A review of detrusor overactivity and the overactive bladder after radical prostate cancer treatment

There are various forms of treatment for prostate cancer. In addition to oncologic outcomes, physicians, and increasingly patients, are focusing on functional and adverse outcomes. Symptoms of overactive bladder (OAB), including urinary frequency, urgency and incontinence, can occur regardless of treatment modality. This article examines the prevalence, pathophysiology and options for treating OAB after radical prostate cancer treatment. OAB seems to be more common and severe after radiation therapy than after surgical therapy and even persisted longer with complications, suggesting an advantage for surgery over radiotherapy. Because OAB that occurs after radical prostate surgery or radiotherapy can be difficult to treat, it is important that patients are made aware of the potential development of OAB during counselling before decisions regarding treatment choice are made. To ensure a successful outcome of both treatments, it is imperative that clinicians and non‐specialists enquire about and document pretreatment urinary symptoms and carefully evaluate post‐treatment symptoms.     

Results of a randomized,double-blind,placebo-controlled study of mirabegron in a Taiwanese population with overactive bladder and comparison with other clinical trials

ObjectiveMirabegron, a β₃-adrenoceptor agonist, has been shown to be effective and safe in the treatment of overactive bladder (OAB). The aim of this study was to assess the efficacy and safety of mirabegron (50 mg) versus placebo in Taiwanese patients with OAB.Materials and patientsThis was a multicenter, randomized, double-blind, parallel-group, placebo- and active-controlled trial conducted at 12 sites in Taiwan. Patients were randomized in a 1:1:1 ratio to receive placebo, mirabegron (50 mg), or tolterodine extended release (4 mg) orally once daily for 12 weeks. The primary efficacy end point was the change in the mean number of micturitions per 24 hours from baseline to the final visit. Secondary end points were volume voided, and the number of urgency, urinary incontinence, urge incontinence, and nocturia episodes per 24 hours; in addition, the King's Health Questionnaire (KHQ) was administered to assess effects on quality of life.ResultsA total of 218 patients were included in the full analysis set (68 in the placebo group; 76 in the mirabegron group; and 74 in the tolterodine group). The adjusted mean difference between the mirabegron and placebo groups for the change in mean number of micturitions per 24 hours was −1.42 (p = 0.004). The adjusted mean difference between the mirabegron and placebo groups with regard to the change in volume voided per micturition was 16.7 mL (p = 0.013). However, the mirabegron group did not show statistically significant superiority to the placebo group in the other efficacy variables. There was also no statistically significant difference between mirabegron and placebo in any KHQ domain score. The incidence of treatment-emergent adverse events in the mirabegron group was low and similar to that in the placebo group.ConclusionMirabegron at a dose of 50 mg once daily for 12 weeks is superior to placebo in reducing the frequency of micturitions in Taiwanese patients with symptoms of OAB. No clinically relevant, serious adverse events were identified.     

锯叶棕提取物治疗BPH伴OAB的疗效观察

目的：探讨锯叶棕提取物治疗BPH伴膀胱过度活动症（OAB）的临床疗效。方法：将2012年7月～2013年3月在我院诊断为BPH伴OAB患者100例随机分为研究组50例及对照组50例,研究组口服锯叶棕提取物（沙芭特）160mg,每天2次;对照组口服坦索罗辛0．2mg,每天1次。两组患者均服药8周,对比观察两组开始服药前、服药8周后的IPSS评分、OABSS评分、生活质量评分、最大尿流率（Qmax）、24h排尿次数、夜尿次数、每次排尿量等指标,观察研究组用药前后的疗效。结果：两组患者OAB较治疗前均有明显好转,治疗前后各项指标差异具有统计学意义（P〈0．05）;除max外,研究组与对照组其余观察指标治疗前后的变化值比较,差异均有统计学意义（P〈0．05）。结论：锯叶棕提取物（沙芭特）对于BPH伴OAB有明显的治疗作用,临床疗效较好。