LUTS: Lower Urinary Tract Symptoms最新文献_第5页

Efficacy and safety of the Rezum system for the treatment of catheter-dependent urinary retention: Three-year real-world outcomes in a multimorbid, multiethnic population Rezum系统治疗导尿管依赖性尿潴留的有效性和安全性:在多疾病、多种族人群中的三年真实结果

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-05-15 DOI: 10.1111/luts.12482

Mustufa Babar, Zaki Masoud, Kevin Labagnara, Justin Loloi, Rahman Sayed, Sandeep Singh, Kevin Tang, Umar Syed, Michael Ciatto

Objectives

To evaluate the long-term real-world efficacy and safety of Rezum for the treatment of catheter-dependent urinary retention in a multimorbid, multiethnic population.

Methods

A single-office, retrospective study was conducted on patients treated with Rezum between 2017 and 2019. Patients were included if they had catheter-dependent urinary retention prior to treatment and at least one follow-up within 36 months postoperatively. Patient demographics, procedural characteristics, adverse events (AEs), and outcome measures, including benign prostate hyperplasia (BPH) medication usage and postvoid residual (PVR), were collected at 3, 6, 12, and/or 36 months postoperatively. Regret was assessed at 36 months using the 5-item Decisional Regret Scale (DRS).

Results

A total of 27 patients met the inclusion criteria, with the majority being Asian (29.6%), followed by non-Hispanic Black (26.0%) and Hispanic (22.2%). Most patients (77.8%) had at least one comorbidity. Trial of void (TOV) was attempted at a median of 8 days (7, 13). Fourteen patients (51.9%) failed their initial TOV. Median time until catheter independence was 13.5 days (8.5, 28.8). Common AEs included urinary retention (51.9%), urinary tract infections (UTIs) (25.9%), and dysuria (25.9%). All cases of UTIs (7/7) and most cases of dysuria (6/7) occurred in patients who failed their initial TOV. At 36 months, there was a significant median percentage change in PVR (−100.0% [−100.0, −36.7], p = .049), and 40.4% of patients discontinued their BPH medications (p = .001). Of the 11 patients who filled out the DRS, 10 (90.9%) agreed/strongly agreed that they made the right decision. By 36 months, 4 patients (14.8%) underwent reoperation and 24 (88.9%) remained catheter-independent.

Conclusions

At long-term follow-up, Rezum effectively treated catheter-dependent urinary retention with minimal decisional regret. In patients with urinary retention, urologists should consider delaying TOV until 2 weeks postoperatively to maximize the likelihood of a successful TOV and minimize the risk of AEs.

目的评价Rezum在多疾病、多种族人群中治疗导尿管依赖性尿潴留的长期疗效和安全性。方法对2017 - 2019年接受Rezum治疗的患者进行单室回顾性研究。如果患者在治疗前有导尿管依赖性尿潴留，且术后36个月内至少有一次随访，则纳入研究。在术后3、6、12和/或36个月收集患者人口统计学、手术特征、不良事件(ae)和结局指标，包括良性前列腺增生(BPH)药物使用和术后残留(PVR)。在36个月时使用5项决策后悔量表(DRS)评估后悔。结果符合纳入标准的患者共27例，以亚裔(29.6%)居多，其次是非西班牙裔黑人(26.0%)和西班牙裔(22.2%)。大多数患者(77.8%)至少有一种合并症。无效试验(TOV)的中位数为8天(7,13)。14例(51.9%)患者首次TOV失败。到导管独立的中位时间为13.5天(8.5天，28.8天)。常见的ae包括尿潴留(51.9%)、尿路感染(25.9%)和排尿困难(25.9%)。所有尿路感染病例(7/7)和大多数排尿困难病例(6/7)发生在首次TOV失败的患者中。在36个月时，PVR的中位百分比变化显著(- 100.0% [- 100.0，- 36.7]，p = 0.049)， 40.4%的患者停止了BPH药物治疗(p = 0.001)。在填写DRS的11名患者中，10名(90.9%)同意或强烈同意他们做出了正确的决定。36个月时，4例患者(14.8%)再次手术，24例患者(88.9%)保持导管独立。结论:在长期随访中，Rezum有效地治疗了导尿管依赖性尿潴留，决策后悔最小。对于有尿潴留的患者，泌尿科医生应考虑延迟TOV至术后2周，以最大限度地提高TOV成功的可能性，并尽量减少不良反应的风险。

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引用次数: 1

Mirabegron versus vibegron in previously untreated female patients with overactive bladder: A randomized, single-clinic, open-label trial Mirabegron与vibegron在未经治疗的女性膀胱过动症患者中的疗效:一项随机、单诊所、开放标签试验

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-05-04 DOI: 10.1111/luts.12480

Hirotaka Sato, Shota Otsuka, Sachiyuki Tsukada

Objectives

This study aimed to assess the efficacy and safety of mirabegron compared with vibegron (both 50 mg once daily) in Japanese female patients with symptoms of overactive bladder (OAB).

Methods

This prospective, 12-week, two-arm, parallel-group, open-label randomized trial (UMIN000038288) was conducted at a single clinic from December 2019 to September 2022. The primary efficacy outcome measure was the change in mean total overactive bladder symptom scores (OABSSs) from baseline to end of treatment (EOT) (Week 12). The secondary efficacy outcome measures were changes in mean International Prostate Symptom Score from baseline to EOT, the ratio of patients who achieved a minimal clinically important change (MCIC) of total OABSS, and individual domains of the King's Health Questionnaire. Safety assessments, such as adverse events (AEs), postvoid residual volume, and patient-reported incidences, were recorded at every visit.

Results

There was no statistically significant adjusted mean difference between mirabegron and vibegron in terms of the primary outcome of the mean change from baseline to EOT in the total OABSS. The difference in the percentage of patients in the mirabegron and vibegron groups achieving an MCIC on the total OABSS was not statistically significant but appeared to be clinically important. The incidence of treatment-related AEs was significantly higher for the vibegron group (38.5%) than the mirabegron group (19.1%) (p = .047).

Conclusions

These results showed that both drugs were effective in female OAB patients, with no significant differences in terms of efficacy. However, the safety of vibegron requires further investigation.

目的:本研究旨在评估mirabegron与vibegron(均为50 mg，每日1次)在日本女性膀胱过动症(OAB)患者中的疗效和安全性。该前瞻性、为期12周、平行组、开放标签随机试验(UMIN000038288)于2019年12月至2022年9月在一家诊所进行。主要疗效指标是平均膀胱过度活动症状评分(OABSSs)从基线到治疗结束(EOT)(第12周)的变化。次要疗效指标包括从基线到EOT的平均国际前列腺症状评分的变化，达到最小临床重要变化(MCIC)的总OABSS的患者比例，以及King's健康问卷的各个领域。安全性评估，如不良事件(ae)、空隙后残留量和患者报告的发生率，在每次就诊时都被记录下来。结果mirabegron和vibegron在总OABSS从基线到EOT的平均变化的主要结局方面没有统计学上的显著差异。美瑞比龙组和威比龙组在总OABSS上达到MCIC的患者百分比差异无统计学意义，但似乎具有重要的临床意义。vibegron组治疗相关不良事件发生率(38.5%)显著高于mirabegron组(19.1%)(p = 0.047)。结论两种药物对女性OAB患者均有效，且疗效无显著差异。然而，威必荣的安全性需要进一步调查。

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引用次数: 1

The efficacy of antibiotic and alpha-blocker combination therapy versus antibiotic monotherapy in chronic prostatitis/chronic pelvic pain syndrome: A systematic review 抗生素和α受体阻滞剂联合治疗与抗生素单药治疗慢性前列腺炎/慢性盆腔疼痛综合征的疗效:系统综述

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-04-02 DOI: 10.1111/luts.12477

Fina Widia, Widi Atmoko, Natanael Parningotan Agung, Harrina Erlianti Rahardjo, Nur Rasyid, Ponco Birowo, Akmal Taher

Objectives

This study attempted to explore the efficacy of a combination of alpha-blockers and antibiotics compared with antibiotic monotherapy in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Methods

We searched PubMed/MEDLINE, Cochrane/CENTRAL, EBSCOHost/CINAHL, ProQuest, and Scopus on January 2020. Randomized controlled trials comparing antibiotic monotherapy with combination therapy of antibiotics and alpha-blockers in CP/CPPS patients lasting at least 4 weeks were included. The study eligibility assessment, data extraction, and study quality assessment were carried out by each author independently and in duplication.

Results

A total of six low- to high-quality studies with 396 patients were included in the study. Two reviews reported lower National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total scores in the monotherapy arm at Week 6. Only one study reported otherwise. On Day 90, the NIH-CPSI score was found to be lower in the combination group. In the pain, urinary, and quality-of-life domain, most studies agree that combination therapy is not superior to monotherapy. However, on Day 90, all domains were found to be lower in the combination therapy. Responder rates were found to vary between studies. Only four out of six studies reported a response rate. Responder rates were lower in the combination group at 6 weeks of observation. On Day 90, responder rates were found to be better in the combination group.

Conclusions

The combination therapy of antibiotics and alpha-blockers is not substantially better than antibiotic monotherapy in the first 6 weeks of treatment for CP/CPPS patients. This might not be applicable to a longer duration of treatment.

目的探讨α -受体阻滞剂联合抗生素治疗慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)的疗效，并与抗生素单药治疗进行比较。方法于2020年1月检索PubMed/MEDLINE、Cochrane/CENTRAL、EBSCOHost/CINAHL、ProQuest和Scopus。在CP/CPPS患者中，比较抗生素单药治疗与抗生素和α受体阻滞剂联合治疗持续至少4周的随机对照试验。研究合格性评估、数据提取和研究质量评估由每位作者独立完成，并重复进行。结果本研究共纳入6项低质量到高质量的研究，共纳入396例患者。两篇综述报道，在第6周，单药治疗组的美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)总分较低。只有一项研究与此相反。在第90天，发现联合组的NIH-CPSI评分较低。在疼痛、泌尿和生活质量方面，大多数研究一致认为联合治疗并不优于单一治疗。然而，在第90天，发现联合治疗的所有域都较低。研究发现应答率在不同的研究中有所不同。六项研究中只有四项报告了反应率。观察6周时，联合用药组的应答率较低。在第90天，发现联合组的应答率更好。结论在CP/CPPS患者治疗的前6周，抗生素与α受体阻滞剂联合治疗并不明显优于抗生素单药治疗。这可能不适用于较长时间的治疗。

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引用次数: 0

Lower urinary tract symptoms are elevated with depression in Japanese women 日本女性的下尿路症状随着抑郁症而升高

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-03-30 DOI: 10.1111/luts.12478

Sahoko Ninomiya, Takashi Kawahara, Sohgo Tsutsumi, Hiroki Ito, Kazuhide Makiyama, Hiroji Uemura

Objectives

Depression might worsen lower urinary tract symptoms (LUTS), but the correlation is still disputed. This study examined the influence of depression on LUTS in Japanese women.

Methods

This study used a web-based questionnaire to evaluate the mental status of depression and LUTS. The mental status of depression was evaluated using the Quick Inventory of Depressive Symptomatology-Japanese version (QIDS-J), and LUTS was assessed based on the Overactive Bladder Symptom Score (OABSS) and responses to the International Consultation on Incontinence Questionnaire-Short Form.

Results

A total of 4151 of 5400 (76.9%) women responded to the questionnaire. The mean age was 48.3 ± 13.8 years. The OABSS gradually increased with the QIDS-J score. The incidence of overactive bladder (OAB) and urgency urinary incontinence (UUI) also increased along with the QIDS-J score. In the younger age group (20–39 years old), the risks of OAB and UUI were higher than in the elderly group (7.42 for OAB and 7.44 for UUI).

Conclusions

This study revealed that worsening of LUTS was correlated with depression.

目的抑郁症可能加重下尿路症状(LUTS)，但其相关性仍有争议。本研究考察了抑郁对日本女性LUTS的影响。方法采用基于网络的问卷调查方法，对抑郁症和LUTS患者的精神状态进行评估。采用抑郁症状快速量表-日本版(QIDS-J)评估抑郁的精神状态，根据膀胱过度活动症状评分(OABSS)和对失禁国际咨询问卷-短表的反应评估LUTS。结果5400名受访女性中有4151名(76.9%)回复了问卷。平均年龄48.3±13.8岁。OABSS随QIDS-J评分逐渐升高。膀胱过动症(OAB)和急迫性尿失禁(UUI)的发生率也随着QIDS-J评分的增加而增加。在年轻年龄组(20-39岁)，OAB和UUI的风险高于老年组(OAB为7.42,UUI为7.44)。结论LUTS的恶化与抑郁相关。

{"title":"Lower urinary tract symptoms are elevated with depression in Japanese women","authors":"Sahoko Ninomiya, Takashi Kawahara, Sohgo Tsutsumi, Hiroki Ito, Kazuhide Makiyama, Hiroji Uemura","doi":"10.1111/luts.12478","DOIUrl":"10.1111/luts.12478","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Depression might worsen lower urinary tract symptoms (LUTS), but the correlation is still disputed. This study examined the influence of depression on LUTS in Japanese women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used a web-based questionnaire to evaluate the mental status of depression and LUTS. The mental status of depression was evaluated using the Quick Inventory of Depressive Symptomatology-Japanese version (QIDS-J), and LUTS was assessed based on the Overactive Bladder Symptom Score (OABSS) and responses to the International Consultation on Incontinence Questionnaire-Short Form.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4151 of 5400 (76.9%) women responded to the questionnaire. The mean age was 48.3 ± 13.8 years. The OABSS gradually increased with the QIDS-J score. The incidence of overactive bladder (OAB) and urgency urinary incontinence (UUI) also increased along with the QIDS-J score. In the younger age group (20–39 years old), the risks of OAB and UUI were higher than in the elderly group (7.42 for OAB and 7.44 for UUI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study revealed that worsening of LUTS was correlated with depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.12478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9765915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Anatomic outcomes of sacrohysteropexy without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles: Is a rectouterine mesh really necessary? 无症状1级和2级直肠前突患者骶子宫切除术不放置后路补片的解剖结果:直肠后突补片真的有必要吗?

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-03-30 DOI: 10.1111/luts.12479

Adem Sancı, Khaled Obaid, Murat Topcuoglu, Mehmet İlker Gokce, Evren Süer, Ömer Gülpinar

Objectives

To present the anatomic outcomes of sacrohysteropexy surgery without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles.

Methods

The patients who underwent abdominal sacrohysteropexy without posterior mesh placement for the treatment of symptomatic grade 3 and 4 anterior/apical prolapse + asymptomatic grade 1 and 2 rectocele between May 2015 and January 2021 were evaluated retrospectively. The success rate, the anatomic outcomes (for anterior, apical, and posterior pelvic organ prolapse [POP]), and perioperative data of the surgical procedure were assessed. The objective failure criteria after surgery included the presence of grade 1 or higher in any compartment (anatomical criteria), recurrent POP requiring an operation, and/or usage of pessaries. Perioperative adverse events were categorized according to the Clavien–Dindo classification.

Results

Fifty-one patients underwent sacrohysteropexy without posterior mesh. The mean age of the patients was 56.8 ± 10 years. The success rates (anatomical outcomes) for the anterior/apical and posterior POP in the study group were 60.7%, 54.9%, and 58.8%, respectively, at a median follow-up time of 40.24 (24–71) months. The median hospital stay was 3.1 (2–6) days. The mean estimated blood loss was 127.6 (80–150) mL. The mean operation time was 114 (90–156) min. The mean urethral and catheter removal times were 1.3 (1, 2) and 2.1 (2–4) days, respectively. The mean recovery time of gastrointestinal motility was 14.4 h (11–35).

Conclusions

Sacrohysteropexy without posterior mesh placement might be associated with less pain, shorter operative time, and shorter recovery time of gastrointestinal motility, without compromising the anatomic success.

目的探讨无症状1级和2级直肠前突的骶宫闭术无后置补片的解剖效果。方法回顾性分析2015年5月至2021年1月间行无后置补片腹骶宫闭术治疗症状性3级和4级前/根尖脱垂+无症状性1级和2级直肠前突的患者。评估手术的成功率、解剖结果(前、顶、后盆腔器官脱垂[POP])和围手术期数据。手术后的客观失败标准包括任何隔室存在1级或更高级别(解剖学标准)，需要手术的复发性POP，和/或使用子宫托。围手术期不良事件按照Clavien-Dindo分类进行分类。结果51例患者行无后路补片骶子宫切除术。患者平均年龄56.8±10岁。在中位随访时间40.24(24-71)个月期间，研究组前/根尖和后侧POP的成功率(解剖学结果)分别为60.7%，54.9%和58.8%。中位住院时间为3.1(2-6)天。平均估计失血量为127.6 (80-150)mL，平均手术时间为114 (90-156)min，平均拔尿时间分别为1.3(1,2)天和2.1(2 - 4)天。胃肠运动恢复时间平均为14.4 h(11-35)。结论骶宫闭术后置补片可减轻疼痛，缩短手术时间，缩短胃肠运动恢复时间，不影响解剖成功。

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引用次数: 0

TOT in combination with solifenacin or intravaginal prasterone in postmenopausal women with mixed urinary incontinence: A retrospective analysis in 112 patients TOT联合索利那新或阴道内普酮治疗绝经后混合性尿失禁112例回顾性分析

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-03-04 DOI: 10.1111/luts.12476

Federica Sala, Melania Loggia, Giorgia Cardella, Claudia Morgani, Giovanni Grossi, Marzio Angelo Zullo, Herbert Carmelo Carlo Valensise, Pier Luigi Palazzetti, Michele Carlo Schiavi

Objectives

The aim of this study was to compare the efficacy of the transobturator tape (TOT) procedure combined with solifenacin (TOT-S) or prasterone (TOT-P) in postmenopausal women affected by mixed urinary incontinence (MUI) with a predominant stress urinary incontinence component.

Methods

This is a retrospective analysis including 112 patients: 60 patients of the TOT-S group and 52 patients of the TOT-P group. Physical examination, 3-day voiding diary, urodynamic tests, and Vaginal Health Index (VHI) were compared at the beginning of the analysis and after 12 weeks of follow-up (FU). Specific questionnaires were administered to indagate the impact on women's quality of life and sexual function.

Results

After 12 weeks of FU, the detrusor's peak flow pressure was significantly different between the two groups (p = .02). Detrusor overactivity decreased only in the TOT-P group (p = .05). At the end of FU, 58 patients (96.7%) of the TOT-S group and 50 patients (96.2%) of the TOT-P group were dry at the stress test. A significative group difference was observed in urge urinary incontinence (24 h) (p = .01) but not in the mean number of voids (24 h) and urgent micturition events (24 h). VHI improved only in the TOT-P group (12.57 ± 3.80 vs. 19.75 ± 4.13, p < .0001). The questionnaires and Patient Global Index of Improvement (PGI-I) scores showed comparable improvements, while the Female Sexual Function Index improved especially in the TOT-P group (p < .001).

Conclusions

In postmenopausal women with MUI, TOT-P demonstrated the same effectiveness as TOT-S in reducing urinary symptoms. In addition, TOT-P increased VHI and sexual function scores compared with TOT-S.

目的本研究的目的是比较经通气带(TOT)手术联合索利那新(TOT- s)或普睾酮(TOT- p)对绝经后妇女混合性尿失禁(MUI)的疗效，其中主要是压力性尿失禁成分。方法对112例患者进行回顾性分析，其中TOT-S组60例，TOT-P组52例。比较分析开始时和随访12周后的体格检查、3天排尿日记、尿动力学试验和阴道健康指数(VHI)。通过具体的问卷调查来显示对女性生活质量和性功能的影响。结果FU治疗12周后，两组逼尿肌峰值血流压力差异有统计学意义(p = 0.02)。只有TOT-P组逼尿肌过度活动减少(p = 0.05)。FU结束时，58例(96.7%)TOT-S组和50例(96.2%)TOT-P组在压力测试中处于干燥状态。急尿失禁(24 h)组间差异有统计学意义(p = 0.01)，平均排尿次数(24 h)和紧急排尿事件(24 h)组间差异无统计学意义(p = 0.01)。VHI仅在TOT-P组得到改善(12.57±3.80 vs. 19.75±4.13,p < 0.0001)。问卷调查和患者整体改善指数(PGI-I)评分显示出类似的改善，而女性性功能指数改善，特别是在TOT-P组(p < .001)。结论在绝经后MUI妇女中，TOT-P与TOT-S在减轻泌尿系统症状方面表现出相同的效果。此外，与TOT-S相比，TOT-P可提高VHI和性功能评分。

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引用次数: 0

Efficacy and safety of vibegron compared with mirabegron for overactive bladder: A systematic review and network meta-analysis vibegron与mirabegron治疗膀胱过动症的疗效和安全性:一项系统评价和网络荟萃分析

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-03-02 DOI: 10.1111/luts.12475

Wenjuan He, Yuqian Zhang, Guangliang Huang, Yunfei Tian, Qian Sun, Xiuju Liu

Objectives

The aim of this study was to indirectly compare the efficacy and safety of mirabegron and vibegron in patients with overactive bladder.

Methods

A systematic search was performed on Pubmed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases to identify studies from the date of database inception to January 1, 2022. All randomized controlled trials comparing mirabegron or vibegron with tolterodine, imidafenacin, or placebo were eligible. One reviewer extracted data, and a second reviewer checked. Included trials were assessed for similarity, and networks were developed using Stata 16.0 software. Mean differences for continuous variables and odds ratios for dichotomous variables together with their 95% confidence intervals (CIs) were used to rank treatments and compare the differences, respectively.

Results

A total of 11 randomized controlled trials and 10 806 patients were included. For each outcome, results for all licensed treatment doses were included. Both vibegron and mirabegron were more efficacious than placebo at reducing the frequency of micturition, incontinence, urgency, urgency incontinence, and nocturia. Vibegron was more efficacious than mirabegron in reducing mean voided volume/micturition (95% CI [5.15, 14.98]). Safety outcomes for vibegron and mirabegron were similar to those in the placebo group, except for mirabegron, which had a higher risk of nasopharyngitis and cardiovascular adverse events than placebo.

Conclusions

Both drugs seem to be comparable and well tolerated, particularly as direct comparisons are not available. However, vibegron may be more effective than mirabegron in reducing mean voided volume.

目的:间接比较mirabegron和vibegron治疗膀胱过动症的疗效和安全性。方法系统检索Pubmed、Web of Science、Embase和Cochrane Central Register of Controlled Trials数据库，确定从数据库建立日期到2022年1月1日的研究。所有比较米拉比格隆或威比格隆与托特罗定、咪达那辛或安慰剂的随机对照试验均符合条件。一个审稿人提取数据，另一个审稿人进行检查。对纳入的试验进行相似性评估，并使用Stata 16.0软件开发网络。连续变量的平均差异和二分类变量的比值比及其95%置信区间(ci)分别用于对治疗进行排序和比较差异。结果共纳入11项随机对照试验，10 806例患者。对于每个结果，包括所有许可治疗剂量的结果。vibegron和mirabegron在减少尿频、尿失禁、尿急、尿急和夜尿方面都比安慰剂更有效。Vibegron在减少平均排尿量/排尿量方面比mirabegron更有效(95% CI[5.15, 14.98])。vibegron和mirabegron的安全性结果与安慰剂组相似，但mirabegron鼻咽炎和心血管不良事件的风险高于安慰剂组。结论:两种药物似乎具有可比性和良好的耐受性，特别是在没有直接比较的情况下。然而，在减少平均排尿量方面，威比格龙可能比米拉比格龙更有效。

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引用次数: 1

Determining the optimal initial dose for Japanese patients with nocturnal polyuria using an initial dose of desmopressin 50 μg 确定日本夜间多尿患者的最佳初始剂量，初始剂量为去氨加压素50 μg

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-02-08 DOI: 10.1111/luts.12474

Hirofumi Kurose, Keisuke Komiya, Naoyuki Ogasawara, Kosuke Ueda, Katsuaki Chikui, Kiyoaki Nishihara, Makoto Nakiri, Mitsunori Matsuo, Shigetaka Suekane, Tsukasa Igawa

Objective

There is no consistent opinion on the optimal initial dose of desmopressin for patients with nocturnal polyuria. Over a period of 12 weeks, we investigated the safety and efficacy of an initial dose of 50 μg of desmopressin for elderly men.

Methods

Eighty patients (mean age: 78.8 years) were started on an initial dose of 50 μg of desmopressin for nocturia associated with nocturnal polyuria. Safety and efficacy were evaluated after 1, 4, and 12 weeks using a frequency-volume chart, Athens Insomnia Scale, Patient Global Impression of Improvement scale, physical examination, blood tests, and a body composition analyzer.

Results

Along with reduction in the frequency and volume of night-time urination, improvements in hours of undisturbed sleep, nocturnal polyuria index, and International Prostate Symptom Score, and Overactive Bladder Symptom Scores on quality of life measures were also observed. Hyponatremia was observed in 15 patients (18.7%). However, only 5.0% of patients had hyponatremia after the dose was reduced to 25 μg, and the continuation rate at 12 weeks was high at 87.5%. Age and other physical factors, such as body mass index, body water content, body fat mass, and muscle mass were not significant predictors of adverse events.

Conclusions

Our study suggests that an initial dose of 50 μg is more effective than a uniformly minimum dose based on factors such as age and physique. Furthermore, a high continuation rate can be achieved by appropriately reducing the dose, if adverse events occur.

目的对去氨加压素治疗夜间多尿患者的最佳起始剂量尚无一致的意见。在12周的时间里，我们研究了初始剂量50 μg去氨加压素对老年男性的安全性和有效性。方法80例患者(平均年龄78.8岁)初始剂量50 μg去氨加压素治疗夜尿合并多尿。在1周、4周和12周后，使用频率容积图、雅典失眠量表、患者整体改善印象量表、体格检查、血液检查和身体成分分析仪评估安全性和有效性。结果随着夜间排尿次数和排尿量的减少，未受干扰的睡眠时间、夜间多尿指数、国际前列腺症状评分和膀胱过度活跃症状评分的生活质量指标也有所改善。低钠血症15例(18.7%)。然而，在剂量降至25 μg后，只有5.0%的患者出现低钠血症，12周时的持续率高达87.5%。年龄和其他身体因素，如身体质量指数、身体含水量、身体脂肪质量和肌肉质量不是不良事件的显著预测因子。结论基于年龄和体质等因素，50 μg的初始剂量比统一的最低剂量更有效。此外，如果发生不良事件，可以通过适当减少剂量来实现高延续率。

{"title":"Determining the optimal initial dose for Japanese patients with nocturnal polyuria using an initial dose of desmopressin 50 μg","authors":"Hirofumi Kurose, Keisuke Komiya, Naoyuki Ogasawara, Kosuke Ueda, Katsuaki Chikui, Kiyoaki Nishihara, Makoto Nakiri, Mitsunori Matsuo, Shigetaka Suekane, Tsukasa Igawa","doi":"10.1111/luts.12474","DOIUrl":"10.1111/luts.12474","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There is no consistent opinion on the optimal initial dose of desmopressin for patients with nocturnal polyuria. Over a period of 12 weeks, we investigated the safety and efficacy of an initial dose of 50 μg of desmopressin for elderly men.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty patients (mean age: 78.8 years) were started on an initial dose of 50 μg of desmopressin for nocturia associated with nocturnal polyuria. Safety and efficacy were evaluated after 1, 4, and 12 weeks using a frequency-volume chart, Athens Insomnia Scale, Patient Global Impression of Improvement scale, physical examination, blood tests, and a body composition analyzer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Along with reduction in the frequency and volume of night-time urination, improvements in hours of undisturbed sleep, nocturnal polyuria index, and International Prostate Symptom Score, and Overactive Bladder Symptom Scores on quality of life measures were also observed. Hyponatremia was observed in 15 patients (18.7%). However, only 5.0% of patients had hyponatremia after the dose was reduced to 25 μg, and the continuation rate at 12 weeks was high at 87.5%. Age and other physical factors, such as body mass index, body water content, body fat mass, and muscle mass were not significant predictors of adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study suggests that an initial dose of 50 μg is more effective than a uniformly minimum dose based on factors such as age and physique. Furthermore, a high continuation rate can be achieved by appropriately reducing the dose, if adverse events occur.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9411974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Does histological prostatic inflammation during transurethral resection of the prostate for bladder outlet obstruction affect post-operative urinary outcomes? 经尿道前列腺切除术治疗膀胱出口梗阻时的组织学前列腺炎症是否影响术后泌尿预后?

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-01-23 DOI: 10.1111/luts.12473

Bharti Arora, Munad Khan, Simon Pridgeon

Objective

Benign prostate hyperplasia (BPH) is a common cause for bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS) in men. The pathophysiology of BPH is multifactorial and inflammation has been linked with progression of BPH and LUTS. The association between histological prostatitis found at transurethral resection of the prostate (TURP) and adverse post-operative urinary outcomes is not clearly defined. Our aim was to evaluate the association between histological prostatitis and adverse post-operative urinary outcomes following TURP procedure.

Methods

Patients who had undergone TURP for BPH at a single institution between 2014 and 2018 were included. The study population was divided into three cohorts: those with no histological inflammation, those with any form of inflammation and those specifically with prostatic stromal inflammation. Functional outcomes were assessed by defining a series of measurable post-operative “LUTS events” and comparing these to time-to-event profile using a Kaplan–Meier estimator.

Results

A total 198 patients were included (no inflammation n = 101; any inflammation n = 97, prostatic stromal inflammation n = 81). All three groups were comparable in terms of baseline characteristics. The any inflammation group had significantly more adverse post-operative outcomes after TURP compared to the no inflammation group, P = 0.0065. The stromal inflammation group had more LUTS events after surgery compared to the no inflammation groups in the first year of follow-up n = 0.011; over a 5-year follow-up period the results were not statistically significant, P = 0.244.

Conclusion

Histological prostatitis is associated with worse urinary outcomes after TURP compared to no inflammation. These results are useful in improving prognostic discussions with patients after TURP.

目的良性前列腺增生(BPH)是男性膀胱出口梗阻(BOO)和下尿路症状(LUTS)的常见原因。BPH的病理生理是多因素的，炎症与BPH和LUTS的进展有关。经尿道前列腺切除术(TURP)中发现的组织学前列腺炎与术后泌尿系统不良预后之间的关系尚不明确。我们的目的是评估组织学前列腺炎与TURP手术后泌尿系统不良预后之间的关系。方法纳入2014年至2018年在单一机构接受前列腺增生手术的患者。研究人群被分为三组:没有组织学炎症的，有任何形式炎症的和有前列腺间质炎症的。通过定义一系列可测量的术后“LUTS事件”来评估功能结果，并使用Kaplan-Meier估计器将其与事件发生时间进行比较。结果共纳入198例患者(无炎症101例;任何炎症n = 97，前列腺基质炎症n = 81)。所有三组在基线特征方面具有可比性。与无炎症组相比，任何炎症组在TURP术后的不良预后明显增加，P = 0.0065。随访第一年间质炎症组术后LUTS事件发生率高于无炎症组n = 0.011;5年随访结果无统计学意义，P = 0.244。结论与无炎症相比，组织学前列腺炎与TURP术后尿路预后差相关。这些结果有助于改善TURP后患者的预后讨论。

{"title":"Does histological prostatic inflammation during transurethral resection of the prostate for bladder outlet obstruction affect post-operative urinary outcomes?","authors":"Bharti Arora, Munad Khan, Simon Pridgeon","doi":"10.1111/luts.12473","DOIUrl":"10.1111/luts.12473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Benign prostate hyperplasia (BPH) is a common cause for bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS) in men. The pathophysiology of BPH is multifactorial and inflammation has been linked with progression of BPH and LUTS. The association between histological prostatitis found at transurethral resection of the prostate (TURP) and adverse post-operative urinary outcomes is not clearly defined. Our aim was to evaluate the association between histological prostatitis and adverse post-operative urinary outcomes following TURP procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who had undergone TURP for BPH at a single institution between 2014 and 2018 were included. The study population was divided into three cohorts: those with no histological inflammation, those with any form of inflammation and those specifically with prostatic stromal inflammation. Functional outcomes were assessed by defining a series of measurable post-operative “LUTS events” and comparing these to time-to-event profile using a Kaplan–Meier estimator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total 198 patients were included (no inflammation <i>n</i> = 101; any inflammation <i>n</i> = 97, prostatic stromal inflammation <i>n</i> = 81). All three groups were comparable in terms of baseline characteristics. The any inflammation group had significantly more adverse post-operative outcomes after TURP compared to the no inflammation group, <i>P</i> = 0.0065. The stromal inflammation group had more LUTS events after surgery compared to the no inflammation groups in the first year of follow-up <i>n</i> = 0.011; over a 5-year follow-up period the results were not statistically significant, <i>P</i> = 0.244.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Histological prostatitis is associated with worse urinary outcomes after TURP compared to no inflammation. These results are useful in improving prognostic discussions with patients after TURP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10810132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cold stress-induced bladder overactivity in type 2 diabetic mellitus rats is mitigated by the combination of a M3-muscarinic antagonist and a β3-adrenergic agonist M3毒蕈碱拮抗剂和β3-肾上腺素能激动剂联合应用可减轻2型糖尿病大鼠冷应激诱导的膀胱过度活动

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2022-12-21 DOI: 10.1111/luts.12472

Hiroaki Hara, Tetsuya Imamura, Ataru Suzuki, Manabu Ueno, Tomonori Minagawa, Teruyuki Ogawa, Osamu Ishizuka

Objectives

Goto-Kakizaki (GK) rats with type 2 diabetes mellitus respond to low temperature (LT) environments with bladder overactivity, including increased voiding frequency and decreased voiding interval and micturition volume. We determined if bladder overactivity could be inhibited by treatment with the combination of a M₃-muscarinic receptor antagonist and a β₃-adrenergic receptor agonist.

Methods

Ten-week-old female GK rats were fed a high-fat diet for 4 weeks. Cystometric investigations were conducted at room temperature (RT, 27 ± 2°C). The rats were then intraperitoneally administered the vehicle, the M₃-muscarinic receptor antagonist solifenacin, the β₃-adrenergic agonist mirabegron, or a combination of solifenacin and mirabegron. Ten minutes after the administrations, the rats were transferred to the LT environment (4 ± 2°C), where the cystometric measurements were continued. The expressions of both M₃-muscarinic and β₃-adrenergic receptors were investigated.

Results

After transfer from RT to LT, both voiding interval and bladder capacity of the vehicle-, solifenacin-, or mirabegron-treated rats were significantly decreased. However, the combination of solifenacin and mirabegron significantly mitigated the bladder overactivity. While both M₃-muscarinic and β₃-adrenergic receptors were detected, the expression of M₃-muscarinic receptor mRNA was significantly higher than that of β₃-adrenergic receptor mRNA.

Conclusions

The cold stress-induced bladder overactivity was not improved by either the M₃-muscarinic receptor antagonist or the β₃-adrenergic receptor agonist alone. However, the combined treatment mitigated the cold stress responses. Combined therapy with M₃-muscarinic antagonists and β₃-adrenergic agonists could reduce side effects and improve the quality of life for diabetic patients with bladder overactivity.

目的Goto Kakizaki（GK）2型糖尿病大鼠对低温（LT）环境的反应是膀胱过度活动，包括排尿频率增加、排尿间隔和排尿量减少。我们确定了M3毒蕈碱受体拮抗剂和β3-肾上腺素能受体激动剂的联合治疗是否可以抑制膀胱过度活动。方法10周龄雌性GK大鼠采用高脂饮食喂养4周周。在室温下（RT，27 ± 2°C）。然后对大鼠腹膜内给药载体、M3毒蕈碱受体拮抗剂索非那新、β3-肾上腺素能激动剂米拉贝隆或索非那新和米拉贝隆的组合。给药10分钟后，将大鼠转移到LT环境中（4 ± 2°C），其中继续进行膀胱测量。研究了M3毒蕈碱受体和β3-肾上腺素能受体的表达。结果从RT转为LT后，赋形剂、索非那新或米拉贝隆治疗的大鼠的排尿间隔和膀胱容量均显著降低。然而，索非那新和米拉贝隆的联合用药显著减轻了膀胱过度活动。当同时检测到M3毒蕈碱受体和β3-肾上腺素能受体时，M3毒蕈碱受体mRNA的表达显著高于β3-肾上腺素受体mRNA。结论M3毒蕈碱受体拮抗剂和β3-肾上腺素能受体激动剂均不能改善冷应激引起的膀胱过度活动。然而，联合治疗减轻了冷应激反应。M3毒蕈碱拮抗剂和β3-肾上腺素能激动剂的联合治疗可以减少膀胱过度活动的糖尿病患者的副作用，提高生活质量。

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引用次数: 0