555) of women with initial urinary incontinence, and concomitant or subsequent surgery for prolapse was performed in 4.4 % (13/299).
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A novel sacral neuromodulation system (SacralStim) which has an electrode with six contact points was recently designed.
To evaluate the effectiveness and safety of the SacralStim system for treating patients with refractory overactive bladder (OAB).
This was a multicenter, randomized, single-blind clinical trial. Patients with refractory OAB were enrolled from January 2018 to May 2020.
Participants were randomly allocated to the treatment group (SNM on) or the control group (SNM off) for a single-blind period of 12 ± 2 wk.
The primary outcome was the percentage of patients with a reduction in the average number of voids/24 h of at least 50% at the 12-wk follow-up visit. Other follow-up evaluations, including voiding diary outcomes, questionnaires on Overactive Bladder Symptom Score (OABSS), quality of life (QoL), device satisfaction, and causes of adverse events (AEs), were performed over the first 48 wk after implantation.
The therapeutic success rate at 12 wk was 56.76% in the treatment group and 11.11% in the control group (p < 0.001). There were significant differences in voiding diary variables between the two groups, including changes in the average number of voids/24 h, micturition volume/void, and improvement in the urge incontinence ratio. No severe AEs occurred. A limitation is the sham stimulation used as a control in the study. A head-to-head study is required to make a direct comparison of devices with six and four contact points.
This clinical trial provides strong evidence that patients with refractory OAB benefit from the novel SacralStim system. More research is required for direct comparison of the SacralStim system with traditional four-contact-point devices.
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Definition and epidemiology of overactive bladder

Abstract

Section snippets

Past definition

Epidemiology: prevalence

Epidemiology: quality of life and comorbidities

Associated costs

Conclusion

Urology

Urology

Urology

Urology

Urology

Urology

The standardisation of terminology of lower urinary tract functionreport from the Standardisation Subcommittee of the International Continence Society

Neurourol Urodyn

The overactive bladder and incontinencedefinitions and a plea for discussion

Neurourol Urodyn