INJ Search

CLOSE


Int Neurourol J > Volume 19(3); 2015 > Article
Hsiao, Liao, Lin, and Kuo: Duration of Antimuscarinic Administration for Treatment of Overactive Bladder Before Which One Can Assess Efficacy: An Analysis of Predictive Factors

ABSTRACT

Purpose:

To determine the duration of antimuscarinic therapy for overactive bladder syndrome (OAB) appropriate for assessment of the efficacy of treatment, and to evaluate the possible predictive factors for response to therapy.

Methods:

All OAB patients who visited a urology outpatient clinic of a tertiary referral center and who were prescribed 5 mg of solifenacin or 4 mg of tolterodine extended release capsules daily were enrolled in the study. Patients were asked to continue therapy for 6 months. All enrolled patients completed the patient perception of bladder condition, overactive bladder symptom score (OABSS), and the modified Indevus Urgency Severity Scale questionnaires. All patients underwent uroflowmetry.

Results:

A total of 164 patients were enrolled and 125 patients (76%) had at least one follow-up visit. The mean follow-up interval was 1 month (range, 0.5–6 months). Sixty-two patients (49.6%; 95% confidence interval [CI], 40.7–58.5) responded to antimuscarinic treatment. The median time for the onset of response was 3 months (95% CI, 1–6). Multivariate Cox proportional-hazards model revealed that elevated baseline OABSS was an independent predictor of responsiveness to therapy. Receiver operating characteristic (ROC) curve analysis revealed an optimal OABSS cutoff value of ≥7, with an area under the ROC curve of 0.79 (95% CI, 0.70–0.88; sensitivity, 91.9%; specificity, 60.7%).

Conclusions:

The median time for a therapeutic response was 3 months, and OABSS was the only predictor for responsiveness. These findings may serve as a guideline when prescribing antimuscarinic treatment for OAB patients.

left
    right

    INTRODUCTION

    Overactive bladder syndrome (OAB), with or without incontinence, is characterized by urinary urgency, frequent urination, and nocturia. Muscarinic receptor antagonists are the first-line pharmacotherapeutic agents for the treatment of OAB. At present, several antimuscarinic drugs are available for the treatment of OAB. Each of these has demonstrated significant efficacy for the treatment of OAB symptoms, although their pharmacokinetic and adverse effect profiles vary [1,2].
    The duration of antimuscarinic treatment for OAB has varied in previous studies, and there is no consensus regarding the optimal duration of treatment for OAB patients. The treatment durations in clinical studies have been reported to range from 2 weeks to 12 months [3-11], or as the time taken to reach an optimal dose (i.e., the dose that achieved a maximum dose or a balance between improvement in incontinence symptoms and tolerability of side effects) plus one additional week [12]. Nevertheless, a specific definition of refractory OAB would be useful, and would allow for timely initiation and evaluation of second-and third-line treatments [13].
    In-depth knowledge about both the optimal duration of therapy and the predictors of response to antimuscarinic treatment would be helpful in clinical practice. Identification of patients likely to be refractory to antimuscarinic treatment could help prevent administration of ineffective medication and potential drug-related adverse effects. Thus, the aim of this study was to estimate the duration of treatment required before classifying a patient unresponsive to antimuscarinic therapy, and to determine if any factors predict a patient’s response to antimuscarinic treatment.

    MATERIALS AND METHODS

    One hundred sixty-four consecutive patients, who visited the urologic outpatient clinics of a referral hospital for treatment of OAB, were prospectively enrolled in this study. Inclusion criteria included age ≥18 years and ≥1-month history of OAB symptoms, including frequent and urgent urination, with or without incontinence. Patients with predominant symptoms of urinary stress incontinence, previous bladder or urethral surgery, possible neurogenic lesions, or active urinary tract infection were excluded. The study was approved by the Research Ethics Committees of Buddhist Tzu Chi General Hospital.
    The screening visit was designated as visit 0. Eligibility was determined at visit 1 (baseline; 2 weeks after visit 0) using the results recorded in the 3-day voiding diary prior to visit 1. Differentiation between OAB-wet (i.e., at least one episode of urge urinary incontinence every 3 days) and OAB-dry (i.e., urgency at least once per day without urge urinary incontinence) was based on the presenting symptoms and the 3-day voiding diary. Patients received 5-mg solifenacin or 4-mg tolterodine extended-release (ER) capsules daily. Patients were followed-up at 2 weeks (visit 2), 1 month (visit 3), 3 months (visit 4), and 6 months (visit 5). In addition, patients who had received at least one dose of the study medication were evaluated for adverse events at each visit.
    All enrolled patients were asked to complete the patient perception of bladder condition (PPBC) [14], the overactive bladder symptom score (OABSS) [15], the modified Indevus urgency severity scale (IUSS) [16], and the International Prostate Symptoms Score (IPSS) questionnaires [17]. The urgency severity scale was rated by marking 0, 1, 2, or 3, which were defined as none, mild, moderate, and severe urgency, respectively. In addition, urgency with urinary incontinence was assigned a score of 4 [18]. Total prostate volume and transition zone index were obtained by ultrasound in each patient. Uroflowmetry was performed and postvoid residual volume was measured by transabdominal ultrasound at each outpatient clinic visit. The voided volume was derived from the uroflowmetry data.
    A response to antimuscarinic therapy was defined as a reduction of ≥3 in the OABSS from baseline until the follow-up visit [19]. Data of patients with at least one follow-up visit, who failed to attend further follow-ups before the occurrence of a response to antimuscarinic therapy, were considered censored data.
    STATA 11.0 (StataCorp LP., College Station, TX, USA) was used for the statistical analysis. A Cox proportional-hazards model was applied to identify the factors affecting responsiveness. Multivariate analysis was performed using the criteria that univariate test of any variable had a P-value <0.05. A P-value <0.05 was considered statistically significant. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value for predicting responsiveness. The optimal cutoff value was determined by the point on the ROC curve closest to the upper left-hand corner.

    RESULTS

    A total of 164 patients were enrolled in the study, among which 125 patients (76%) had at least one follow-up visit. Baseline data of these 125 patients, along-with follow-up visit data, are tabulated in Table 1. Except for age and maximum flow rate, the values of the other variables did not differ between women and men (Table 1). The mean follow-up interval was 1 month (range, 0.5–6 months). Sixty-two patients (49.6%; 95% confidence interval [CI], 40.7–58.5) were responsive to antimuscarinic therapy during the treatment period. The response rate did not differ between genders (Table 1). The median treatment duration before response was 3 months (95% CI, 1–6) (Fig. 1A). The nonresponsiveness probability curve did not differ between genders (P=0.423; log-rank test) (Fig. 1B). The persistence rate of antimuscarinics at 3 months was 40.8% (51 of 125).
    Among the 62 responsive patients, 13 became unresponsive during follow-up. However, none of the baseline variables could predict this phenomenon.
    In addition to antimuscarinics, 59 out of the 81 patients with benign prostate hyperplasia were concomitantly treated with an alpha blocker (tamsulosin [n=46], silodosin [n=8] or doxazosin [n=5]). Among these 59 patients, 12 patients also received 5-alpha reductase inhibitor treatment (dutasteride; Table 1).
    Univariate Cox proportional-hazards model revealed that the presence of OAB-wet and elevated baseline PPBC, OABSS, and IUSS were the factors associated with a response to therapy. However, multivariate Cox proportional-hazards model revealed that only a higher OABSS independently predicted a response to therapy (Table 2).
    ROC analysis revealed that an OABSS≥7 was the optimal cutoff value for predicting a response to therapy, with the area under the ROC curve being 0.79 (95% CI, 0.70–0.88; sensitivity, 91.9%; specificity, 60.7%) (Fig. 2).
    Excluding all 16 patients with parkinsonism or stroke during the final analyses, OABSS remained the only independent predictor for a response to therapy (n=109; Table 2). ROC analysis also revealed that an OABSS≥7 was the optimal cutoff value for predicting a response to therapy, with the area under the ROC curve being 0.80 (95% CI, 0.71–0.89; sensitivity, 90.7%; specificity, 63.3%).
    As compared with PPBC, IUSS, or IPSS storage subscore (IPSS-S). OABSS had the highest Spearman’s ρ between the responsiveness and the change of clinical data at last visit from baseline (Table 3).

    DISCUSSION

    We demonstrated that the average treatment duration of 3 months was necessary to determine the responsiveness to antimuscarinic therapy. To our knowledge, no previous studies have determined a minimum duration of treatment for assessing the responsiveness of OAB patients to antimuscarinic therapy. Additionally, there has been no universal definition of a response to antimuscarinics. Patients not responding after 3 or 6 months of antimuscarinic therapy have been labeled as refractory in some studies [20-22]. However, Brubaker et al. [23] defined refractory as inadequate symptom control after 2 or more attempts at pharmacotherapy. Nitti et al. [13] emphasized the importance of defining refractory OAB. A specific definition of refractory OAB would allow for proper initiation and evaluation of second- and third-line treatments. As is evident from Fig. 1, the probability of becoming responsive to therapy after 3 months was limited. Thus, based on our results, refractory OAB could be defined as inadequate symptom control (such as improvement in OABSS to less than 3) after 3 months of pharmacotherapy. Thus, we concluded that antimuscarinic therapy must be continued even when a poor response is obtained in the first few months of treatment.
    The duration of antimuscarinic therapy for OAB varies among different studies [9], and there has been no consensus regarding the optimal treatment duration for OAB patients. In some randomized clinical studies using solifenacin or tolterodine, the treatment intervals were <12 weeks [4-6]. Therefore, the efficacy of these medications may have been underestimated. On the other hand, therapy for more than 12 weeks may be longer than necessary for evaluating efficacy [10,11]. In our opinion, due to the low probability of becoming responsive to therapy after 3 months (Fig. 1), the ideal duration of therapy for evaluating efficacy should be 3 months, unless long-term efficacy needs to be determined [10,11].
    We also found that higher OABSSs were associated with improved responsiveness to antimuscarinics, which is consistent with previous studies [1,24]. The coefficient of OABSS was −0.39 (95% CI, −0.61 to −0.18) for the change of OABSS after 12 weeks of antimuscarinic therapy [1]. High scores on the IUSS, a questionnaire similar to OABSS, were also found to be associated with a good therapeutic responsiveness [24]. However, as compared with OABSS, a lower area under the ROC curve was observed with IUSS in this study (0.70 vs. 0.79) [24]. In addition, OABSS had the highest Spearman ρ between the responsiveness and the change of clinical data, as compared with PPBC, IUSS, or IPSS-S (Table 3). Thus, OABSS is a better questionnaire than IUSS for predicting a therapeutic response.
    An OABSS≥7 was found to be the optimal cutoff value for predicting responsiveness. Therefore, for patients with baseline OABSS≥7, alternative treatment may be considered earlier if there is no response to antimuscarinic therapy. On the other hand, for patients with a baseline OABSS<7, continuous antimuscarinic therapy may be considered even after 3 months of treatment, especially for patients with a questionable response. As compared with the IUSS cutoff value (4) for predicting response [24], the cutoff values (≥7) for OABSS showed a significant clinical advantage with a larger area under the ROC curve.
    Alpha blockers and/or 5-alpha reductase inhibitor can improve storage symptoms in men with benign prostate hyperplasia, and concomitant antimuscarinic therapy may have an additional effect on the improvement of storage symptoms [25]. Despite the presence of benign prostate hyperplasia or concomitant alpha blocker/5-alpha reductase inhibitor, there were no independent predictors to determine responsiveness to therapy in our analysis (Table 2). Our results may exaggerate the therapeutic effect of antimuscarinics, especially in men treated with alpha blockers and/or 5-alpha reductase inhibitor.
    However, this study has several limitations. Only 76% of our patients had at least one follow-up visit. D’Souza et al. [26] also reported that only 57.3% of patients obtained a refill of tolterodine ER after the initial prescription. In addition, this study was not a randomized trial, and thus the differences in the therapeutic efficacy of solifenacin and tolterodine may be over- or underestimated.
    To conclude, the median interval for the occurrence of a response to antimuscarinic therapy was 3 months, and OABSS was the only independent predictor for a positive response to antimuscarinic therapy. These findings may serve as an important guideline when prescribing antimuscarinic therapy for OAB patients.

    NOTES

    Research Ethics
    The study was performed according to the Helsinki Declaration (http://www.wma.net/en/30publications/10policies/b3/) and the study design was approved by the Institutional Review Board of Buddhist Tzu Chi General Hospital (IRB No. 102-05).
    Conflict of Interest
    No potential conflict of interest relevant to this article was reported.

    REFERENCES

    1. Hsiao SM, Liao SC, Chen CH, Chang TC, Lin HH. Psychometric assessment of female overactive bladder syndrome and antimuscarinics-related effects. Maturitas 2014;79:428-34. PMID: 25238744
    crossref pmid
    2. Hsiao SM, Su TC, Chen CH, Chang TC, Lin HH. Autonomic dysfunction and arterial stiffness in female overactive bladder patients and antimuscarinics related effects. Maturitas 2014;79:65-9. PMID: 25022469
    crossref pmid
    3. Abrams P, Cardozo L, Chapple C, Serdarevic D, Hargreaves K, Khullar V, et al. Comparison of the efficacy, safety, and tolerability of propiverine and oxybutynin for the treatment of overactive bladder syndrome. Int J Urol 2006;13:692-8. PMID: 16834644
    crossref pmid
    4. Jacquetin B, Wyndaele J. Tolterodine reduces the number of urge incontinence episodes in patients with an overactive bladder. Eur J Obstet Gynecol Reprod Biol 2001;98:97-102. PMID: 11516807
    crossref pmid
    5. Altan-Yaycioglu R, Yaycioglu O, Aydin Akova Y, Guvel S, Ozkardes H. Ocular side-effects of tolterodine and oxybutynin, a single-blind prospective randomized trial. Br J Clin Pharmacol 2005;59:588-92. PMID: 15842558
    crossref pmid pmc
    6. Herschorn S, Stothers L, Carlson K, Egerdie B, Gajewski JB, Pommerville P, et al. Tolerability of 5 mg solifenacin once daily versus 5 mg oxybutynin immediate release 3 times daily: results of the VECTOR trial. J Urol 2010;183:1892-8. PMID: 20303119
    crossref pmid
    7. Chapple CR, Fianu-Jonsson A, Indig M, Khullar V, Rosa J, Scarpa RM, et al. Treatment outcomes in the STAR study: a subanalysis of solifenacin 5 mg and tolterodine ER 4 mg. Eur Urol 2007;52:1195-203. PMID: 17574730
    crossref pmid
    8. Novara G, Galfano A, Secco S, D’Elia C, Cavalleri S, Ficarra V, et al. A systematic review and meta-analysis of randomized controlled trials with antimuscarinic drugs for overactive bladder. Eur Urol 2008;54:740-63. PMID: 18632201
    crossref pmid
    9. Visco AG, Brubaker L, Richter HE, Nygaard I, Paraiso MF, Menefee SA, et al. Anticholinergic therapy vs. onabotulinumtoxina for urgency urinary incontinence. N Engl J Med 2012;367:1803-13. PMID: 23036134
    crossref pmid pmc
    10. Halaska M, Ralph G, Wiedemann A, Primus G, Ballering-Bruhl B, Hofner K, et al. Controlled, double-blind, multicentre clinical trial to investigate long-term tolerability and efficacy of trospium chloride in patients with detrusor instability. World J Urol 2003;20:392-9. PMID: 12811500
    crossref pmid
    11. Yokoyama T, Koide T, Hara R, Fukumoto K, Miyaji Y, Nagai A. Long-term safety and efficacy of two different antimuscarinics, imidafenacin and solifenacin, for treatment of overactive bladder: a prospective randomized controlled study. Urol Int 2013;90:161-7. PMID: 23207959
    crossref pmid
    12. Versi E, Appell R, Mobley D, Patton W, Saltzstein D. Dry mouth with conventional and controlled-release oxybutynin in urinary incontinence. The Ditropan XL Study Group. Obstet Gynecol 2000;95:718-21. PMID: 10775736
    crossref pmid
    13. Nitti VW, Kopp Z, Lin AT, Moore KH, Oefelein M, Mills IW. Can we predict which patient will fail drug treatment for overactive bladder? A think tank discussion. Neurourol Urodyn 2010;29:652-7. PMID: 20432330
    crossref pmid
    14. Coyne KS, Matza LS, Kopp Z, Abrams P. The validation of the patient perception of bladder condition (PPBC): a single-item global measure for patients with overactive bladder. Eur Urol 2006;49:1079-86. PMID: 16460875
    crossref pmid
    15. Homma Y, Yoshida M, Seki N, Yokoyama O, Kakizaki H, Gotoh M, et al. Symptom assessment tool for overactive bladder syndrome-overactive bladder symptom score. Urology 2006;68:318-23. PMID: 16904444
    crossref pmid
    16. Nixon A, Colman S, Sabounjian L, Sandage B, Schwiderski UE, Staskin DR, et al. A validated patient reported measure of urinary urgency severity in overactive bladder for use in clinical trials. J Urol 2005;174:604-7. PMID: 16006914
    crossref pmid
    17. Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 1992;148:1549-57. PMID: 1279218
    crossref pmid
    18. Chung SD, Liao CH, Chen YC, Kuo HC. Urgency severity scale could predict urodynamic detrusor overactivity in patients with overactive bladder syndrome. Neurourol Urodyn 2011;30:1300-4. PMID: 21560153
    crossref pmid
    19. Gotoh M, Homma Y, Yokoyama O, Nishizawa O. Responsiveness and minimal clinically important change in overactive bladder symptom score. Urology 2011;78:768-73. PMID: 21855969
    crossref pmid
    20. Kuo HC. Effectiveness of intravesical resiniferatoxin for anticholinergic treatment refractory detrusor overactivity due to nonspinal cord lesions. J Urol 2003;170:835-9. PMID: 12913711
    crossref pmid
    21. Kuo HC, Liu HT, Yang WC. Therapeutic effect of multiple resiniferatoxin intravesical instillations in patients with refractory detrusor overactivity: a randomized, double-blind, placebo controlled study. J Urol 2006;176:641-5. PMID: 16813911
    crossref pmid
    22. Natalin R, Reis LO, Alpendre C, Ikari LY, Prudente A, D’Ancona CA. Triple therapy in refractory detrusor overactivity: a preliminary study. World J Urol 2010;28:79-85. PMID: 19294389
    crossref pmid
    23. Brubaker L, Richter HE, Visco A, Mahajan S, Nygaard I, Braun TM, et al. Refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol 2008;180:217-22. PMID: 18499184
    crossref pmid pmc
    24. Hsiao SM, Lin HH, Kuo HC. Factors associated with a better therapeutic effect of solifenacin in patients with overactive bladder syndrome. Neurourol Urodyn 2014;33:331-4. PMID: 23494586
    crossref pmid
    25. Chung SD, Chang HC, Chiu B, Liao CH, Kuo HC. The efficacy of additive tolterodine extended release for 1-year in older men with storage symptoms and clinical benign proastatic hyperplasia. Neurourol Urodyn 2011;30:568-71. PMID: 21344494
    crossref pmid
    26. D’Souza AO, Smith MJ, Miller LA, Doyle J, Ariely R. Persistence, adherence, and switch rates among extended-release and immediate-release overactive bladder medications in a regional managed care plan. J Manag Care Pharm 2008;14:291-301. PMID: 18439051
    crossref pmid

    Fig. 1.
    Probability of nonresponsiveness in all patients (A) and both genders (B) with overactive bladder syndrome undergoing antimuscarinic therapy over time.
    inj-19-3-171f1.gif
    Fig. 2.
    Area under the receiver operating characteristic (ROC) curve for overactive bladder symptoms score as a predictive test for a response to antimuscarinic therapy.
    inj-19-3-171f2.gif
    Table 1.
    Baseline characteristics of patients with overactive bladder syndrome, and their response rate and adverse effects
    Variable Total (n = 125) Women (n = 44) Men (n = 81) P-valuea)
    Age (yr) 71.1 ± 13.0 66.5 ± 15.2 73.5 ± 11.0 0.007
    OAB-wet 98 (78) 32 (73) 66 (81) 0.358
    Treatment
     Solifenacin 106 (85) 39 (89) 67 (83) 0.444
     Tolterodine 19 (15) 5 (11) 14 (17) -
    Diabetes mellitus 21 (17) 8 (18) 13 (16) 0.761
    Hypertension 30 (24) 8 (18) 22 (27) 0.262
    CRF 7 (6) 2 (5) 5 (6) 1.000
    Stroke 10 (8) 3 (7) 7 (9) 0.740
    Parkinsonism 6 (5) 1 (2) 5 (6) 0.424
    BPH in men (n = 81) 69 - 69 -
     Concomitant treatment for BPH
      Alpha blocker 59 - 59 -
      5ARI 12 - 12 -
    PPBC 3.7 ± 1.7 3.9 ± 1.7 3.6 ± 1.7 0.332
    OABSS 8.6 ± 3.6 8.5 ± 3.8 8.7 ± 3.6 0.729
    IUSS 3.4 ± 1.3 3.2 ± 1.5 3.4 ± 1.2 0.452
    IPSS-V 5.9 ± 5.5 5.0 ± 5.7 6.4 ± 5.4 0.137
    IPSS-S 7.7 ± 3.5 8.4 ± 3.4 7.4 ± 3.5 0.116
    TPV (mL) 40.7 ± 18.2 - 40.7 ± 18.2 -
    TZI (%) 32.7 ± 13.5 - 32.7 ± 13.5 -
    Qmax (mL/sec) 13.3 ± 7.9 16.5 ± 9.9 11.5 ± 5.8 0.007
    VV (mL) 171 ± 102 176 ± 106 168 ± 99 0.831
    PVR (mL) 46.9 ± 57.6 43.8 ± 54.0 48.6 ± 59.8 0.416
    Response 62 (50) 23 (52) 39 (48) 0.660
    Dry mouth 24 (19) 9 (20) 15 (19) 0.793
    Constipation 4 (3) 1 (2) 3 (4) 1.000
    Dizziness 4 (3) 2 (5) 2 (2) 0.613

    Values were presented as mean±standard deviation or number (%) unless otherwise indicated.

    OAB, overactive bladder; CRF, chronic renal failure; BPH, benign prostate hyperplasia; 5ARI, 5-alpha reductase inhibitor; PPBC, patient perception of bladder condition; OABSS, overactive bladder symptom score; IUSS, indevus urgency severity score; IPSS, International Prostate Symptom Score; IPSS-V, IPSS voiding subscore; IPSS-S, IPSS storage subscore; TPV, total prostate volume; TZI, transition zone index; Qmax, maximum flow rate; VV, voided volume; PVR, postvoidal residual.

    a) Comparisons of data between women and man by Wilcoxon rank-sum test, chi-square test or Fisher exact test.

    Table 2.
    Cox proportional-hazards model for predicting responsiveness to antimuscarinic treatment for all patients (n=125) or patients excluding Parkinsonism and stroke (n=109)
    Variable Univariate analysis (n=125)
    Multivariate analysis (n=125)
    Multivariate analysis (n = 109)
    HR (95% CI) P-value HR (95% CI) P-value HR (95% CI) P-value
    Age (yr) 0.99 (0.97–1.01) 0.332 - - - -
    Male sex 0.84 (0.50–1.40) 0.499 - - - -
    OAB-wet 6.09 (1.90–19.4) 0.002 0.31 (0.04–2.45) 0.267 0.25 (0.03–1.99) 0.189
    Treatment
     Solifenacin 1.29 (0.61–2.71) 0.507 - - - -
     Tolterodine 0.78 (0.37–1.64) 0.507
    Diabetes mellitus 1.07 (0.56–2.06) 0.829 - - - -
    Hypertension 0.97 (0.54–1.77) 0.931 - - - -
    CRF 0.90 (0.28–2.87) 0.855 - - - -
    Stroke 0.86 (0.34–2.14) 0.740 - - - -
    Parkinsonism 1.10 (0.35–3.53) 0.867 - - - -
    BPH in Men (n = 81) 0.83 (0.37–1.90) 0.663
     Alpha blocker 0.76 (0.39–1.49) 0.428
     5ARI 1.29 (0.57–2.94) 0.539 - - - -
    PPBC 1.23 (1.04–1.461) 0.016 0.97 (0.78–1.20) 0.762 0.92 (0.73–1.16) 0.491
    OABSS 1.19 (1.11–1.28) <0.001 1.20 (1.05–1.36) 0.006 1.20 (1.05–1.38) 0.007
    IUSS 2.44 (1.32–4.52) 0.004 2.63 (0.90–7.69) 0.078 2.89 (0.97–8.61) 0.056
    IPSS-V 0.99 (0.94–1.04) 0.631 - - - -
    IPSS-S 1.07 (1.00–1.15) 0.053 0.93 (0.85–1.02) 0.134 0.93 (0.84–1.02) 0.143
    TPV (mL) 0.996 (0.98–1.02) 0.735 - - - -
    TZI (%) 2.93 (0.17–50.76) 0.460 - - - -
    Qmax (mL/sec) 1.00 (0.96–1.04) 0.951 - - - -
    VV (mL) 1.00 (0.997–1.002) 0.680 - - - -
    PVR (mL) 1.00 (0.996–1.004) 0.985 - - - -
    Dry mouth 0.94 (0.50–1.77) 0.852 - - - -
    Constipation 1.62 (0.51–5. 18) 0.413 - - - -
    Dizziness 1.55 (0.48–5.00) 0.461

    HR, hazard ratio; CI, confidence interval; OAB, overactive bladder; CRF, chronic renal failure; BPH, benign prostate hyperplasia; 5ARI, 5-alpha reductase inhibitor; PPBC, patient perception of bladder condition; OABSS, overactive bladder symptom score; IUSS, indevus urgency severity score; IPSS, International Prostate Symptom Score; IPSS-V, IPSS voiding subscore; IPSS-S, IPSS storage subscore; TPV, total prostate volume; TZI, transition zone index; Qmax, maximum flow rate; VV, voided volume; PVR, postvoidal residual.

    Table 3.
    Comparisons of changes of the data at last visit from baseline between the response (n=62) and the nonresponse (n=63) groups
    Variable Baseline
    Change from baseline
    ρ for responsivenessb)
    Response Nonresponse P-valuea) Response Nonresponse P-valuea)
    Age (yr) 69.8 ± 13.2 72.3 ± 12.8 0.237
    Male sex 39 (63) 42 (67) 0.660
    OAB wet 59 (60) 3 (12) <0.001
    PPBC 4.2 ± 1.5 3.2 ± 1.7 0.002 –1.9 ± 2.1 –0.2 ± 1.8 <0.001 –0.44***
    OABSS 10.4 ± 2.6 6.6 ± 3.7 <0.001 –5.2 ± 3.6 1.0 ± 2.9 <0.001 –0.75***
    IUSS 3.9 ± 0.3 2.8 ± 1.7 <0.001 –2.1 ± –2.5 0.0 ± 1.7 <0.001 –0.48***
    IPSS-V 5.7 ± 5.6 6.1 ± 5.5 0.641 –1.4 ± 5.1 –0.9 ± 4.6 0.520 –0.06
    IPSS-S 8.4 ± 3.4 7.0 ± 3.5 0.017 –3.2 ± 4.4 –0.1 ± 3.9 <0.001 –0.38***
    Qmax (mL/sec) 13.5 ± 8.5 13.1 ± 8.5 0.913 4.5 ± 10.8 2.8 ± 6.9 0.553 0.05
    VV (mL) 170.5 ± 98.2 171.3 ± 106.6 0.811 80.3 ± 141.3 45.6 ± 123.6 0.217 0.11
    PVR (mL) 49.8 ± 63.5 43.5 ± 50.1 0.713 8.1 ± 80.0 35.8 ± 70.0 0.082 –0.16

    Values are presented as mean±standard deviation or number (%).

    OAB, overactive bladder; PPBC, patient perception of bladder condition; OABSS, overactive bladder symptom score; IUSS, indevus urgency severity score; IPSS, International Prostate Symptom Score; IPSS-V, IPSS voiding subscore; IPSS-S, IPSS storage subscore; Qmax, maximum flow rate; VV, voided volume; PVR, postvoidal residual.

    a) By Wilcoxon rank-sum test.

    b) Each parameters and responsiveness are compared with Spearman rank-correlation coefficient (response, 1; nonresponse, 0).

    *** P<0.001.

    TOOLS
    Share :
    Facebook Twitter Linked In Google+
    METRICS Graph View
    • 14 Web of Science
    • 10 Crossref
    • 12 Scopus
    • 9,295 View
    • 83 Download
    We recommend


    ARTICLE & ORGAN
    Article Category

    Browse all articles >

    Organ

    Browse all articles >

    ISSUES
    DISEASES & TOPICS
    Diseases

    Browse all articles >

    Topics

    Browse all articles >

    AUTHOR
    INFORMATION

    Official Journal of Korean Continence Society & ESSIC (International Society for the Study of BPS) & Korean Society of Urological Research & The Korean Children’s Continence and Enuresis Society & The Korean Association of Urogenital Tract Infection and Inflammation & Korean Society of Geriatric Urological Care
    Editorial Office
    Department of Urology, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine,
    29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
    Tel: +82-2-2001-2237     Fax: +82-2-2001-2247    E-mail: choys1011@naver.com

    Copyright © 2024 by Korean Continence Society.

    Developed in M2PI

    Close layer
    prev next