6 Although the presence of preoperative DO does not appear to significantly worsen the treatment outcome in women with SUI, OAB symptoms may only resolve in about 50% of patients with mixed urodynamic stress incontinence (USI) and DO after anti-incontinence surgery such as tension-free vaginal tape procedure.47–49 However, persistent SUI, persistent

OAB symptoms, or de novo DO may occur in women who have undergone a midurethral sling procedure or a bladder neck sling procedure, and especially in patients who have undergone an anti-incontinence procedure resulting in BOO.49 Urinary NGF level was measured in 38 women with urodynamic SUI (UUSI) with OAB, in 26 women with urodynamic DO but Inhibitors,research,lifescience,medical not SUI, in 21 women with persistent USI after antiincontinence surgery, in 15 women with de novo DO, and in 31 normal controls.50 All subjects underwent a videourodynamic study for differential diagnosis of the underlying causes of incontinence. Inhibitors,research,lifescience,medical Urinary NGF/Cr levels were low in controls and in women with pure USI (P = .108). The NGF/Cr levels were significantly higher in women with mixed USI and DO than in controls (P = .001) and in pure USI patients (P = .006), but were similar to the levels in women with pure DO (P = .058). NGF/Cr level was undetectable in women with persistent USI, but was significantly higher in those with de novo DO after antiincontinence Inhibitors,research,lifescience,medical surgery compared with the controls

and USI patients. A urinary NGF/Cr level higher than 0.05 was found in 9% of USI, 77% of DO, 81% of mixed USI and DO, and 80% of de novo DO patients (Figure Inhibitors,research,lifescience,medical 6). Analysis of Decitabine chemical structure clinical symptoms and urodynamic findings in this study also revealed that OAB symptoms in women with SUI are not reliable for the occurrence of DO. Although all of the women in this study had both SUI

and OAB symptoms, urodynamic SUI was found in 45% and DO was detected in 55% of women. With the use of urinary NGF level as biomarker, the sensitivity of detecting urodynamic DO was higher than basing on the clinical symptoms alone. Figure 6 Urinary Inhibitors,research,lifescience,medical nerve growth factor/creatinine levels (NGF/Cr) were low both in controls and in women with pure urodynamic stress incontinence (USI), significantly higher in women with mixed USI and detrusor overactivity (DO) than in controls and in pure USI … Urinary NGF Level in OAB Patients After Antimuscarinic first Therapy NGF levels in urine were found to increase in patients with OAB.26,27,29 Effective antimuscarinic treatment of OAB might act mainly on the muscarinic receptors in sensory pathways and alter urinary NGF production, which in turn reduces urgency sensation during bladder filling. If urinary NGF can be demonstrated to reduce OAB in patients with symptomatic improvement after antimuscarinic treatment, it would support the existence of a link between NGF production and muscarinic receptor activation in OAB.