Pub Date : 2025-01-02DOI: 10.1038/s41585-024-00974-9
Jelizaveta Pereca, Adrian Wagg, Megan Kennedy, Christopher Chapple
A number of reports have suggested that the use of prolonged antibiotic treatment could be an effective therapy for patients with overactive bladder (OAB); however, this approach is contrary to existing recommendations regarding the prolonged non-specific use of antibiotics. The existing evidence in this area seems to be circumstantial and anecdotal but, despite this limitation, the use of long-term antibiotic therapy for OAB seems to be increasing. Review and synthesis of the existing evidence for use of antibiotic therapy in patients with OAB identify few studies — just seven papers and four conference proceedings — which are heterogeneous in their design, inclusion and exclusion criteria, treatment regimen employed, approach to the use of antimuscarinic medications, follow-up protocols, and measured outcomes. Overall, the limitation of these published data, the potential adverse events associated with long-term antibiotic use, concerns about antimicrobial resistance and the wide availability of other conventional treatments mean that no compelling data support the routine use of antibiotic therapy and that antibiotic treatment of OAB is not supported by an adequate contemporary evidence base. In the absence of acute urinary tract infection, the management of the non-specific syndrome of OAB should follow existing evidence-based investigational and treatment guidelines. Contemporary therapy following attention to fluid intake relies upon anticholinergic or β3-adrenergic agonist treatment with progression to intravesical onabotulinumtoxinA therapy or neuromodulation in non-responders to oral therapy.
{"title":"Antibiotic therapy for treating overactive bladder is not supported by clinical evidence","authors":"Jelizaveta Pereca, Adrian Wagg, Megan Kennedy, Christopher Chapple","doi":"10.1038/s41585-024-00974-9","DOIUrl":"https://doi.org/10.1038/s41585-024-00974-9","url":null,"abstract":"<p>A number of reports have suggested that the use of prolonged antibiotic treatment could be an effective therapy for patients with overactive bladder (OAB); however, this approach is contrary to existing recommendations regarding the prolonged non-specific use of antibiotics. The existing evidence in this area seems to be circumstantial and anecdotal but, despite this limitation, the use of long-term antibiotic therapy for OAB seems to be increasing. Review and synthesis of the existing evidence for use of antibiotic therapy in patients with OAB identify few studies — just seven papers and four conference proceedings — which are heterogeneous in their design, inclusion and exclusion criteria, treatment regimen employed, approach to the use of antimuscarinic medications, follow-up protocols, and measured outcomes. Overall, the limitation of these published data, the potential adverse events associated with long-term antibiotic use, concerns about antimicrobial resistance and the wide availability of other conventional treatments mean that no compelling data support the routine use of antibiotic therapy and that antibiotic treatment of OAB is not supported by an adequate contemporary evidence base. In the absence of acute urinary tract infection, the management of the non-specific syndrome of OAB should follow existing evidence-based investigational and treatment guidelines. Contemporary therapy following attention to fluid intake relies upon anticholinergic or β3-adrenergic agonist treatment with progression to intravesical onabotulinumtoxinA therapy or neuromodulation in non-responders to oral therapy.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"252 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-11DOI: 10.1038/s41585-024-00986-5
Maria Chiara Masone
{"title":"Personalized 3D models for prostate cancer surgery","authors":"Maria Chiara Masone","doi":"10.1038/s41585-024-00986-5","DOIUrl":"10.1038/s41585-024-00986-5","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"22 1","pages":"4-4"},"PeriodicalIF":12.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-09DOI: 10.1038/s41585-024-00967-8
Jan Krhut, Hanne Kobberø, Reine Kanaan, Mikkel Fode, Mads Poulsen, Peter Zvara
Neuromodulation has been used in the treatment of various pelvic organ dysfunctions for almost 40 years and several placebo-controlled studies have confirmed its clinical effect. Many neuromodulation methods using different devices and stimulation parameters, targeting different neural structures have been introduced, but only a limited number have been adopted into routine clinical use. A substantial volume of basic research and clinical studies addressing specific effects of neuromodulation in the treatment of overactive bladder (OAB) have been published to date; however, their mechanistic implications have not been comprehensively summarized. Thus, our understanding of the mechanism of action of neuromodulation in OAB treatment is mainly based on postulated theories. Results from animal experiments suggest that different neuromodulation methods used to treat OAB share the same basic principles. The most likely explanation for the effect of neuromodulation in OAB therapy is the suppression of bladder afferent signalling, promotion of spinal guarding reflexes and modulation of non-specific supraspinal regulatory circuits.
{"title":"The mechanism of action of neuromodulation in the treatment of overactive bladder","authors":"Jan Krhut, Hanne Kobberø, Reine Kanaan, Mikkel Fode, Mads Poulsen, Peter Zvara","doi":"10.1038/s41585-024-00967-8","DOIUrl":"https://doi.org/10.1038/s41585-024-00967-8","url":null,"abstract":"<p>Neuromodulation has been used in the treatment of various pelvic organ dysfunctions for almost 40 years and several placebo-controlled studies have confirmed its clinical effect. Many neuromodulation methods using different devices and stimulation parameters, targeting different neural structures have been introduced, but only a limited number have been adopted into routine clinical use. A substantial volume of basic research and clinical studies addressing specific effects of neuromodulation in the treatment of overactive bladder (OAB) have been published to date; however, their mechanistic implications have not been comprehensively summarized. Thus, our understanding of the mechanism of action of neuromodulation in OAB treatment is mainly based on postulated theories. Results from animal experiments suggest that different neuromodulation methods used to treat OAB share the same basic principles. The most likely explanation for the effect of neuromodulation in OAB therapy is the suppression of bladder afferent signalling, promotion of spinal guarding reflexes and modulation of non-specific supraspinal regulatory circuits.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"28 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1038/s41585-024-00982-9
Louise Lloyd
{"title":"PEACEing together prostate cancer therapy","authors":"Louise Lloyd","doi":"10.1038/s41585-024-00982-9","DOIUrl":"10.1038/s41585-024-00982-9","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"22 1","pages":"4-4"},"PeriodicalIF":12.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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