Roxburgh C, Cook J, Dublin N
Glasgow Royal Infirmary, 2nd Floor Queen Elizabeth Building, Alexandra Parade, Glasgow, UK, G31 2ER.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD003190. doi: 10.1002/14651858.CD003190.pub3.
Overactive bladder syndrome is defined as "urgency with or without urge incontinence, usually with frequency and nocturia". It is a common condition with significant economic and quality of life implications. While the condition's pathophysiology remains to be fully elucidated, pharmacotherapy is the main treatment option. Despite uncertainty as to drug treatment of choice, anticholinergics are increasingly being used in primary and secondary care settings. This review compares anticholinergic drugs with other types or classes of drugs for treating overactive bladder syndromes.
To compare anticholinergic drugs with other types or classes of drugs for treating overactive bladder symptoms.
We searched the Cochrane Incontinence Group Specialised Trials Register (searched 20 December 2006) and the reference lists of relevant articles. No language or other limits were imposed.
All randomised and quasi-randomised controlled trials comparing anticholinergic drugs with other drugs for the treatment of overactive bladder symptoms. At least one arm of the study used an anticholinergic drug and at least one other arm used a non-anticholinergic drug.
Two reviewers assessed the identified studies for eligibility and methodological quality and independently extracted data from the included studies. Data analysis was performed using RevMan software (version 4.2.8).
Thirteen trials were included in the review. There were eight crossover trials and five parallel group studies. For the comparisons between anticholinergic drugs with tricyclic antidepressants, alpha adrenergic agonists, afferent nerve inhibitors, and calcium channel blocker a single trial was identified for each. Ten trials compared flavoxate with anticholinergics. There was no evidence of a difference in cure rates between anticholinergics and flavoxate. Adverse effects were more frequent in anticholinergic groups versus flavoxate groups (RR 2.28 95% CI 1.45 to 3.56). There was no strong evidence to favour either anticholinergic drugs or the comparators.
AUTHORS' CONCLUSIONS: Many of the drugs considered in trials in this review are no longer used in clinical practice (and this includes the most commonly tested - flavoxate). There is inadequate no evidence as to whether any of the available is better or worse than anticholinergic medications. Larger randomised controlled trials in clinical settings are required to further establish the role of these other medications in the management of overactive bladder syndrome.
膀胱过度活动症综合征被定义为“伴有或不伴有急迫性尿失禁的尿急，通常伴有尿频和夜尿症”。它是一种常见病症，对经济和生活质量有重大影响。虽然该病症的病理生理学仍有待充分阐明，但药物治疗是主要的治疗选择。尽管对于首选药物治疗存在不确定性，但抗胆碱能药物在初级和二级护理环境中越来越多地被使用。本综述比较了抗胆碱能药物与其他类型或类别的药物在治疗膀胱过度活动症综合征方面的效果。
比较抗胆碱能药物与其他类型或类别的药物在治疗膀胱过度活动症症状方面的效果。
我们检索了Cochrane尿失禁小组专业试验注册库（检索时间为2006年12月20日）以及相关文章的参考文献列表。未施加任何语言或其他限制。
所有比较抗胆碱能药物与其他药物治疗膀胱过度活动症症状的随机和半随机对照试验。研究的至少一个组使用抗胆碱能药物，至少一个其他组使用非抗胆碱能药物。
两名评价员评估所识别的研究是否符合纳入标准和方法学质量，并独立从纳入研究中提取数据。使用RevMan软件（版本4.2.8）进行数据分析。
本综述纳入了13项试验。其中有8项交叉试验和5项平行组研究。对于抗胆碱能药物与三环类抗抑郁药、α肾上腺素能激动剂、传入神经抑制剂和钙通道阻滞剂之间的比较，每项均仅识别出一项试验。10项试验比较了黄酮哌酯与抗胆碱能药物。没有证据表明抗胆碱能药物和黄酮哌酯在治愈率上存在差异。抗胆碱能药物组的不良反应比黄酮哌酯组更频繁（风险比2.28，95%置信区间1.45至3.56）。没有有力证据支持抗胆碱能药物或对照药物。
本综述中试验所考虑的许多药物在临床实践中已不再使用（这包括最常测试的——黄酮哌酯）。没有足够证据表明任何一种现有药物比抗胆碱能药物更好或更差。需要在临床环境中进行更大规模的随机对照试验，以进一步确定这些其他药物在膀胱过度活动症综合征管理中的作用。
