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"Tesis ini disusun untuk mengetahui efektivitas stimulasi elektrik saraf tibialis posterior pada pasien overactive bladder (OAB). Penelitian ini menggunakan desain uji eksperimental Randomized Control Trial. Subjek penelitian merupakan pasien OAB diatas usia 18 tahun. Dua puluh pasien dibagi secara acak menjadi 2 kelompok yaitu kelompok perlakuan dan kontrol. Semua subjek dari kedua kelompok mendapatkan tatalaksana standar berupa terapi perilaku, latihan otot dasar panggul dan pemberian antimuskarinik imidafenacine 2 x 0,1 mg. Sebagai tambahan, kelompok perlakuan diberikan stimulasi elektrik saraf tibialis posterior secara transkutan 10 Hz, 200 us, dengan intensitas yang masih dapat ditoleransi pasien, dilakukan 2x/minggu selama 8 minggu. Hasil keluaran penelitian ini berupa Overactive Bladder Symptom Score (OABSS) dan parameter catatan berkemih sebelum intervensi (T0), setelah 4 minggu (T1) dan setelah 8 minggu intervensi (T2). Analisis statistik dilakukan untuk membandingkan perubahan nilai OABSS dan parameter catatan berkemih sesudah intervensi pada kelompok perlakuan dan kontrol. Hasil penelitian menyatakan bahwa stimulasi elektrik saraf tibialis posterior efektif dalam menurunkan frekuensi berkemih pada pasien OAB setelah diberikan intervensi selama 8 minggu. Rerata penurunan frekuensi berkemih pada kelompok perlakuan dan kontrol masing-masing sebesar 6,81±3,09 dan 3,74±1,83 dan didapatkan perbedaan signifikan dengan nilai p = 0,009. Diperlukan penelitian lebih lanjut dengan waktu intervensi yang lebih lama untuk menilai efektivitas stimulasi elektrik saraf tibialis posterior pada pasien OAB.......This thesis was aimed to determine the effectiveness of posterior tibial nerve stimulation in overactive bladder (OAB). This study design was randomized control trial. The subjects were OAB patients aged over 18 years old. Twenty subjects were randomly divided into 2 groups: intervention and control groups. The subjects from both groups received standard therapy consist of : behavioral therapy, pelvic floor exercise and antimuscarinic (imidafenacine 0,1 mg twice daily). In addition, the intervention group was given transcutaneous posterior tibial nerve stimulation of 10 Hz, 200 us, 30 minutes, with an intensity tolerable pain, 2 times/ week for 8 weeks. The Overactive Bladder Symptom Score (OABSS) and voiding diary parameters were used to measure before the intervention (T0), after 4 weeks (T1) and after 8 weeks of intervention(T2). Statistical analysis was performed to compare changes in OABSS and voiding diary between the intervention and control groups. The results stated that the posterior tibial nerve stimulation was effective in reducing the frequency of urination in OAB patients after being given an intervention for 8 weeks. The mean reduction in voiding frequency in the intervention and control groups was 6.81 ± 3.09 and 3.74 ± 1.83, respectively, and a significant difference was obtained with a value of p = 0.009. Further studies are needed with longer intervention times to assess the effectiveness of posterior tibial nerve electrical stimulation in OAB patients"

"Pendahuluan dan tujuan: Overactive bladder (OAB) terjadi pada sekitar 17-41% pada lansia di lingkungan tempat tinggal komunitas. Selama beberapa tahun, antimuskarinik telah divalidasi sebagai pilihan pertama untuk tata laksana OAB. Meskipun banyak data yang diperoleh dari uji klinis terkait penggunaan antimuskarinik. Penelitian terkait efek samping dari obat antimuskarinik terhadap fungsi kognitif pada lansia masih jarang dilakukan. Tujuan dari penelitian ini adalah untuk mengetahui efek dari terapi antimuskarinik terhadap fungsi kognitif pada pasien lanjut usia dengan OAB. Metode: Desain penelitian ini adalah tinjauan sistematis dan meta-analisis. Studi dikumpulkan menggunakan beberapa mesin pencari; diantaranya adalah PubMed, Science Direct, Cochrane, and EBSCOhost menggunakan kata kunci MeSH yang sudah ditentukan sebelumnya dengan operator Boolean. Pemilihan studi dilakukan oleh 3 pengulas. Seluruh studi yang memenuhi kriteria inklusi selanjutnya melalui proses review full-text. Untuk setiap artikel full-text yang terpilih, ekstraksi data dilakukan pada data: demografis pasien, tipe antimuskarinik yang digunakan, placebo, dosis, follow-up, dan skor total Mini Mental State Examination(MMSE). Hasil: Total sebanyak 8 studi yang terpilih dari 146 publikasi yang ada sebelumnya. Terdapat 8 jenis antimuskarinik yang dievaluasi dari studi-studi yang ada, yaitu: Oksibutinin, Darifenacin, Tolterodin, Trospium, Imidafenacin, Propiverin hidroklorida, Fesoterodin, dan Solifenacin. Oksibutinin menunjukkan efek yang paling besar pada penurunan skor MMSE [Perbedaan rerata: -2,90; 95% CI: -4,07, -1,73]. Darifenacin dan Tolterodin juga menunjukkan penurunan yang signifikan pada skor total MMSE, namun lebih inferior daripada Oksibutinin Kesimpulan: Penggunaan obat-obatan antimuskarinik hanya memiliki efek yang minimal terhadap fungsi kognitif dalam penanganan OAB pada pasien usia lanjut. Akan tetapi, Oksibutinin, Darifenacin, dan Tolterodin menunjukkan penurunan yang signifikan terhadap fungsi kognitif, ditunjukkan dari penurunan total skor MMSE.......Introduction: Overactive bladder (OAB) affects 17-41% older adults in community dwelled setting. For several years, antimuscarinics have been validated as the first-line medical treatment for OAB. Despite abundant data obtained from clinical trials provisions the use of antimuscarinics, investigation about the effect of this drug on cognitive function in elderly remains scarce. The objective of this study is to investigate the effect of antimuscarinics therapy on cognitive functions in OAB geriatric patients.Methods: This study design is a systematic review and meta-analysis. Studies were collected using several search engines; those were PubMed, Science Direct, Cochrane, and EBSCOhost using predetermined MeSH keywords with Boolean operators. Selection of studies was done by three reviewers. Studies which fulfilled the inclusion and exclusion criteria underwent full-text review. For every selected full text, we extracted the following data if available: patients demographics, types of antimuscarinics used, placebo, dose, follow-up period, and Mini-Mental State Examination (MMSE) total score.Results: A total of 8 studies from an initial 146 publications were selected. There were 8 antimuscarinic agents evaluated in the studies, including Oxybutynin, Darifenacin, Tolterodine, Trospium, Imidafenacin, Propiverine hydrochloride, Fesoterodine, and Solifenacin. Oxybutynin was shown to have largest effect towards the decline of MMSE score [Mean difference: -2.90; 95% CI: -4.07, -1.73]. Darifenacin and Tolterodine were also shown to be significant in the decline of total MMSE score, although still inferior to Oxybutynin.Conclusion: The use of most antimuscarinics medication has little to no effect towards the cognitive function in the management of overactive bladder in elderly patients. However, Oxybutynin, Darifenacin, and Tolterodine was shown to have significant decrease in cognitive functions, as shown in the decline of total MMSE score."

"Overactive bladder (OAB) merupakan suatu kondisi yangsering terjadi dan diperkirakan sekitar 455 juta orang (11%penduduk dunia) pernah mengalami gejala tersebut. Kondisiini dapat memberikan dampak yang signifikan bagi kualitashidup pasien. Tatalaksana lini pertama OAB adalah terapikonservatif dan medikamentosa dengan obat antimuskarinik.Bagi pasien yang resisten terhadap pilihan terapi tersebut,terdapat beberapa alternatif tatalaksana, antara lain operasi,stimulasi elektrik, dan injeksi toksin botulinum. Dari antarapilihan tersebut, percutaneous tibial nerve stimulation(PTNS) merupakan pilihan yang invasif minimal. PTNS bekerjadengan menstimulasi pleksus saraf sakral, sekelompok sarafyang berperan dalam regulasi fungsi kandung kemih. Setelahmendapat sertifikasi food and drug administration (FDA) padatahun 2007, PTNS semakin banyak digunakan dengan hasilmenjanjikan. Pada tinjauan pustaka ini disajikan berbagaistudi nonkomparatif dan komparatif yang membandingkanPTNS dengan prosedur sham, terapi antimuskarinik, dan terapikombinasi yang menggabungkan PTNS dan antimuskarinikdengan data yang mendukung penggunaan PTNS pada OAB."

"ABSTRACTBackground: urinary tract infection (UTI) is often treated in daily practice as overactive bladder (OAB) by giving anticholinergic, the recommended treatment options of OAB. However, anticholinergic application for UTI symptoms relief has never been investigated. To our knowledge, this study was the first randomized trial which investigate anticholinergic use for UTI treatment. This study aimed to evaluate whether additional anticholinergic is beneficial alongside an empiric antibiotic therapy in reducing symptoms and tolerable for females with uncomplicated UTI. Methods: this was a randomized double-blind controlled trial that included female aged >18 y.o with uncomplicated lower UTI. Patients were randomly assigned to either solifenacin succinate 5 mg (group 1) or placebo (group 2) in addition to empiric levofloxacin 500 mg treatment for 3 days. Those with structural and/or functional abnormalities of the urinary tract and allergic reaction history were excluded. We observed changes in overactive bladder symptom score (OABSS), patient perception of bladder condition (PPBC) score, patient-reported symptoms and adverse events. Results: a total of 126 patients, 63 for each group, initiated the trial with median age of 44 (19-67) y.o. There were no differences of age, OABSS, and PPBC score between the 2 groups at baseline. We found significant (p<0.05) reduction of OABSS and PPBC score in both groups at the end of therapy; however the amount of reduction were not different between groups. In group 1 we found 22.2% of patients complained of dry mouth and 25.4%, 4.7%, 3.2% of patients complained of nausea, somnolence and constipation respectively. In group 2 we found 20.0%, 21.7% and 3.3% patients who complained of dry mouth, nausea, and somnolence respectively. One patient in group 2 experienced allergic reaction and was dropped out. Conclusion: we found no significant difference in OABSS and PPBC score reduction by adding anticholinergic to antibiotic therapy for females with uncomplicated UTI. There was no serious adverse event recorded."

"Background: overactive bladder (OAB) affects 17-41% older adults in community dwelled setting. For several years, antimuscarinics have been validated as the first-line medical treatment for OAB. Despite abundant data obtained from clinical trials provisions the use of antimuscarinics, investigation about the effect of this drug on cognitive function in elderly remains scarce. The objective of this study is to investigate the effect of antimuscarinics therapy on cognitive functions in OAB geriatric patients. Methods: this study design is a systematic review and meta-analysis. Studies were collected using several search engines; those were PubMed, Science Direct, Cochrane, and EBSCOhost using predetermined MeSH keywords with Boolean operators. Selection of studies was done by three reviewers. Studies which fulfilled the inclusion and exclusion criteria underwent full-text review. For every selected full text, we extracted the following data if available: patients demographics, types of antimuscarinics used, placebo, dose, follow-up period, and Mini-Mental State Examination (MMSE) total score. Results: a total of 8 studies from an initial 146 publications were selected. There were 8 antimuscarinic agents evaluated in the studies, including Oxybutynin, Darifenacin, Tolterodine, Trospium, Imidafenacin, Propiverine hydrochloride, Fesoterodine, and Solifenacin. Oxybutynin was shown to have largest effect towards the decline of MMSE score [Mean difference: -2.90; 95% CI: -4.07, -1.73]. Darifenacin and Tolterodine were also shown to be significant in the decline of total MMSE score, although still inferior to Oxybutynin. Conclusion: the use of most antimuscarinics medication has little to no effect towards the cognitive function in the management of overactive bladder in elderly patients. However, Oxybutynin, Darifenacin, and Tolterodine was shown to have significant decrease in cognitive functions, as shown in the decline of total MMSE score."

"Latar Belakang Disfungsi saluran kemih bawah (LUTD) adalah istilah yang merujuk pada gangguan penyimpanan dan pengosongan urin, atau disfungsi kandung kemih, termasuk gejala saluran kemih bawah (LUTS). Arus interferensial digunakan untuk memberikan arus frekuensi rendah yang diperlukan untuk stimulasi transkutan struktur internal tanpa menyebabkan ketidaknyamanan. Elektroterapi interferensial (IET) telah banyak digunakan untuk mengobati LUTD. Namun, IET belum banyak diteliti dalam hal evaluasi klinisnya, terutama pada anak-anak dengan LUTD. Penelitian ini bertujuan untuk mengkaji efektivitas dan efek IET terhadap kualitas hidup pasien disfungsi kandung kemih dibandingkan dengan terapi konservatif konvensional.Metode Basis data PubMed, Cochrane Library, Scopus, EBSCOhost EMBASE, dan CINAHL dicari secara sistematis termasuk semua studi dengan data primer yang membandingkan kualitas hidup dan hasil urodinamik terapi listrik interferensial dan terapi konservatif konvensional. Risiko bias untuk studi yang termasuk dievaluasi. Meta-analisis dilakukan dengan menggunakan Review Manager (Revman 5.4).Hasil Delapan studi yang memenuhi kriteria inklusi, dengan sebagian besar menunjukkan risiko bias rendah, telah dimasukkan dalam tinjauan ini. Dari delapan studi yang termasuk, lima studi dapat dianalisis lebih lanjut menggunakan meta-analisis. Hasil meta-analisis menunjukkan bahwa IET secara signifikan mengurangi kejadian inkontinensia siang hari (RR: 0,27, 95% CI: 0,14-0,50), dan pola pengosongan abnormal (RR: 0,44, 95% CI: 0,22-0,91) dibandingkan dengan CCT. Namun, tidak ada perbedaan signifikan yang diamati dalam kejadian inkontinensia malam hari, waktu pengosongan, volume pengosongan, PVR, Qmax, atau Qave dengan IET dibandingkan dengan CCT.Kesimpulan Studi ini mengkonfirmasi IET sebagai modalitas yang efektif dalam pengobatan disfungsi kandung kemih dengan beberapa LUTS pada anak-anak.......Background Lower urinary tract dysfunction (LUTD) is an exclusive term that refers to impairments in urine storage and voiding, or bladder dysfunction, including lower urinary tract symptoms (LUTS). During recent decades, inferential electrotherapy (IET) has been expanded and extensively used to treat LUTD in both adults and children. Despite some prior studies, to our knowledge IET has not been studied much in terms of its clinical evaluation, especially in children with LUTD. This systematic review and meta-analysis aims to address the efficacy and effect of IET on the quality of life for bladder dysfunction patients compared to conventional conservative therapy (CCT).Methods PubMed, Cochrane Library, Scopus, EBSCOhost EMBASE and CINAHL databases were systematically searched including all studies with primary data that compared the quality of life and urodynamic outcomes of interferential electric and conventional conservative therapy. The risk of bias for included studies was assessed. Meta-analysis was performed in Review Manager (Revman 5.4).Results Eight Studies were included that meet the eligibility criteria, with the majority exhibiting a low risk of bias. Of the eight studies included, five studies were able to be further analyzed using meta-analysis. The meta-analysis results show that IET significantly reduced the incidence of daytime incontinence (RR: 0.27, 95% CI: 0.14-0.50), and abnormal voiding patterns (RR: 0.44, 95% CI: 0.22–0.91) compared to CCT. However, no significant difference was observed in the incidence of nighttime incontinence, voiding time, voiding volume, PVR, Qmax or Qave with IET compared to CCT.Conclusion Overall, studies confirm IET as an effective modality in the treatment of bladder dysfunction with several LUTS in children. IET is safe, with no significant adverse events reported promising results in bowel and urinary disorders in children."