Phé Véronique, de Wachter Stefan, Rouprêt Morgan, Chartier-Kastler Emmanuel
Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Paris 6 University, Paris, France.
Neurourol Urodyn. 2015 Jan;34(1):2-11. doi: 10.1002/nau.22512. Epub 2013 Oct 24.
To present the different definitions of "refractory" IOAB.
A review of the literature based on PubMed and Cochrane library databases has been conducted. The criteria for defining the success or failure of antimuscarinic treatment and the different definitions of refractory IOAB used in studies evaluating the effects of posterior tibial nerve stimulation, sacral neuromodulation and intradetrusor botulinum toxin-A injections, have been presented. The primary endpoints of these studies were compared. Additionally, different definitions of refractory IOAB were retrieved.
There are discrepancies in the definition of "refractory" IOAB in the literature. The definitions of antimuscarinic success in clinical trials are not always transposable into daily practice. Moreover, these clinical trial endpoints do not explore the entirety of a meaningful patient-centered outcome. The failure of antimuscarinic treatments may be defined by different factors, including lack and loss of efficacy, intolerance to side effects, contraindications, willingness of patients to go further with treatment and inadequacy of patient's expectations. Ideally, the best functional outcomes would assess patient's expectations and the physician's objectives and objective measurements. Finally, assessing quality of life might be the most reliable outcome to measure, by considering of all the discussed data.
An appropriate definition is complex and needs to consider subjective tools. The "refractory" IOAB needs to be more specifically defined so that alternative treatments can be used at the appropriate time.
阐述“难治性”膀胱过度活动症（IOAB）的不同定义。
基于PubMed和Cochrane图书馆数据库对文献进行了综述。介绍了在评估胫后神经刺激、骶神经调节及膀胱逼尿肌内注射A型肉毒毒素效果的研究中，用于定义抗毒蕈碱治疗成败的标准以及难治性IOAB的不同定义。对这些研究的主要终点进行了比较。此外，还检索了难治性IOAB的不同定义。
文献中关于“难治性”IOAB的定义存在差异。临床试验中抗毒蕈碱治疗成功的定义并不总是能直接应用于日常实践。而且，这些临床试验终点并未涵盖以患者为中心的有意义结局的全部内容。抗毒蕈碱治疗失败可能由不同因素定义，包括疗效缺失和丧失、对副作用不耐受、禁忌证、患者继续治疗的意愿以及患者期望不充分。理想情况下，最佳功能结局应评估患者期望、医生目标及客观测量指标。最后，考虑到所有讨论的数据，评估生活质量可能是最可靠的测量结局。
合适的定义很复杂，需要考虑主观工具。“难治性”IOAB需要更明确地定义，以便能在适当的时候使用替代治疗方法。
