OAB Research Roundup: 5 Recent Trials

1. Patient-reported outcomes in the setting of a randomized control trial on the efficacy of transcutaneous stimulation of the posterior tibial nerve compared to percutaneous stimulation in idiopathic overactive bladder syndrome

The study randomized patients with refractory OAB symptoms and detrusor overactivity to receive 12 weeks of transcutaneous tibial nerve stimulation (TTNS) or percutaneous tibial nerve stimulation (PTNS). Patients were asked to complete self-report OAB questionnaire short form (q-SF) and incontinence (I)-QoL questionnaires prior to treatment and at weeks 6 and 12. The investigators also had patients report self-perceived benefits on symptoms (treatment benefit scale [TBS]).

Overall, 61 patients completed all of the study questionnaires. In both the TTNS and PTNS groups, results on the OAB-q-SF and I-QoL showed statistically significant improvements in scores between baseline and end of treatment. Scores on the symptoms bother and health-related QoL scales from the OAB-q-SF showed no statistically significant difference between the TTNS and PTNS arms. Likewise, outcomes were also not significantly different between the 2 groups on the I-QoL questionnaire (P = .607) or on TBS responses.

“These findings along with TTNS ease of application and less invasiveness may lead to an increased indication of this technique for OAB,” the authors wrote in their conclusion.

Abstract: Ramírez‐García I, Kauffmann S, Blanco‐Ratto L, et al. Neurourol Urodyn. doi: 10.1002/nau.24554

2. A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?

The retrospective study sought to determine whether clinical care pathways (CCP) could improve follow-up rates and use of third-line treatments in patients with OAB. An OAB CCP was implemented for new patients in a fellowship Female Pelvic Medicine and Reconstructive Surgery trained urologist's academic practice. Among 769 patients with OAB identified, 261 were treated pre-CCP and 508 were treated with the CCP.

The use of a CCP was associated with a significant increase in the mean number of follow-up visits at 6 months (0.94 vs 1.64; P = .001) and 12 months (1.26 vs 2.46; P <.003). The follow-up rate at 3 months increased from 38.7% to 50.2% (P = .002) with the use of a CCP.

The rates of third-line therapy use also increased at 6 months (7.7% vs 13.4%; P = .018) and 12 months (11.1% vs 16.5%; P = .044), and there was a significant decrease in the mean time to third-line treatment use (280 vs 160 days; P = .016).

Abstract: Du C, Berg WT, Siegal AR, et al. Neurourol Urodyn. 2020. doi: 10.1002/nau.24573

3. Is There Any Difference Between Depression and Anxiety in Overactive Bladder According to Sex? A Systematic Review and Meta-Analysis

Using the PubMed, MEDLINE, and SciELO databases, the researchers identified published papers that specifically addressed anxiety and depression in patients with OAB. Overall, the researchers assessed data across studies for 7468 patients with OAB evaluated for depression and 8030 patients with OAB evaluated for anxiety.

A positive correlation was identified between depression and anxiety and OAB. The likelihood of having anxiety was much higher among men with OAB versus women with OAB (odds ratio [OR], 1.56); however, no difference was observed in the likelihood of depression between men with OAB and women with OAB (OR, 0.96)

Abstract: Melotti IGR, Juliato CRT, de Albuquerque Coelho SC, et al. Int Neurourol J. 2017 Sep;21(3):204-211. doi: 10.5213/inj.1734890.445

4.Is there a unique symptom in lower urinary tract dysfunction in children?

The study included 189 pediatric patients who were grouped into 4 categories of lower urinary tract (LUT) conditions using the uroflowmetry/electromyography (UF/EMG): overactive bladder (OAB), dysfunctional voiding (DV), underactive bladder, or primary bladder neck dysfunction (PBND). Data were collected using voiding dysfunction symptom score, bladder diary, urine analysis, and ultrasonography. The investigators also obtained a history of the patients’ bowel habits.

Overall, 106 patients were female. The largest group was OAB with 91 patients. The only symptoms specific to any of the LUT dysfunction (LUTD) categories were hesitancy occurring in 89.4% of patients with PBND and constipation occurring in 78.6% of patients with DV.

“The main outcome of this study is that there is a generally weak correlation between the specificity of symptoms and LUTD. Symptoms-based approach may lead to misdiagnosis in LUTD. Thus, it may be essential to focus on the underlying pathologies and UF/EMG test may help this,” the authors wrote in their conclusion.

Abstract: Özen MA, Taşdemir M, Aygün MS, et al. Low Urin Tract Symptoms. 2020. doi: 10.1111/luts.12363

5. Evaluation of progression from first to second stage sacral neuromodulation and unplanned device removal

The study was a retrospective analysis evaluating data for 128 patients who received sacral neuromodulation (SNM) at a single institution. Patients were treated between June 2012 and May 2019. Overall, there were 103 patients with OAB, 15 patients with urinary retention, 4 patients neurogenic bladder dysfunction, 4 patients with constipation, and 2 patients with fecal incontinence.

SNM is typically performed in 2 separate procedures. Overall, 118 (92.2%) of the 128 patients successfully progressed to stage 2. Failure to progress to stage 2 was associated with patients having conditions beyond OAB, such as bowel disorders or urinary retention (P = .007). Across the overall population, 15 patients needed SNM removal or adjustment within 4 years of implantation. Lower BMI was associated with device removal/revision (P =.036).

The authors concluded that in order to lower morbidity, time, and costs, a one-stage full SNM procedure should be considered for certain patients.

Abstract: Feldkamp A, Amasyali AS, Groegler J, et al. Turk J Urol. 2020. doi: 10.5152/tud.2020.20288