托特罗定治疗特发性膀胱过度活动症

目的观察新型毒蕈咸受体拮抗药托特罗定治疗特发性膀胱过度活动症的有效性和安全性。方法将托特罗定1mg呼奥昔布宁5mg及安慰剂进行对比,疗程3周。夜间入睡前2h口服。结果与安慰剂相比,托特罗定和奥昔布宁都使入睡前1h夜尿次数(P<0.01)显著减少。两种药物的副作用主要为口干。在口干(发生率和强度)方面,托特罗定要明显优于奥昔布宁(P<0.05)。结论托特罗定治疗特发性膀胱过度活动症效果明确,疗程3周即能达到疗效。尽管奥昔布宁也具有很好的疗效,但不良反应限制了它的应用。     

Solifenacin significantly improves all symptoms of overactive bladder syndrome

Overactive bladder syndrome (OAB) is a chronic condition characterised by urgency, with or without associated urge incontinence. Solifenacin succinate is a once daily, bladder selective antimuscarinic available in two doses (5 and 10 mg). The recommended dose is 5 mg once daily and can be increased to 10 mg once daily if 5 mg is well tolerated. This article presents pooled efficacy and safety data from four large, placebo-controlled, multinational phase III trials of solifenacin succinate with a total enrolment of over 2800 patients. Data from these trials show that solifenacin 5 and 10 mg once daily is significantly more effective than placebo at reducing urgency, incontinence, micturition frequency and nocturia and at increasing volume voided per micturition. Adverse events were mainly mild-to-moderate in all treatment groups. The results of these phase III trials support the use of solifenacin in the treatment of OAB.     

Darifenacin in the treatment of overactive bladder

Antimuscarinic drug therapy has been shown to be effective in the management of patients with symptoms of the overactive bladder syndrome (OAB), but the bothersome antimuscarinic adverse effects of dry mouth, constipation, somnolence and blurred vision often affect compliance with medication. The development of bladder selective M3 specific antagonists offers the possibility of increasing efficacy whilst minimising adverse effects. The M3 specific antagonist solifenacin has recently been marketed, and darifenacin will soon be available. The purpose of this article is to review the pharmacology and clinical trial data available for darifenacin, in addition to examining its role in the treatment of the OBS.     

盆底肌训练结合盐酸奥昔布宁在缓解女性膀胱过度活动症中的效果

目的探讨盆底肌训练在缓解女性膀胱过度活动症(OAB)患者症状中的效果。方法选取120例女性OAB患者中配合完成研究者110例,随机分为观察组50例(盆底肌训练加盐酸奥昔布宁治疗)和对照组60例(常规盐酸奥昔布宁治疗),比较2组患者干预前及干预14 d、30 d、90 d、6个月的膀胱过度活动症症状评分(OABSS),比较2组患者干预前及干预14 d、30 d、90 d的盆底肌肌力牛津分级,并比较2组患者干预前及干预90 d、6个月的King生活质量量表评分。结果治疗30 d、90 d后,观察组患者盆底肌力得分分别为(3.23±0.52)、(3.49±0.50)分,高于对照组的(3.03±0.54)、(2.97±0.62)分,差异有统计学意义(P0.05);治疗后6个月随访时,观察组OABSS评分为(1.17±1.87)分,低于对照组的(2.56±2.03)分,差异有统计学意义(P0.05);治疗90 d后,2组King生活质量量表中总体健康感受、行为受限、排尿问题严重性、运动受限、社交受限、症状严重程度得分比较,差异有统计学意义(P0.05)。结论盆底肌训练结合盐酸奥昔布宁治疗能有效缓解女性OAB症状。     

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。     

女性膀胱过度活动症的行为干预治疗及护理

目的探讨综合性护理干预在治疗女性膀胱过度活动症(OAB)过程中的应用及治疗效果。方法本组共包括107例女性OAB患者,分为干预组56例,对照组51例。干预组给予药物治疗及综合性护理干预(行为干预及心理护理),对照组给予药物治疗及普通护理,观察2组治疗效果。结果 2组OAB患者治疗总有效率干预组为91.07%,对照组为70.58%;24 h排尿次数干预组为(10.14±5.13)次,对照组为(17.96±5.38)次;尿急次数干预组为(6.23±2.83)次,对照组为(11.41±4.50)次,组间比较均有显著差异(P0.05)。结论实施综合性护理干预不仅可改善OAB患者的尿频尿急等下尿路症状,同时可提高患者对疾病的认识程度,帮助患者建立良性循环,从而缓解症状,提高患者的生活质量。     

Comparisons of the therapeutic safety of seven oral antimuscarinic drugs in patients with overactive bladder: a network meta-analysis

ObjectivesThis network meta-analysis aimed to assess the safety profiles of seven commonly used oral antimuscarinic drugs (darifenacin, fesoterodine, imidafenacin, oxybutynin, propiverine, solifenacin, and tolterodine) in patients with overactive bladder (OAB).MethodsPubMed, Cochrane Library, EMBASE, CNKI, and Wanfang databases were searched for randomized controlled trials (RCTs). Studies comparing one or more antimuscarinic drugs for treating OAB with reported adverse effects (AEs) were eligible. Data were extracted, and a network meta-analysis was performed by two authors independently.ResultsForty-five RCTs and 124,587 patients were included. The results demonstrated that tolterodine had better safety outcomes for 7 out of 12 major AEs, including dry mouth, constipation, urinary retention, dizziness, urinary tract infection, dry eyes, and dry skin. Darifenacin, fesoterodine, imidafenacin, oxybutynin, and solifenacin presented comparable safety profiles.ConclusionsTolterodine may be preferable as it showed a reduced association with important AEs. Darifenacin, fesoterodine, imidafenacin, oxybutynin, and solifenacin have similar safety profiles in treating patients with OAB. Taken together, this analysis provides a valuable overview of the therapeutic safety for oral antimuscarinic drugs and is useful for personalized medicine in patients with OAB.Trial registration: This trial was retrospectively registered at INPLASY (https://inplasy.com/) with the registration number 202170095.     

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.     

Intradetrusor onabotulinumtoxinA for overactive bladder

Introduction: Overactive bladder is a life-compromising disease that affects approximately 11.8% of all men and women, with increasing rates in the elderly. The mainstay of pharmacotherapy for this disease, anticholinergics, has up to a 71% discontinuation rate at 6 months. The emerging data of intradetrusor onabotulinumtoxinA (onabotA) use for treatment of idiopathic overactive bladder is showing to be an efficacious and well-tolerated alternative to the mainstay of therapy.

Areas covered: This study covers the use of onabotA and its use for idiopathic overactive bladder, stemming from its use in neurogenic detrusor overactivity, by evaluating the conclusions of current studies. A literature search and review was carried out for onabotA in treatment of overactive bladder using PubMed.

Expert opinion: Multiple randomized clinical trials have shown that intradetrusor injection with onabotA is effective in treating non-neurogenic bladder with promising efficacy in patients who have failed traditional pharmacotherapy. This treatment may be superior in certain patients due to its higher rate of compliance and higher rates of complete symptom resolution. Long-term studies are needed.     

综合护理干预在女性膀胱过度活动症病人中的应用

[目的]探讨综合护理干预在女性膀胱过度活动症病人治疗过程中的效果。[方法]将80例成年女性膀胱过度活动症病人随机分为对照组和观察组各40例。对照组采用药物治疗及行为疗法,观察组在对照组治疗的基础上加强心理干预、健康教育、强化行为疗法,出院后定期进行系统的电话随访,干预2周、4周、8周后观察记录两组病人排尿症状、排尿间隔时间和储尿期的单次尿量。[结果]干预4周、8周后观察组病人尿频、尿急、夜尿和尿失禁发生率均低于对照组(P<0.05);观察组病人排尿间隔时间和储尿期的单次尿量比对照组延长或增加(P<0.05)。[结论]综合护理干预治疗成年女性膀胱过度活动症能有效改善排尿症状。     

生物反馈治疗联合康复训练在中年女性膀胱过度活动症患者中的应用效果

目的 探讨生物反馈治疗联合康复训练在中年女性膀胱过度活动症(OAB)患者中的应用效果.方法 选取医院2015年2月—2017年8月收治的中年女性OAB患者96例为研究对象,将患者按照组间年龄、病程、膀胱过度活动症患者症状评估表(OABSS)评分匹配的原则分为对照组和观察组,每组48例.对照组采取常规护理及药物治疗,观察...     

感觉相关的排尿日记在社区女性膀胱过度活动症中的应用研究

目的 应用感觉相关的排尿日记评价40岁及以上的社区女性的膀胱过度活动症(OAB)发病情况.方法 620例女性(平均58岁)完成了3 d的感觉相关的排尿日记.膀胱感觉的定义:0级=膀胱没有感觉,1级=膀胱有涨满的感觉,但没有排尿的愿望,2级=有排尿愿望,3级=有强烈的排尿愿望,4级=有非常紧迫的排尿愿望,但没有急迫性尿失禁,5级=出现因尿急引起的漏尿.结果 96例(15.5%)有OAB症状,包括74例(11.9%)没有急迫性尿失禁(即干性OAB)和22例(3.5%)伴有急迫性尿失禁(即湿性OAB).在全部的11 418次排尿中,随着膀胱感觉等级的增加,排尿量显著增加.干性OAB受试者的24 h排尿量显著高于正常受试者.湿性OAB受试者的平均排尿量显著低于干性OAB受试者和正常受试者.无尿急感觉的正常组的膀胱感觉3级时平均排尿量显著高于其他各组.湿性OAB组的膀胱感觉4级和5级时排尿量显著低于正常组和干性OAB组.结论 感觉相关的排尿日记能有效地评价排尿感觉、尿失禁和排尿模式.正常组、干性OAB组和湿性OAB组中引起诸如尿急或尿频等症状的原因可能不同.     

针灸及护理干预治疗女性膀胱过度活动症的临床研究

目的 针灸及护理干预治疗女性膀胱过度活动症疗效观察.方法 选择女性膀胱过度活动症患者60例,随机分为对照组和观察组各30例.对照组采用行为干预护理;观察组在与对照组相同的行为干预护理基础上配合针灸治疗,一个疗程(5周)后观察记录两组患者排尿症状和储尿期的单次尿量及膀胱最大容量及尿动力学结果的评估.结果 观察组治疗后在尿频、尿急、夜尿和尿失禁的发生率均少于对照组;观察组治疗后储尿期的单次尿量及膀胱最大容量的改善高于对照组;观察组治疗后尿动力学结果逼尿肌不稳定型的例数少于对照组,差异均有显著意义(P＜0.05).结论 针灸及护理干预治疗女性膀胱过度活动症,能有效改善临床症状.     

Symptom-specific efficacy of tolterodine extended release in patients with overactive bladder: the IMPACT trial

We evaluated the efficacy of tolterodine extended release (ER) for patients' most bothersome overactive bladder (OAB) symptom in a primary care setting. Patients with OAB symptoms for >or=3 months received tolterodine ER (4 mg q.d.) for 12 weeks. Among incontinent patients (n = 772), the most bothersome OAB symptoms were daytime frequency (28%), urgency urinary incontinence (UUI; 27%), nocturnal frequency (26%) and urgency (19%); among continent patients (n = 91), they were daytime frequency (47%), nocturnal frequency (42%) and urgency (10%). Sixty-nine per cent of patients had one or more comorbid conditions. By week 12, there were significant reductions in patients' most bothersome symptom: -80% for UUI, -78% for urgency episodes, -40% for nocturnal frequency and -30% for daytime frequency (p < 0.0001). The most common adverse events were dry mouth (10%) and constipation (4%). In primary care practice, bothersome OAB symptoms can be effectively and safely treated with tolterodine ER, even in patients with comorbid conditions.     

Fesoterodine for overactive bladder: A review of the literature

Background: Overactive bladder (OAB) is a chronic condition affecting both men and women, with prevalence increasing with age. Antimuscarinics form the cornerstone of treatment of OAB. Fesoterodine, a nonselective muscarinic-receptor antagonist, was approved by the US Food and Drug Administration in late 2008 for once daily, oral administration in the treatment of OAB to relieve the symptoms of urinary urge incontinence, urgency, and frequency.Objective: The aim of this review was to provide an overview of the mechanism of action of and clinical trial data for fesoterodine, and to discuss the present status of fesoterodine in the management of OAB.Methods: The MEDLINE and Google Scholar databases were searched (June 1, 1999-December 1, 2009) using the terms fesoterodine, overactive bladder, and muscarinic antagonists. Full-text articles in English were selected for reference, and articles presenting the mechanism of action, pharmacokinetics, and data from clinical trials were included. The parameters measured were tolerability, efficacy, and health-related quality of life (HRQoL). Trials involving animals and Phase I studies were excluded.Results: The initial literature search yielded 48 papers. A total of 20 articles fulfilled the inclusion criteria. In two 12-week, randomized, multicenter, Phase III clinical trials involving patients with increased micturition frequency and urgency and/or urinary urge incontinence (n = 836 and 1132 in each trial), both fesoterodine 4 and 8 mg were associated with significantly improved symptoms of OAB (frequency of micturition, urgency, and urge incontinence) compared with placebo (P < 0.05). In a post hoc analysis of pooled data of the Phase III trials, HRQoL improved significantly with both doses. In a 12-week, Phase Illb trial, fesoterodine 4 and 8 mg led to treatment satisfaction in ∼80% of patients (of 516 enrolled) who were initially unsatisfied with their previous treatment.Conclusion: A review of the literature suggests that fesoterodine is an efficacious and well-tolerated treatment option for patients with OAB.     

The assessment of quality of life in female Turkish patients with overactive bladder

The objective of this study was to examine the quality of life in female Turkish patients with overactive bladder (OAB). The investigation was conducted as a cross-sectional study between January and April 2010. Two hundred eighty female patients responded to the Overactive Bladder Validated Eight-Question Screener, the OAB disease-specific health-related quality-of-life scale (OAB questionnaire (OAB-q)) and the general quality-of-life scale EuroQol Five-Dimensional Questionnaire (EQ-5D) for the study. Of the 280 patients, 38.9% was classified as having OAB. The mean age was 47.0 ± 8.7. All of the quality-of-life domains (coping, concern, sleep and social) and OAB-q total scores in women with OAB were significantly worse than in women without OAB (P < 0.001 for all). Similarly, the EQ-5D(index) and EQ-5D(VAS) scores for women with OAB were significantly worse than for women without OAB (P < 0.001 and P = 0.006, respectively). OAB-q and EQ-5D(index) scores in menopausal women were significantly lower than non-menopausal women (P < 0.05) in patients with OAB. In conclusion, OAB negatively affects quality of life in Turkish women. However, many women's quality of life can be improved if the patients seek medical treatment. Thus, nurses should encourage the patients to seek medical support in order to cope with health-related quality-of-life problems.     

Darifenacin treatment for overactive bladder in patients who expressed dissatisfaction with prior extended-release antimuscarinic therapy

Introduction and objective: Patient perception of overactive bladder (OAB) treatment outcomes can be a useful indicator of benefit and may help drive persistence on treatment, which is known to be poor in OAB. It remains unclear whether OAB patients dissatisfied with one antimuscarinic can achieve satisfaction with another and supporting data are limited. This study investigated patient‐reported outcomes and clinical parameters during darifenacin treatment in OAB patients who expressed dissatisfaction with prior extended‐release (ER) oxybutynin or tolterodine therapy (administered for ≥ 1 week within the past year). Methods: This open‐label study was conducted in darifenacin‐naïve OAB patients. Patients received 7.5 mg darifenacin once daily with the possibility of up‐titrating to 15 mg after 2 weeks, for up to 12 weeks. Efficacy parameters included the Patient’s Perception of Bladder Condition (PPBC), patient satisfaction with treatment, micturition frequency and number of urgency and urge urinary incontinence (UUI) episodes. Adverse events (AEs) were also recorded. Results: In total, 497 patients were treated (84.1% women). Darifenacin treatment resulted in statistically significant improvements in PPBC scores, micturition frequency, urgency and UUI episodes from baseline at 12 weeks. The improvements were similar for patients previously treated with oxybutynin ER or tolterodine ER. More than 85% of patients expressed satisfaction with darifenacin. As noted in other studies, the most common AEs were dry mouth and constipation, but these infrequently resulted in treatment discontinuation, which was low overall. Conclusions: In this study, PPBC score and OAB symptoms were significantly improved, and satisfaction was high during treatment with darifenacin (7.5/15 mg) in patients who were dissatisfied with the previous antimuscarinic treatment.     

受体阻滞剂联合用药及单用治疗膀胱过度活动症合并膀胱出口梗阻的效果比较

目的比较α受体阻滞剂联合用药及单用治疗膀胱过度活动症合并膀胱出口梗阻的疗效。方法选取100例膀胱过度活动症合并膀胱出口梗阻患者,随机分为2组。对照组患者采用α受体阻滞剂进行治疗,研究组患者采用α受体阻滞剂联合M受体阻滞剂的治疗方式,比较2组治疗效果。结果研究组患者治疗后的疼痛评分、排尿评分、总积分显著低于对照组患者(P0.05)。对照组患者治疗后OABSS评分为(7.2±1.5)分,研究组患者治疗后OABSS评分为(4.8±1.2)分,差异有统计学意义(P0.05)。研究组患者并发症发生率为4.0%,显著低于对照组患者的10.0%(P0.05)。结论在膀胱过度活动症合并膀胱出口梗阻患者的临床治疗中,受体阻滞剂联合用药具有更好的治疗效果。     

宫颈炎引起膀胱过度活动症的神经机制研究

目的探讨慢性宫颈炎引起排尿异常的神经机制。方法电刺激大鼠子宫颈,记录膀胱的肌电活动及其在神经封闭、植物神经切除后的变化。结果电刺激大鼠子宫颈时在膀胱肌层可记录到较稳定的、波形呈慢波的肌电活动波。利多卡因阻滞子宫颈组织内的神经传导后,可使膀胱肌电活动波幅下降,潜伏期延长,与阻滞前相比,差异均有统计学意义(P0.01);而改用生理盐水子宫颈注入前后各时段波幅和潜伏期差异均无统计学意义(P0.05);颈髓横断后对膀胱肌电活动无显著影响。破坏同侧T13～L5交感神经干后对膀胱肌电活动有显著影响;而同侧L6～S3副交感神经切断后,膀胱肌电活动波基本消失。结论子宫颈与膀胱间存在神经反射,可能为脊髓固有的神经反射,通过此反射宫颈炎时可以引起膀胱过度活动症。     

Patient-reported goal achievement after antimuscarinic treatment in patients with overactive bladder symptoms

Aim: Standardised traditional outcome measures may fail to address factors that are important to patients and address irrelevant factors. Aim of this study was to assess patient‐reported goals and goal achievement (GA) in the antimuscarinic treatment for overactive bladder (OAB) patients. Methods: Men and women aged ≥ 18 years with OAB symptoms were eligible for the study. Treatment began with a dose of 10 mg oxybutynin, to be increased if necessary to 30 mg. Before treatment, each patient’s primary treatment goal was identified. After 12‐week treatment, patients reported GA using a Likert scale from 0 (no achievement) to 5 (complete achievement). Successful achievement was defined as a score of 4 or 5. Traditional outcome measures including voiding diaries, the OAB questionnaire short form, patient perception of bladder condition, and treatment benefit and satisfaction were assessed. Baseline characteristics affecting GA and the correlation between GA and traditional outcome measures were evaluated. Results: A total of 303 goals were identified from 303 patients (51 men, 252 women). Of those, 72.3% addressed symptom relief and frequency as the most common target symptom. Other goals addressed were improving quality of life (13.5%) and eliminating coping behaviours (14.2%). After treatment, 42% had a successful GA with a median score of 3 (interquartile range; 2–4). Age had a negative effect on GA. Goal achievement was the outcome measure most correlated with treatment benefit and satisfaction. Discussion and Conclusions: Goal achievement can be a valuable outcome measure in OAB patients, addressing individual treatment goals and reflecting treatment benefit and patient satisfaction.