酒石酸托特罗定、吲哚美辛栓联合舒适护理用于前列腺术后膀胱痉挛48例

目的 观察酒石酸托特罗定、吲哚美辛栓联合舒适护理防治前列腺术后膀胱痉挛的疗效.方法 将96例前列腺增生术后膀胱痉挛患者随机分为治疗组和对照组,各48例.对照组患者于手术当日应用吲哚美辛栓50 mg纳入肛内,每日2次;治疗组在对照组基础上加服酒石酸托特罗定2 mg,每日2次,并予以舒适护理.比较72 h内两组膀胱痉挛次数、持续时间、持续膀胱冲洗时间、膀胱冲洗液转清时间及舒适度和满意度.结果 治疗组各项观察指标均明显优于对照组(P＜0.05).结论 早期应用酒石酸托特罗定、吲哚美辛栓联合舒适护理防治前列腺术后膀胱痉挛,疗效显著,患者的舒适度和满意度均明显提高,值得临床推广.     

托特罗定联合塞来昔布治疗经尿道前列腺增生术后膀胱痉挛的临床效果

目的 探讨托特罗定联合塞来昔布治疗良性前列腺增生(BPH)术后膀胱痉挛的疗效.方法 将BPH患者256例随机均分为两组,术后口服托特罗定和塞来昔布(联合用药组)和单用托特罗定(托特罗定组).记录术后出现膀胱痉挛的例数、痉挛持续时间及视觉模拟疼痛评分.结果 联合用药组术后第2、3天膀胱痉挛次数分别为(1.25±0.71)次和(1.05±0.69)次,少于托特罗定组的(1.63±0.83)次和(1.38±0.78)次(P＜0.05);膀胱痉挛持续时间分别为(7.85±2.91) min、(6.43±3.32) min,亦少于托特罗定组的(11.24±3.11) min、(9.43±3.63) min(P＜0.05).结论 联合应用托特罗定和塞来昔布治疗经尿道前列腺术后膀胱痉挛的效果优于单用托特罗定.     

托特罗定治疗良性前列腺增生切除术后膀胱痉挛疗效观察

目的:探讨托特罗定治疗良性前列腺增生切除术后膀胱痉挛的临床疗效.方法:选取2016年5月～2017年5月我院收治的92例良性前列腺增生切除术后膀胱痉挛患者,随机分为两组(对照组和研究组),每组46例,对照组予以双氯芬酸那栓塞肛治疗,研究组予以托特罗定治疗,并比较两组术后膀胱痉挛发生率、每天发作次数、痉挛持续天数.结果:研究组术后膀胱痉挛发生率为56.5％,对照组术后膀胱痉挛发生率为71.7％,差异无统计学意义(P>0.05);研究组术后每天膀胱痉挛发生次数以及术后膀胱痉挛持续天数均明显低于对照组(P<0.05).结论:托特罗定有助于减少前列腺增生切除术后痉挛发生率、发作频次以及缩短持续时间,值得推广.     

坦索罗辛联合托特罗定用于高危前列腺电切患者疗效观察

目的探讨坦索罗辛联合托特罗定用于行经尿道前列腺电切术的高危前列腺增生患者的围手术期临床效果和安全性。方法 2011年4月至2014年2月本院就诊的行经尿道前列腺电切术的高危前列腺增生患者共99例,分入组1(联用坦索罗辛和托特罗定,35例)、组2(服用坦索罗辛,20例)和组3(未服用坦索罗辛或托特罗定,44例)。比较各组术后住院天数,术后膀胱痉挛发生率、持续天数和日发生次数,拔尿管后急迫性尿失禁发生率、持续天数和日发生次数。结果 99例患者手术均成功,无严重出血、膀胱穿孔和前列腺电切综合征等明显并发症。术后住院天数,组1、组2和组3分别为(8.8±2.0)、(10.2±2.5)和(10.4±2.5)d,组1显著短于组2和组3,差异具有统计学意义(P=0.011);拔管后急迫性尿失禁持续时间和日发生次数,组1<组2和组3(P<0.05);术后膀胱痉挛发生率组1、组2和组3分别为68.6%、95.0%和90.9%,组1明显低于组2和组3(P=0.009);膀胱痉挛持续时间及日发生次数组1也小于组2和组3(P<0.05)。结论坦索罗辛联合托特罗定用于行经尿道前列腺电切术的高危前列腺增生患者安全有效,能促进患者恢复,并且可以减少术后膀胱痉挛的发生。     

索利那新联合坦索罗辛治疗TURP术后膀胱过度活动症20例报告

目的观察索利那新联合坦索罗辛治疗TURP术后膀胱过度活动症(OAB)的临床疗效。方法采用随机对照单盲临床实验设计,将入选40例TURP术后患者随机分为两组。实验组:术后当日起口服琥珀酸索利那新片5mg 1日1次,联合坦索罗辛胶囊0.2mg,晚服1次,至拔除导尿管后7天(用药共持续2周);对照组:不予索利那新和坦索罗辛治疗,疼痛时临时予吲哚美辛栓25mg纳肛对症治疗。两组在实验期间均不予其它可能干扰膀胱逼尿肌收缩的药物。结果 40例患者均完成实验统计。实验组术后膀胱痉挛次数、持续时间均少于对照组;拔除尿管自主排尿后,实验组排尿次数、发生急迫性尿失禁次数、OABSS评分等均较对照组减少,而每次排尿量、最大尿流率等指标均好于对照组,P均<0.05。结论提示索利那新联合坦索罗辛能改善TURP术后早期储尿排尿情况,对TURP术后OAB症状有良好的治疗作用。     

中药外敷治疗经尿道前列腺电切术后膀胱过度活动症临床分析

目的：探讨中药外敷神阙、气海、关元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：通过对2012年5月～2015年6月在我院治疗的62例经尿道前列腺电切术后膀胱过度活动症患者进行随机分组,实验组应用中药外敷治疗,对照组实施托特罗定治疗,观察比较两组治疗效果、膀胱痉挛次数、痉挛持续时间、每日排尿次数、尿失禁次数、PABSS评分。结果：实验组治疗效果同对照组比较明显提高,膀胱痉挛次数、痉挛持续时间、每日排尿次数、尿失禁次数、0ABSS评分明显低于对照组,差异具有统计学意义（P<0.05）。结论：针对经尿道前列腺电切术后膀胱过度活动症采取中药外敷神阙、气海、关元治疗可提高治疗效果,促进患者康复,具有创伤小、安全性高等特点,临床值得推广。     

酒石酸托特罗定缓释片治疗膀胱过度活动症的多中心双盲双模拟随机对照临床研究

目的 评价国产酒石酸托特罗定缓释片（抗膀胱过度活动症药）治疗膀胱过度活动症的有效性和安全性.方法 用随机双盲双模拟多中心临床试验设计,232例（试验组和对照组均为116例）托特罗定缓释片每日1次,每次4 mg;对照组口服托特罗定片每日2次,每次2 mg.均服药6周.结果 试验组（n=111）和对照组（n=112）24 h平均排尿次数减少、平均尿失禁次数均减少;平均每次尿量均增加,2组比较无统计学意义（P＞0.05）.试验组和对照组总药物不良反应发生率分别为39.3%和41.2%,主要表现为口干,发生率分别为35.7%,30.7%,经比较无统计学意义（P＞0.05）.结论 酒石酸托特罗定缓释片治疗膀胱过度活动症的疗效及安全性与其普通片相当.     

酒石酸托特罗定预防前列腺电切术后膀胱痉挛的疗效分析

目的探讨酒石酸托特罗定预防前列腺电切术后膀胱痉挛的临床疗效。方法将64例行经尿道前列腺电切术(TURP)的患者术后随机分为治疗组(酒石酸托特罗定片组)和对照组(双氯芬酸钠栓组)各32例,术后72h注意观察膀胱痉挛发生次数、膀胱痉挛平均持续时间及膀胱冲洗转清时间。结果治疗组发生膀胱痉挛次数、膀胱痉挛持续时间及膀胱冲洗转清时间均少于对照组。结论 TURP术后早期预防性使用托特罗定片是有效解决膀胱痉挛的方法,能减少并发症的发生。     

托特罗定治疗顽固性膀胱痉挛34例

目的:观察托特罗定治疗顽固性频繁发作膀胱痉挛的临床疗效和安全性.方法:采用随机、双盲的方法将68例膀胱痉挛频繁发作患者分为治疗组和对照组各34例,治疗组给托特罗定2 mg,对照组给予维拉帕米80 mg,服药方法均为bid,po,疗程1周.观察两组显效例数、起效时间、维持时间及不良反应.结果:治疗组显效33例(97.1%),对照组显效28例(82.4%);起效时间两组差异无显著性(P＞0.05);但维持时间治疗组长于对照组,差异有极显著性(P＜0.01).治疗组不良反应发生率29.4%,而对照组发生率为100.0%,两组间差异有极显著性(P＜0.01).结论:托特罗定是治疗顽固性频繁发作膀胱痉挛的有效药物,疗效好,不良反应发生率低于维拉帕米.     

索利那新治疗膀胱过度活动症的疗效及安全性分析

目的:评价索利那新治疗膀胱过度活动症的疗效及其安全性.方法:采用随机、双盲法将90例诊断为膀胱过度活动症(OAB)的患者分为两组:实验组45例,给予索利那新每日1次,每次5 mg,早饭后口服,疗程为8周;对照组45例,给予托特罗定每日2次,每次2 mg,早晚口服,疗程8周.记录两组患者服药前后24h排尿次数、24h尿急次数并比较其改善情况,结合患者治疗前后初始尿意容量、最大膀胱压容量、最大尿流率对索利那新的疗效进行评价;通过用药主要不良反应发生率的比较分析对索利那新的安全性进行评估.结果:治疗组患者24h排尿次数、24h尿急次数以及初始尿意容量、最大膀胱压容量、最大尿流率比较对照组改善显著(P＜0.05);治疗组患者各种不良反应发生率较对照组低(P＜0.05).结论:与托特罗定相比,索利那新是治疗OAB更有效安全的药物.     

间苯三酚联合托特罗定预防下尿路微创术后膀胱痉挛的疗效观察

目的探讨间苯三酚联合托特罗定预防下尿路微创术后膀胱痉挛的临床疗效。方法选取2014年1月—2016年1月涿州市医院泌尿外科收治的下尿路微创手术患者128例,随机分为对照组和治疗组,每组各64例。对照组术后口服酒石酸托特罗定缓释片,2 mg/次,2次/d。治疗组在对照组基础上肌肉注射间苯三酚注射液,40 mg/次,2次/d。两组患者均治疗至停留置导尿后1 d。比较两组的VAS评分、膀胱痉挛次数、痉挛持续时间、膀胱冲洗转清时间和尿管拔除时间情况。结果术后0~24、24~48、48~72 h,治疗组膀胱痉挛次数均显著少于同期对照组,两组比较差异有统计学意义(P0.05)。术后0~24、24~48、48~72 h,治疗组膀胱痉挛持续时间均显著短于同期对照组,两组比较差异有统计学意义(P0.05)。治疗后,治疗组膀胱冲洗转清时间和尿管拔出时间均显著短于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组VAS评分均显著下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组VAS评分的下降程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论间苯三酚联合托特罗定预防下尿路微创术后膀胱痉挛具有较好的临床疗效,可改善临床症状,缩短膀胱冲洗转清和尿管拔出时间,安全性好,具有一定的临床推广应用价值。     

托特罗定治疗顽固性膀胱痉挛34例

目的 观察托特罗定治疗顽固性频繁发作膀胱痉挛的临床疗效和安全性。方法 采用随机、双盲的方法对68例膀胱痉挛频繁发作病人进行托特罗定与异搏停的对比研究,服药方法每日2次,每次托特罗定2mg或异搏停80mg。观察两组显效例数、起效时间、维持时间及不良反应。结果 托特罗定组34例中显效33例(97.1％),异搏停组34例中显效28例(82.4％)。起效时间两组差异无显著意义(P>0.05),但维持时间托特罗定组长于异搏停组,差异有显著性意义(P<0.01)。托特罗定组病人副作用发生率29％,而异搏停组发生率为87.1％,两组间差别有显著意义(P<0.01)。结论 托特罗定是治疗顽固性频繁发作膀胱痉挛的有效药物,疗效好于异搏停,且不良反应明显低于异搏停。     

屈他维林联合托特罗定治疗经尿道前列腺电切术后膀胱痉挛的疗效观察

目的探讨屈他维林联合托特罗定治疗经尿道前列腺电切术后膀胱痉挛的临床疗效。方法选取2016年6月—2017年6月在河北省沧州中西医结合医院治疗的经尿道前列腺电切术后后膀胱痉挛患者82例,随机将患者分为对照组(41例)和治疗组(41例)。对照组口服酒石酸托特罗定片,2 mg/次,2次/d。治疗组在对照组基础上口服盐酸屈他维林片,80 mg/次,3次/d。两组均在拔出尿管3 d后停药。观察两组患者临床疗效,比较治疗前后两组患者膀胱痉挛次数和持续时间以及膀胱过度活动症评分(OABSS)评分、膀胱状况感知量表(PPBC)评分、视觉模拟评分法(VAS)评分和生活质量(QOL)评分。结果治疗后,对照组和治疗组临床有效率分别为80.49%和97.56%,两组比较差异具有统计学意义(P0.05)。治疗2、3 d后,两组膀胱痉挛次数和持续时间均较治疗前显著减少,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组膀胱痉挛次数和持续时间比同时期对照组均显著减少,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者OABSS评分、PPBC评分、VAS评分和QOL评分均明显降低;同组比较差异具有统计学意义(P0.05);且治疗组上述相关评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论屈他维林联合托特罗定治疗经尿道前列腺电切术后膀胱痉挛可显著改善患者临床症状,减轻患者疼痛,具有一定的临床推广应用价值。     

Tolterodine: a review of its use in the treatment of overactive bladder

Tolterodine is a competitive muscarinic receptor antagonist that shows in vivo selectivity for the bladder over the salivary glands compared with oxybutinin. Results of randomised double-blind placebo-controlled studies indicate that tolterodine 4 mg/day (administered as immediate-release tablets 2mg twice daily or extended-release capsules 4mg daily) is superior to placebo in improving micturition diary variables in patients with overactive bladder. Moreover, tolterodine 2mg twice daily is as effective as oxybutynin 5mg 3 times daily. Maximum treatment effects with both drugs occurred after 5 to 8 weeks of treatment and improvements were maintained during long term treatment for up to 24 months. In a pooled analysis of four 12-week studies, equivalent and significant reductions in micturition frequency (-2.3 and -2.0 vs -1.4, p < 0.001) and the incidence of urge incontinence episodes (-1.6 and -1.8 vs -1.1, p < 0.05) were reported for tolterodine 2mg twice daily and oxybutynin 5mg 3 times daily compared with placebo. Functional bladder capacity was also significantly increased. Improvements in patient perceptions of their urgency symptoms and of problems caused by their bladder condition were significantly greater during treatment with tolterodine than with placebo. Tolterodine was generally well tolerated in clinical trials of up to 24 months' duration. Dry mouth was the most frequent adverse event. The incidence (40 vs 78%, p < 0.001) and intensity of this event was lower with tolterodine 2mg twice daily than oxybutynin 5mg 3 times daily. Additionally, a 23% lower incidence of dry mouth was reported with once daily extended-release tolterodine capsules than with twice daily immediate-release tablets (p < 0.02). The incidence of adverse CNS events with tolterodine was low and similar to that of placebo. Tolterodine was well tolerated in elderly patients and no serious tolerability concerns were identified. CONCLUSION: Tolterodine is the first antimuscarinic agent to specifically developed for the treatment of overactive bladder. The functional selectivity of tolterodine for the bladder translates into good efficacy and tolerability in patients, including the elderly, with overactive bladder. Tolterodine is as effective as oxybutynin in improving micturition diary variables but is associated with a significantly lower incidence and intensity of dry mouth. This favourable tolerability profile, together with sustained clinical efficacy during long term treatment, places tolterodine as valuable treatment for the symptoms of overactive bladder.     

Twelve-month treatment of overactive bladder: efficacy and tolerability of tolterodine

CONTEXT: Tolterodine is a bladder-selective antimuscarinic agent designed for the treatment of overactive bladder. Traditional antimuscarinic therapies are poorly tolerated due to a high incidence of anticholinergic adverse events and consequently few patients remain on long term therapy. OBJECTIVE: To evaluate the long term efficacy and tolerability of tolterodine in patients with symptoms of overactive bladder. DESIGN: Twelve-month open-label extension of 4 randomised, placebo-controlled, double-blind, multinational, multicentre trials of 4 weeks' duration. PATIENTS: 714 patients (aged 18 to 92 years) with symptoms of overactive bladder who completed the double-blind portion of the studies. INTERVENTION: Tolterodine 2 mg twice daily for up to 12 months. MAIN OUTCOME MEASURES: Micturition diary variables: number of micturitions per 24 hours, number of urge incontinence episodes per 24 hours, mean urine volume voided per micturition. Safety variables: adverse events, study discontinuation rate. RESULTS: A total of 441 patients (62%) completed 12 months' open-label treatment with tolterodine, which significantly reduced the number of micturitions per 24 hours [mean change -2.4, 95% confidence interval (CI) -2.7 to -2.2, median change -20%, p < 0.0001] and number of urge incontinence episodes per 24 hours (mean change -1.3, 95% CI -1.6 to -1.0, median change -74%, p < 0.0001), while the mean volume voided per micturition was significantly increased (+33 ml, 95% CI +28 to +38, median change +18%; p < 0.0001). 41% of patients reported dry mouth (27% mild, 10% moderate, 3% severe). Dosage reduction to 1 mg twice daily was required in 23% of patients. 15% of patients withdrew from the study due to adverse events, with 5% having associated dry mouth. CONCLUSIONS: The high percentage of patients completing 12 months' treatment indicates that tolterodine is an effective and well tolerated agent for long term treatment of overactive bladder.     

索利那新和奥昔布宁治疗老年经尿道前列腺电切术后膀胱痉挛的比较研究

目的比较索利那新和奥昔布宁治疗老年经尿道前列腺电切术后膀胱痉挛的临床疗效。方法选取2016年2月—2017年2月在儋州市人民医院治疗的老年经尿道前列腺电切术后膀胱痉挛患者90例,按照治疗方法的不同分为对照组(45例)和治疗组(45例)。对照组口服盐酸奥昔布宁片,5 mg/次,2次/d。治疗组口服琥珀酸索利那新片,5 mg/次,2次/d。所有患者均在拔出尿管后3 d停药。评价两组患者临床疗效,同时比较治疗前后两组患者膀胱痉挛次数和持续时间,尿频和尿急次数,OABSS和PPBC评分。结果治疗后,对照组和治疗组总有效率分别为82.22%、97.78%,两组比较差异具有统计学意义(P0.05)。治疗2、3 d后,治疗组膀胱痉挛次数和持续时间均明显少于对照组(P0.05)。治疗1、3 d后,治疗组患者尿频、尿急次数均显著少于对照组(P0.05)。治疗后,两组OABSS和PPBC评分均明显下降(P0.05);且治疗组患者OABSS和PPBC评分明显低于对照组(P0.05)。结论索利那新治疗老年经尿道前列腺电切术后膀胱痉挛效果显著,可有效改善患者临床症状,具有一定的临床推广应用价值。     

康复新液联合索利那新治疗前列腺电切术后膀胱痉挛的疗效观察

目的探讨康复新液联合琥珀酸索利那新片治疗前列腺电切术后膀胱痉挛的临床疗效。方法选取2017年1月—2018年1月河北省沧州中西医结合医院收治的前列腺电切术术后膀胱痉挛患者100例为研究对象,根据随机区组设计法将患者分为对照组和治疗组,每组各50例。对照组于术后当天口服琥珀酸索利那新片,5 mg/次,1次/d,尿管拔除后用生理盐水持续冲洗膀胱。治疗组在对照组治疗的基础上口服康复新液,10 m L/次,3次/d,尿管拔除后用生理盐水与康复新液以1∶10比例持续冲洗膀胱。两组患者均在拔除尿管后3 d停药。观察两组的临床疗效,比较两组的膀胱功能改善情况、膀胱功能评分、临床治疗指标。结果治疗后,对照组和治疗组的总有效率分别为82.0%、96.0%,两组比较差异有统计学意义(P0.05)。与术后1 d比较,两组术后2、3 d膀胱痉挛次数、持续时间、尿频次数、尿急次数均显著下降,且治疗组术后1、2、3 d痉挛次数、持续时间、尿频次数、尿急次数均显著低于同期对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组VAS疼痛评分、OABSS评分、PPBC评分均显著下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组膀胱功能评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组膀胱冲洗、冲洗液转清、留置导尿管时间均显著短于对照组,两组比较差异具有统计学意义(P0.05)。结论康复新液联合琥珀酸索利那新片治疗前列腺电切术后膀胱痉挛具有较好的临床疗效,可改善临床症状,促进膀胱功能恢复,安全性较好,具有一定的临床推广应用价值。     

Characteristics of antimuscarinic responders versus suboptimal responders in a randomized clinical trial of patients with overactive bladder symptoms

Objective: To assess the characteristics of tolterodine extended-release (ER) 4?mg responders and suboptimal responders (≤50% decrease in UUI episodes/24?h) among patients with overactive bladder (OAB), including urgency urinary incontinence (UUI), and identify predictors of a >50% UUI response with fesoterodine 8?mg in tolterodine suboptimal responders.

Methods: Adult patients with OAB symptoms for ≥6 months and ≥8 micturitions, and ≥2 and <15 UUI episodes/24?h at week ?2 received open-label tolterodine ER 4?mg during a 2 week run-in. Suboptimal responders after tolterodine treatment (week 0) were randomized to fesoterodine (4?mg for 1 week, 8?mg for weeks 2–12) or placebo once daily. Post-hoc analyses compared the percentage change from week ?2 to week 0 in UUI episodes/24?h in tolterodine responders versus suboptimal responders and identified significant predictors of a UUI response at week 12 with fesoterodine 8?mg among tolterodine suboptimal responders.

Results: Of 897 patients, 610 (68%) were UUI suboptimal responders during the run-in period. UUI episodes/24?h at week ?2 were similar in tolterodine responders and suboptimal responders (4.2 vs. 4.3), but responders showed a significantly greater median percentage decrease in UUI episodes/24?h after tolterodine treatment at week 0 (80.0% versus 15.3%; p?p?=?.0027). Fesoterodine (vs. placebo), no previous antimuscarinic use before tolterodine run-in, and less UUI severity at baseline were significant predictors of a UUI response.

Conclusions: For patients with OAB, including UUI, who were treated initially with tolterodine and showed a suboptimal UUI response, nearly 70% demonstrated a UUI response with second-line fesoterodine 8?mg. No antimuscarinic use before tolterodine and fewer baseline UUI episodes were significant predictors of a UUI response with fesoterodine.     

舍尼亭联合山茛菪碱治疗PKVP术后膀胱痉挛

目的评价舍尼亭联合山茛菪碱治疗经尿道双极等离子前列腺电切术(PKVP)术后膀胱痉挛的价值。方法将80例因前列腺增生行PKVP术后的患者随机分为实验组和对照组,每组40例。实验组除常规抗感染、止血、补液治疗外,给予舍尼亭联合山茛菪碱治疗;对照组只常规予抗感染、止血、补液治疗。观察并记录患者膀胱痉挛出现的时间、持续时间和次数。结果膀胱痉挛出现的时间在实验组和对照组无明显差异(P>0.05),但在膀胱痉挛的持续时间和次数上差异明显,有统计学意义(P<0.05)。结论舍尼亭联合山茛菪碱治疗PKVP术后膀胱痉挛效果良好。