Refractory Overactive Bladder in Men Kristy M Borawski
Refractory Overactive Bladder in Men Kristy M. Borawski Associate Professor University of North Carolina Department of Urology @Borawski. Kristy
n Overall prevalence of OAB is significant n EPIC study n 11. 8% n with OAB NICE study n 18 -64 y/o: 3% urinary incontinence n >65: 8. 5% n 28. 5% of these with clinically significant urge urinary incontinence Irwin, et al. Eur Urol 2006; 50: 1306 -1314. Morant SV, et al. Int J Clin Pract 2008; 62: 688 -694
n Overall prevalence of OAB is significant n Stewart, et al. US based study n 16% prevalence of OAB in men n OAB wet symptoms increase with age with substantial increases after age 64 in men n Lower Urinary Tract Dysfunction Research Network (LURN) n 51% of responders reported any urinary incontinence n n 46% urge incontinence Older patients with higher odds of nocturia &urgency Stewart, et al. World J Urol 2003; 20(6): 327 -336. Cameron, et al. J Urol 2018; 199(4): 10231031.
Coyne KS, et al. Urol 2011; 77(5): 1081 -1087.
Economic Impact $76. 2 billion in 2015 Coyne KS, et al. J Manag Care Pharm 2014; 20(2): 130 -140.
Are we ignoring male OAB? n Morant et al 25% men diagnosed with OAB n 6 -7% of men with storage LUTS were placed on anticholinergics n 36% of men with LUTS/BPP received alpha blocker and/or 5 -alpha reductase inhibitor n Morant, et al. Int H Clin Pract 2008; 62: 688 -694.
Pathophysiology of OAB in men Hormonal changes n Bladder outlet obstruction n Aging n Ischemia n Neurologic conditions n Gomelsky, et al. Ther Adv Urol 2009; 1(4): 209 -221.
Will OAB symptoms improve after treatment of BOO?
Will OAB symptoms improve after treatment of BOO? n Persistent OAB symptoms associated with: Advanced age n Lower maximum cystometric capacity n Early onset detrusor overactivity n High amplitude detrusor overactive contraction n Antunes et al. J Urol 2015; 193: 2028 -2032.
Management for male refractory OAB f
Weight Modification
Combination therapy Solifenacin + mirabegron Mueller, et al. Neurol Urodyn 2019; 38: 779 -792.
Solifenacin 5 mg + mirabegron 50 mg n Combination group with greater improvement over monotherapy Incontinence episodes / 24 hr n Micturitions / 24 hr n Mueller, et al. Neurol Urodyn 2019; 38: 779 -792.
Solifenacin 5 mg + mirabegron 50 mg Safety n 47. 2% all patients reported at least one adverse event Higher incidence in combination group n Increase in mean pulse rates from baseline of >1 bpm were noted in combination & mirabegron group only in younger age groups n Blood pressure: all three groups had minor increase in systolic blood pressure n n No clinically significant change in combination group compared to monotherapy groups Mueller, et al. Neurol Urodyn 2019; 38: 779 -792.
Solifenacin 5 mg + mirabegron 50 mg Safety n Increased residual urine volume No patients in mirabegron group had increased PVR n No patients in solifenacin group had increased PVR n 3/1206 had increased PVR in combination group n n No data on gender available n Age: 2 were <75 y/o Mueller, et al. Neurol Urodyn 2019; 38: 779 -792.
Solifenacin 5 mg + mirabegron 50 mg Safety n Urinary retention Mirabegron: 1 (0. 3%) patient >65 y/o n Solifenacin: 1 (0. 3%) patient <65 y/o n Combination group: 6 (0. 5%) patients all <75 n n No data on gender available Mueller, et al. Neurol Urodyn 2019; 38: 779 -792.
Onabotulinumtoxin. A
Onabotulinumtoxin. A n Chapple, et al. 2013: placebo vs Onabot. A 100 U n 84. 5% female
Onabotulinumtoxin. A n Dmochowski, et al. 2010: Placebo vs Onabot. A 50 U/100 U/150 U/200 U/300 U n 92% female
Onabotulinumtoxin. A n Nitti, et al. 2013: Placebo vs Onabot. A 100 U n 88. 4% / 90% female
Onabotulinumtoxin. A
n Male subjects >18 years of age with confirmed detrusor overactivity on urodynamics who received intradetrusor Bo. NT-A from 2004 – present n 65 men received 133 Bo. NT-A treatments
Faure Walker et al. Urol 2019; 123: 242 -246.
Faure Walker et al. Urol 2019; 123: 242 -246.
Faure Walker et al. Urol 2019; 123: 242 -246.
n 88 male patients with mean follow up of 69 months n Success defined as patient still on treatment at last follow-up or stopped botox treatment due to cure of symptoms
n Side effects 5% required de novo CIC n 12. 5% UTI n
Randomized, double-blind, placebo controlled pilot study of intradetrusor injections of onabotulinumtoxin. A 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. 2 center double blinded RCT in patients with OAB secondary to BOO refractory or anticholinergic medication & persistent >3 months after surgical intervention for BOO n Placebo vs 200 U onabotulinumtoxin. A n
Randomized, double-blind, placebo controlled pilot study of intradetrusor injections of onabotulinumtoxin. A 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. n Onabotulinumtoxin. A groupw ith improved QOL scores at 180 & 270 days after treatment Lower ICIQ scores n Decreased urinary frequency (11 8) although statistical significance not achieved n IPSS, PVR & urgency were unchanged postoperatively in both groups n
Sacral Nerve Stimulation
Sacral Nerve Stimulation
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