[Prevalence and initial management of overactive bladder in France: A cross-sectional study]. / Prévalence et prise en charge initiale de l'hyperactivité vésicale en France : une étude transversale.

AIMS: To determine the prevalence of overactive bladder (OAB) syndrome in France and gather data about initial patient trajectories in the healthcare system. METHODS: A dedicated questionnaire (41 questions) has been sent to a 12,000 sample of people representative of the global population. The following data were investigated: social and demographic features, medical history, Urinary Symptom Profile questionnaire, bother, history of symptoms, care seeking and treatments received. Patient were considered having OAB in case if presenting at least two episodes of urgency per week, or being under treatment of OAB. OAB prevalence was the main outcome, and associated factors were characterized by univariate and multivariate analysis. RESULTS: Based on 8842 available questionnaires, the global prevalence of OAB was estimated to be 14.4%. Prevalence was significantly higher in women, older age groups, as well as obesity, irritable bowel syndrome, urinary tract infections, enuresia, constipation, anxiety/depression, neurological diseases, sleep apnea syndrome, asthma, chronic obstructive pulmonary disease, diabetes and hypertension. Only 34.6% of patients with OAB had visited a health practitioner for this problem. General practitioners were most frequently implicated in patient primary care and evaluation. Seventy-two percent of patients with OAB had had additional investigations (mostly a urine culture) and only 6% of patients had to complete a bladder diary. The most frequent treatment option was oral antimuscarinics. Physical therapy and rehabilitation have been prescribed in 26% of cases, as well as dietary advice. CONCLUSIONS: OAB is a frequent syndrome. Its prevalence increases with age, and OAB frequently concern elderly frail people with many other associated diseases. LEVEL OF EVIDENCE: 3.

[Fungal infections and ureteral material: How to manage?]. / Infections fongiques et matériel urétéral: quelle prise en charge?

INTRODUCTION: Urinary tract infections due to Candida species are mostly encountered in hospital environment. The management of candiduria on ureteral catheter is not consensual. The objective of our work was to make a review of medical literature related to definition, physiopathology, management and prevention of candiduria on ureteral catheter. MATERIAL AND METHODS: The research was made on Medline using the following keywords: Candida; fungal; urinary tract infection; ureteral stent; ureteric stent; double-J pigtail. RESULTS: The threshold defining candiduria is 10(5) CFU/mL. Candiduria corresponds to many different clinical presentations from colonization to candidemia. Species found are mostly Candida albicans (19-72%) and Candida glabrata (15.6-49.4%). The colonization of ureteral stent due to Candida is of 10% and comes with candiduria in 40% of the cases, due to the presence of biofilm. Prevention of infections on ureteral stents requires a regular change of material every 3-6 months depending on the patients risk groups. In case of symptomatic candiduria on ureteral stent, an anti-fungal therapy should be initiated 48 hours to 3 weeks before the change of the stent, in order to get a sterilization of urines and prevent the recolonization of the stent. Fluconazole is the drug of choice to use. CONCLUSION: Colonization of ureteral stents due to Candida is common and can be responsible of symptomatic infection. Anti-fungal therapy should be introduced before the change of the stent but a consensual duration of treatment before surgery is not found in the literature.

[Idiopathic overactive bladder and BOTOX(®): Literature review]. / Hyperactivité vésicale idiopathique et BOTOX(®): revue de la littérature.

AIM: Systematically review literature on the efficacy and tolerability of botulinum toxin A (onabotulinumtoxineA, BOTOX(®), Allergan, CA, USA) in refractory idiopathic overactive bladder (iOAB) METHODS: Pubmed search on the efficacy, toxicity and adverse events of onabotulinumtoxinA in clinical trials only with level 1 and 2 evidence. RESULTS: Eleven controlled randomised trials have been selected, of which 3 phase III trials. The studies published data of 1008 patients with refractory iOAB treated with onabotulinumtoxineA. In the phase II and III trials, doses from 50 U to 300 U have been evaluated; more than half of the patients (n = 676) with 100 U. In the 2 main phase III trials, onabotulinumtoxinA has demonstrated to be more efficient compared to placebo on continence, symptoms and quality of live (QoL). Urodynamic results, reported in the phase II trials, demonstrated higher changes compared to placebo only from dose 100 U on, although not always significant. Adverse events (urinary retention, dysuria, urinary tract infection) were easily treated and did not influence patient's QoL. CONCLUSION: Intradetrusor injections of onabotulinumtoxinA (BOTOX(®)), a minimally-invasive procedure, seem to be efficient and well tolerated in the treatment of refractory iOAB.

Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies.

OBJECTIVES: To conduct a systematic review to determine whether there is an association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) or overactive bladder (OAB) in women. METHODS: We systematically reviewed English language observational studies on the effect of MetS (or component factors) on the presence of OAB or LUTS in women. We searched PubMed, Web of Science and The Cochrane Library with no date restrictions, checked reference lists and undertook citation searches in PubMed and Google Scholar. Studies were assessed for risk of bias. Because of heterogeneity, results were not pooled, but are reported narratively. RESULTS: Of 27 included studies, only three looked at the link between MetS and OAB. The rest looked at links between OAB and components of MetS such as obesity or insulin resistance (n = 10), between MetS and urinary symptoms (n = 3) and between urinary symptoms and components of MetS, such as obesity (n = 14). Evidence is currently limited, but it does suggest that there may be important links between MetS and OAB and components of MetS such as obesity. CONCLUSIONS: The literature on MetS and OAB or LUTS in women is limited, and poor quality. However, the evidence available on obesity appears to support MetS as a contributor and predictor of LUTS in women. Many of the women with LUTS will be overweight and will have features of the MetS, if looked for. This provides not only an opportunity to encourage weight loss as an adjunct to therapy for the OAB symptoms but also a window of opportunity to address cardiovascular risk factors and prevent future cardiovascular morbidity and mortality.

Guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management: Translation of French recommendations.

OBJECTIVE: Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management. PATIENTS AND METHODS: Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts. RESULTS: In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1 mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200 mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection. CONCLUSIONS: Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio.

[Intra-detrusor injection of botulinum toxin for female refractory idiopathic overactive bladder syndrome]. / Injections intra-détrusoriennes de toxine botulinique pour l'hyperactivité vésicale idiopathique réfractaire de la femme.

INTRODUCTION: Botulinum toxin-A detrusor injections are now approved for use (extension of marketing authorization) in the management of refractory idiopathic overactive bladder. The goal of the current study was to study the value and efficacy of this therapy. PATIENTS AND METHODS: A literature review was performed on Medline, Embase and Cochrane databases, using the following keywords: botulinum toxin; overactive bladder syndrome; urinary incontinence; detrusor injection. RESULTS: The recommended first step dose is 50 units of BOTOX(©) (dose selected for tolerance assessment). However, the cure rates for urge incontinence are greater with 100 units. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by the patient, because of the risk of urinary retention (6%). The administration of BOTOX(©) comprises an intra-detrusor injection using a cystoscope, performed under local anesthesia. Clinical improvement is generally observed in the first two weeks after the injection. Patients should be considered for reinjection when the clinical effect of the previous injection has diminished, approximately 6-9 months after the first injection. An injection of 100 units may be considered when the clinical benefit of the 50-unit injection is not satisfactory concerning incontinence symptoms. CONCLUSION: Botulinum toxin detrusor injections may be offered to women who develop refractory OAB.

Efficacy and safety of repeated dosing of netupitant, a neurokinin-1 receptor antagonist, in treating overactive bladder.

AIM: NK-1 receptors in sensory nerves, the spinal cord and bladder smooth muscle participate in complex sensory mechanisms that regulate bladder activity. This study was designed to assess the efficacy and safety of a new NK-1 receptor antagonist, netupitant, in patients with OAB. METHODS: This was a phase II, multicenter, double-blind study in which adults with OAB symptoms >6 months were randomized to receive 1 of 3 doses of netupitant (50, 100, 200 mg) or placebo once daily for 8 weeks. The primary efficacy endpoint was percentage change from baseline in average number of daily micturitions at week 8. Urinary incontinence, urge urinary incontinence (UUI), and urgency episodes were also assessed. RESULTS: The primary efficacy endpoint was similar in the treatment groups (-13.85 for placebo to -16.17 in the netupitant 200 mg group) with no statistically significant differences between netupitant and placebo. The same was true for most secondary endpoints although a significant difference for improvement in UUI episodes and a trend for the greatest decrease in urgency episodes were seen in the netupitant 100 mg group. Netupitant was well tolerated with most treatment emergent adverse events (AEs) being mild. While the overall incidence of AEs increased with netupitant dose, there was no evidence for this dose dependency based on relationship to treatment, intensity, or time to onset. CONCLUSIONS: The study failed to demonstrate superiority of netupitant versus placebo in decreasing OAB symptoms, despite a trend favoring netupitant 100 mg. There were no safety concerns with daily administration of netupitant over 8 weeks.

[Guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management]. / Recommandations pour l'utilisation de la toxine botulinique de type A (Botox®) dans l'hyperactivité vésicale réfractaire idiopathique.

OBJECTIVES: Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic Overactive Bladder management. PATIENTS AND METHODS: Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts. RESULTS: In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection. CONCLUSIONS: Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio.

[Mini-sling for management of stress urinary incontinence in women: a literature review]. / Mini-bandelettes pour le traitement de l'incontinence urinaire d'effort féminine : revue de la littérature.

AIM: To conduct a review about the use of single incision mini-slings (SIMS) to manage non-neurogenic stress urinary incontinence in women. METHODS: Literature search in Pubmed/MEdline database until june 2013. TVT-Secur™ was excluded because this device is not anymore marketed. RESULTS: Ajust™ and Mini-Arc™ were the two main SIMS evaluated in the literature. Studies about Mini-Arc™ generated heterogeneous results, with a success rate between 44% and 91% after 1 year. Ajust™ was the most promising device with 80% efficacy after mid-term follow-up. All evaluated SIMS had a low rate of immediate complications. Two randomized controlled trials comparing SIMS and traditional mid-urethral slings were identified, as well as one meta-analysis; they all concluded to non-superiority or inferiority for the mini-sling versus traditional slings. CONCLUSION: Due to short follow-up, limited evidence and heterogeneous data, SIMS are not yet standard of care and further research is warranted.

[Pharmacological treatment of idiopathic overactive bladder: a literature review]. / Traitements pharmacologiques de l'hyperactivité vésicale idiopathique: revue de la littérature.

OBJECTIVE: To depict the recent advances in the field of pharmacological treatment of idiopathic overactive bladder (iOAB). METHODS: A literature search was conducted, using the PubMed/Medline database. Articles were included if published as full papers, after 2008 and before September 2012, and focused on recent pharmacologic treatment options for iOAB management. Publications having the highest level of evidence have been analyzed to summarize the available evidence, prioritizing the treatments available in France. RESULTS: Some meta-analyses have been published between 2008 and 2012, gathering information about 82 level 1 evidence studies about efficacy and safety of anticholinergics. According to the most recent meta-analysis, anticholinergics have proved their efficacy for iOAB management, reducing the number of micturitions per day by up to 1.59, the number of incontinence episodes per day by up to 0.7, the number of urgency episodes by up to 1.7, the number of urgency incontinence episodes by up to 2.25, and the number of nocturnal voids by up to 0.24. Safety profile was good, especially for solifenacin and fesoterodine, supported by strong scientific evidence. However, data were limited to short-term follow-up, with no anticholinergic drug superior to another. Few data were available about observance, risk factors for failure and results in specific populations. Anticholinergics can be used safely for management of lower urinary tract symptoms in men, but their role is still to be determined. Data about innovative drugs were still preliminary. CONCLUSIONS: Anticholinergics are a valuable option for management of iOAB, and have a growing role in management of lower urinary tract symptoms in men without bladder outlet obstruction.

Repeat mid-urethral sling for recurrent female stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to assess the effectiveness of repeat mid-urethral sling after a failed primary sling for stress urinary incontinence. METHODS: A total of 112 women with recurrent stress incontinence after primary mid-urethral sling underwent a repeat procedure between 2000 and 2011. All patients had a preoperative clinical and urodynamic evaluation. Outcomes were divided into three groups: cured (no more leaks), improved (decrease of leaks), or failed. RESULTS: All patients had urethral hypermobility and 12.9 % had intrinsic sphincter deficiency [maximum urethral closure pressure (MUCP) ≤ 20 cmH2O]. Median MUCP was 41 cmH20. Overactive bladder was found in 5.7 % of women. The second sling placed was one of the following: retropubic Tension-free Vaginal Tape (49 %), transobturator tape (48 %), or mini-sling (3 %). No intraoperative morbidity was reported. After the second sling was placed, 68 (60.7 %) patients were subjectively cured and 18 (16.1 %) improved (76.8 % success overall) with a mean follow-up of 21 months. Success rates were 72.2 and 81.8 % for transobturator and retropubic slings, respectively, with no significant difference. Multivariable analysis showed higher odds of cure and improvement with the retropubic approach after adjusting for MUCP. Late complication rates were comparable to those observed after a first sling. Urodynamic parameters were not associated with postoperative success. CONCLUSIONS: Repeat mid-urethral sling for recurrent female stress urinary incontinence is nearly 77 % successful in a group of patients with persistent urethral hypermobility. A retropubic approach might be preferred for patients with low urethral closure pressures.

[Salvage therapy with artificial urinary sphincter after Advance™ male sling failure for post-prostatectomy incontinence: a first clinical experience]. / Thérapie de sauvetage par implantation d'un sphincter artificiel urinaire après échec de bandelette Advance™ pour incontinence urinaire après prostatectomie : une expérience monocentrique.

OBJECTIVES: To assess the clinical outcome following artificial urinary sphincter (AUS) implantation after failure of Advance™ sub-urethral male sling for post-prostatectomy incontinence (PPI). METHODS: A prospective evaluation was conducted about consecutive patients who received an AUS after failure of Advance™ therapy in one tertiary reference center. Evaluation included medical history, pad use and operative data (duration, cuff size, technical difficulties). Follow-up was scheduled at 1, 6, 12 months and yearly thereafter. Clinical outcome was evaluated by pad use, patient global impression of improvement (PGI-I) scale and assessment of side effects. Cure was defined as no pad usage. RESULTS: Twelve patients were included in this evaluation. Median follow-up was 20 months (12-43). No patient was lost to follow-up. Four patients had a history of radiation therapy and all patients had mild or moderate PPI with previous failed Advance™ surgery. Median (range) operative time was 47 minutes (40-60). No technical problem occurred during AUS implantation. Hospital stay duration and catheterization duration were respectively 2 days and 24 hours in all but one case. At last follow-up, 10/12 patients (83%) were cured and fully satisfied. Two were improved, wearing only one pad per day. Postoperative complications were noted in two cases (17%) (one case of cutaneous erosion and one case of superficial iliac wound infection). CONCLUSIONS: AUS implantation is feasible in patients who have undergone Advance™ male sling implantation. Mid-term results of this procedure are comparable to those obtained after first line AUS implantation.

[Predictive value of the penile cuff-test for the assessment of bladder outlet obstruction in men]. / Valeur prédictive du cuff-test dans le diagnostic de l'obstruction sous-vésicale chez l'homme.

PURPOSE: To assess the diagnostic performances and the acceptability of the penile cuff test (PCT) which is a non invasive method for the evaluation of bladder outlet obstruction (BOO), in comparison with the pressure flow study (PFS), the actual gold-standard. MATERIAL: Monocentric prospective study comparing the following subsets: "obstructed", "not obstructed" or "equivocal", deduced from PFS vs PCT, in 30 consecutive patients presenting with lower urinary tract symptoms. For the PCT, a cuff placed around the penis inflated automatically during the micturition, until flow rate interruption. The interruption cuff pressure revealed the isovolumetric bladder pressure (Pcuff-int). The data collected - Pcuff-int and maximum flow rate - were automatically reported on ICS modified nomogram. RESULTS: With the PFS, 11 patients (39%) were classified "obstructed", six patients (22%) "non-obstructed" and 11 patients (39%) "equivocal". In 61% cases, the patient was classified in the same category by both techniques. The "obstructed positive predictive value" of the PCT was 82% and the "non-obstructed-equivocal negative predictive value" was 88%. The median acceptability visual analogic scale score was 1/10 (0-3) for the PCT whereas it was 5/10 (2-10) for the PFS. This difference was statistically significant (p=0.004). CONCLUSION: The PCT was a reliable non-invasive tool for the diagnosis of BOO in male, in comparison with PFS. The predictive values of the PCT were relevant and its tolerance was better than PFS.