Socioeconomic Costs of Overactive Bladder and Stress Urinary Incontinence in Korea

성우석,이선주,유현욱,윤태영 대한배뇨장애요실금학회 2012 International Neurourology Journal Vol.16 No.1

Purpose: We quantified and described the economic burden of overactive bladder and stress urinary incontinence in Korea. We calculated direct costs by identifying public and private data sources that contain population-based data on resource utilization by patients with stress urinary incontinence and overactive bladder. Methods: For estimating indirect costs (productivity loss), the human capital approach was applied. Data were collected from several institutes, including the Health Insurance Review Agency. Results: The estimated total economic cost in treating overactive bladder was 117 billion Korean Won (KRW, the currency of South Koea) in 2006 and 145 billion KRW in 2007. The estimated total cost in treating stress urinary incontinence was 122 billion KRW in 2006 and 59 billion KRW in 2007. Conclusions: By quantifying the total economic costs of overactive bladder and stress urinary incontinence, this study provides an important perspective in Korea. Because the average age of the Korean population is rapidly increasing, this study provides important information on the direct and indirect costs of overactive bladder and stress urinary incontinence for an aging society.

폐경 후 여성 요실금과 과민성 방광의 침 치료법에 대한 고찰

조세인,김동일,최수지 대한한방부인과학회 2022 大韓韓方婦人科學會誌 Vol.35 No.4

Objectives: The purpose of this study is to review the acupuncture treatment Urinary incontinence (UI) and Overactive bladder (OAB) in postmenopausal women. Methods: We searched articles in 8 search engines with keywords related to ‘Overactive bladder’, ‘Urinary incontinence’ and ‘Menopause’ in July 2022. Randomized Controlled Trials (RCT) that used acupuncture on Urinary incontinence (UI) and Overactive bladder (OAB) after menopause were included. Animal studies and non RCT data were excluded. Data on acupuncture treatment such as methods, site, duration, frequency, and period were analyzed. Also, network analysis between acupoints was conducted. Results: 15 articles were selected and analyzed. Studies were conducted using manual acupuncture, electroacupuncture, pharmacopuncture and fire acupuncture. Most studies used more than one acupoint, and there were 32 acupoints selected for acupuncture treatment for UI and OAB after menopause. The most commonly used acupoint was 中極 (CV3) (n=8). In terms of the correlation of acupoints, 太谿 (KI3) had the highest value of degree centrality at 0.75. The mean treatment time, number of treatments, and duration were 26.42±6.10 minutes, 18.71±9.09 times, and 6.87±4.77 weeks. Conclusions: The results of this study could be useful in establishing the evidence for performing standardized acupuncture treatment for Urinary incontinence and Overactive bladder in postmenopausal women.

심혈관질환 및 심혈관질환에 대한 위험요인이 과민성 방광 환자와 복압성 요실금 환자에게 미치는 영향에 대한 상관 분석

이효련 ( Hyo Ryun Lee ),김수림 ( Soo Rim Kim ),문여정 ( Yeo Jung Moon ),김세광 ( Sei Kwang Kim ),배상욱 ( Sang Wook Bai ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.10

목적 이 연구는 복압성 요실금 또는 과민성 방광을 가진 환자군을 대상으로 심혈관질환의 발생 빈도와 상관성을 입증하기 위하여 시행되었다. 연구방법 순수한 복압성 요실금 환자와 순수한 과민성 방광 환자 232명을 대상으로 후향적 연구방법으로 진행되었으며, 심혈관질환은 관상동맥질환, 뇌혈관질환, 말초혈관질환으로 정의하였으며, 심혈관질환의 위험요인으로는 나이(≥65세), 관상동맥질환의 가족력, 뇌혈관질환의 가족력, 흡연력, 음주력, 고혈압, 당뇨, 공복혈당장애, 지질장애, 체질량지수가 포함되었다. T-test, chi-square test, Fisher`s exact test, Logistic regression을 이용하여 분석하였다. 결과 심혈관질환은 과민성 방광에서 더 많이 발생하였으나 유의한 통계적 차이는 없었다. 심혈관질환과 나이, 당뇨, 고혈압, 흡연력, 공복혈당장애, 관상동맥질환의 가족력, 지질장애는 과민성 방광에서 더 많았고, 체질량지수, 뇌혈관질환의 가족력, 음주력은 과민성 방광에서 더 많았지만 모두 유의한 통계적 차이는 없었다. 당뇨는 과민성 방광 환자와 유의한 상관관계를 보였다. 결론 비록 통계적 유의성을 갖지는 못했지만 심혈관질환, 특이 뇌혈관질환에서 과민성 방광 환자가 더 많은 빈도를 보였다. 당뇨를 제외한 심혈관질환의 모든 위험요인의 빈도가 복압성 요실금과 과민성 방광에서 차이가 없었다. Objective The purpose of this study was to investigate associations between overactive bladder/stress urinary incontinence and cardiovascular risk factors and disease. Methods We performed a retrospective review of 132 women with overactive bladder and 100 women with stress urinary incontinence, enrolled at Severance Hospital. Risk factors of cardiovascular disease included age, obesity, hypertension, diabetes, impaired fasting glucose, dyslipidemia, cardiovascular disease and familial history of cardiovascular disease. Results The two groups had no difference with cardiovascular disease, history of cardiovascular disease, age, obesity, smoking, alcohol, hypertension, dyslipidemia, excluding diabetes. In the univariate logistic regression analysis, diabetes was associated with prevalence of overactive bladder than stress urinary incontinence. In the multiple logistic regression analysis, there was no factor which had influence on the status of urinary incontinence. Conclusion While most risk factors of cardiovascular disease were not associated with overactive bladder, this study suggests that diabetes may have influence to overactive bladder than stress urinary incontinence.

Characterization of Bladder Selectivity of Antimuscarinic Agents on the Basis of In Vivo Drug-Receptor Binding

Shizuo Yamada,Shiori Kuraoka,Yoshihiko Ito 대한배뇨장애요실금학회 2012 International Neurourology Journal Vol.16 No.3

The in vivo muscarinic receptor binding of antimuscarinic agents (oxybutynin, solifenacin, tolterodine, and imidafenacin) used to treat urinary dysfunction in patients with overactive bladder is reviewed. Transdermal administration of oxybutynin in rats leads to significant binding of muscarinic receptors in the bladder without long-term binding in the submaxillary gland and the abolishment of salivation evoked by oral oxybutynin. Oral solifenacin shows significant and long-lasting binding to muscarinic receptors in mouse tissues expressing the M3 subtype. Oral tolterodine binds more selectively to muscarinic receptors in the bladder than in the submaxillary gland in mice. The muscarinic receptor binding of oral imidafenacin in rats is more selective and longer-lasting in the bladder than in other tissues such as the submaxillary gland, heart, colon, lung, and brain, suggesting preferential muscarinic receptor binding in the bladder. In vivo quantitative autoradiography with (+)N-[11C]methyl-3-piperidyl benzilate in rats shows significant occupancy of brain muscarinic receptors with the intravenous injection of oxybutynin, solifenacin, and tolterodine. The estimated in vivo selectivity in brain is significantly greater for solifenacin and tolterodine than for oxybutynin. Imidafenacin occupies few brain muscarinic receptors. Similar findings for oral oxybutynin were observed with positron emission tomography in conscious rhesus monkeys with a significant disturbance of short-term memory. The newer generation of antimuscarinic agents may be advantageous in terms of bladder selectivity after systemic administration.

Relationship between Lower Urinary Tract Dysfunction and Dementia

Na Hae Ri,조성태 대한치매학회 2020 Dementia and Neurocognitive Disorders Vol.19 No.3

Lower urinary tract dysfunction (LUTD) is a common health challenge in dementia patients with significant morbidity and socioeconomic burden. It often causes lower urinary tract (LUT) symptoms, restricts activities of daily life, and impairs quality of life. Among several LUT symptoms, urinary incontinence (UI) is the most prominent storage symptom in the later stages of dementia. UI in patients with dementia results not only from cognitive impairment, but also from urological defects such as detrusor overactivity. Management of LUTD in patients with dementia is based on multiple factors, including cognitive state, functional impairment, concurrent comorbidities, polypharmacy and urologic condition. Behavioral therapy under caregiver support represents appropriate treatment strategy for UI in these patients. Pharmacological treatment can be considered in patients refractory to behavioral therapy, but it is more effective when combined with behavioral therapy. Antimuscarinics and mirabegron, a beta-3 receptor agonist, are effective for managing storage symptoms involving the LUT. However, anticholinergic side effects in elderly subjects are a concern, particularly when there is a risk of exacerbating cognitive impairment with prolonged use of antimuscarinics. Proper recognition and treatment of LUTD in dementia can improve quality of life in these patients.

과민성방광 여성 환자의 성생활에 관한 지각된 질병의거변화의 영향요인

조정림(Cho, Jeong Lim),이은남(Lee, Eun Nam) 대한근관절건강학회 2013 근관절건강학회지 Vol.20 No.1

Purpose: This study was conducted to explore factors that influence illness intrusiveness of the sexual life in women with overactive bladder. Methods: Ninety-two women diagnosed with overactive bladder, from D University Hospital and three private urology hospitals in B region, participated in a survey between April 7 and August 7, 2012. The Overactive Bladderquestionnaire (OAB-q), the Marital Intimacy Tool, the Center for Epidemiologic Studies Depression (CES-D), and 1 question to ask illness intrusiveness of the sexual life were used in the study. Results: The illness intrusiveness score of the sexual life in women with overactive bladder was 2.22 out of 5. There were no significant differences of illness intrusiveness by demographic and disease related characteristics. The predictor were the clinical symptom score and depression, accounting for 13% of the variance of the illness intrusiveness of the sexual life in the women with overactive bladder. Conclusion: Effective nursing intervention to relieve clinical signs of overactive bladder and reduce depression can improve quality of sexual life in women with overactive bladder.

Maximum Voided Volume Is a Better Clinical Parameter for Bladder Capacity Than Maximum Cystometric Capacity in Patients With Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: A Prospective Cohort Study

김민혁,서준교,공현중,오승준 대한배뇨장애요실금학회 2022 International Neurourology Journal Vol.26 No.4

Purpose: Bladder capacity is an important parameter in the diagnosis of lower urinary tract dysfunction. We aimed to determine whether the maximum bladder capacity (MCC) measured during a urodynamic study was affected by involuntary detrusor contraction (IDC) in patients with Lower Urinary Tract Symptoms (LUTS)/Benign Prostatic Hyperplasia (BPH). Methods: Between March 2020 and April 2021, we obtained maximum voided volume (MVV) from a 3-day frequency-volume chart, MCC during filling cystometry, and maximum anesthetic bladder capacity (MABC) during holmium laser enucleation of the prostate under spinal or general anesthesia in 139 men with LUTS/BPH aged >50 years. Patients were divided according to the presence of IDC during filling cystometry. We assumed that the MABC is close to the true value of the MCC, as it is measured under the condition of minimizing neural influence over the bladder. Results: There was no difference in demographic and clinical characteristics between the non-IDC (n=20) and IDC groups (n=119) (mean age, 71.5±7.4) (P>0.05). The non-IDC group had greater bladder volume to feel the first sensation, first desire, and strong desire than the IDC group (P<0.001). In all patients, MABC and MVV were correlated (r=0.41, P<0.001); however, there was no correlation between MCC and MABC (r=0.19, P=0.02). There was no significant difference in MABC between the non-IDC and IDC groups (P=0.19), but MVV and MCC were significantly greater in the non-IDC group (P<0.001). There was no significant difference between MABC and MVV (MABC-MVV, P=0.54; MVV/MABC, P=0.07), but there was a significant difference between MABC and MCC between the non-IDC and IDC groups (MABC-MCC, P<0.001; MCC/MABC, P<0.001). Conclusions: Maximum bladder capacity from a urodynamic study does not represent true bladder capacity because of involuntary contractions.

Eight-Year Experience With Botulinum Toxin Type-A Injections for the Treatment of Nonneurogenic Overactive Bladder: Are Repeated Injections Worthwhile?

Shannon HK Kim,David Habashy,Sana Pathan,Vincent Tse,Ruth Collins,Lewis Chan 대한배뇨장애요실금학회 2016 International Neurourology Journal Vol.20 No.1

Purpose: To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drugrefractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome. Methods: Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson’s chi-square tests. Results: Fifty-two patients with a mean age of 67.4 years (range, 26–93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9–101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥70 years) and younger (<70 years) patient cohorts. Conclusions: Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.

Intravesical electrical stimulation treatment for overactive bladder: An observational study

J. Joshua Yune,Jim K. Shen,Matthew A. Pierce,Jeffrey S. Hardesty,Joo Kim,Sam Siddighi 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.4

Purpose: Intravesical electrical stimulation treatment (IVES) has been successfully used to treat neurogenic bladder. We report the results of an observational study regarding the use of IVES for women with overactive bladder syndrome (OAB) and/or urgency urinary incontinence (UUI). Materials and Methods: IVES was performed in women with OAB (defined by frequency ≥8/day, nocturia ≥2/night, or ≥3 episodes of UUI on 3-day voiding diary) who failed prior medical therapy. Subjects underwent 4 weeks of treatment with an 8-Fr Detruset™ IVES catheter. Primary outcome was Patient Global Impression of Improvement (PGI-I) at 3 months. Secondary outcomes included Visual Analog Scale (VAS), Short Form OAB Questionnaire (OAB-q SF), Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ), reduction in frequency and UUI on voiding diary, and adverse effects. Analysis was done with paired t-tests and Wilcoxon signed rank tests. Results: Seventeen subjects completed the study. At 4 weeks post-treatment, 15 improved on PGI-I (11 subjects: ‘a little better’, 2: ‘much better’, 2: ‘very much better’). There were significant improvements in symptom bother and health-related quality of life as measured by OAB-q SF and pelvic organ prolapse and urinary distress as measured by PFDI. Frequency decreased from 10.3±4.3 at baseline to 8.9±2.3 (p=0.04) at 3 months. No pain was reported during treatment. There was one urinary tract infection during the study period. No other adverse events were reported. Conclusions: IVES appears to be a safe and effective novel treatment for OAB. Larger comparative studies are needed to investigate its potential for long-term treatment.

Expression of bladder α1-adrenoceptor subtype after relief of partial bladder outlet obstruction in a rat model

이지용,박종목,나용길,송기학,임재성,양승우,김건화,신주현 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.3

Purpose: Many patients with benign prostatic hyperplasia require treatment for persistent storage symptoms, even when the obstruction is successfully relieved by surgery. Previous studies identified a characteristic increase in α1D-adrenoceptor levels in the bladder in a bladder outlet obstruction (BOO) model. Here, we investigated the expression of α1-adrenoceptor subtypes in the bladder after relief of partial BOO (pBOO) in a rat model. Materials and Methods: A total of 60 female Sprague–Dawley rats were randomly divided into three groups (sham-operated, pBOO, and pBOO relief groups), and the expression of α1-adrenoceptor subtypes in the urothelium and detrusor muscle tissues was examined by western blot. Results: The expression of the α1D-adrenoceptor was significantly higher in the urothelium and detrusor muscle tissue of the pBOO and pBOO relief groups than in the corresponding tissue of the sham-operated group. Additionally, the α1A-adrenoceptor was predominant in the sham-operated group but significantly decreased in the urothelium in the pBOO group. No significant differences were found in α1A-adrenoceptor levels in detrusor muscle or whole bladder. Conclusions: Our results showed that α1D-adrenoceptor levels were consistently increased with pBOO, even after relief, suggesting that the α1D-adrenoceptor might be a cause of persistent storage symptoms after relief of pBOO.