Chen Jing-Liang, Chen Sheng-Fu, Jiang Yuan-Hong, Kuo Hann-Chorng
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2016 Jan-Mar;28(1):1-5. doi: 10.1016/j.tcmj.2015.12.003. Epub 2016 Jan 25.
The prevalence of overactive bladder (OAB) increases with age. Degeneration of the central nervous system in the elderly has been proposed as one of the pathogenic factors of OAB. Antimuscarinic therapy is effective in the treatment of OAB; however, intolerable systemic adverse events and cognitive dysfunction during treatment with nonselective antimuscarinic agents is of growing concern in elderly patients. The newly developed beta-3 adrenoceptor agonist mirabegron does not adversely affect flow rate and detrusor pressure, and its therapeutic efficacy and tolerability are similar in patients aged > 65 years and > 75 years, suggesting it might be the therapeutic choice in older patients with OAB. Nocturia can cause sleep deprivation at night and increase daytime sleepiness and loss of energy in the elderly. Desmopressin add-on therapy is effective in improving nocturia and storage symptoms. However, elderly patients with a baseline serum sodium level below the normal range are at high risk of developing significant hyponatremia.
膀胱过度活动症（OAB）的患病率随年龄增长而增加。老年人中枢神经系统的退化被认为是OAB的致病因素之一。抗胆碱能疗法对OAB治疗有效；然而，非选择性抗胆碱能药物治疗期间难以耐受的全身不良事件和认知功能障碍在老年患者中日益受到关注。新开发的β-3肾上腺素能受体激动剂米拉贝隆对尿流率和逼尿肌压力无不利影响，其治疗效果和耐受性在65岁以上和75岁以上患者中相似，这表明它可能是老年OAB患者的治疗选择。夜尿症可导致老年人夜间睡眠剥夺，并增加白天嗜睡和精力丧失。去氨加压素附加疗法对改善夜尿症和储尿期症状有效。然而，基线血清钠水平低于正常范围的老年患者发生严重低钠血症的风险很高。
