Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK.
World J Urol. 2012 Jun;30(3):385-92. doi: 10.1007/s00345-011-0742-8. Epub 2011 Aug 19.
Overactive bladder (OAB) is a common condition that is associated with a negative impact on quality of life. Urgency is the essential symptom when making a diagnosis, and its effective treatment is a principal aim in OAB management. However, urgency has often been relatively neglected as an outcome measure in clinical trials. The aim of this review is, first, to describe the background to urgency in OAB; second, to determine whether results provided by several tools used to measure urgency in clinical trials could be cross-related to each other in a meaningful way.
The wording of various tools used to measure urgency in OAB was compared against the definition of urgency proposed by the International Continence Society (ICS). Urgency data were evaluated from two randomised, double-blinded, placebo-controlled trials with solifenacin in which seven tools were used to measure urgency as a primary or secondary outcome. In particular, subanalyses were available from these tools, which measured urgency equating to the ICS definition, excluding data points that could be interpreted as normal/strong desire to void.
Baseline scores for ICS-defined urgency differed between the tools, which might reflect imprecision in their wording and consequent overlap between urgency and normal/strong desire to void. All the tools detected broadly similar mean percentage reductions in the number of urgency episodes from baseline to the endpoint of the studies.
Urgency should be the primary or co-primary endpoint for future studies of OAB and detrusor overactivity. Greater clarity is needed in the development of instruments for measuring urgency, so that they do not confuse urgency with normal bladder sensations; more education and guidance are needed on how urgency is defined.
膀胱过度活动症（OAB）是一种常见病症，会对生活质量产生负面影响。尿急是诊断的基本症状，有效治疗是 OAB 管理的主要目标。然而，在临床试验中，尿急往往相对被忽视为一种疗效评价指标。本综述旨在：首先，描述 OAB 中尿急的背景；其次，确定在临床试验中用于测量尿急的几种工具所提供的结果是否可以以有意义的方式相互关联。
将用于测量 OAB 中尿急的各种工具的措辞与国际尿控协会（ICS）提出的尿急定义进行了比较。从两项使用索利那新的随机、双盲、安慰剂对照试验中评估了尿急数据，这两项试验将七种工具用于测量尿急作为主要或次要疗效评价指标。特别是，从这些工具中获得了亚分析，这些工具测量的尿急等同于 ICS 定义，排除了可以解释为正常/强烈尿意的数据点。
根据工具的不同，ICS 定义的尿急的基线评分存在差异，这可能反映了措辞不够精确，以及尿急和正常/强烈尿意之间的重叠。所有工具都检测到了从基线到研究终点的尿急发作次数的平均百分比大致相似的降低。
未来的 OAB 和逼尿肌过度活动研究应该将尿急作为主要或共同主要的疗效评价指标。在开发用于测量尿急的仪器时需要更加明确，以避免将尿急与正常膀胱感觉混淆；需要对如何定义尿急进行更多的教育和指导。
