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"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.

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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."

"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."

"Overactive Bladder OAB masih menjadi masalah dan mengurangi kualitas hidup pada penderitanya. Terapi akupunktur dapat dipakai sebagai terapi OAB. Penelitian ini menggunakan metode uji klinis quasi experimental, terdiri atas 23 orang diterapi dengan akupunktur, 23 orang lainnya diterapi dengan obat Tolterodine. Penilaian keberhasilan dilihat dari penurunan skor OABSS. Setelah 18 hari terapi, terjadi penuruan rerata skor OABSS pada kelompok akupunktur dari 8,045 1,863 menjadi 1.909 0.867 dan pada kelompok tolterodine dari 8,000 0,617 menjadi 2,272 0,631 p = 0,357 . Dua minggu pasca terapi pada kelompok akupunktur masih terjadi penurunan skor OABSS dari 1.909 0.867 menjadi 1.272 0.702 dan pada kelompok tolterodine terjadi peningkatan skor OABSS dari 2,272 0,631 menjadi 2,590 0,503 p = 0,003 . Akupunktur mempunyai efek terapi yang sama baiknya dengan tolterodine dalam menurunkan OABSS tanpa efek samping. Efek terapi akupunktur masih bekerja walau terapi telah dihentikan 2 minggu.

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Overactive Bladder still gives problems and reducing their quality of life. Acupunture can be used for treatment of OAB. This research using clinical trial quasi experimental, consisted of 23 participant were treated with acupuncture and 23 others were treated with Tolterodine. Assessment of therapeutic success seen from the decrease in OABSS. After 18 days therapy in Acupuncture Group from 8,045 1,863 to 1,909 0,867 and Tolterodine Group from 8,000 0,617 to 2,272 0,631 p 0,357 . After 2 weeks post therapy in Acupuncture Group OABSS was still a decline from 1.909 0.867 to 1.272 0.702 and in Tolterodine Group OABSS was still a increase from 2,272 0,631 to 2,590 0,503 p 0,003 . Acupuncture has the same therapeutic effect with tolterodine in reducing OABSS without side effect. Therapeutic effect of acupuncture was still working even though therapy had been 2 weeks discontinued."

"Overactive bladder in clinical practice provides a timely and comprehensive update on the overactive bladder (OAB) syndrome. The symptoms of urgency, with or without urge incontinence, usually with frequency or nocturia, now defined as the overactive bladder syndrome, have become a hot topic in urology, gynecology and urogynecology. Epidemiological data show very high disease prevalence (19%), particularly when compared with other chronic conditions such as diabetes (2%) and asthma (7%). OAB symptoms impact severely on patient’s quality of life, causing significant impairment of patient vitality and limiting their physical role, similar to diabetes. The OAB syndrome involves all age groups, both sexes and is frequently found in neurogenic patients. This book will cover all aspects of OAB epidemiology, economics, pathophysiology, conservative, pharmaceutical and surgical."

"Overactive bladder (OAB) is a clinical syndrome consisting of symptom complex of urgency, with or without incontinence which has significant effects on quality of life and has to be managed properly. The aim of this study was to review the management of OAB by Indonesian urologists. A self-constructed questionnaires containing diagnostic and treatment options of OAB patients were distributed to indonesian urologists. This was a cross-sectional study and descriptive analyze the data. 129 Indonesian urologists participated in this study. Most of them faced more than 20 OAB cases per year with the most common type was OAB without incontinence or dry OAB (57,4%). Most urologists (34.1%) ordered at least three diagnostic tools to determine OAB. They were bladder diary, urinalysis and scoring system. The most used scoring system (48.9%) was the overactive bladder symptoms score (OABSS). Thirty-five point seven percent (35.7%) of urologist used antimuscarinic and behavioral therapy as initial therapy. Solifenacin 5 mg/day was the most common antimuscarinic prescribed as the first line therapy (48%). Most common items commonly evaluated for follow-up: symptoms (96.9%), bladder diary (72.9%); and drug's side effect (58.1%). When initial therapy had failed, most of the urologists (54.3%) chose to increase the dose of antimuscarinic. None of them chose bladder botulinum toxin injection as their additional therapy. OAB is a frequent disorder which remains a challenge for urologists. The management of patients with OAB by Indonesian urologists has been suitable with the previous studies and guidelines."

"Latar BelakangOveractive bladder (OAB) adalah kondisi medis yang menyebabkan keinginan untuk buang air kecil yang sering dan mendadak. Gangguan ini cukup umum ditemukan dan dapat menurunkan kualitas hidup, terutama pada populasi lansia. Meskipun terdapat berbagai pilihan terapi OAB, efek samping dari pengobatan farmakologis sering menyebabkan penghentian terapi. Asuhan mandiri akupresur dapat menjadi alternatif yang efektif. Namun, perlu diketahui bagaimana pengetahuan masyarakat mengenai terapi ini, masih belum banyak diketahui oleh masyarakat, termasuk di kalangan lansia. MetodePenelitian ini merupakan penelitian deskriptif dengan desain cross-sectional yang dilakukan di Panti Werdha Wisma Mulia, Jakarta, pada bulan September-Oktober 2024. Data dikumpulkan melalui wawancara dengan 42 lansia menggunakan kuesioner yang mencakup Overactive Bladder Symptom Score (OABSS) dan penilaian tingkat pengetahuan mengenai terapi akupresur.HasilSebanyak 61,9% lansia mengalami overactive bladder, dengan 33,3% di antaranya termasuk kategori OAB ringan dan 28,6% termasuk kategori OAB sedang. Tidak ditemukan kasus OAB berat. Selain itu, tingkat pengetahuan mengenai terapi akupresur di kalangan lansia cukup bervariasi, dengan mayoritas memiliki pengetahuan yang baik. KesimpulanProporsi OAB pada lansia di panti jompo wilayah Jakarta cukup tinggi. Tingkat pengetahuan lansia mengenai terapi akupresur sudah cukup baik. Namun, pengetahuan ini masih bisa ditingkatkan untuk memaksimalkan penggunaan terapi akupresur sebagai terapi alternatif yang potensial untuk mengelola gejala OAB secara sederhana dan tanpa efek samping yang signifikan.

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Introduction

Overactive bladder (OAB) is a medical condition characterized by frequent and sudden urges to urinate. This condition is relatively common and can significantly reduce the quality of life, particularly in the elderly population. Although there are various treatment options for OAB, the side effects of pharmacological treatments often lead to discontinuation. Self-care through acupressure may be an effective alternative. However, public knowledge of this therapy, especially among the elderly, needs to be assessed. Method

This descriptive study with a cross-sectional design was conducted at Panti Werdha Wisma Mulia, Jakarta, during September-October 2024. Data were collected through interviews with 42 elderly individuals using questionnaires that included the Overactive Bladder Symptom Score (OABSS) and an assessment of their knowledge about acupressure therapy.

Results

A total of 61.9% of the elderly had overactive bladder, with 33.3% categorized as having mild OAB and 28.6% as having moderate OAB. No severe OAB cases were found. In addition, the level of knowledge about acupressure therapy among the elderly varied, with the majority showing good knowledge.

Conclusion

The proportion of OAB among the elderly in a nursing home in Jakarta is relatively high. The elderly's knowledge of acupressure therapy is generally good but could be further improved to maximize the use of acupressure as a potential alternative therapy to manage OAB symptoms with minimum side effects."

"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."

"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.

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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"

"Peningkatan populasi lansia di Indonesia menimbulkan tantangan kesehatan, termasuk penurunan fungsi kognitif yang dapat memengaruhi kemandirian dan kualitas hidup. Stimulus kognitif, seperti permainan tradisional congklak, menawarkan solusi yang mudah diakses. Penelitian ini bertujuan mengevaluasi efek permainan congklak terhadap fungsi kognitif lansia menggunakan MoCA-Ina. Penelitian melibatkan 64 lansia yang dibagi menjadi kelompok intervensi dan kontrol. Kelompok intervensi memainkan congklak selama 10 sesi (45 menit per sesi) dalam dua minggu, sementara kelompok kontrol melanjutkan aktivitas rutin. Fungsi kognitif diukur pada empat waktu: sebelum intervensi, segera setelah intervensi, satu bulan, dan dua bulan pasca intervensi. Hasil menunjukkan peningkatan signifikan skor MoCA-Ina pada kelompok intervensi, dari rata-rata 15,1 menjadi 18,6 segera setelah intervensi. Efek positif ini bertahan hingga dua bulan, meski sedikit menurun. Permainan congklak efektif menjaga dan meningkatkan fungsi kognitif lansia, mendukung penerapan permainan tradisional dalam program kesehatan lansia.

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The increasing elderly population in Indonesia poses health challenges, including cognitive decline, which can affect independence and quality of life. Cognitive stimulation, such as the traditional congklak game, offers an accessible solution. This study aims to evaluate the effect of the congklak game on cognitive function in the elderly using MoCA-Ina. The study involved 64 elderly participants divided into intervention and control groups. The intervention group played congklak for 10 sessions (45 minutes per session) over two weeks, while the control group continued their routine activities. Cognitive function was measured at four time points: before the intervention, immediately after the intervention, one month, and two months post-intervention. The results showed a significant increase in MoCA-Ina scores in the intervention group, from an average of 15.1 to 18.6 immediately after the intervention. This positive effect persisted for up to two months, although slightly diminished. The congklak game effectively maintains and improves cognitive function in the elderly, supporting its inclusion in elderly health programs."

"Material dan Metode: Kami mendapatkan 50 pasien terpasang DJ stent perendoskopi dan dibagi menjadi kelompok kontrol terdiri dari 25 pasien dan kelompok yang mendapat obat antimuskarinik terdiri dari 25 pasien. Kedua kelompok tersebut kami bandingkan keluhan LUTS dan kualitas hidup pasca pemasangan DJ stent yang dinilai pada saat satu hari setelah lepas kateter dan dua minggu pasca pemasangan DJ stent. Penilaian LUTS pasien dilakukan dengan total skor IPSS dan kualitas hidup pasien dengan pertanyaan QoL. Hasil: Satu hari pasca lepas kateter antara kelompok kontrol dengan kelompok yang mendapat obat antimuskarinik, tidak didapatkan perbedaan yang bermakna secara statistik pada total skor IPSS, skor IPSS komponen storage symptoms dan voiding symptoms, dan nilai QoL. Dua minggu pasca pemasangan DJ stent pada kedua kelompok didapatkan perbedaan yang bermakna total skor IPSS, skor IPSS komponen storage symptoms dan voiding symptoms, dan nilai QoL, yaitu lebih rendah pada kelompok pasien yang mendapat obat antimuskarinik. Perbandingan antara satu hari setelah lepas kateter dengan dua minggu pasca pemasangan DJ stent pada kelompok obat antimuskarinik, terdapat penurunan dengan perbedaan bermakna pada total skor IPSS, skor IPSS komponen storage symptoms dan voiding symptoms, dan nilai QoL. Kesimpulan: Pemberian obat antimuskarinik selama jangka waktu tertentu, memberikan perbaikan gejala LUTS, baik voiding symptoms maupun storage symptoms, dan peningkatan kualitas hidup pada pasien-pasien yang terpasang DJ stent.

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Objective: To analyze the effect of antimuscarinic drug on LUTS and Quality of Life (QOL) in patients with DJ stent.

Materials and Methods: We analyzed 50 patients who have DJ stent inserted endoscopically and divided the subjects into two groups, 25 patients had anti- muscarinic and 25 patients as the control group. LUTS and QoL were compared in both groups one day after catheter released and at the second week after DJ stent insertion. The severity of LUTS was examined based on total IPSS score and quality of life based on QoL questionnaire.

Results: In day 1 after the catheter released, there were no statistically significant differences on the total IPSS score, storage and voiding symptoms score on IPSS, and QoL score between two groups. Two weeks after DJ stent insertion, there were significant differences on total IPSS score, storage and voiding symptoms score on IPSS, and QoL score between two groups, where the group with anti- muscarinic had lower score than the control group. Group with antimuscarinic drug showed significant decrease of total IPSS score, storage and voiding symptoms score on IPSS and QoL score at the second week after DJ stent insertion compared to the first day.

Conclusion: Antimuscarinic administration for a period of time, improved LUTS symptoms and increased quality of life in patients with DJ stent."