Nocturia is one of the most bothersome symptoms of lower urinary tract and may be the leading symptom in medical examination. Nocturia has a special aspect of being of multifactorial etiology so an interdisciplinary approach for the diagnosis and treatment is obligatory. At present, nocturia is considered to be a new entity excluded from the symptoms of lower urinary tract and may be a consequence of serious disease. Diagnosis consists of non-invasive methods and the mainstay is the micturition diary. Treatment is based on desmopressin therapy and drugs influencing lower urinary tract in some cases.

• MeSH
• lidé MeSH
• nykturie diagnóza   etiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

Nocturia is the complaint that the individual has to wake at night one or more times to void, according to the International Continence Society definition from the ICS Standardisation of Terminology Report 2002. As the nocturia definition is complicated there are also other slightly modified definitions. It is currently not absolutely clear if prevalence or incidence is more important for epidemiology evaluation of nocturia. Nocturia is a variable symptom and its presence in individuals is reversible therefore it is very difficult to obtain reliable incidence data. Nocturia prevalence varies remarkably in different studies according to evaluation methodology, nocturia definition, methods of data collection and characteristics of evaluated population. There are not enough studies, especially demographic ones, evaluating lower urinary tract symptoms and/or nocturia in males and females. There is relatively large number of comparative studies confirming strong correlation between aging and prevalence of nocturia. Prevalence of two or more voids per night in individuals in their twenties varies between 5-15 %, it progresses with age, and in the seventh decade of life ranges between 35-50 %. Prevalence evaluated by gender is higher among younger women compared to older women and older men compared to younger men. Currently there are only limited sources of data regarding nocturia incidence. Incidence of nocturia (two or more voids per night) in a population older than 60 years is 213 new cases/1000 persons/1 year in two year observation. Incidence of two or more voids per night is 75 new cases/1000 male/1 year in five year observation and 126 new cases/1000 male/1 year in ten year observation in male population. Incidence of nocturia rises significantly with age. Incidence of two or more voids per night increases by 2,7 % in the population of women after child birth during 5 year follow up and by 5,9 % during 12 year follow up. Incidence of nocturia newly diagnosed in a pregnancy drops down by 98% in 3 month after the child birth. The incidence data indicate that incidence of nocturia rises with age and probability of nocturia relief decreases with age. Incidence of mild nocturia is higher compared to incidence of severe nocturia and significant relief of nocturia in women after child birth is very inconsistent compared to increase of other lower urinary tract symptoms. Ethiology of nocturia might be polyuria, nocturnal polyuria or reduced bladder capacity. Nocturia and its ethiology can be determined in most cases with simple and commonly used investigative methods on the out-patients bases. The diagnostic algorithm should lead to verification of nocturia and identifying its cause because treatment of nocturia differs remarkably according to the etiology.

• MeSH
• celosvětové zdraví MeSH
• diagnostické techniky urologické * MeSH
• incidence MeSH
• lidé MeSH
• nykturie * diagnóza   epidemiologie   etiologie   MeSH
• prevalence MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

CONTEXT: The role of a placebo response in the management of overactive bladder (OAB) remains unclear. OBJECTIVE: The aim of this review is to methodically study the placebo response extracted from the control arms of randomized clinical trials assessing therapy in patients with OAB. EVIDENCE ACQUISITION: Medline (PubMed), The Cochrane Library, EMBASE, and Scopus were searched to identify randomized controlled trials (RCTs) published until September 2019. Randomized placebo-controlled trials investigating oral drug therapy for OAB were included. The articles were critically appraised by two reviewers. The primary outcomes were the placebo response in the main patient-reported urinary outcomes together with assessing the impact of patient demographic factors on the placebo response. EVIDENCE SYNTHESIS: The initial search resulted in 1982 records after reviewing the titles and abstracts, and reference lists of other systematic reviews; 57 studies with an overall estimated 12 901 patients were included in the meta-analysis. The included studies were of overall high/acceptable quality. The standardized mean difference was -0.45 (95% confidence interval [CI] -0.51 to -0.40; p<0.001) for daily micturition episodes, -0.33 (95% CI -0.42 to -0.24; p<0.001) for daily nocturia episodes, -0.46 (95% CI -0.55 to -0.37; p<0.001) for urgency urinary incontinence episodes, -0.50 (95% CI -0.61 to -0.39; p<0.001) for daily urgency episodes, -0.51 (95% CI -0.60 to -0.43; p<0.001) for daily incontinence episodes, and 0.25 (95% CI 0.211-0.290; p<0.001) for volume voided per micturition. The meta-regression of age-related impact of the placebo response on nocturia showed a slope of -0.02 (p<0.001). CONCLUSIONS: Placebo has a statistically significant effect on improving symptoms and signs associated with OAB; this effect is age dependent. However, there is no consensus on what change of OAB symptoms and signs is clinically meaningful for the affected patient. Taken together, the placebo response seems to be non-negligible in OAB, supporting the need for placebo control in RCTs. PATIENT SUMMARY: Placebo is an inert treatment method often used in clinical research for comparison with active treatment. However, studies show that placebo has an effect of its own. A placebo response means the total improvement resulting from receiving a placebo. In our study, placebo had a significant role in improving the symptoms of overactive bladder.

• Klíčová slova
• Overactive bladder *, Placebo response *, Systematic review *,
• MeSH
• hyperaktivní močový měchýř * terapie   MeSH
• lidé MeSH
• nykturie * MeSH
• placebo efekt MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

INTRODUCTION: The aim of this study was to determine whether peroneal electrical Transcutaneous NeuroModulation (peroneal eTNM®) using the URIS® neuromodulation system can be used in individuals with refractory overactive bladder (OAB). METHODS: Eighteen female patients with idiopathic OAB who failed previous behavioral and pharmacological therapy were enrolled. Patients were treated with the URIS® neuromodulation system using active electrodes placed on the popliteal fossa, targeting the peroneal nerve for 30 min once a week for 12 weeks. Changes in OAB symptoms and patient-reported outcomes from baseline to the end of the study were analyzed. A nonparametric Wilcoxon signed-rank test was used to assess changes in variables. Statistical significance was defined as p ≤ 0.05. RESULTS: We observed a significant reduction in micturition frequency (p = 0.022), number of severe urgency episodes (p < 0.001), urgency incontinence episodes (p = 0.001), and nocturia episodes (p = 0.027). A decrease in Patient Perception of Bladder Condition score (p < 0.001) was also observed. Posttreatment, 15 patients (83.3%) reported a moderate or significant reduction in their bladder bother. Throughout the study, two adverse events were recorded with no causal relationship to the study treatment. DISCUSSION/CONCLUSIONS: Our study documented a significant reduction in all OAB symptoms and an improvement in all patient-reported outcomes in patients treated with peroneal eTNM® using the URIS® neuromodulation system.

• Klíčová slova
• Neuromodulation, Overactive bladder, Patient-reported outcomes, Peroneal nerve, Urgency,
• MeSH
• hodnocení výsledků péče pacientem MeSH
• hyperaktivní močový měchýř * farmakoterapie   MeSH
• inkontinence moči * MeSH
• lidé MeSH
• nykturie * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Suburethral tension-free vaginal tape is used for the treatment of stress urinary incontinence with a high success rate. Often patients report having stress incontinence, as well as co-existing micturition problems which are attributable to overactive bladder syndrome (OAB). The present study examines the effect of suburethral tape on the symptoms of OAB. In the study, we used the transobturator vaginal tape inside-out technique (TVT-O). Materials and Methods: 53 patients were included in the study, all had proven urodynamic stress incontinence and symptoms of overactive bladder. The patients were examined preoperatively and 3 months after the TVT-O placement. Results: The individual OAB symptoms improved significantly, with urinary frequency and urge incontinence improving more than nocturia. The frequency of micturition decreased on average from 16.1 to 10.1 episodes/24 hours, while nocturnal frequency of micturition decreased from 2.2 to 1.1. Not a single patient experienced the simultaneous worsening of all three measured variables, however 19 % of patients did report their simultaneous disappearance. Their quality of life that had been affected by OAB was measured on the basis of validated questionnaires, and found to have improved significantly. Only 28 % of patients reported a desire for drug treatment of OAB symptoms following tape placement. Conclusions: TVT-O placement leads to a significant improvement of the symptoms of overactive bladder syndrome. Patient quality of life - which was affected by OAB - was also enhanced by the tape placement. This accounts for a substantial share of the overall success of the suburethral tape.

Das spannungsfreie suburethrale Vaginalband wird zur Behandlung der Belastungsinkontinenz mit hohen Erfolgsraten eingesetzt. Oft berichten Patientinnen mit Belastungsinkontinenz aber auch von gleichzeitig bestehenden Miktionsproblemen, die dem Syndrom der überaktiven Harnblase (engl. overactive bladder – OAB) zuzuordnen sind. Die vorliegende Studie prüft die Wirkung des suburethralen Bandes auf die Symptome der OAB. In der Studie verwendeten wir ein transobturatorisch geführtes Band in der Inside-out-Technik (TVT-O). Material und Methoden: In die Studie wurden 53 Patientinnen eingebracht, die alle außer einer urodynamisch nachgewiesenen Belastungsinkontinenz Symptome der überaktiven Harnblase aufwiesen. Die Patientinnen wurden präoperativ und 3 Monate nach Implantation von TVT-O untersucht. Ergebnisse: Die einzelnen OAB-Symptome verbesserten sich signifikant, Dranginkontinenz und Pollakisurie mehr als Nykturie. Die Miktionsfrequenz sank im Mittel von 16,1 auf 10,1 Miktionen/24 Stunden, die nächtliche Miktionsfrequenz von 2,2 auf 1,1. Bei keiner einzigen Patientin kam es zur gleichzeitigen Verschlechterung aller 3 gemessenen Parameter, dafür jedoch bei 19 % der Patientinnen zu ihrem gleichzeitigen Verschwinden. Die durch die OAB beeinträchtigte Lebensqualität verbesserte sich signifikant, was anhand von validierten Fragebögen gemessen wurde. Nur 28 % der Patientinnen gaben nach Bandeinlage noch den Wunsch nach medikamentöser Behandlung der OAB-Symptome an. Schlussfolgerungen: Die Implantation von TVT-O führt zur signifikanten Verbesserung der Symptome der überaktiven Harnblase. Auch die durch die OAB beeinträchtigte Lebensqualität wird durch die Bandimplantation gesteigert, was einen wesentlichen Anteil am allgemeinen Erfolg des suburethralen Bandes ausmachen dürfte.

• Klíčová slova
• overactive bladder, suburethral sling, urinary incontinence, urodynamics,
• Publikační typ
• časopisecké články MeSH