Update on Overactive Bladder Therapeutic Options.

IF 2.9 4区 医学 Q2 PHARMACOLOGY & PHARMACY American journal of therapeutics Pub Date : 2024-07-01 Epub Date: 2023-05-11 DOI:10.1097/MJT.0000000000001637
Caroline P Babin, Nicole T Catalano, David M Yancey, Nathan Z Pearl, Eleanor M Koonce, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M Cornett, Alan D Kaye
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Abstract

Background: Millions of Americans are burdened by overactive bladder (OAB) syndrome and the psychogenic and economic hardships that accompany it. Several theories attempt to explain OAB as a neurogenic dysfunction, myogenic dysfunction, urothelial dysfunction, or decreased expression of a channel protein secondary to bladder outlet obstruction. Given that the etiology of OAB is a working theory, the management of OAB is also an evolving subject matter in medicine. There are uncertainties surrounding the pathophysiology of OAB, the strength of a clinical diagnosis, and accurate reporting because of the disease's stigma and decreased use of health care.

Data sources: This is a narrative review that used PubMed, Google Scholar, Medline, and ScienceDirect to review literature on current and future OAB therapies.

Results: Currently, first-line treatment for OAB is behavioral therapy that uses lifestyle modifications, bladder-control techniques, and psychotherapy. Second-line therapy includes antimuscarinic agents or beta 3 adrenergic agonists, and studies have shown that combination therapy with antimuscarinics and beta 3 adrenergic agonists provides even greater efficacy than monotherapy. Third-line therapies discussed include onabotulinumtoxinA, posterior tibial nerve stimulation, and sacral neuromodulation. OnabotulinumtoxinA has been FDA-approved as a nonpharmaceutical treatment option for refractory OAB with minimal side effects restricted to the urinary tract. Posterior tibial nerve modulation and sacral neuromodulation are successful in treating refractory OAB, but the costs and complication rates make them high-risk procedures. Therefore, surgical intervention should be a last resort. Estrogen therapy is effective in alleviating urinary incontinence in postmenopausal women, consistent with the association between estrogen deficiency and genitourinary syndrome. Potassium channel activators, voltage-gated calcium channel blockers, and phosphodiesterase inhibitors look to be promising options for the future of OAB management. As new therapies are developed, individuals with OAB can better personalize their treatment to maximize their quality of life and cost-effective care.

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膀胱过度活动症治疗方案的最新进展。
背景:数百万美国人深受膀胱过度活动综合征(OAB)的困扰,并承受着随之而来的精神和经济负担。有几种理论试图将 OAB 解释为神经源性功能障碍、肌源性功能障碍、尿道功能障碍或继发于膀胱出口梗阻的通道蛋白表达减少。鉴于 OAB 的病因是一个正在研究中的理论,OAB 的治疗也是一个不断发展的医学课题。OAB 的病理生理学、临床诊断的强度以及准确报告都存在不确定性,这是因为该疾病具有污名化和医疗保健使用减少的特点:这是一篇叙述性综述,使用了PubMed、Google Scholar、Medline和ScienceDirect,对有关当前和未来OAB疗法的文献进行了综述:目前,OAB 的一线治疗方法是行为疗法,采用改变生活方式、膀胱控制技术和心理疗法。二线疗法包括抗心绞痛药或β3肾上腺素能激动剂,研究表明,抗心绞痛药和β3肾上腺素能激动剂联合疗法比单一疗法疗效更好。所讨论的三线疗法包括奥那巴妥妥毒素 A、胫后神经刺激疗法和骶神经调节疗法。奥那保妥适已获得 FDA 批准,可作为治疗难治性 OAB 的非药物疗法,其副作用极小,仅限于泌尿系统。胫后神经调节术和骶神经调节术可成功治疗难治性 OAB,但其费用和并发症发生率使其成为高风险手术。因此,手术治疗应作为最后的手段。雌激素疗法可有效缓解绝经后妇女的尿失禁问题,这与雌激素缺乏和泌尿生殖系统综合征之间的关联是一致的。钾离子通道激活剂、电压门控钙离子通道阻滞剂和磷酸二酯酶抑制剂看起来是未来治疗尿失禁的有前途的选择。随着新疗法的开发,OAB 患者可以更好地进行个性化治疗,最大限度地提高生活质量和护理成本效益。
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来源期刊
American journal of therapeutics
American journal of therapeutics PHARMACOLOGY & PHARMACY-
CiteScore
5.50
自引率
9.50%
发文量
142
审稿时长
6-12 weeks
期刊介绍: American Journal of Therapeutics is an indispensable resource for all prescribing physicians who want to access pharmacological developments in cardiology, infectious disease, oncology, anesthesiology, nephrology, toxicology, and psychotropics without having to sift through stacks of medical journals. The journal features original articles on the latest therapeutic approaches as well as critical articles on the drug approval process and therapeutic reviews covering pharmacokinetics, regulatory affairs, pediatric clinical pharmacology, hypertension, metabolism, and drug delivery systems.
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