酒石酸托特罗定联合吲哚美辛预防性治疗TURP后膀胱痉挛效果观察

目的:探讨酒石酸托特罗定联合吲哚美辛栓剂预防性治疗经尿道前列腺切除术(TURP)后膀胱痉挛的效果.方法:将128例良性前列腺增生患者随机分为联合药物组(酒石酸托特罗定+吲哚美辛栓剂)、托特罗定组(酒石酸托特罗定)、吲哚美辛组及对照组各32例.比较各组TURP后72 h内膀胱区阵发性痉挛性疼痛伴(或不伴)急迫性尿失禁的次数、膀胱痉挛持续时间、持续膀胱冲洗时间、膀胱冲洗液转清时间、留置导尿管时间.结果:联合药物组术后24～48 h、48～72 h膀胱痉挛次数、膀胱痉挛平均持续时间、膀胱冲洗时间、冲洗液转清时间、留置导尿管时间均短于托特罗定组、吲哚美辛组、对照组(P<0.05).结论:TURP后早期预防性联合使用酒石酸托特罗定片与吲哚美辛直肠栓剂是缓解患者膀胱痉挛的一种安全、有效的方法.     

抗胆碱能药物索利那新和托特罗定治疗膀胱过度活动症的比较研究

目的探讨抗胆碱能药物索利那新和托特罗定在治疗膀胱过度活动症(OAB)中的应用,比较其临床疗效。方法分析2010年3月至2015年4月天津市西青医院收治的68例膀胱过度活动症患者的临床资料,将其分为治疗组(36例)和对照组(32例),治疗组采用新型抗胆碱药物索利那新治疗,5 mg,1次/d,晚饭后口服;对照组采用托特罗定治疗,2 mg,2次/d,早晚饭后口服;比较两组患者治疗前后临床症状及不良反应发生情况。结果患者在给予索利那新治疗后,最大尿流率、残余尿量、日间排尿次数、急迫性尿失禁次数、夜尿次数较托特罗定明显改善,差异有统计学意义(P0.05);治疗组膀胱过度活动症评分生活质量评分明显优于对照组。结论抗胆碱能药物索利那新在治疗膀胱过度活动症中的效果优于托特罗定,能够更好地改善OAB患者的临床症状,减少药物不良反应的发生。     

托特罗定联合盆底电刺激治疗女性膀胱过度活动症效果观察

目的观察托特罗定联合盆底神经电刺激治疗女性膀胱过度活动症的效果并探讨其作用机制。方法将2009年10月至2010年12月就诊的73例女性膀胱过度活动症患者随机分为两组：托特罗定组口服托特罗定2mg／次,2次／d,疗程4周;联合治疗组口服托特罗定2mg／次,20：／d,加用盆底神经电刺激治疗,隔日1次,疗程4周。结果与治疗前比较,两组患者的膀胱过度活动症状（尿急、急迫性尿失禁、排尿次数、每次排尿量）减轻（P均〈0．05）。两组之间比较,在减轻尿急次数、尿失禁次数及夜尿次数指标上,两组差异无统计学意义（P均〉0．05）,但联合治疗组在减少每日排尿次数[（5．6±0．1）次]及每次排尿量[（248±14．6）ml]的增加方面优于托特罗定组[（7．6±0．3）次、（207±11．3）ml],差异有统计学意义（P均〈0．05）。结论托特罗定联合盆底神经电刺激能明显改善女性OAB症状,提高患者生活质量,疗效优于单用托特罗定,有一定临床意义。     

膀胱过度活动症的护理及治疗体会(附16例报告)

目的 总结膀胱过度活动症的行为干预护理及联合药物治疗的经验.方法 回顾性分析2004-01-2012-01收治的16例膀胱过度活动症患者的临床资料.结果 患者的临床症状以及尿流动力学检查明确膀胱过度活动症的诊断.通过一系列的行为干预护理来改变患者的行为习惯和生活方式,再辅助联合应用托特罗定+盐酸坦索罗辛,使患者的尿频、尿急、尿失禁等下尿路症状得到明显缓解.结论 膀胱过度活动症临床上没有明确有效的治疗方法,临床医生只能通过对症处理来缓解患者的症状,提高生活质量.     

行为疗法联合托特罗定治疗女性膀胱过度活动症伴急迫性尿失禁的疗效观察

目的探讨行为疗法联合托特罗定治疗女性膀胱过度活动症(OAB)伴急迫性尿失禁(UUI)的临床疗效。方法选取北京市清河社区卫生服务中心就诊的女性OAB伴UUI患者91例,按就诊时间随机分为2组,A组45例,给予口服托特罗定8周;B组46例,给予行为疗法联合口服托特罗定联合治疗8周。比较2组治疗后患者的排尿日记、生活质量评分和尿流动力学检查结果。结果治疗后2组患者24h排尿次数、24h尿失禁次数均明显减少,每次排尿量、膀胱测压容积均明显增加,生活质量评分均改善,B组较A组效果更明显,差异有统计学意义(P0.05)。结论行为疗法联合托特罗定比单用托特罗定治疗女性OAB伴UUI更有效。     

加倍剂量酒石酸托特罗定治疗脊髓损伤致逼尿肌过度活动的效果观察

目的观察加倍剂量酒石酸托特罗定治疗脊髓损伤所致膀胱过度活动的临床效果。方法采用自身对临床试验对30例患有膀胱过度活动症的脊髓损伤患者且使用酒石酸托特罗定2 mg/次,每日两次治疗,4周后效果不佳者,加倍剂量(4 mg, 每日两次)进行治疗,以排尿日记和生活质量评分观察其治疗的效果。主观感受评价采用国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)。结果4周后30例患者有28例完成试验,2例患者因口干不能耐受退出。28例患者使用加倍剂量酒石酸托特罗定治疗后每次导尿量由(196.3±44.7) ml增加到(393.5±54.3) ml。漏尿次数由每天(4.96±2.15)次减少到(3.92±2.14)次。ICI-Q-SF评价显示,治疗后改善25例,无效3例。结论脊髓损伤导致的膀胱过度症在可耐受口干的条件下酒石酸托特罗定加倍剂量可有效增加膀胱容量,减少漏尿次数。     

托特罗定联合生物反馈/电刺激治疗膀胱过度活动症

目的 观察托特罗定联合生物反馈/电刺激治疗膀胱过度活动症疗效及安全性.方法 2008-06-2010-06我们将102例患者随机分为两组,所有患者均口服托特罗定2 mg/次,2次/d口服,疗程30 d;治疗组加用生物反馈/电刺激治疗,隔日1次,15次为1个疗程.结果 与对照组比较,生物反馈组的改善效果更显著(P＜0.05).结论 托特罗定联合生物反馈/电刺激治疗膀胱过度活动症疗效显著.     

肾移植受者留置导尿管时间探讨及护理对策

目的探讨肾移植受者留置导尿管时间与发生尿路感染的关系，并总结预防尿路感染的有效护理措施。方法选取2006年1月～2007年12月在本科室行同种异体肾移植手术的受者83例。所有患者术前留置导尿管，于拔除导尿管前行尿培养。观察患者拔除尿管当天的症状，对尿培养结果进行分析。结果患者尿培养结果阳性23例。其中留置导尿时间10d以上的患者尿培养阳性率明显高于留置导尿时间10d内（含10d）的患者，差异有统计学意义（P〈0．05）。结论建议肾移植受者留置导尿管拔除时间为术后第9～10d，而执行环境消毒措施、预防逆行性感染，保持出入量平衡是预防尿路感染的有效护理措施。     

电针联合中药敷脐治疗经尿道前列腺电切术后膀胱过度活动症的疗效观察

目的分析中药敷脐与电针联合治疗经尿道前列腺电切术后膀胱过度活动症的临床疗效。方法将2016年3月～2017年12月我院收治的86例经尿道前列腺电切术后膀胱过度活动症患者随机分为观察组和对照组各43例。对照组以托特罗定口服治疗,观察组以中药敷脐与电针联合治疗,比较两组治疗效果。结果术后7d内,观察组膀胱痉挛次数、膀胱痉挛时间均明显少于对照组(P0.05);术后第2周,观察组每次尿量明显高于对照组,每日排尿次数、每日尿急次数、急迫性尿失禁次数均明显少于对照组(P0.05)。治疗后,观察组OABSS评分明显低于对照组(P0.05)。对照组不良反应发生率13.95%,观察组无明显不良反应,组间比较,差异有统计学意义(P0.05)。结论经尿道前列腺电切术后膀胱过度活动症患者行电针联合中药敷脐治疗,可有效减轻置管期膀胱痉挛、自主期尿急及尿频症状,促使患者症状明显改善,且治疗安全性高。     

骶神经根磁刺激治疗逼尿肌反射亢进和急迫性尿失禁疗效观察

目的 观察骶神经根磁刺激对脊髓疾患所致逼尿肌反射亢进和急迫性尿失禁的影响.方法 采用骶神经根磁刺激治疗脊髓疾患后逼尿肌反射亢进导致急迫性尿失禁患者15例,治疗10 d,应用排尿日记、生活质量评分和尿流动力学检查评定疗效.结果 治疗后24 h平均排尿次数减少,平均单次排尿量明显增加,平均尿失禁次数减少,生活质量提高,治疗有效率85.7%;尿流动力学检查显示,应用骶神经磁刺激后初尿意时膀胱容量增加(P《0.05),最大膀胱测压容量明显增加(P《0.01),充盈末逼尿肌压力明显降低(P《0.01).结论 骶神经根磁刺激通过抑制逼尿肌反射,增加膀胱测压容积,从而改善尿频症状,减少急迫性尿失禁,提高生活质量,是非常有应用前景的新型康复治疗技术.     

Relationships between improvements in symptoms and patient assessments of bladder condition, symptom bother and health-related quality of life in patients with overactive bladder treated with tolterodine

Aims: Relationships were evaluated between treatment‐related improvements in overactive bladder (OAB) symptoms as recorded in bladder diaries and patient‐reported symptom bother, bladder‐related problems and health‐related quality of life (HRQL). Methods: A post hoc analysis was performed on data from patients with OAB (n = 863) enrolled in a 12‐week open‐label trial of tolterodine extended release (ER) in a primary care setting. At baseline and week 12, patients recorded every micturition, urgency episode and urgency urinary incontinence episode in 3‐day bladder diaries. Patients also completed the Overactive Bladder Questionnaire (OAB‐q) and Patient Perception of Bladder Condition (PPBC). Relationships between week 12 changes in bladder diary variables and OAB‐q and PPBC scores were evaluated using Spearman correlations. Results: By week 12, tolterodine ER‐related improvements in all bladder diary variables were significantly correlated with improvements on the PPBC (r = 0.26–0.36; p < 0.001), OAB‐q Symptom Bother scale (r = 0.30–0.51; p < 0.001), and all OAB‐q HRQL domains (r = ?0.24 to ?0.42; p < 0.001), although the correlations were generally small to moderate in size. Improvements on the PPBC were also significantly correlated with improvements on the OAB‐q Symptom Bother scale (r = 0.63; p < 0.001) and all HRQL domains (r = ?0.40 to ?0.59; p < 0.001). Conclusions: Tolterodine ER‐related improvements in OAB symptoms (assessed by diary variables) and patients’ perceptions of the changes in symptom bother, bladder‐related problems and HRQL (assessed by PPBC and OAB‐q) were significantly correlated. The OAB‐q and the PPBC provide a relevant and important patient perspective for OAB treatment evaluation.     

Effects of flexible‐dose fesoterodine on overactive bladder symptoms and treatment satisfaction: an open‐label study

Aims: To evaluate the efficacy and tolerability of flexible‐dose fesoterodine in subjects with overactive bladder (OAB) who were dissatisfied with previous tolterodine treatment. Methods: This was a 12‐week, open‐label, flexible‐dose study of adults with OAB (≥ 8 micturitions and ≥ 3 urgency episodes per 24 h) who had been treated with tolterodine (immediate‐ or extended‐release) for OAB within 2 years of screening and reported dissatisfaction with tolterodine treatment. Subjects received fesoterodine 4 mg once daily for 4 weeks; thereafter, daily dosage was maintained at 4 mg or increased to 8 mg based on the subject’s and physician’s subjective assessment of efficacy and tolerability. Subjects completed 5‐day diaries, the Patient Perception of Bladder Condition (PPBC) and the Overactive Bladder Questionnaire (OAB‐q) at baseline and week 12 and rated treatment satisfaction at week 12 using the Treatment Satisfaction Question (TSQ). Safety and tolerability were assessed. Results: Among 516 subjects treated, approximately 50% opted for dose escalation to 8 mg at week 4. Significant improvements from baseline to week 12 were observed in micturitions, urgency urinary incontinence episodes, micturition‐related urgency episodes and severe micturition‐related urgency episodes per 24 h (all p < 0.0001). Approximately 80% of subjects who responded to the TSQ at week 12 reported satisfaction with treatment; 38% reported being very satisfied. Using the PPBC, 83% of subjects reported improvement at week 12 with 59% reporting improvement ≥ 2 points. Significant improvements from baseline (p < 0.0001) exceeding the minimally important difference (10 points) were observed in OAB‐q Symptom Bother and Health‐Related Quality of Life (HRQL) scales and all four HRQL domains. Dry mouth (23%) and constipation (5%) were the most common adverse events; no safety issues were identified. Conclusion: Flexible‐dose fesoterodine significantly improved OAB symptoms, HRQL, and rates of treatment satisfaction and was well tolerated in subjects with OAB who were dissatisfied with prior tolterodine therapy.     

Canadian economic comparison of extended-release oxybutynin and immediate-release tolterodine in the treatment of overactive bladder

BACKGROUND: Overactive bladder (OAB) is a condition characterized by urgency, increased frequency of micturition, or urge incontinence. It affects a considerable segment of the population, particularly with increasing age. Pharmacotherapy is one of the most common approaches to the treatment of OAB. OBJECTIVE: This article describes the development and results of a model comparing health-economic outcomes for the new extended-release (XL) formulation of oxybutynin and immediate-release (IR) tolterodine in a population of community-dwelling Canadian adults with OAB. METHODS: A Markov model was developed to compare health-economic outcomes over the course of 1 year. Effectiveness and treatment-persistence data were derived from the OBJECT (Overactive Bladder: Judging Effective Control and Treatment) trial, a 3-month comparison of oxybutynin XL 10 mg and tolterodine IR 4 mg, and were used, together with data from the literature (identified through a MEDLINE search of articles published between 1990 and 2003), to project outcomes beyond the trial period. Severity-specific cost profiles for incontinence were developed. In the principal analyses, cost items were limited to drug therapy, physician visits, use of pads or other protection, and laundry costs. Costs are reported in 2002 Canadian dollars. RESULTS: Costs after 1 year were estimated to be an average of $32 less per patient for oxybutynin XL compared with tolterodine IR, and 3.1 additional patients in every 100 who received oxybutynin XL were expected to attain complete continence compared with those who received tolterodine. During the course of 1 year, patients receiving oxybutynin XL were expected to have a mean 16.5 additional incontinence-free days compared with those receiving tolterodine IR. The results were sensitive to relative drug prices. In the other sensitivity analyses, however, oxybutyrin XL maintained its advantage over a wide range of inputs. CONCLUSION: The results of these analyses suggest that when priced equivalently, oxybutynin XL would reduce costs and provide better results than tolterodine IR over 1 year of treatment.     

Bladder dysfunction after a stroke--it's not always inevitable

Bladder dysfunction frequently accompanies a stroke but, with appropriate management, is not necessarily a permanent deficit. Voiding problems most often experienced after a stroke include urgency, frequency, incontinence, and urinary retention. A clamping routine prior to indwelling urinary catheter removal did not affect the incidence of voiding dysfunction after a stroke. Checking consecutive post-voided residual urine volumes after a stroke is indicated to evaluate the effectiveness of bladder emptying; intermittent sterile catheterization is recommended if there is a problem.     

膀胱过度活动症症状评分表评估膀胱过度活动症的临床研究

目的 确定膀胱过度活动症症状评分表(OABSS)在评价膀胱过度活动症(OAB)中的临床应用价值.方法 初发的OAB患者接受抗毒蕈碱药物托特罗定治疗.在基线期及12周治疗后完成3 d排尿日记和OABSS,通过对比分析治疗前后相关指标的变化、变量的一致性和变化的相关性.结果 本次研究包括59例患者,男22例,女37例,年龄(31.1±9.6)岁,OABSS和相应的3 d排尿日记均显示有统计学意义的疗效改善变化.OABSS中尿急评分的效应值最大(2.10),总评分效应值1.55,排尿日记中尿急评分效应值0.92.OABSS中除白天排尿次数外,其余效应值均大于相应排尿日记的效应值,标准反应均数的变化与效应值的变化相同.OABSS中项目评分和相应排尿日记的变量在基线期及12周治疗后有良好的一致性.急迫性尿失禁及夜尿在OABSS和相应排尿日记的变量有高度相关性.结论 OABSS对治疗相关OAB症候群变化有高度敏感性,在日常临床实践中,OABSS借其简易性及可靠性,可成为排尿日记之外的一种可供选择的评估症状和疗效的工具.     

Prospective randomized controlled trial of extended-release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: results of the OBJECT Study

OBJECTIVE: To compare the efficacy and tolerability of extended-release oxybutynin chloride and tolterodine tartrate at 12 weeks in participants with overactive bladder. SUBJECTS AND METHODS: The OBJECT (Overactive Bladder: Judging Effective Control and Treatment) study was a prospective, randomized, double-blind, parallel-group study conducted between March and October 2000 at 37 US study sites. Participants who had between 7 and 50 episodes of urge incontinence per week and 10 or more voids in 24 hours received extended-release oxybutynin, 10 mg/d, or tolterodine, 2 mg twice daily. The outcome measures were the number of episodes of urge incontinence, total incontinence, and micturition frequency at 12 weeks adjusted for baseline. RESULTS: A total of 315 women and 63 men were randomized and treated, and 332 participants (276 women, 56 men) completed the study. At the end of the study, extended-release oxybutynin was significantly more effective than tolterodine in each of the main outcome measures: weekly urge incontinence (P=.03), total incontinence (P=.02), and micturition frequency episodes (P=.02) adjusted for baseline. Both drugs improved symptoms of overactive bladder significantly from baseline to the end of the study as assessed by the 3 main outcome measures (P<.001). Dry mouth, the most common adverse event, was reported by 28.1% and 33.2% of participants taking extended-release oxybutynin and tolterodine, respectively (P=.32). Rates of central nervous system and other adverse events were low and similar in both groups. CONCLUSIONS: Extended-release oxybutynin was more effective than tolterodine as measured by end-of-study urge incontinence, total incontinence, and micturition frequency episodes. Both groups had similar rates of dry mouth and other adverse events.     

Tolterodine extended release improves patient-reported outcomes in overactive bladder: results from the IMPACT trial

We evaluated the effect of tolterodine extended release (ER) on patient- and clinician-reported outcomes in a primary care setting. Patients had overactive bladder (OAB) symptoms for >or=3 months and were at least moderately bothered by their most bothersome symptom, as indicated on the patient-completed OAB Bother Rating Scale. Patients completed the Overactive Bladder Questionnaire (OAB-q), American Urological Association Symptom Index (AUA-SI), and Patient Perception of Bladder Condition at each visit; investigators completed the Clinical Global Impression-Improvement at week 12. By week 12, there were statistically significant and clinically meaningful decreases on the OAB-q and AUA-SI total and subscale scores (p < 0.0001). Seventy-nine per cent of patients experienced some improvement in their overall bladder condition. Physicians reported that 68% of patients were 'much improved' or 'very much improved'. For symptom-defined conditions, patient-reported outcomes are a valuable means for determining responses to treatment.     

老年糖尿病膀胱过度活动症患者疾病感知现状及其与生活质量的相关性

目的 探讨老年糖尿病膀胱过度活动症(overactive bladder,OAB)患者疾病感知现状,并分析其与生活质量的相关性.方法 2020年5月至2021年4月,便利抽样法选取镇江市某三级甲等医院208例老年糖尿病OAB患者为研究对象.采用一般资料调查表、膀胱过度活动症症状评分量表、简化版疾病感知问卷、膀胱过度活动...     

Satisfaction with tolterodine: assessing symptom-specific patient-reported goal achievement in the treatment of overactive bladder in female patients (STARGATE study)

AIMS: Open-label study to evaluate the effect of tolterodine extended-release (ER) on symptom-specific patient-reported goal achievement (PGA) of overactive bladder (OAB) symptoms in females. METHODS: Eligible patients who had frequency >or= 8 and urgency >or= 2 episodes per 24 h with or without urgency incontinence were treated with 12-week tolterodine ER (4 mg once daily). Primary end-point was the rate of PGA by a visual analogue scale compared with initial expectation with treatment. At baseline, patients were asked to set their personal goals for each OAB symptom with treatment. Secondary efficacy variables were changes in symptom severity, voiding diary and patient perception of bladder condition (PPBC), global impression of improvement (GII), and willingness to continue treatment. RESULTS: A total of 56 patients were entered. The median rate of symptom-specific PGA and reductions in symptom severity were for frequency (60%, 45%), episodes of urgency 60%, 55%), urge incontinence (80%, 71%), nocturia (50%, 52%) and tenesmus (30%, 26%) after 12 weeks treatment. There was a significant improvement in all OAB symptoms in voiding diary. Thirty-five patients (62.5%) experienced an improvement of >or= 2 points in PPBC. Thirty (53.6%) and 22 (39.3%) of patients reported much and little improvement of their symptoms in GII. A total of 41 (73.2%) patients wanted to continue taking the medication at the end of the study. CONCLUSIONS: Most OAB patients reported improvement of their OAB symptoms with 12-week tolterodine ER 4 mg treatment. There was a significant achievement of symptom-specific goal on the key OAB symptoms. But, PGA did not correlate with objective outcomes.     

Sonographic evaluation of anatomic results after the pubovaginal sling procedure for stress urinary incontinence.

OBJECTIVE: To investigate the anatomic changes after the pubovaginal sling procedure in women with stress urinary incontinence by transrectal sonography METHODS: This study enrolled 56 women with varying types of stress urinary incontinence who were treated with the pubovaginal sling procedure using self-fashioned polypropylene mesh. The suburethral sling was fixed without tension and was placed at the position between the bladder neck and the proximal urethra. The patients were investigated preoperatively and postoperatively by transrectal sonography of the bladder and urethra. RESULTS: At a median follow-up of 24 months (range, 6-39 months), 48 patients (85.7%) were cured, 6 (10.7%) had improved, and 2 (3.6%) had treatment failures. Transrectal sonography revealed a well-suspended bladder neck and proximal urethra in all patients who were cured. As measured by changes of the axis of the pubovesical ligament, the position of the bladder neck was elevated by a mean of 29.6 +/- 21.5 degrees in the resting condition and 47.4 +/- 27.7 degrees in the straining condition. An incompetent bladder neck and proximal urethra were noted in 8 patients who had stress urinary incontinence after surgery. The incidence of opening of the bladder neck was 84.6% in 13 patients with de novo urgency or urge incontinence, whereas only 2 (4.7%) of 43 patients who did not have postoperative urgency had opening of the neck (P = .000). CONCLUSION: Transrectal sonography provides useful information about anatomic changes after the pubovaginal sling procedure. Bladder neck incompetence after surgery was closely related to postoperative urgency or urge incontinence.