Women Undergoing Third Line Overactive Bladder Treatment Demonstrate Elevated Thermal Temporal Summation.

Reynolds WS, Kowalik C, Cohn J, Kaufman M, Wein A, Dmochowski R, Bruehl S
J Urol. 2018 200 (4): 856-861

PMID: 29746857 · PMCID: PMC6146049 · DOI:10.1016/j.juro.2018.05.007

PURPOSE - We sought to determine whether women with overactive bladder who required third line therapy would demonstrate greater central sensitization, indexed by temporal summation to heat pain stimuli, than those with overactive bladder.

MATERIALS AND METHODS - We recruited 39 women with overactive bladder from the urology clinic who were planning to undergo interventional therapy for medication refractory overactive bladder with onabotulinumtoxinA bladder injection or sacral neuromodulation. We also recruited 55 women with overactive bladder who were newly seen at our urology clinic or who responded to advertisements for study participation. Participants underwent quantitative sensory testing using a thermal temporal summation protocol. The primary study outcome was the degree of temporal summation as reflected in the magnitude of positive slope of the line fit to the series of 10 stimuli at a 49C target temperature. We compared the degree of temporal summation between the study groups using linear regression.

RESULTS - Women in the group undergoing third line therapy showed significantly higher standardized temporal summation slopes than those in the nontreatment group (β = 1.57, 95% CI 0.18-2.96, t = 2.25, p = 0.027). On exploratory analyses a history of incontinence surgery or hysterectomy was associated with significantly greater temporal summation.

CONCLUSIONS - In this study the degree of temporal summation was elevated in women undergoing third line overactive bladder therapy compared to women with overactive bladder who were not undergoing that therapy. These findings suggest there may be pathophysiological differences, specifically in afferent nerve function and processing, in some women with overactive bladder.

Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

MeSH Terms (20)

Adult Aged Botulinum Toxins, Type A Central Nervous System Sensitization Cohort Studies Female Follow-Up Studies Hot Temperature Humans Linear Models Lumbosacral Plexus Middle Aged Pain Perception Retrospective Studies Risk Assessment Severity of Illness Index Temporal Lobe Transcutaneous Electric Nerve Stimulation Treatment Outcome Urinary Bladder, Overactive

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