Tag Archive | "overactive-bladder"

Tests for Overactive Bladder Drugs Produce Mixed Results

A randomized placebo-controlled trial showed that overactive bladder (OAB) symptoms decreased significantly within four weeks after the start of treatment with the investigational beta-3 agonist mirabegron.  Frequency of urinary incontinence and urination decreased significantly with two different doses of mirabegron.

This improvement in symptoms was correlated with improvement in patient-reported outcomes, including treatment satisfaction, symptoms, and quality of life.

According to presentations at the American Urological Association meeting adverse events occurred at similar rates in the placebo-controlled and mirabegron-treated patients.

Mirabegron is a first-in-class agent developed specifically for the treatment of OAB that has not been approved by the FDA.  It selectively binds and activates beta-3 adrenoreceptors on bladder detrusor muscle to facilitate filling and storage.

Favorable results from phase II studies of mirabegron led to this phase III, randomized and placebo-controlled study involving more than 1,300 patients with OAB.  Investigators at 132 sites throughout the United States and Canada randomized the patients to receive either the placebo or 50-mg or 100-mg of mirabegron.  Researchers examined patient diaries recording changes in the number of daily episodes of urinary incontinence and urination from baseline to 12 weeks.

About three-fourths of study participants were women with a mean age of 60.  About four in ten patients had mixed stress/urgency incontinence with urgency predominance, a third had no incontinence, and the remainder had urgency incontinence.

The number of incontinence episodes per 24 hours had declined in all three treatment groups after 12 weeks, but there were more significant reduction in the 50-mg and 100-mg mirabegron treatment groups.  The incidence and severity of adverse events including hypertension, urinary tract infection, headache and nasopharyngitis were similar across the three groups.  Patient-reported outcomes were all significantly better in the mirabegron treatment groups compared with the placebo-controlled group.

In contrast to these mirabegron results, findings from a randomized trial of ONO-8359, a prostaglandin EP1 receptor antagonist, showed no significant improvement in any of its treatment groups.   The study involved 435 patients randomized to a placebo, tolterodine, or one of three doses of ONO-8539.  In this study, patients were randomized on the basis of findings from a three-day placebo run-in that showed at least eight micturitions per 24-hour period, at least one urgency episode per 24 hours, and at least six urgency episodes during the three-day run-in.  Researcher compared the number of urinations per 24 hours at baseline to 12 weeks.    They found no significant differences between any dose of ONO-8358 and placebo for any of the outcomes.

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Coffee and Prostate Health: Is it Bad for You?

Is coffee good or bad for men’s health?  A recent study suggests that coffee and caffeine may be safe (for now) in regards to prostate cancer, but components within coffee can negatively affect men who have benign prostatic hyperplasia (BPH).

For men who have BPH, drinking coffee can be detrimental because caffeine can stimulate an already overactive bladder, which means it can increase urinary frequency and urgency and may even result in urge incontinence.  Caffeine acts on the bladder in several ways.  First, it increases how fast the bladder fills up by increasing the rate of urine production.  Second, caffeine enhances the sensation and contractility of the bladder, thus making the organ feel a potentially erroneous urge to empty.

Caffeine can also irritate the bladder because it is a theoxanthine, which is a family of drugs that includes theobromine (found in chocolate) and theophylline (found in tea).  Theophylline also stimulates and irritates the bladder; however, tea contains half as much caffeine as coffee does, and green tea specifically contains even less.

The impacts of coffee on prostate cancer have piqued the interests of researchers worldwide.  According to recent research conducted by Dr. Chang-Hae Park from the National Cancer Center in South Korea, there is no association between prostate cancer and drinking coffee, but there is still some controversy.  Park and his team evaluated the results of 12 studies that compared coffee intake and prostate cancer risk.  Eight of the studies were case-control studies and four were cohort studies.

The controversial part is that although the investigators found a significant harmful association between coffee consumption and prostate cancer risk in seven of the eight case-control studies, they also explained that the studies had severe limitations that affected the outcomes.  None of the cohort studies showed any significant association between coffee consumption and prostate cancer.  Therefore, while Park and his team reported there is no evidence that coffee consumption has an effect on prostate cancer, further prospective cohort studies are needed.

The journal Molecular Nutrition and Food Research published a study in 2009 in which researchers evaluated the impact of coffee and tea on prostate health.  The investigators’ results showed that no apparent relationship with prostate cancer existed; however, the evidence from animal and in vitro studies suggested that tea, especially green tea, is a healthier choice than coffee for prostate health.

A study at Umea University in Sweden analyzed the effects of both filtered and boiled coffee on the incident of cancer.  From a study population of more than 64,000, there were 3,034 cases of cancer, with up to 15 years of follow-up.  The investigators did not find an association between consumption of filtered or boiled coffee and all types of cancer combined, or for prostate or colorectal cancer in particular.

Another large study conducted by Harvard evaluated 50,000 men.  Researchers used data from the Health professionals’ follow-up study to determine if there was an association between the consumption of regular and decaffeinated coffee and prostate cancer.  The investigators found that over two decades, 4,975 cases of prostate cancer were diagnosed.  According to Kathryn Wilson, Ph.D., from Harvard Medical School and the Harvard School of Public Health, she and her team “specifically looked at different types of prostate cancer, such as advanced vs. localized cancers or high-grade vs. low-grade cancer.”  They found that men who had the highest intake of coffee had a 60 percent lower risk of advanced prostate cancer.  Wilson noted:  “Our results do suggest there is no reason to stop drinking coffee out of any concern about prostate cancer.”

Coffee and caffeine have an impact on other aspects of your health outside of prostate health.  Some studies suggest that consuming coffee and caffeine is associated with a reduced risk of certain diseases.  One study published in Cancer Causes & Control in January 2011 found that drinking three or more cups of coffee daily was associated with a 44 percent reduced risk of developing liver cancer in a group of older Chinese adults.

In addition, the Journal of Alzheimer’s Disease reported the results of a recent review study that explored a relationship between coffee and dementia.  The investigators concluded that coffee drinking may be associated with a reduced risk of dementia and Alzheimer’s disease.

But despite these positive studies, a combination of coffee, caffeine, and stress can be very unhealthy.  Here are some reasons why these three don’t always mix well.

  1. Coffee raises stress hormone levels.  Elevated levels of stress hormones, including norepinephrine and especially cortisol, are responsible for raising heart rate and blood pressure.  When you combine coffee/caffeine with stress, you place your stress hormones on high alert, which in turn puts your heart rate and blood pressure in unhealthy states as well.  Elevated stress hormones also weaken your immune system.  If you reduce your coffee/caffeine consumption, you will lower your stress hormone levels, blood pressure, and heart rate, and help preserve your immune system health.
  2. Coffee contributes to weight gain.  The higher cortisol levels associated with coffee consumption are also linked to insulin resistance, increased appetite, and cravings for fatty foods.  High cortisol levels can also contribute to fat deposits in the abdomen, which is a risk factor for heart disease.
  3. Coffee plus stress may equal heart attack.  Coffee consumption can increase stress, which is a known risk factor for heart attack, heart palpitations, and elevated homocysteine, another risk factor for heart disease.  If you are stressed, coffee is not a health beverage for your heart.
  4. Stress and coffee affect the brain.  Stress has a detrimental effect on the parts of the brain responsible for planning, decision making, and reasoning.  When you add caffeine, your mental abilities, mood, and memory can suffer, because caffeine interferes with blood flow to the brain.  To keep mentally sharp, reduce your use of coffee and caffeine.
  5. Stress and coffee disrupt sleep.  Stress and worry can keep you awake, and the stimulating effects of caffeine can disrupt your ability to sleep.  If you eliminate coffee, you may regain the ability to sleep.
  6. Stress and coffee irritate your GI tract.  Coffee and caffeine are highly acidic, which can increase the risk of heartburn, ulcers, and irritable bowel syndrome.  Reduce your coffee intake, and reduce your risk of these gastrointestinal problems.

An occasional cup of coffee will not likely have a negative effect on prostate health or your overall health.  But if you have BPH, coffee consumption should be limited.  If you want to enhance prostate health and general well-being, however, the better choice is green tea.

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Implanted Pacemaker for Overactive Bladders

More than 200 million people suffer from an over-active bladder; many of these victims feel like they are held hostage by their own bathrooms.

One over-active bladder patient, Sue Nelson, says soda pop used to be a nightmare.  “You have to constantly be close to a bathroom.”  Nelson, like the 25 million people living with bladder control issues, had a bladder condition that kept telling her it was full, even though it was not.  The result:  she could not leave the house very often.

“People get embarrassed because it is not something you sit down and talk about over dinner,” said Nelson.

In fact, Dr. Christopher Smith, MD, at Baylor College of Medicine said, “It’s almost like the bladder reverts back to a child-like bladder.”

But a solution now exists that is similar to the same technology doctors use on heart problems.  It is called sacral nerve stimulation (InterStim Therapy) and is a pacemaker that has been implanted into many patients, like Sue, who are experiencing over-active bladder syndrome.  The device weighs just an ounce and works by sending an electric stimulation signal to the base of the spine, telling patients when their bladder is truly full.

“It filters these signals, these overactive signals—between a patient’s bladder and their brain,” explains Dr. Smith.

And studies are showing just how effective this bladder pacemaker is.  Over 56 percent of users actually cut their bathroom trips in half, and 46 percent of patients experience zero bladder control issues.

Sue Nelson, who has had the device successfully implanted, happily recommends the product: “It’s like, back to my old life.  This [over-active bladder problem] is just something that happens to some people, and there is hope.”

Experts say up to 75 percent of people suffering from over-active bladder do not respond to medication.  With so many suffering from the condition, researchers have been searching for a solution with minimal intrusion, and patients seem to agree this is one successful answer.

Those who want the device can wear an external version for seven days before committing to full implantation.

Over 75,000 worldwide patients have gone on to receive the full version of sacral nerve stimulation.  The therapy is minimally invasive and is indicated for patients who suffer from urinary urge incontinence, urinary urgency-frequency, or non-obstructive urinary retention.  Permanent implantation is done under general anesthesia and requires a one-night stay in the hospital.  The neurostimulator is about the size of a pocket stopwatch and is inserted under the patient’s abdomen.  Wires, or leads, running from the stimulator carry electrical impulses from the stimulator to the sacral nerves located in the lower back.  The device does contain a battery inside the neurostimulator, and this battery typically needs to be replaced every three to five years.

If you have long suffered the inconveniences and embarrassment of an over-active bladder, please discuss the symptoms with your doctor in order to determine if this therapy is right for you.

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