Nonsurgical Management of Overactive Bladder

2018 ◽  
Author(s):  
Sharon Jakus-Waldman
Keyword(s):  
Overactive Bladder ◽  
Pelvic Floor Muscle ◽  
Treatment Options ◽  
The United States ◽  
Anticholinergic Medication ◽  
Adult Women ◽  
Urinary Urgency ◽  
Adrenergic Agonists ◽  
Bladder Training ◽  
Patient Reported

Overactive bladder affects up to one-third of elderly adults and 17% of adult women in the United States. The diagnosis is based on patient-reported symptoms of urinary urgency and frequency, with or without urinary incontinence after exclusion of any other possible pathology. Treatment options are based on a staged approach beginning with lifestyle and behavioral modifications. Bladder training and pelvic floor muscle training have been shown to be as effective as antimuscarinic medication and possibly most useful when these therapies are combined with medication. A newer class of OAB medication, β3-adrenergic agonists, has fewer side effects compared to antimuscarinics and is an important alternative for elderly patients at a risk of dementia. This review contains 5 figures and 63 references Key Words: anticholinergic medication, antimuscarinics, β-adrenergic agonists, nocturia, overactive bladder, urge incontinence, urinary frequency, urinary urgency

scholarly journals The Public’s Perception of Interventions for Migraine Headache Disorders: A Crowdsourcing Population-Based Study

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Orr Shauly ◽  
Daniel J Gould ◽  
Ketan M Patel
Keyword(s):  
Migraine Headache ◽  
Treatment Options ◽  
The United States ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
Amazon Mechanical Turk ◽  
Cross Sectional ◽  
Economic Productivity ◽  
Migraine Headaches ◽  
Patient Reported

Abstract Background Migraine disorders are a leading cause of morbidity and decreased economic productivity in the United States among both men and women. As such, it is important to consider patient opinions, and have an accurate representation of the burden and sentiment toward currently available interventions among those suffering from migraines. Objectives The aim of the study was to assess patient options regarding adverse outcomes of the various treatment options available for migraine headaches. Methods A prospective cross-sectional study of volunteers recruited through an internet crowdsourcing service, Amazon Mechanical Turk©, was conducted. Surveys were administered to collect patient-reported opinions regarding adverse outcomes of both surgical and nonsurgical treatment options for migraine headaches. Results The prevalence of migraine headache across all study participants was 15.6% and varied slightly across participant demographics. Individuals ages 35–44 (2.73 migraines per month) experienced the fewest migraine and with the lowest severity. Those individuals ages 45+ experienced the most severe headaches (Visual Analog Scale = 44.23 mm). Additionally, the greatest migraine frequency and severity existed among those households with yearly income of $75,000–$100,000. The lowest injection therapy utility scores were obtained for adverse outcomes of hematoma (47.60 mm) and vertigo (54.40 mm). Conclusions Migraine headaches remains a significant problem among the US population, with an overall prevalence of 15.6% (approximately 50 million Americans). Additionally, physicians interesting in offering minimally invasive or surgical treatment for migraine headaches should focus on mitigating patient fears regarding clinical outcomes and cost of care.

Implementing value-based cancer care: A multidisciplinary approach to defining breast cancer outcomes.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 16-16
Author(s):  
Oluwadamilola M. Fayanju ◽  
Tinisha L. Mayo ◽  
Tracy E. Spinks ◽  
Seohyun Lee ◽  
Carlos Hernando Barcenas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Performance Improvement ◽  
Cancer Care ◽  
Treatment Options ◽  
The United States ◽  
Multidisciplinary Teams ◽  
Patient Portal ◽  
Breast Cancer Patients ◽  
Patient Centered ◽  
Patient Reported

16 Background: Value in healthcare (patient-centered outcomes achieved per dollar spent) unifies performance improvement goals with health outcomes of importance to patients. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. Methods: A review of the breast cancer literature was conducted on treatment options as well as expected outcomes and potential treatment complications. Patient perspective was obtained via focus groups. Multidisciplinary teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration, planned for spring 2016. Results: Outcomes were divided into 3 previously defined tiers (NEJM 2010; 363:2477-2481) that reflect the entire cycle of care (Table).Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria, specifications for reporting, and sources for data including the EHR and validated patient-reported outcome questionnaires (e.g., FACT-B+4) administered via our patient portal. Conclusions: A value-based approach to cancer care with transparently reported patient outcomes not only creates opportunity for performance improvement but also enables benchmarking within and across providers, healthcare systems, and even countries. Our value-based framework for breast cancer is the first of its kind in the United States, with a similar model being pursued internationally as well. [Table: see text]

scholarly journals Urinary Incontinence: An Update

2013 ◽  
Vol 1 (1) ◽  
pp. 13-17
Keyword(s):  
Urinary Incontinence ◽  
South Asian ◽  
Lifestyle Modification ◽  
Pelvic Floor Muscle ◽  
Urge Urinary Incontinence ◽  
Anticholinergic Medication ◽  
Bladder Training ◽  
Pelvic Floor Muscle Exercises ◽  
Physician Patient Communication ◽  
Physician Patient

ABSTRACT Patients usually under-report symptoms of incontinence. Therefore, improved physician-patient communication is vital . Most urinary incontinence can be evaluated and treated after careful history and simple clinical assessment. Initial treatment, for both urge urinary incontinence and stress urinary incontinence, is lifestyle modification and pelvic floor muscle exercises. Urgency responds to bladder training and drug therapy with anticholinergic medication. Pharmacotherapy has a limited place in stress incontinence. How to cite this article Malhotra J, Garg R, Agrawal P. Urinary Incontinence: An Update. J South Asian Feder Menopause Soc 2013;1(1):13-17.

A VALIDATED PATIENT REPORTED MEASURE OF URINARY URGENCY SEVERITY IN OVERACTIVE BLADDER FOR USE IN CLINICAL TRIALS

2005 ◽  
Vol 174 (2) ◽  
pp. 604-607 ◽  
Author(s):  
ANNABEL NIXON ◽  
SHOSHANA COLMAN ◽  
LUANN SABOUNJIAN ◽  
BOBBY SANDAGE ◽  
UTE E. SCHWIDERSKI ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Overactive Bladder ◽  
Urinary Urgency ◽  
Patient Reported

Medications and Botulinum Toxin for Overactive Bladder

2020 ◽  
Author(s):  
Kirin K Syed ◽  
Angelo E Gousse
Keyword(s):  
Botulinum Toxin ◽  
Overactive Bladder ◽  
Treatment Options ◽  
Symptom Control ◽  
The United States ◽  
Office Visits ◽  
Phosphodiesterase Type 5 Inhibitors ◽  
Symptom Complex ◽  
Phosphodiesterase Type ◽  
Nonneurogenic Overactive Bladder

Previously published literature has estimated that approximately 16.5% of American adults have OAB, and up to 37% of OAB patients have concomitant urinary incontinence (OAB-wet). In fact, OAB is one the most common urologic disorders, accounting for more than 2 million physician office visits in the United States (2007). Nonneurogenic OAB is a symptom complex, which is defined by the International Continence Society standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of proven infection or other obvious pathology. Urgency with at least one other symptom is essential to diagnose OAB and is the cornerstone component of OAB. To date, there is a paucity of validated instruments to define urinary urgency, and therefore, the diagnosis of OAB is based on patient symptomatology. Diagnosis does not rely on urodynamic findings or characteristics and therefore a thorough history and physical examination are essential. Treatment for this nonsurgical condition is therefore aimed toward symptom control. This review provides the reader with a better understanding of the voiding cycle and available medical treatment options for nonneurogenic overactive bladder (OAB). This review contains 11 figures, 7 tables, and 90 references. Key Words: anticholinergic, β3 agonist, botulinum toxin, chemodenervation, cialis, intradetrusor onabotulinumtoxinA, micturation cycle, mirabegron, overactive bladder, phosphodiesterase type 5 inhibitors, urinary retention

Effectiveness of the transcutaneous tibial nerve stimulation and pelvic floor muscle training with biofeedback in women with multiple sclerosis for the management of overactive bladder

2020 ◽  
pp. 135245852092666
Author(s):  
Cansu Polat Dunya ◽  
Zeliha Tulek ◽  
Murat Kürtüncü ◽  
Jalesh N Panicker ◽  
Mefkure Eraksoy
Keyword(s):  
Multiple Sclerosis ◽  
Overactive Bladder ◽  
Pelvic Floor ◽  
Nerve Stimulation ◽  
Pelvic Floor Muscle Training ◽  
Tibial Nerve ◽  
Pelvic Floor Muscle ◽  
Treatment Options ◽  
Muscle Training ◽  
Tibial Nerve Stimulation

Background: Overactive bladder (OAB) is common in patients with multiple sclerosis (MS) with a limited number of treatment options. Objective: To investigate the effect of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on OAB symptoms in female MS patients. Methods: This study was conducted at the outpatient MS clinic in Istanbul. At baseline bladder diary, post-voiding residue (PVR), OAB, and Qualiveen Scales (QoL: Quality of Life; Siup: Specific Impact of Urinary Problems on QoL) were assessed. Patients were allocated to receive TTNS or PFMT daily for 6 weeks and reevaluated using the same tests. Results: Fifty-five patients (TTNS = 28, PFMT = 27) were included. Compared with baseline, both TTNS and PFMT groups improved in terms of OAB ( p = 0.0001, p = 0.0001), Qualiveen-siup ( p = 0.0001, p = 0.0001), Qualiveen-QoL ( p = 0.002, p = 0.006), PVR ( p = 0.0001, p = 0.21), frequency ( p = 0.0001, p = 0.69), nocturia ( p = 0.0001, p = 0.19), urgency ( p = 0.0001, p = 0.0001), and urge incontinence ( p = 0.0001, p = 0.0001). Between-group comparisons showed significant differences in 24-hour frequency ( p = 0.002) in favor of TTNS. Conclusion: Our study demonstrates the efficacy of both TTNS and PFMT for managing OAB symptoms in MS, associated with a significant impact on QoL, but did not show superiority of the methods. Further studies are needed to explore differences between these two non-invasive treatments.

scholarly journals Managing Vasomotor Symptoms in Menopausal Women

2014 ◽  
Vol 2 (2) ◽  
pp. 87-90
Author(s):  
Amit Tandon ◽  
Meenal Jain ◽  
S Shantha Kumari
Keyword(s):  
Urinary Incontinence ◽  
South Asian ◽  
Lifestyle Modification ◽  
Pelvic Floor Muscle ◽  
Urge Urinary Incontinence ◽  
Vasomotor Symptoms ◽  
Anticholinergic Medication ◽  
Bladder Training ◽  
Menopausal Women ◽  
Physician Patient

ABSTRACT Patients usually under-report symptoms of incontinence. Therefore, improved physician-patient communication is vital. Most urinary incontinence can be evaluated and treated after careful history and simple clinical assessment. Initial treatment, for both urge urinary incontinence and stress urinary incontinence, is lifestyle modification and pelvic floor muscle exercises. Urgency responds to bladder training and drug therapy with anticholinergic medication. Pharmacotherapy has a limited place in stress incontinence. How to cite this article Malhotra J, Garg R, Kumari SS, Tandon A, Jain M, Malhotra N. Managing Vasomotor Symptoms in Menopausal Women. J South Asian Feder Menopause Soc 2014;2(2):87-90.

scholarly journals Physical Therapists and Physicians Evaluate Nonarthritic Hip Disease Differently: Results From a National Survey

2020 ◽  
Vol 100 (6) ◽  
pp. 917-932
Author(s):  
Lindsey Brown-Taylor ◽  
Andrew Lynch ◽  
Randi Foraker ◽  
Marcie Harris-Hayes ◽  
Bryant Walrod ◽  
...  
Keyword(s):  
National Survey ◽  
Patient Reported Outcomes ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Treatment Options ◽  
The United States ◽  
Survey Study ◽  
Patient Reported ◽  
Hip Disease ◽  
Movement Assessment

Abstract Background Physical therapy and surgery are viable treatment options for nonarthritic hip disease (NAHD). Interdisciplinary collaboration can help patients make informed treatment decisions. Understanding how each provider can contribute is a critical first step in developing collaborative evaluation efforts. Objective The objective of this study was to describe the current evaluation of NAHD by both physical therapists and physicians, and evaluate national use of expert-recommended evaluation guidelines. Design A national survey study distributed in the United States was implemented to accomplish the objective. Methods A survey was distributed to 25,027 potential physical therapist and physician respondents. Respondents detailed their evaluation content for patients with NAHD across the following domains: patient-reported outcomes, patient history, special tests, movement assessment, clinical tests, and imaging. Respondents ranked importance of each domain using a 5-point Likert scale (not important, slightly important, important, very important, or extremely important). Odds ratios (ORs [95% CIs]) were calculated to identify the odds that physical therapists, compared with physicians, would report each evaluation domain as at least very important. Fisher exact tests were performed to identify statistically significant ORs. Results Nine hundred and fourteen participants (3.6%) completed the survey. Physical therapists were more likely to indicate movement assessment (OR: 4.23 [2.99–6.02]) and patient-reported outcomes (OR: 2.56 [1.67–3.99]) as at least very important for determining a diagnosis and plan of care. Physical therapists had lower odds of rating imaging (OR: 0.09 [0.06–0.14]) and special tests (OR: 0.72 [0.53–0.98]) as at least very important compared with physicians. Limitations This survey study did not include many orthopedic surgeons and thus, primarily represents evaluation practices of physical therapists and nonsurgical physicians. Conclusions Physical therapists were more likely to consider movement assessment very important for the evaluation of patients with NAHD, whereas physicians were more likely to consider imaging and special testing very important.

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