Nadczynność pęcherza – Rokowania, prognozy i postęp choroby

Nadczynność pęcherza
Rokowania, prognozy i postęp choroby

Nadczynność pęcherza moczowego (OAB) charakteryzuje się parciami nagłymi, zwiększoną częstotliwością mikcji i nokturii, z lub bez nietrzymania moczu z parcia, przy braku infekcji. Częstość występowania wynosi 9-43% u kobiet i 7-27% u mężczyzn. Kluczowymi parametrami prognostycznymi są wskaźnik nadaktywności (OI) oraz stosunek maksymalnej pojemności cystometrycznej (MCC) do oczekiwanej pojemności pęcherza (EBC), gdzie wzrost MCC koreluje z lepszymi wynikami leczenia. Leczenie toksyną botulinową typu A (BTX-A) wykazuje skuteczność na poziomie 66% po pierwszej iniekcji, a pozytywna odpowiedź na pierwszą dawkę jest dobrym predyktorem sukcesu kolejnych. W diagnostyce i monitorowaniu OAB u dzieci przydatne są nieinwazyjne biomarkery, takie jak grubość ściany pęcherza (BWTh) oraz poziomy nerwowego czynnika wzrostu (NGF/Cr), które wykazują czułość i swoistość powyżej 85%. Wykazano także związek między stanem zapalnym a OAB, gdzie podwyższony systemowy wskaźnik odporności i stanu zapalnego (SII) koreluje ze zwiększonym ryzykiem rozwoju zespołu, szczególnie u osób z niższym wykształceniem (OR 1,476) i niskim wskaźnikiem ubóstwa (OR 1,324).

Prognoza nadczynności pęcherza moczowego

Czynniki prognostyczne w leczeniu nadczynności pęcherza
Biomarkery i narzędzia predykcyjne w nadczynności pęcherza
Przewidywanie wyniku leczenia po operacjach ginekologicznych
Czynniki ryzyka czystego przerywanego cewnikowania po leczeniu toksyną botulinową

Zastosowanie uczenia maszynowego w prognozowaniu wyników leczenia OAB
Modele predykcyjne dla ryzyka nadczynności pęcherza
Czas do uzyskania efektów leczenia i ogólna prognoza

Przewidywanie wyników u dzieci z OAB
Podsumowanie prognozy w nadczynności pęcherza
Kolejne rozdziały

Prognoza nadczynności pęcherza moczowego

Nadczynność pęcherza moczowego (ang. Overactive Bladder, OAB) stanowi złożony zespół objawów charakteryzujący się parciami nagłymi, zwiększoną częstotliwością mikcji, nokturią, z lub bez towarzyszącego nietrzymania moczu z parcia, przy braku infekcji lub innych ewidentnych patologii. Częstość występowania OAB waha się od 9% do 43% u kobiet i od 7% do 27% u mężczyzn.¹ Przewidywanie wyników leczenia oraz identyfikacja czynników ryzyka stanowią istotny element postępowania terapeutycznego w OAB.

Czynniki prognostyczne w leczeniu nadczynności pęcherza

Badania wykazały, że obserwacja nadaktywności wypieracza (detrusor overactivity, DO) oraz maksymalnej pojemności cystometrycznej (maximum cystometric capacity, MCC) może ukierunkować racjonalną farmakoterapię. Silna korelacja wskaźnika nadaktywności (overactivity index, OI) oraz stosunku MCC do oczekiwanej pojemności pęcherza (expected bladder capacity, EBC) jest użyteczna, ponieważ wzrost MCC jest czynnikiem predykcyjnym pozytywnego wyniku leczenia.² OI okazał się istotnym predyktorem obecności objawów OAB i korelował z liczbą epizodów parć naglących. Może on szacować, jak bardzo MCC różni się od EBC.³

W przypadku leczenia zabiegowego nadczynności pęcherza moczowego, istotną rolę odgrywają czynniki prognostyczne określające skuteczność terapii. W przypadku iniekcji toksyny botulinowej typu A (BTX-A), pozytywna odpowiedź była obserwowana u 90 pacjentów (66%) po pierwszej iniekcji. Co istotne, odpowiedź na pierwszą iniekcję może być dobrym predyktorem sukcesu po drugim podaniu leku.⁴ Żaden z badanych parametrów nie okazał się jednak jednoznacznym predyktorem pozytywnej odpowiedzi na leczenie, choć zaobserwowano tendencję do niższej skuteczności u kobiet po wcześniejszej operacji implantacji taśmy podcewkowej z powodu wysiłkowego nietrzymania moczu (p = 0,06).⁵

Biomarkery i narzędzia predykcyjne w nadczynności pęcherza

Badania wskazują na istnienie związku między stanem zapalnym a rozwojem nadczynności pęcherza moczowego. Wykazano pozytywną korelację między poziomami wskaźnika odporności systemowej i stanu zapalnego (systemic immunity-inflammation index, SII) a OAB, co sugeruje, że wyższe poziomy SII są związane ze zwiększonym ryzykiem rozwoju OAB. Wyniki analiz podgrup dotyczących poziomów edukacji i wskaźnika ubóstwa pozostają solidne i stabilne, przy czym najwyższe ryzyko obserwowano u osób z wykształceniem niższym niż średnie (OR 1,476, 95% CI 1,194-1,824) oraz wskaźnikiem ubóstwa ≤1 (OR 1,324, 95% CI 1,106-1,587). Wyniki te sugerują, że podwyższone poziomy SII mogą przyczyniać się do zwiększonej częstości występowania OAB i potencjalnie mogą być wykorzystane jako opłacalny i bezpośredni biomarker do wykrywania OAB.⁶

Inne potencjalne biomarkery moczu, w tym ATP, acetylocholina (ACh), tlenek azotu (NO), azotyny, MCP-1 i IL-5, były badane pod kątem ich zdolności do przewidywania wysokiego wyniku objawowego OAB. Jednakże w analizie regresji logistycznej tylko wiek wykazał statystycznie istotną moc predykcyjną.⁷ Dokładność diagnostyczna opracowanych modeli logistycznych w rozróżnianiu grupy z wysokim wynikiem objawowym OAB od grupy z niskim wynikiem objawowym OAB została oceniona za pomocą analizy ROC. Wszystkie sześć modeli logistycznych wykazało wyższe wartości NPV i PPV w porównaniu do samego DO, zarówno przy niższej, jak i wyższej częstości występowania, zarówno u kobiet, jak i u mężczyzn.⁸

W przypadku dzieci z OAB, pomiary grubości ściany pęcherza (bladder wall thickness, BWTh) i wartości czynnika wzrostu nerwów (nerve growth factor, NGF/Cr) mogą służyć jako nieinwazyjne narzędzia do przewidywania problemów z oddawaniem moczu w ciągu dnia. W analizie ROC, pomiar grubości ściany pęcherza wykazał czułość 85% i swoistość 84,2% w przewidywaniu wyników leczenia u dzieci z OAB. Z kolei NGF/Cr miał czułość 90% i swoistość 92,1% w prognozowaniu efektów terapii.⁹ Po uroterapii 22 dzieci miało podobne wartości BWTh i NGF/Cr w porównaniu do grupy kontrolnej. Po leczeniu antycholinergicznym wartości BWTh i NGF/Cr nie różniły się istotnie od grupy kontrolnej.¹⁰

Przewidywanie wyniku leczenia po operacjach ginekologicznych

Badania fokusujące się na czynnikach przewidujących obecność objawów OAB po operacji wypadania narządów miednicy (pelvic organ prolapse, POP) wykazały, że najlepszym predyktorem braku objawów pooperacyjnych był brak uciążliwych objawów OAB przed operacją.¹¹ Co ciekawe, operacja z użyciem materiału z siatki pochwowej (Prolift) miała korzystny wpływ na objawy parcia naglącego w porównaniu do konwencjonalnej chirurgii. Brak noktturii chronił przed pooperacyjną częstotliwością oddawania moczu i noctturią, z OR wynoszącym ponad 7 (aż do 7,4; 95% CI 4,2; 13,2).¹²

Ogólnie po operacji POP zaobserwowano poprawę objawów OAB, co jest zgodne z istniejącą literaturą. Częstotliwość oddawania moczu i parcia naglące były bardziej skłonne do poprawy lub zniknięcia w porównaniu do nietrzymania moczu z parcia i noktturii. De novo uciążliwe objawy OAB pojawiły się u 56% kobiet.¹³

Czynniki ryzyka czystego przerywanego cewnikowania po leczeniu toksyną botulinową

W przypadku kobiet poddawanych pierwszemu leczeniu toksyną botulinową typu A (BTX-A), częstość występowania czystego przerywanego cewnikowania (clean intermittent catheterization, CIC) wyniosła 8,6% (n=34).¹⁴ Nietrzymanie moczu z parcia (urgency urinary incontinence, UUI) zmniejszało ryzyko konieczności stosowania CIC (OR 0,30, 95% CI 0,09-0,97). Pojemność pęcherza wynosząca 500 ml lub więcej w dzienniku pęcherza zwiększała ryzyko CIC (OR 2,46, 95% CI 1,06-5,70), podczas gdy zgłaszane epizody wycieku moczu były związane ze zmniejszonym ryzykiem CIC (OR 0,24, 95% CI 0,10-0,57).¹⁵

Wieloczynnikowa analiza regresji logistycznej wykazała, że plastyka przedniej ściany pochwy (OR 3,71, 95% CI 1,52-9,06) i przyrosty o 10 ml w medianie maksymalnej pojemności cystometrycznej (OR 1,03, 95% CI 1,00-1,06) przewidywały konieczność CIC, podczas gdy UUI było czynnikiem ochronnym przed CIC (OR 0,23, 95% CI 0,07-0,79).¹⁶ Historia plastyki przedniej ściany pochwy, duża pojemność pęcherza oraz brak epizodów nietrzymania moczu w dzienniku pęcherza lub w badaniu urodynamicznym (UDS) były czynnikami ryzyka CIC po pierwszym leczeniu BTX-A.¹⁷

Zastosowanie uczenia maszynowego w prognozowaniu wyników leczenia OAB

Wykorzystując nowatorskie podejście uczenia maszynowego (machine learning, ML), naukowcy opracowali algorytmy do przewidywania wyników pacjentów po leczeniu OAB za pomocą iniekcji OnabotulinumtoxinA (OBTX-A) i neuromodulacji krzyżowej (sacral neuromodulation, SNM).¹⁸ Wytrenowane algorytmy wykazały doskonałą dokładność w przewidywaniu odpowiedzi na leczenie (OBTX-A: AUC 0,95; SNM: 0,88). Algorytmy okazały się lepsze od ekspertów w przewidywaniu odpowiedzi na leczenie OBTX-A i nie gorsze od ekspertów w przewidywaniu odpowiedzi na SNM.¹⁹

W kolejnej analizie, najlepsze algorytmy wykazały doskonałą dokładność predykcyjną dla poprawy funkcji pęcherza zgłaszanej przez pacjentów zarówno dla OBTX-A (AUC 0,86), jak i SNM (AUC 0,96) i były nie gorsze niż oceny ekspertów urologów. Algorytmy były również wysoce dokładne w przewidywaniu poprawy wycieku moczu zgłaszanej przez pacjentów dla obu metod leczenia (AUC 0,75 dla OBTX-A i 0,80 dla SNM) i były nie gorsze niż eksperci.²⁰

Badacze zasugerowali, że wyniki te mogą być zastosowane nie tylko w leczeniu OAB czy w urologii, ale w każdym kontekście, gdzie konieczna jest decyzja oparta na danych. Może istnieć podgrupa pacjentów, zdefiniowana przez wiek, parametry badania pęcherza lub inne zmienne, które mogą pomóc w doradzaniu pacjentom na temat potencjalnego ryzyka.²¹

Modele predykcyjne dla ryzyka nadczynności pęcherza

Dokładny model predykcyjny mógłby identyfikować osoby z wysokim ryzykiem wystąpienia OAB wśród populacji ogólnej i umożliwić wczesną profilaktykę, co może obniżyć związane z tym koszty medyczne. Jednak do tej pory nie opracowano skutecznego modelu do przewidywania wystąpienia OAB.²² Trwają badania nad opracowaniem modelu do przewidywania wystąpienia OAB w ciągu 5 lat w populacji ogólnej.²³

Jeśli uda się opracować dokładny model predykcyjny, osoby z wysokim ryzykiem mogłyby zostać zidentyfikowane i zachęcone do zmiany nawyków na wczesnym etapie, co mogłoby zapobiec wystąpieniu OAB i zaoszczędzić koszty medyczne związane z farmakoterapią.²⁴ Modele predykcyjne dla OAB będą musiały zostać zewnętrznie zwalidowane, a ich wpływ na praktykę kliniczną powinien zostać zbadany.²⁵

Czas do uzyskania efektów leczenia i ogólna prognoza

Objawy nadczynności pęcherza moczowego mogą powodować znaczny stres. Leczenie może być trudne do prowadzenia, a objawy mogą nigdy całkowicie nie ustąpić. Jednak wiele osób jest zadowolonych z otrzymanego leczenia i często doświadcza dramatycznej poprawy jakości życia.²⁶

Ćwiczenia mięśni dna miednicy i zmiany stylu życia mogą wymagać od sześciu do ośmiu tygodni, zanim zaczną dawać rezultaty. Wiele leków zaczyna relaksować mięśnie pęcherza już po kilku godzinach, ale może minąć do miesiąca, zanim zaczną w pełni działać. Większość pacjentów zaczyna obserwować poprawę po sześciu zabiegach stymulacji nerwów, jednak może być potrzebnych nawet 12 zabiegów, aby zobaczyć rezultaty.²⁷

Metoda leczenia	Czas do uzyskania efektu	Skuteczność	Czynniki prognostyczne pozytywnej odpowiedzi
Ćwiczenia mięśni dna miednicy	6-8 tygodni	Zmienna	Regularne wykonywanie ćwiczeń
Farmakoterapia	Kilka godzin do 1 miesiąca	Umiarkowana	Brak wcześniejszego leczenia OAB
Toksyna botulinowa (BTX-A)	1-2 tygodnie	66% po pierwszej iniekcji	Pozytywna odpowiedź na pierwszą iniekcję, obecność UUI
Neuromodulacja krzyżowa (SNM)	6-12 zabiegów	Wysoka (AUC 0,88)	Przewidywane przez algorytmy ML

Przewidywanie wyników u dzieci z OAB

W przypadku dzieci z OAB, pomiary grubości ściany pęcherza i poziomy NGF/Cr mogą służyć jako nieinwazyjne narzędzia do przewidywania problemów z mikcją w ciągu dnia i efektów leczenia.²⁸ Po leczeniu antycholinergicznym, pogrubiona ściana pęcherza i w konsekwencji poziomy NGF/Cr zmniejszyły się (podobnie jak w grupie kontrolnej) w odpowiedzi na leczenie antycholinergiczne.²⁹

Badanie to jest pierwszym, które ocenia kombinację NGF w moczu i grubości ściany pęcherza u dzieci z OAB, co może służyć jako nieinwazyjne narzędzie do oceny wyników leczenia OAB.³⁰

Podsumowanie prognozy w nadczynności pęcherza

Ogólnie rzecz biorąc, prognoza w nadczynności pęcherza moczowego jest pozytywna, szczególnie gdy pacjenci otrzymują odpowiednie leczenie. Chociaż objawy mogą nigdy całkowicie nie ustąpić, znaczna większość pacjentów doświadcza istotnej poprawy jakości życia. Rozwój nowych biomarkerów, modeli predykcyjnych i zastosowanie uczenia maszynowego obiecuje lepszą identyfikację pacjentów z wysokim ryzykiem OAB oraz bardziej spersonalizowane podejście do leczenia.³¹³²³³

Nowe algorytmy uczenia maszynowego oferują dokładne przewidywanie odpowiedzi na leczenie, przewyższając ekspertów urologów w przewidywaniu wyników OBTX-A i będąc nie gorsze niż eksperci w przewidywaniu wyników SNM.³⁴ Takie narzędzia prognostyczne mogą pomóc w identyfikacji pacjentów, którzy najprawdopodobniej odniosą korzyści z konkretnych interwencji, co może prowadzić do bardziej spersonalizowanego leczenia i lepszych wyników klinicznych.³⁵

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Materiały źródłowe

#1 New participant stratification and combination of urinary biomarkers and confounders could improve diagnostic accuracy for overactive bladder | Scientific Reports
https://www.nature.com/articles/s41598-020-59973-6
Overactive bladder (OAB) is a highly prevalent symptom complex characterised by symptoms of urinary urgency, increased frequency, nocturia, with or without urge incontinence; in the absence of proven infection or other obvious pathology. […] Current diagnostic approaches are based on discordant measures, suffer from subjectivity and are incapable of detecting the proposed OAB phenotypes. […] Therefore, this study provides the foundation for the development of novel non-invasive diagnostic tools for OAB phenotypes that may lead to personalised treatment. […] The prevalence of OAB ranges between 9% to 43% and 7% to 27% in female and male, respectively. […] Therefore, there is an unmet need for an objective OAB symptom-based classification approach. […] The individual ability of the candidate urinary biomarkers (including ATP, ACh, NO, Nitrite, MCP-1 and IL-5), and confounders (age and gender) in predicting the identified high OAB symptomatic score group (cluster 2) from the low OAB symptomatic score group (cluster 1) was assessed using binary logistic regression.
#2 Overactivity index: A noninvasive and objective outcome measure in overactive bladder in children – PubMed
https://pubmed.ncbi.nlm.nih.gov/35474164/
Reports showed that observing detrusor overactivity (DO) and maximum cystometric capacity (MCC) may guide rational pharmacotherapy. […] A strong correlation of OI and MCC/EBC ratio is useful, as rise in MCC is predictive of a positive outcome. […] OI was found to be a significant predictor of the presence of OAB symptoms and correlated with the number of urgency episodes. It could estimate how much MCC differs from EBC.
#3 Overactivity index: A noninvasive and objective outcome measure in overactive bladder in children – PubMed
https://pubmed.ncbi.nlm.nih.gov/35474164/
Reports showed that observing detrusor overactivity (DO) and maximum cystometric capacity (MCC) may guide rational pharmacotherapy. […] A strong correlation of OI and MCC/EBC ratio is useful, as rise in MCC is predictive of a positive outcome. […] OI was found to be a significant predictor of the presence of OAB symptoms and correlated with the number of urgency episodes. It could estimate how much MCC differs from EBC.
#4
https://journals.lww.com/pbj/fulltext/2022/04000/treatment_of_idiopathic_overactive_bladder_with.2.aspx
A positive response was obtained in 90 patients (66%) after the first injection. […] In real clinical practice, BTX-A injection is an effective (66%) and safe treatment, capable of improving quality of life. Moreover, responding to the first injection seems to predict good clinical outcomes in the second treatment. […] On univariate analyses, none of the parameters evaluated was useful of predicting successful response, although there was a trend in women who had had a previous midurethral sling surgery for stress urinary incontinence, to have a lower chance of having a positive response after the first injection (P = .06). […] This could lead us to suspect that a favorable clinical response to the first treatment can be used as a good predictor of a successful response to a second treatment.
#5
https://journals.lww.com/pbj/fulltext/2022/04000/treatment_of_idiopathic_overactive_bladder_with.2.aspx
A positive response was obtained in 90 patients (66%) after the first injection. […] In real clinical practice, BTX-A injection is an effective (66%) and safe treatment, capable of improving quality of life. Moreover, responding to the first injection seems to predict good clinical outcomes in the second treatment. […] On univariate analyses, none of the parameters evaluated was useful of predicting successful response, although there was a trend in women who had had a previous midurethral sling surgery for stress urinary incontinence, to have a lower chance of having a positive response after the first injection (P = .06). […] This could lead us to suspect that a favorable clinical response to the first treatment can be used as a good predictor of a successful response to a second treatment.
#6 The association between overactive bladder and systemic immunity-inflammation index: a cross-sectional study of NHANES 2005 to 2018 | Scientific Reports
https://www.nature.com/articles/s41598-024-63448-3
Current research indicate that inflammation is linked to the development of overactive bladder (OAB). […] Our study reveals a positive correlation between SII levels and OAB, indicating that higher SII levels are associated with an increased likelihood of developing OAB. […] The results of the subgroup analyses of educational levels and poverty ratio remain robust and stable, with the highest risk observed for those with less than a high school education (OR 1.476, 95% CI 1.1941.824) and poverty ratio1 (OR 1.324, 95% CI 1.1061.587), respectively. […] Our findings imply that increased SII levels are linked to OAB. This suggests that higher levels of SII may contribute to an increased incidence of OAB and could potentially be used as a cost-effective and direct biomarker for the detection of OAB.
#7 New participant stratification and combination of urinary biomarkers and confounders could improve diagnostic accuracy for overactive bladder | Scientific Reports
https://www.nature.com/articles/s41598-020-59973-6
Overactive bladder (OAB) is a highly prevalent symptom complex characterised by symptoms of urinary urgency, increased frequency, nocturia, with or without urge incontinence; in the absence of proven infection or other obvious pathology. […] Current diagnostic approaches are based on discordant measures, suffer from subjectivity and are incapable of detecting the proposed OAB phenotypes. […] Therefore, this study provides the foundation for the development of novel non-invasive diagnostic tools for OAB phenotypes that may lead to personalised treatment. […] The prevalence of OAB ranges between 9% to 43% and 7% to 27% in female and male, respectively. […] Therefore, there is an unmet need for an objective OAB symptom-based classification approach. […] The individual ability of the candidate urinary biomarkers (including ATP, ACh, NO, Nitrite, MCP-1 and IL-5), and confounders (age and gender) in predicting the identified high OAB symptomatic score group (cluster 2) from the low OAB symptomatic score group (cluster 1) was assessed using binary logistic regression.
#8 New participant stratification and combination of urinary biomarkers and confounders could improve diagnostic accuracy for overactive bladder | Scientific Reports
https://www.nature.com/articles/s41598-020-59973-6
Age was the only parameter that was shown to have statistically significant prediction power. […] The diagnostic accuracy of the developed logistic models in distinguishing the high OAB symptomatic score group (cluster 2) from the low OAB symptomatic score group (cluster 1) was assessed by ROC analysis. […] All the six logistic models were shown to have higher NPV and PPV values compared to DO at both lower and higher end of the prevalence range for both female and male. […] This study provides the foundation for the development of novel non-invasive diagnostic tools for OAB, where the effects of biomarkers and key OAB confounders could be considered in conjunction.
#9 SciELO Brazil – Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with overactive bladder? Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with ov
https://www.scielo.br/j/ibju/a/dYybtqfbrKdwkJDWvrymcgd/?lang=en
Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). […] Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder. […] In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% in predicting treatment outcome in children with OAB. […] NGF/Cr had sensitivity of 90% and specificity of 92.1% in predicting treatment outcome in children with OAB. […] The mean bladder wall thickness was significantly higher in group 1 compared to group 2. […] After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls.
#10 SciELO Brazil – Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with overactive bladder? Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with ov
https://www.scielo.br/j/ibju/a/dYybtqfbrKdwkJDWvrymcgd/?lang=en
After anticholinergic treatment, BWTh levels and NGF/Cr values had no significantly difference compared to controls. […] Eighteen children had significantly higher BWTh and NGF/Cr although they received urotherapy. […] After anticholinergic treatment, the thickened bladder wall and therefore NGF/Cr decreased (similar with controls) in response to the anticholinergic treatment. […] To our knowledge, the present study is the first to evaluate the combination of urinary NGF and bladder wall thickness in children with OAB, which may serve as a noninvasive tool for outcome of treatment in OAB.
#11
https://link.springer.com/article/10.1007/s00192-010-1152-y
This study focussed on the factors which predict the presence of symptoms of overactive bladder (OAB) after surgery for pelvic organ prolapse (POP). […] The best predictor for the absence of postoperative symptoms was the absence of preoperative bothersome OAB symptoms. […] The absence of bothersome OAB symptoms preoperatively was the best predictor for the absence of postoperative symptoms. […] The absence of preoperative OAB symptoms was by far the best predictor for the absence of postoperative OAB symptoms. […] Interestingly, we have found that an operation with the use of vaginal mesh material (Prolift) had a favourable effect on urgency symptoms as compared to conventional surgery. […] The absence of nocturia protected against postoperative frequency and nocturia, with an OR of more than 7 (as high as 7.4 (95% CI 4.2; 13.2)).
#12
https://link.springer.com/article/10.1007/s00192-010-1152-y
This study focussed on the factors which predict the presence of symptoms of overactive bladder (OAB) after surgery for pelvic organ prolapse (POP). […] The best predictor for the absence of postoperative symptoms was the absence of preoperative bothersome OAB symptoms. […] The absence of bothersome OAB symptoms preoperatively was the best predictor for the absence of postoperative symptoms. […] The absence of preoperative OAB symptoms was by far the best predictor for the absence of postoperative OAB symptoms. […] Interestingly, we have found that an operation with the use of vaginal mesh material (Prolift) had a favourable effect on urgency symptoms as compared to conventional surgery. […] The absence of nocturia protected against postoperative frequency and nocturia, with an OR of more than 7 (as high as 7.4 (95% CI 4.2; 13.2)).
#13
https://link.springer.com/article/10.1007/s00192-010-1152-y
Overall, an improvement of OAB symptoms after POP surgery has been found, which is in line with the existing literature. […] Frequency and urgency were more likely to improve or disappear as compared to urinary urge incontinence and nocturia. […] De novo bothersome OAB symptoms appeared in 56% of women.
#14
https://link.springer.com/article/10.1007/s00192-024-05960-8
We aimed to evaluate the clean intermittent catheterization (CIC) rate in women undergoing their first OnabotulinumtoxinA (BTX-A) treatment and to investigate factors predictive of initiating CIC. […] CIC rate was 8.6% (n=34) following the first BTX-A treatment. […] Urgency urinary incontinence (UUI) reduced the risk of undergoing CIC (OR 0.30, 95% CI 0.090.97). […] A bladder capacity of 500 ml or greater in the bladder diary increased the risk of CIC (OR 2.46, 95% CI 1.065.70), whereas reported leakages were associated with a decreased risk of CIC (OR 0.24, 95% CI 0.100.57). […] Multivariate logistic regression analysis showed that anterior colporrhaphy (OR 3.71, 95% CI 1.529.06) and 10-ml increments in median maximum cystometric capacity (OR 1.03, 95% CI 1.001.06) predicted CIC, whereas UUI was a protective factor for CIC (OR 0.23, 95% CI 0.070.79).
#15
https://link.springer.com/article/10.1007/s00192-024-05960-8
We aimed to evaluate the clean intermittent catheterization (CIC) rate in women undergoing their first OnabotulinumtoxinA (BTX-A) treatment and to investigate factors predictive of initiating CIC. […] CIC rate was 8.6% (n=34) following the first BTX-A treatment. […] Urgency urinary incontinence (UUI) reduced the risk of undergoing CIC (OR 0.30, 95% CI 0.090.97). […] A bladder capacity of 500 ml or greater in the bladder diary increased the risk of CIC (OR 2.46, 95% CI 1.065.70), whereas reported leakages were associated with a decreased risk of CIC (OR 0.24, 95% CI 0.100.57). […] Multivariate logistic regression analysis showed that anterior colporrhaphy (OR 3.71, 95% CI 1.529.06) and 10-ml increments in median maximum cystometric capacity (OR 1.03, 95% CI 1.001.06) predicted CIC, whereas UUI was a protective factor for CIC (OR 0.23, 95% CI 0.070.79).
#16
https://link.springer.com/article/10.1007/s00192-024-05960-8
We aimed to evaluate the clean intermittent catheterization (CIC) rate in women undergoing their first OnabotulinumtoxinA (BTX-A) treatment and to investigate factors predictive of initiating CIC. […] CIC rate was 8.6% (n=34) following the first BTX-A treatment. […] Urgency urinary incontinence (UUI) reduced the risk of undergoing CIC (OR 0.30, 95% CI 0.090.97). […] A bladder capacity of 500 ml or greater in the bladder diary increased the risk of CIC (OR 2.46, 95% CI 1.065.70), whereas reported leakages were associated with a decreased risk of CIC (OR 0.24, 95% CI 0.100.57). […] Multivariate logistic regression analysis showed that anterior colporrhaphy (OR 3.71, 95% CI 1.529.06) and 10-ml increments in median maximum cystometric capacity (OR 1.03, 95% CI 1.001.06) predicted CIC, whereas UUI was a protective factor for CIC (OR 0.23, 95% CI 0.070.79).
#17
https://link.springer.com/article/10.1007/s00192-024-05960-8
A history of anterior colporrhaphy, large bladder capacity, and absence of incontinence episodes in bladder diary or UDS were risk factors for CIC after the first BTX-A treatment. […] In our retrospective cohort of 397 women, we report a CIC rate of 8.6% following the first BTX-A treatment. […] Women with a history of anterior colporrhaphy were at a risk of CIC nearly four times higher. […] We confirm an association between increased MCC and the risk of CIC. […] Elevated bladder capacity and a lack of reported leakages in pretreatment bladder diaries predicted CIC, aligning with the risk factors identified through UDS.
#18 Machine learning provides an accurate prognostication model for refractory overactive bladder treatment response and is noninferior to human experts – PubMed
https://pubmed.ncbi.nlm.nih.gov/35078268/
Machine learning provides an accurate prognostication model for refractory overactive bladder treatment response and is noninferior to human experts. […] Utilizing a novel machine learning (ML) approach, we sought to develop algorithms to predict patient outcomes following the overactive bladder treatments OnabotulinumtoxinA (OBTX-A) injection and sacral neuromodulation (SNM). […] Trained algorithms demonstrated outstanding accuracy in predicting treatment response (OBTX-A: AUC 0.95; SNM: 0.88). Algorithms were superior to human experts in response prediction for OBTX-A, and noninferior to human experts in response prediction for SNM. […] Novel ML algorithms were accurate, superior to expert urologists in predicting OBTX-A outcomes, and noninferior to expert urologists in predicting SNM outcomes.
#19 Machine learning provides an accurate prognostication model for refractory overactive bladder treatment response and is noninferior to human experts – PubMed
https://pubmed.ncbi.nlm.nih.gov/35078268/
Machine learning provides an accurate prognostication model for refractory overactive bladder treatment response and is noninferior to human experts. […] Utilizing a novel machine learning (ML) approach, we sought to develop algorithms to predict patient outcomes following the overactive bladder treatments OnabotulinumtoxinA (OBTX-A) injection and sacral neuromodulation (SNM). […] Trained algorithms demonstrated outstanding accuracy in predicting treatment response (OBTX-A: AUC 0.95; SNM: 0.88). Algorithms were superior to human experts in response prediction for OBTX-A, and noninferior to human experts in response prediction for SNM. […] Novel ML algorithms were accurate, superior to expert urologists in predicting OBTX-A outcomes, and noninferior to expert urologists in predicting SNM outcomes.
#20 Machine Learning Bests Experts in Predicting Patient Response to Overactive Bladder Treatment
https://consultqd.clevelandclinic.org/machine-learning-bests-experts-in-predicting-patient-response-to-overactive-bladder-treatment
The top algorithms showed excellent predictive accuracy for patient-reported bladder function improvement for both OBTX-A (Area under the curve 0.86) and SNM (AUC 0.96) and were noninferior to expert urologists. […] The algorithms were also highly accurate in predicting patient-reported bladder leakage improvement for both modalities (AUC 0.75 for OBTX-A and 0.80 for SNM) and were noninferior to experts. […] The next step, Dr. Werneburg says, is to conduct a prospective analysis that would give the clinician, not the algorithm, the benefit of the doubt. […] We suspect that our results are not only applicable to overactive bladder or even urology for that matter but really any context where a decision based on data is necessary. […] There may be a patient subgroup, either defined by age or bladder testing parameter any number of variablesthat might enable us to advise patients on potential risk.
#21 Machine Learning Bests Experts in Predicting Patient Response to Overactive Bladder Treatment
https://consultqd.clevelandclinic.org/machine-learning-bests-experts-in-predicting-patient-response-to-overactive-bladder-treatment
The top algorithms showed excellent predictive accuracy for patient-reported bladder function improvement for both OBTX-A (Area under the curve 0.86) and SNM (AUC 0.96) and were noninferior to expert urologists. […] The algorithms were also highly accurate in predicting patient-reported bladder leakage improvement for both modalities (AUC 0.75 for OBTX-A and 0.80 for SNM) and were noninferior to experts. […] The next step, Dr. Werneburg says, is to conduct a prospective analysis that would give the clinician, not the algorithm, the benefit of the doubt. […] We suspect that our results are not only applicable to overactive bladder or even urology for that matter but really any context where a decision based on data is necessary. […] There may be a patient subgroup, either defined by age or bladder testing parameter any number of variablesthat might enable us to advise patients on potential risk.
#22 Protocol for development and validation of a prediction model for 5-year risk of incident overactive bladder in the general population: the Nagahama study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-021-00848-x
An accurate prediction model could identify high-risk subjects of incident Overactive bladder (OAB) among the general population and enable early prevention which may save on the related medical costs. However, no efficient model has been developed for predicting incident OAB. In this study, we will develop a model for predicting the onset of OAB at 5-year in the general population setting. […] This will be the first study to develop a model to predict the incidence of OAB. […] If an accurate prediction model can be developed, high-risk subjects could be identified and encouraged to such good habits at an early stage, which might prevent incident OAB and save on the medical cost related to pharmacotherapy. […] Our prediction models have a large sample size and will incorporate various predictive variables based on previous studies and expert opinions.
#23 Protocol for development and validation of a prediction model for 5-year risk of incident overactive bladder in the general population: the Nagahama study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-021-00848-x
An accurate prediction model could identify high-risk subjects of incident Overactive bladder (OAB) among the general population and enable early prevention which may save on the related medical costs. However, no efficient model has been developed for predicting incident OAB. In this study, we will develop a model for predicting the onset of OAB at 5-year in the general population setting. […] This will be the first study to develop a model to predict the incidence of OAB. […] If an accurate prediction model can be developed, high-risk subjects could be identified and encouraged to such good habits at an early stage, which might prevent incident OAB and save on the medical cost related to pharmacotherapy. […] Our prediction models have a large sample size and will incorporate various predictive variables based on previous studies and expert opinions.
#24 Protocol for development and validation of a prediction model for 5-year risk of incident overactive bladder in the general population: the Nagahama study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-021-00848-x
An accurate prediction model could identify high-risk subjects of incident Overactive bladder (OAB) among the general population and enable early prevention which may save on the related medical costs. However, no efficient model has been developed for predicting incident OAB. In this study, we will develop a model for predicting the onset of OAB at 5-year in the general population setting. […] This will be the first study to develop a model to predict the incidence of OAB. […] If an accurate prediction model can be developed, high-risk subjects could be identified and encouraged to such good habits at an early stage, which might prevent incident OAB and save on the medical cost related to pharmacotherapy. […] Our prediction models have a large sample size and will incorporate various predictive variables based on previous studies and expert opinions.
#25 Protocol for development and validation of a prediction model for 5-year risk of incident overactive bladder in the general population: the Nagahama study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-021-00848-x
If we can develop an accurate prediction model for OAB and make it widely available through a web app, we will be able to detect high risk populations and thus intervene at an early stage, which may improve individual HRQOL and decrease the societal health care expenditure. […] As a future perspective, prediction models of incident OAB will need to be externally validated and there should be an investigation of their impact in clinical practice.
#26 Overactive Bladder (OAB): Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/14248-overactive-bladder
Overactive bladder symptoms can cause considerable stress. Treatment can be challenging to manage, and symptoms may never completely disappear. But many people are satisfied with the treatment they receive and often experience a dramatic improvement in their quality of life. […] Pelvic floor exercises and changes to your lifestyle may take six to eight weeks before you start to see results. […] Many medications start to relax your bladder muscles after a few hours. But they may take up to a month to work fully. […] Most people start to see improvement after six nerve stimulation treatments. However, it may take up to 12 treatments to see results.
#27 Overactive Bladder (OAB): Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/14248-overactive-bladder
Overactive bladder symptoms can cause considerable stress. Treatment can be challenging to manage, and symptoms may never completely disappear. But many people are satisfied with the treatment they receive and often experience a dramatic improvement in their quality of life. […] Pelvic floor exercises and changes to your lifestyle may take six to eight weeks before you start to see results. […] Many medications start to relax your bladder muscles after a few hours. But they may take up to a month to work fully. […] Most people start to see improvement after six nerve stimulation treatments. However, it may take up to 12 treatments to see results.
#28 SciELO Brazil – Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with overactive bladder? Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with ov
https://www.scielo.br/j/ibju/a/dYybtqfbrKdwkJDWvrymcgd/?lang=en
Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). […] Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder. […] In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% in predicting treatment outcome in children with OAB. […] NGF/Cr had sensitivity of 90% and specificity of 92.1% in predicting treatment outcome in children with OAB. […] The mean bladder wall thickness was significantly higher in group 1 compared to group 2. […] After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls.
#29 SciELO Brazil – Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with overactive bladder? Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with ov
https://www.scielo.br/j/ibju/a/dYybtqfbrKdwkJDWvrymcgd/?lang=en
After anticholinergic treatment, BWTh levels and NGF/Cr values had no significantly difference compared to controls. […] Eighteen children had significantly higher BWTh and NGF/Cr although they received urotherapy. […] After anticholinergic treatment, the thickened bladder wall and therefore NGF/Cr decreased (similar with controls) in response to the anticholinergic treatment. […] To our knowledge, the present study is the first to evaluate the combination of urinary NGF and bladder wall thickness in children with OAB, which may serve as a noninvasive tool for outcome of treatment in OAB.
#30 SciELO Brazil – Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with overactive bladder? Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with ov
https://www.scielo.br/j/ibju/a/dYybtqfbrKdwkJDWvrymcgd/?lang=en
After anticholinergic treatment, BWTh levels and NGF/Cr values had no significantly difference compared to controls. […] Eighteen children had significantly higher BWTh and NGF/Cr although they received urotherapy. […] After anticholinergic treatment, the thickened bladder wall and therefore NGF/Cr decreased (similar with controls) in response to the anticholinergic treatment. […] To our knowledge, the present study is the first to evaluate the combination of urinary NGF and bladder wall thickness in children with OAB, which may serve as a noninvasive tool for outcome of treatment in OAB.
#31 New participant stratification and combination of urinary biomarkers and confounders could improve diagnostic accuracy for overactive bladder | Scientific Reports
https://www.nature.com/articles/s41598-020-59973-6
Overactive bladder (OAB) is a highly prevalent symptom complex characterised by symptoms of urinary urgency, increased frequency, nocturia, with or without urge incontinence; in the absence of proven infection or other obvious pathology. […] Current diagnostic approaches are based on discordant measures, suffer from subjectivity and are incapable of detecting the proposed OAB phenotypes. […] Therefore, this study provides the foundation for the development of novel non-invasive diagnostic tools for OAB phenotypes that may lead to personalised treatment. […] The prevalence of OAB ranges between 9% to 43% and 7% to 27% in female and male, respectively. […] Therefore, there is an unmet need for an objective OAB symptom-based classification approach. […] The individual ability of the candidate urinary biomarkers (including ATP, ACh, NO, Nitrite, MCP-1 and IL-5), and confounders (age and gender) in predicting the identified high OAB symptomatic score group (cluster 2) from the low OAB symptomatic score group (cluster 1) was assessed using binary logistic regression.
#32 Machine Learning Bests Experts in Predicting Patient Response to Overactive Bladder Treatment
https://consultqd.clevelandclinic.org/machine-learning-bests-experts-in-predicting-patient-response-to-overactive-bladder-treatment
The top algorithms showed excellent predictive accuracy for patient-reported bladder function improvement for both OBTX-A (Area under the curve 0.86) and SNM (AUC 0.96) and were noninferior to expert urologists. […] The algorithms were also highly accurate in predicting patient-reported bladder leakage improvement for both modalities (AUC 0.75 for OBTX-A and 0.80 for SNM) and were noninferior to experts. […] The next step, Dr. Werneburg says, is to conduct a prospective analysis that would give the clinician, not the algorithm, the benefit of the doubt. […] We suspect that our results are not only applicable to overactive bladder or even urology for that matter but really any context where a decision based on data is necessary. […] There may be a patient subgroup, either defined by age or bladder testing parameter any number of variablesthat might enable us to advise patients on potential risk.
#33 Protocol for development and validation of a prediction model for 5-year risk of incident overactive bladder in the general population: the Nagahama study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-021-00848-x
If we can develop an accurate prediction model for OAB and make it widely available through a web app, we will be able to detect high risk populations and thus intervene at an early stage, which may improve individual HRQOL and decrease the societal health care expenditure. […] As a future perspective, prediction models of incident OAB will need to be externally validated and there should be an investigation of their impact in clinical practice.
#34 Machine learning provides an accurate prognostication model for refractory overactive bladder treatment response and is noninferior to human experts – PubMed
https://pubmed.ncbi.nlm.nih.gov/35078268/
Machine learning provides an accurate prognostication model for refractory overactive bladder treatment response and is noninferior to human experts. […] Utilizing a novel machine learning (ML) approach, we sought to develop algorithms to predict patient outcomes following the overactive bladder treatments OnabotulinumtoxinA (OBTX-A) injection and sacral neuromodulation (SNM). […] Trained algorithms demonstrated outstanding accuracy in predicting treatment response (OBTX-A: AUC 0.95; SNM: 0.88). Algorithms were superior to human experts in response prediction for OBTX-A, and noninferior to human experts in response prediction for SNM. […] Novel ML algorithms were accurate, superior to expert urologists in predicting OBTX-A outcomes, and noninferior to expert urologists in predicting SNM outcomes.
#35 Machine Learning Bests Experts in Predicting Patient Response to Overactive Bladder Treatment
https://consultqd.clevelandclinic.org/machine-learning-bests-experts-in-predicting-patient-response-to-overactive-bladder-treatment
Novel machine learning algorithms can be used to assist clinicians in predicting patient-reported outcomes following third-line treatments for overactive bladder (OAB). […] Previously, machine learning algorithms developed by Cleveland Clinic researchers using neural networks accurately predicted the objective outcome of reduction in urge urinary incontinence episodes with OBTXA and SNM in patients with OAB who had been refractory to conventional therapies. […] In a new analysis, the algorithms also predicted patient-reported outcomes in bladder leakage and function, which dont necessarily correspond to objective measures. […] We were interested in using machine learning-based approaches to predict the patients who would perceive versus not perceive improvement in their symptoms following treatment.