De novo urge syndrome and detrusor instability after anti-incontinence surgery: Current concepts, evaluation, and treatment

Kershen, Richard T.; Appell, Rodney A.

doi:10.1007/s11934-002-0075-7

Cited by 31 publications

(29 citation statements)

References 68 publications

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“…In a review of the literature, the incidence of de novo OAB in the setting of BOO ranges from 38-100% [2,5]. In addition, the incidence of de novo urodynamic detrusor overactivity after SUI surgery can approach 30% in some series [3]. While obstructive voiding symptoms resolve consistently in the range of 70-80%, efficacy with respect to OAB is much more variable in our experience.…”

Section: Discussionmentioning

confidence: 83%

“…Several theories have been proposed including denervation sensitivity leading to altered detrusor responsiveness, altered afferent pathways involving cholinergic and purinergic neurotransmission, and urothelial mechanisms [3,5,15]. More recently, impaired perfusion has been shown to correlate with persistent detrusor overactivity in a population of men undergoing TURP for BOO [16], and this deserves further study in similarly obstructed women.…”

Section: Discussionmentioning

confidence: 99%

“…While the clinical presentation of iatrogenic BOO is classically thought of in terms of obstructive voiding and urinary retention, it has become evident that a wide spectrum of lower urinary tract symptoms (LUTS), including the overactive bladder (OAB) symptom complex, is relatively common [3]. In fact, in a large urethrolysis cohort, Carr and Webster [4] noted that OAB symptoms were the most common presenting complaint, occurring in 75% of women, most of whom displayed normal voiding parameters.…”

Section: Introductionmentioning

confidence: 99%

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Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation

et al. 2007

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Refractory overactive bladder (OAB) after urethrolysis for iatrogenic bladder outlet obstruction (BOO) is a clinical dilemma without established guidelines for management. We sought to evaluate the efficacy of sacral neuromodulation (SNM) in the management of this complex patient population. Retrospective review identified eight patients who underwent SNM secondary to refractory OAB after urethrolysis or sling take-down. SNM was performed with the Interstim device (Medtronic, Minneapolis) using a two-stage implant technique. SNM outcomes were determined subjectively during follow-up. Validated questionnaires were completed to assess symptom bother, patient satisfaction, and quality of life. Statistical analyses were conducted using Stata version 9.0. Six patients had a favorable response to SNM during test stimulation and underwent implantation of the implantable pulse generator (IPG). With follow-up of 15.7 +/- 11.1 months (6-34), all patients significantly improved, with three patients being dry and three patients having one to two urgency incontinence episodes per week. Patient-reported outcomes indicated that patients perceived themselves as very much improved (3) or much improved (3) after SNM, while those failing test stimulation perceived no change. Quality of life and symptom bother were significantly better in SNM responders vs nonresponders. SNM appears to be an effective and viable treatment option in this complex patient population. Further work is needed to determine clinical factors predictive of outcome and durability of response.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation

et al. 2007

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“…De novo OAB is a known complication of suburethral sling insertion and the incidence had been reported to vary from 3.1-25.9%. [33][34][35][36][37] In patients with refractory OAB, sling excision was found to relieve the OAB symptoms in 28-64% of patients. 38 In our opinion, identifying underlying causes of OAB symptoms should occur before empiric OAB therapies begin.…”

Section: Discussionmentioning

confidence: 99%

Urogynecological conditions associated with overactive bladder symptoms in women

Forde

Davila

Marks³

et al. 2017

CUAJ

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Cite as: Can Urol Assoc J 2017;11(3-4):E83-7. http://dx.doi.org/10.5489/cuaj.3962 Published online March 16, 2017 Abstract Introduction: Overactive bladder symptoms (OAB) affect 9-43% of women and are associated with underlying disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The aim of this study is to identify urogynecological conditions associated with OAB symptoms. Methods: This prospective, institutional review board-approved study included women referred to a tertiary centre with lower urinary tract symptoms (LUTS). All women completed the selfadministered OAB questionnaire (OABSS). Those with an OABSS ≥8, the cutoff, were considered to have OAB symptoms. Patients underwent a history and physical examination (including BadenWalker prolapse grading and stress test), 24-hour voiding diary, pad test (for urinary incontinence), urinalysis, and uroflow with post-void residual volume. Patients were classified clinically into the following: idiopathic OAB, SUI, POP, bladder outlet obstruction (BOO) neurogenic bladder (NGB), recurrent urinary tract infection (UTI), and miscellaneous. Results: In total, 148 women met the inclusion criteria with a mean age of 67 years. Only 27% had no comorbid conditions and were considered idiopathic OAB. Associated urogynecological conditions included SUI in 37%, POP in 26%, miscellaneous conditions in 18%, recurrent UTI in 11%, NGB in 9%, and BOO in 8%. Some patients met criteria for more than one category, thus the total is greater than 100%. Conclusions: In a tertiary care setting, a significant proportion of women with OAB symptoms have underlying conditions that may cause or contribute to their symptoms. Appropriate evaluation is desirable to enhance our understanding of the relationship of these conditions to the diagnosis, treatment, outcomes, and pathophysiology of OAB.

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“…Long-term urinary retention, de novo urge incontinence, and detrusor overactivity are known complications of SUI surgery [23,24]. Indeed, SUI may be cured only for it to be replaced by side effects that the patient considers to be even worse [25,26].…”

Section: Long-term Safety Profilementioning

confidence: 99%

Patient-perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy

et al. 2006

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Intervention for stress urinary incontinence (SUI) is generally focused on minimizing urinary leakage. However, the overall impact of SUI therapy on patients' quality of life is, arguably, more important than leakage outcomes. We performed a literature search to investigate the effect of urethral injection therapy on quality of life. Significant quality-of-life improvements have been observed with a number of injectable agents, while there is a distinct lack of correlation between subjective and objective outcomes. Two studies comparing urethral injection therapy with surgical intervention found superior objective efficacy with surgery, but no significant differences in quality-of-life improvements. Personal goals of patients undergoing urethral injection are yet to be explored, but there may be willingness to trade a lower success rate in favor of a more minor treatment procedure. In conclusion, quality-of-life improvements after urethral injection appear significant and comparable to those obtained with surgery. Further study of patients' own perceptions, pre- and posttreatment, would be valuable.

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De novo urge syndrome and detrusor instability after anti-incontinence surgery: Current concepts, evaluation, and treatment

Cited by 31 publications

References 68 publications

Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation

Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation

Urogynecological conditions associated with overactive bladder symptoms in women

Patient-perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy

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