Hanna-Mitchell Ann T, Kashyap Mandavi, Chan Wilson Ventura, Andersson Karl-Eric, Tannenbaum Cara
University Hospitals Case Medical Center and Department of Urology, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Neurourol Urodyn. 2014 Jun;33(5):611-7. doi: 10.1002/nau.22582. Epub 2014 May 20.
To investigate the frequency of phenotype profiling of patients with idiopathic overactive bladder (OAB) syndrome, and to determine the effectiveness of treatment among individuals with different pathophysiologic profiles.
The electronic databases MEDLINE, EMBASE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and CINAHL were searched from January 1, 1980 to August 12, 2013 for interventional randomized controlled treatment trials (RCTs) of idiopathic OAB. Phenotying for pathophysiologies originating in the urothelial/mucosal layer of the bladder, the detrusor muscle cell layer, and the central nervous system were sought. Articles that analyzed urgency outcomes based on pathophysiologic profiling were selected. Due to the heterogeneity of the included interventions and outcome assessment measures, meta-analysis was not appropriate and a qualitative synthesis was undertaken.
Of 239 original RCTs of idiopathic OAB, 48 (20%) profiled participants on underlying pathophysiology. Less than half of these (n = 20) reported treatment efficacy for urgency symptoms by pathophysiological sub-type. One examined the effect of botulinum A toxin on interstitial cell protein expression. Four compared treatment efficacy in OAB patients with and without involuntary detrusor contractions. Fifteen compared the effect of treatment on urgency reduction in patients with detrusor overactivity. There were no consistent trends in treatment efficacy according to pathophysiologic sub-type. No studies examined urothelial dysfunction or abnormal central processing of bladder afferent signaling in response to treatment.
In order to advance the field of idiopathic OAB, more trials are needed that profile and test urgency outcomes in participants according to suspected underlying pathophysiology. Neurourol. Urodynam. 33:611-617, 2014. © 2014 Wiley Periodicals, Inc.
研究特发性膀胱过度活动症（OAB）综合征患者的表型分析频率，并确定不同病理生理特征个体的治疗效果。
检索电子数据库MEDLINE、EMBASE、Cochrane CENTRAL、Cochrane系统评价数据库和CINAHL，检索时间为1980年1月1日至2013年8月12日，查找特发性OAB的介入性随机对照治疗试验（RCT）。寻找源于膀胱尿路上皮/黏膜层、逼尿肌细胞层和中枢神经系统的病理生理学表型。选择基于病理生理分析来分析尿急结果的文章。由于纳入的干预措施和结局评估指标存在异质性，不适合进行荟萃分析，因此进行了定性综合分析。
在239项特发性OAB的原始RCT中，48项（20%）对参与者进行了潜在病理生理学分析。其中不到一半（n = 20）报告了按病理生理亚型划分的尿急症状治疗效果。一项研究了A型肉毒杆菌毒素对间质细胞蛋白表达的影响。四项比较了有和无逼尿肌不自主收缩的OAB患者的治疗效果。十五项比较了治疗对逼尿肌过度活动患者尿急缓解的效果。根据病理生理亚型，治疗效果没有一致的趋势。没有研究检测治疗后尿路上皮功能障碍或膀胱传入信号的中枢处理异常。
为了推动特发性OAB领域的发展，需要更多的试验根据疑似潜在病理生理学对参与者进行表型分析并测试尿急结果。《神经泌尿学与尿动力学》。33:611 - 617，2014。© 2014威利期刊公司。
