The Incidence of Pelvic and Low Back Pain in Patients with Pelvic Organ Prolapse.

INTRODUCTION AND HYPOTHESIS: To define the prevalence and incidence of pelvic/low back pain in patients with pelvic organ prolapse (POP). METHODS: Patients presenting for POP to three urogynecology centers in the US, UK, and Chile were enrolled in an IRB-approved cross-sectional study assessing pain, GU, GI and sexual function symptoms. For prevalence, symptoms were noted as present if the participant recorded the symptom and reported the degree of bother as "somewhat," "a moderate amount," or "a lot." For incidence, participants were queried if the symptom's onset concurred with the POP. We also queried if they perceived the symptom was worsened by their POP. RESULTS: Two hundred five participants were recruited: 100 from the US, 46 from the UK, and 59 from Chile. One US participant was excluded due a missing examination. The prevalence of pelvic pain was 42%. Seventy-three percent of these participants reported the onset of pelvic pain coinciding with prolapse onset, and 81% endorsed worsening pelvic pain with POP. The prevalence of low back pain was 46%, with 30% reporting the onset coincided with the onset of POP and 44% responded that prolapse worsened their pain. CONCLUSION: A higher proportion of participants than expected endorsed pelvic/low back pain. Among patients with pelvic pain, the majority experienced symptom onset with POP onset and a worsening of pain with POP. While roughly half of participants reported low back pain; a minority correlated this to their POP. These findings highlight a high incidence of pelvic pain, challenging the perception of POP as a painless condition.

How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI-RS 2018.

BACKGROUND: This paper summarises the discussion in a think tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2018 about the treatment of bladder pain syndrome. AIMS: To review the treatments of bladder pain syndrome from behavioural treatments to surgical interventions. MATERIALS AND METHODS: Review the literature in the light of the think tank discussions. RESULTS: All guidelines recommend different levels of treatment starting with conservative behavioral treatments then introducing oral treatments followed by intravesical instillations. If these treatments fail then more invasive treatments such as botulinum toxin injections, neuromodulation, or surgery could be suggested. CONCLUSION: Unfortunately for all treatments, the numbers are limited and, therefore, the evidence base is not strong. Further suggestions for research are suggested.

The location of pain and urgency sensations during cystometry.

AIMS: The relationship between bladder pain and urinary urgency sensations is poorly understood. We analyzed the relationship between locations and intensities of urgency and pain sensations felt during filling cystometry. METHODS: Participants completed the King's Health Questionnaire (KHQ) to indicate presence of bladder pain or urgency. During cystometry, participants scored the intensity of urgency and pain, both in the suprapubic and the urethral region, on a VAS scale of 0-10 at a baseline, at first desire, normal desire, strong desire to void, and at maximum cystometric capacity during filling. We allocated the participants to six groups; those reporting urgency or not, pain or not, both symptoms and neither. Friedman's Test was used to ascertain if all scores increased significantly, the Wilcoxon Signed Rank Test was used to demonstrate the difference between scores, and agreement for findings during cystometry was tested with Mann-Whitney U. RESULTS: A total of 68 women participated; 38 participants reported pain, 57 reported urgency, and 33 reported both symptoms. Pain and urgency scores significantly increased during cystometry (P < 0.0001). For participants reporting pain, suprapubic pain was rated significantly higher than urethral pain. Participants reporting both symptoms, felt more urgency than pain, and again pain more suprapubically than urethrally. Participants reporting only urgency scored suprapubic and urethral urgency similarly at all desires. CONCLUSIONS: Pain and urgency are well differentiated sensations and are felt at different locations although pain is seemingly easier localized. Neurourol. Urodynam. 36:620-625, 2017. © 2016 Wiley Periodicals, Inc.

ICS teaching module: Ambulatory urodynamic monitoring.

AIM: To present the ICS Teaching Module on ambulatory urodynamics monitoring (AUM). METHODS: This teaching module has been developed by the ICS Urodynamics Committee to assist ICS members in their routine clinical practice. A detailed literature search on studies published on the clinical role of AUM as well as expert opinions have been considered. A slide set on AUM has been developed, approved by all members of the ICS Urodynamics Committee and is available to the ICS membership on the ICS website. The final approved teaching module has been presented at the ICS Annual Scientific Meeting in Brazil 2014. RESULTS: The scientific evidence on the clinical role of AUM in patients with lower urinary tract symptoms is summarized. The catheters and recording systems used, the patient preparation for the test, the technique, the instructions to the patient, the analysis, interpretation, and quality control assessment of AUM trace as well as the contraindications for AUM are described. CONCLUSIONS: The clinical role of AUM is still controversial. The scientific evidence on the usefulness of AUM is still limited but the ICS Urodynamics Committee recommends its use as a second line diagnostic tool when office laboratory urodynamics have failed to achieve a diagnosis. AUM has been showed to be more sensitive than laboratory urodynamics in diagnosing detrusor overactivity but the level of evidence for this measurement is not high. This manuscript summarizes the evidence and provides practice recommendations on AUM for teaching purposes in the framework of an ICS teaching module. Neurourol. Urodynam. 36:364-367, 2017. © 2015 Wiley Periodicals, Inc.

Informed consent checklists for midurethral slings: a common-sense approach.

INTRODUCTION AND HYPOTHESIS: Following the US Food and Drug Administration's (FDA's) warning about the use of transvaginal mesh to treat pelvic organ prolapse (POP) and the use of single-incision slings to treat incontinence, the number of lawsuits for medical negligence regarding the use of any polypropylene mesh in the vagina has increased tremendously. METHODS: This same FDA document did not question the use of polypropylene midurethral slings and polypropylene for sacrocolpopexies. Surprisingly, despite all the evidence and recommendations from respected international scientific societies, we are constantly being called upon by our patients to defend the use of midurethral slings. The most common reasons for the new rash of medicolegal proceedings involving midurethral slings has to do with "breach of duties" resulting from undisclosed postoperative complications on the consent form and/or the lack of information in the medical records confirming that all possible alternative treatment options were presented to and discussed with the patient. RESULTS: One response to these lawsuits involves the addition of preoperative checklists when performing informed consent with patients electing surgical correction of stress urinary incontinence (SUI). CONCLUSIONS: This clinical opinion provides an expert clinician's perspectives and legal point of view on this controversial topic and discusses the role of a preoperative checklist supplementary to the standard informed consent form.

Do ultrasound findings of levator ani "avulsion" correlate with anatomical findings: A multicenter cadaveric study.

AIMS: This study aimed to validate the levator "avulsion" injury as seen on ultrasound against anatomical dissection in the same cadaver. METHODS: Puboviseral muscle (PVM) anatomy of female cadavers was studied using 3D-translabial ultrasonography and an "avulsion" confirmed per standard recommendations [Dietz HP. Aust N Z J Obstet Gynaecol 53:220-230, 2013]. Cadavers were then dissected to determine the macroscopic attachment or detachment of the PVM and the dimensions including the PVM symphysis gap and PVM attachment depth. Intra and inter-observer reliability of USS findings and anatomical measurements were assessed using the Cohen's κ and Bland & Altman plots respectively. McNemar's and Mann-Whitney U tests were used to compare imaging and cadaveric dissection findings. RESULTS: "Avulsions" were seen on imaging in 11/30 (36.7%) cadavers; the defect was bilateral in 1/30 (3.3%) and unilateral in 10/30 (33.3%). No "avulsion" was found at dissection (McNemar's χ(2) = 60.0, P < 0.001). An additional thirty-nine cadavers were dissected with no "avulsion" identified. A narrower PVM insertion depth was strongly associated with "avulsion" on ultrasound (mean: 4.79 mm vs. 6.32 mm, Z = -3.191, P = 0.001). Intra- and inter-observer agreement was perfect (K = 1.0 ± 0.0) and good (K = 0.85 ± 0.142) for anatomical "avulsions" and USS, respectively. CONCLUSIONS: There is a clear difference between anatomical and USS findings. The imaged appearance of an "avulsion" does not represent a true anatomical "avulsion" as confirmed on dissection. The term "avulsion" is misrepresentative and should not be used to describe this imaging finding. Moreover, further attempts at surgically repairing this defect should be avoided, at least until there is a better understanding of its pathophysiology. Neurourol. Urodynam 35:683-688, 2016. © 2015 Wiley Periodicals, Inc.

Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis.

INTRODUCTION AND HYPOTHESIS: Most subjects with multiple sclerosis (MS) suffer from lower urinary tract symptoms (LUTS). Detrusor overactivity, detrusor hypocontractility and detrusor-sphincter dyssynergia are the most common bladder dysfunctions. Management is not straightforward due to the progressive course of the disease. Sacral neuromodulation (SNM) has received increasing attention among new effective treatments for bladder disorders associated with MS. The aim of this study was to review the published literature on the role of SNM in the treatment of LUTS in patients with MS. METHODS: A literature search was carried out up to December 2014, using relevant search terms in MEDLINE and EMBASE databases. The ClinicalTrials.gov and Controlled-trials.com online trial registries and the abstracts from international scientific meetings were searched for English-language studies containing relevant search terms. Relevant reviews and trials and prospective studies were analysed by two independent reviewers. RESULTS: Two prospective studies and four retrospective studies were included. Overall, MS patients represented small series (4 to 25 subjects). The longest follow-up was 7 years and the evaluation of the treatment outcomes was not homogeneous among the studies. The definition of objective cure was often unclear. The subjective cure rate was 45 %, patients' reported satisfaction was 85 % and all the results were stable over time. CONCLUSIONS: SNM seems to be a safe and effective treatment for LUTS in MS patients. Further and larger studies as well as randomized controlled trials are needed to confirm its clinical role in patients with MS.

Posterior tibial nerve stimulation in the management of lower urinary tract symptoms in patients with multiple sclerosis.

INTRODUCTION AND HYPOTHESIS: Bladder dysfunction is a frequent symptom complex in patients with multiple sclerosis (MS) and often compromises the patient's quality of life. Pharmacotherapy has been poorly studied in the MS population showing contradictory results and reduced compliance owing to intolerable side effects. A new neuromodulation technique known as percutaneous tibial nerve stimulation (PTNS) has shown good efficacy and safety in the treatment of neurogenic and non-neurogenic lower urinary tract symptoms. In this article we review the literature and critically summarise the scientific evidence supporting the use of PTNS in the treatment of lower urinary tract symptoms (LUTS) in patients with MS. METHODS: We performed a computer-aided literature search in PubMed and EMBASE up to January 2015 to identify randomised controlled trials, case-control trials and prospective observational cohort studies. RESULTS: A total of 7 open-label, prospective studies and 313 MS patients were included. Three studies reported clinical and urodynamic outcomes at 3 to 9 months after PTNS; one study assessed the long-term efficacy of PTNS; two studies reported the acute effect of PTNS on urodynamic findings; one study assessed whether motor and sensory responses during PTNS could predict treatment outcome. None of the studies included a control group. CONCLUSIONS: Despite the very limited data PTNS seems an effective and safe treatment option in the management of LUTS in patients with MS.

Association between joint hypermobility and pelvic organ prolapse in women: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Abnormalities of common collagen proteins have been noted in individuals affected by POP and JHM, suggesting a common aetiology. We assessed strength, consistency and potential for bias in pooled associations of the relationship between JHM and POP. METHODS: We searched MEDLINE, EMBASE and CINAHL, as well as International Continence Society (ICS) and International Urogynaecologic Association (IUGA) annual meeting abstracts, including reference lists, without language restrictions. We included case-control and cohort studies and applied strict criteria for choosing eligible studies. Methodologically trained reviewers independently screened abstracts and full texts to confirm eligibility. We extracted data on study and patient characteristics, clinical assessment tools, and methodology. We assessed comparability and representativeness of source populations, confidence in the assessment of JHM and POP and adjustment for confounding and missing data. Meta-analysis was performed using a random effects model. RESULTS: We retrieved 39 full texts, of which 14 were used in the meta-analysis. Overall pooled odds ratio (OR) was 2.37 [95 % confidence interval (CI) 1.54-3.64, I(2) = 77.0 %]. We identified no significant factors in meta-regression, and there was no evidence of publication bias; six studies were at high risk of bias with frequent differences in sampling frames, limited validity for clinical assessments and failure to match for important prognostic variables. CONCLUSIONS: We found a strong association between POP and JHM, with an effect size that is clinically relevant. Our findings are limited by high heterogeneity and the potential for residual confounding factors. JHM is an important early indicator for POP risk, and future longitudinal studies should explore the shared aetiology.

Validation of the Polish version of P-QoL questionnaire.

OBJECTIVE: Pelvic organ prolapse (POP) is a common morbidity that affects many women and significantly decreases quality of life. The severity and the impact of the prolapse on the quality of life are important parameters in the management and follow-up of affected patients. The aim of this validation study was to validate the Polish version of the Prolapse Quality of Life questionnaire (P-QoL). MATERIAL AND METHODS: The P-QOL questionnaire was translated into Polish and administered to women recruited from two gynecological outpatient clinics (n = 231). Both symptomatic and asymptomatic women were included in the study and examined in supine position using the Pelvic Organ Prolapse Quantification System (POP-Q). The validity was assessed by comparing symptom scores and quality-of-life scores between symptomatic and asymptomatic women. RESULTS: A total number of 154 symptomatic and 77 asymptomatic women were included. There was a strong correlation between severity of the disease based on physical findings (POP-Q scale) and the P-QoL scores in main prolapse quality-of-life domains. The overall scores for each life domain were significantly different between symptomatic and asymptomatic women (p < 0.001). All the questions regarding symptoms showed significant differences (p < 0.001) between both groups. CONCLUSIONS: The Polish version of P-QoL is a valid, reliable, and easily comprehensible instrument to assess quality of life and symptoms in Polish-speaking women suffering from urogenital prolapse.

Associations between individual lower urinary tract symptoms and bacteriuria in random urine samples in women.

AIMS: Previous studies have noted an association between a diagnosis of overactive bladder and bacteriuria, but little is understood about the relationship of bacteriuria to specific LUTS. We hypothesized that bacteriuria in women would be associated with increased self-reported symptom scores for a wide range of LUTS. METHODS: Women were recruited from general gynecology and urogynecology outpatient clinics in a secondary care setting. Women completed the 12-item International Consultation on Incontinence Questionnaire for Female Lower Urinary Tract Symptoms and provided a clean-catch mid-stream specimen of urine for microscopy and culture. Women with acute urinary tract infection were excluded. Three statistical approaches (Mann-Whitney U-test, multivariable logistic regression, and receiver operating characteristic curves) were used to assess differences in symptom scores between women with and without bacteriuria. RESULTS: Two hundred forty-seven women were recruited, aged 22-82. Sixteen of 247 urine samples (6.5%) demonstrated significant bacteriuria, growing a different range of organisms. Women with significant bacteriuria were more likely to have nocturia (OR 3.56, 95% CI 1.19-10.6, P = 0.02), urgency (OR 6.66, 95% CI 1.47-30.06, P = 0.01), bladder pain (OR 2.82, 95% CI 1-7.92, P = 0.049), urgency incontinence (OR 2.92, 95% CI 1.02-8.36, P = 0.046), nocturnal enuresis (OR 4.21, 95% CI 1.32-13.41, P = 0.01). After adjustment for age, parity, symptomatic prolapse, menopausal status and history of mid-urethral sling urinary urgency, bladder pain, nocturia, and nocturnal enuresis remained significantly associated. CONCLUSIONS: Bacteriuria is associated with a range of LUTS including nocturia, urgency, and bladder pain supporting a role for bacterial colonization in the pathogenesis of OAB symptoms.

The FIGO assessment scoring system (FASS): a new holistic classification tool to assess women with pelvic floor dysfunction: validity and reliability.

INTRODUCTION AND HYPOTHESIS: The aim of our study was to assess the interobserver and intraobserver reliability as well as the content and construct validity of the FIGO prolapse assessment scoring system (FASS). METHODS: Women with and without (controls) symptoms of pelvic organ prolapse (POP) attending gynaecology outpatient clinics in four different countries were recruited prospectively. Each woman was assessed using the FASS which included: (1) physical examination findings designated with the letter P; (2) presence of symptoms of prolapse, urinary and bowel symptoms designated with the letter S; and (3) assessment of degree of bother designated with the letter B. A scoring system was also developed. For interobserver reliability women were examined by two separate examiners using the FASS. For intraobserver reliability the FASS was repeated by the same examiner within 2 weeks. The interclass correlation coefficient (ICC) was also calculated to assess limits of agreements. Validity was assessed by comparing the FASS scores between symptomatic and asymptomatic women using the Mann-Whitney U test (p value <0.001). RESULTS: A total of 177 women (98 symptomatic and 79 controls) were recruited. Intraobserver reliability had ICCs between 0.716 and 1. Interobserver reliability had ICCs between 0.795 and 0.909. Domain and total scores were significantly different between symptomatic and asymptomatic women (p < 0.001, Mann-Whitney U test). There was a good correlation between FASS P scores and POP-Q scores (rho 0.763, p < 0.001). CONCLUSIONS: The FIGO prolapse assessment scoring system has good intraobserver and interobserver agreement and has demonstrated both content and construct validity.

Are the measurements of water-filled and air-charged catheters the same in urodynamics?

INTRODUCTION AND HYPOTHESIS: The aim of our study was to compare air-charged and water-filled catheters simultaneously in the measurement of the intravesical, abdominal and detrusor pressure during urodynamic investigations. METHODS: Consecutive women with lower urinary tract symptoms, referred for urodynamics were prospectively studied. Readings of intravesical pressure (p(ves)), abdominal pressure (p(abd)) and detrusor pressure (p(det)), recorded by both the air-charged and water-filled catheters, were displayed simultaneously and compared at the end of filling, on standing, on sitting prior to voiding and at the maximum involuntary detrusor contraction. The signals (pressures) recorded by both types of catheter were compared using the Bland-Altman plot and paired samples t test. RESULTS: Twenty women with a mean age of 49 (range 36-72) were recruited. One patient with normal urodynamics was excluded in view of the poor quality trace. At each of the four comparison points, the air-charged catheters consistently produced higher mean pressures than the water-filled catheters. There were wide variations in the difference between the readings produced by the two types of catheter. CONCLUSIONS: Pressures measured using air-charged catheters are not comparable with water-filled catheters and are therefore not interchangeable. Caution must be used when comparing urodynamic parameters using air-charged and water-filled catheters.

Botulinum neurotoxin type A injection of the pelvic floor muscle in pain due to spasticity: a review of the current literature.

The role of muscle spasm is not a new concept in the genesis of pain. Botulinum neurotoxin type A (BoNTA) has been successfully employed in a variety of muscular and inflammatory conditions. The aim of our study was to review the published literature on the role of BoNTA injection of the pelvic floor muscle in the management of women with chronic pelvic pain (CPP). A systematic search of the literature published up to June 2012 on the use of BoNTA in the treatment of female pelvic floor muscle spasm was carried out using relevant search terms in MEDLINE and EMBASE databases. The results were limited to full-text English language articles. Relevant trials as well as relevant reviews were selected and analyzed by two independent reviewers. Five studies (2 case reports, 1 prospective pilot study, 1 retrospective study and 1 randomised double-blind placebo controlled study) were included in this systematic review. Overall, BoNTA has shown to be beneficial in relieving CPP related to pelvic floor spasm. The role of BoNTA as a treatment of CPP has been recognized for more than 10 years. Although data are still scarce preliminary results are encouraging. BoNTA is an attractive option for refractory CPP related to pelvic floor muscle spasm, but further studies using validated and reproducible outcome measures are needed, to establish its effectiveness, safeness, technique, optimal dosage, and duration of symptom relief.

Biomarkers in overactive bladder.

A biomarker is an indicator of a particular disease. It is generally used to define the presence (diagnostic biomarker), severity, progression (prognostic biomarker) of a condition and/or its response to a specific treatment (predictive biomarker). Biomarkers can be specific cells, enzymes, hormones, genes or gene products, which can be detected and measured in parts of the body such as blood, urine or tissue. Therefore, biomarkers have been suggested to play an important role in both the clinical assessment and the management of patients, as well as in the research setting. Recently, interest has gathered in urinary biomarkers as a tool to assess overactive bladder (OAB), potentially playing a role in the diagnosis, disease progression and monitoring response to treatment. Urinary biomarkers identified so far include nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), prostaglandins, cytokines and C-reactive protein. The aim of this review was to review the published literature on biomarkers in OAB. A literature review using Pub Med, clinicaltrials.gov and the controlled trials online registries was performed from 1970 up to June 2012. The search keywords were: the International Continence Society (ICS) definition of "OAB", "nerve growth fac- tor" (NGF), "brain derived growth factor" (BDNF), "prostaglandins," "cytokines," "genetic biomarkers" and "C reactive protein".The results were limited for fully published English-language articles. The search was then subsequently expanded to include urinary biomarkers in interstitial cystitis and bladder pain where relevant. Each of the studies/articles was reviewed, interpreted and discussed to consider the role of urinary biomarkers in OAB. Using the search criteria, a total of 20 studies (animal and human) that investigated the role of urinary biomarkers in OAB were identified. Full text versions of these articles were obtained and reviewed. Studies on NGF suggested that urinary levels were higher in OAB patients and decreased with antimuscarinic and botulinum toxin treatment. BDNF studies have demonstrated raised levels in OAB and also increased levels in situations of acute bladder inflammation. The role of urinary prostaglandins, cytokines and CRP does not appear to be specific to the OAB disease process according to the current available evidence. Based on the evidence so far NGF and BDNF appear to be the most promising biomarkers in OAB. Although still in their infancy these neurotrophic factors could potentially diagnose OAB, replacing urodynamics and aiding in monitoring disease progression and response to treatment in addition to clinical symptoms.

Antimuscarinic effects on current perception threshold: a prospective placebo control study.

AIMS: To evaluate the effect of Tolterodine on urethral and bladder afferent nerves in women with detrusor overactivity (DO) in comparison to placebo, by studying the changes in the current perception threshold (CPT). METHODS: Women with overactive bladder symptoms and idiopathic DO were recruited and randomized in a double-blind manner between placebo and tolterodine extended release. All women underwent CPT testing of the bladder and urethra using a Neurometer constant current stimulator. CPT values were determined at three frequencies, including 2,000 Hz (corresponding to Aß-fibers), 250 Hz (corresponding to Aδ-fibers), and 5 Hz (corresponding to C fibers) before and 7 days on treatment. CPT values before and on treatment were compared using a Wilcoxon Signed Rank test. RESULTS: Twenty women (mean age 46 years) were studied. There was no statistical difference between the two groups in terms of age, ethnicity, severity of symptoms and pre-treatment CPT values. Only in the tolterodine group there was a significantly increased CPT value at 5 and 250 Hz upon both urethral and bladder stimulation after 1 week of treatment. When compared with placebo, women taking tolterodine had significantly increased Bladder CPT values at 5 Hz (P-value <0.05). The electrical stimulation with 5 Hz was described as urgency. CONCLUSIONS: This is a randomized placebo control study evaluating the effect of antimuscarinics on sensory nerve function in women with DO. Our results support the animal studies that antimuscarinics have an effect on sensory function.

Fesoterodine in randomised clinical trials: an updated systematic clinical review of efficacy and safety.

INTRODUCTION AND HYPOTHESIS: This is a systematic review of clinical data assessing the safety, efficacy and tolerability of fesoterodine in randomised control trials (RCTs) in the treatment of overactive bladder (OAB). METHODS: We performed a MEDLINE literature search of articles published between 2005 and 2010 regarding the efficacy and safety of fesoterodine. The US Food and Drug Administration Web site was also searched for RCTs. RESULTS: Two studies demonstrated significant improvement of OAB symptoms with fesoterodine compared with placebo. Two phase III studies showed both doses of fesoterodine to be more effective than placebo for most symptoms. Another phase III trial confirmed the superiority of 8 mg fesoterodine compared with tolterodine ER 4 mg. Dry mouth was the commonest side effect. CONCLUSIONS: Fesoterodine is effective for treating OAB symptoms. Its once-daily dosing regime and the flexibility to increase the dose are appealing factors.

Use of mirabegron in treating overactive bladder.

The lack of an alternative to antimuscarinics has led to the search for new drug targets for overactive bladder (OAB) symptoms. The presence of ß-3 adrenoreceptors in the bladder has been confirmed, and they are known to have a role in bladder relaxation. Targeting these receptors improves bladder compliance on filling and increases bladder capacity. MEDLINE literature search on efficacy and safety of mirabegron was performed. The US Food and Drug Administration Web site, clinicaltrials.gov, and controlled-trials.com online trial registries were searched for English-language articles containing the term "mirabegron". Finally, abstracts from recent International scientific meetings were searched for randomised controlled trials (RCTs). Studies show that mirabegron reduces the number of micturitions and incontinence episodes in a 24-h period compared with placebo. Dry mouth and gastrointestinal disturbances are the most common side effects, but these have been rated as mild to moderate. A small rise in mean heart rate and blood pressure has been shown. Further investigations are ongoing and results are awaited. Although mirabegron is metabolised by CYP2D6, it is also thought to inhibit the activity of this enzyme. Therefore, potential drug interactions with other CYP2D6 substrates need to be further studied. Mirabegron is a promising alternative to antimuscarinics. Further information on its long-term use in terms of efficacy, safety, and tolerability is awaited.