Department of Urology and Surgery, Continence Center, Dokkyo Medical University, Mibu, Tochigi, Japan.
Int J Urol. 2020 Oct;27(10):899-904. doi: 10.1111/iju.14319. Epub 2020 Aug 7.
To examine the urodynamic effects of fesoterodine on neurogenic detrusor overactivity and/or low compliance bladder.
A total of 77 patients (52 men, 25 women; aged 61.6 ± 20.3 years) were given fesoterodine 4-8 mg/day and prospectively followed for 12 weeks. The primary end-point variable was change in the maximum cystometric capacity on urodynamic study. The secondary end-point was to assess the number of patients whose neurogenic detrusor overactivity disappeared, and the changes in the urodynamic parameters, lower urinary tract symptoms questionnaires and the 3-day frequency volume chart parameters after the treatment.
A total of 13 patients (16.9%) withdrew because of adverse events (dry mouth or blurred vision), and four patients dropped out for unknown reasons. Finally, 60 patients completed the study. Bladder capacity at first desire to void, maximum cystometric capacity and bladder compliance increased by 29.2 mL, 79.9 mL and 22.2 mL/cm H O, respectively, showed statistical significance (P = 0.026, P < 0.001 and P < 0.001). Neurogenic detrusor overactivity disappeared in 12 of 51 patients (23.5%), and a significant increase was observed in bladder capacity at first involuntary contraction (P < 0.001), and a significant decrease was observed in maximum detrusor contraction (P < 0.001). In patients with low compliance bladder (with detrusor underactivity without neurogenic detrusor overactivity; n = 9), maximum cystometric capacity and bladder compliance increased significantly (P = 0.003 and P = 0.006, respectively). Overactive bladder symptom score, International Consultation on Incontinence Questionnaire-Short Form, most items of King's Health Questionnaire, and the number of urgency episodes and leaks in a day decreased significantly after treatment.
Fesoterodine seems to be a valid treatment option for neurogenic detrusor overactivity and/or low compliance bladder in neurogenic bladder patients.
研究非索罗定对神经原性逼尿肌过度活动和/或顺应性低的膀胱的尿动力学影响。
77 例患者（52 例男性，25 例女性；年龄 61.6±20.3 岁）给予非索罗定 4-8mg/天，并前瞻性随访 12 周。主要终点变量是尿动力学研究中最大膀胱容量的变化。次要终点是评估神经原性逼尿肌过度活动消失的患者数量，以及治疗后尿动力学参数、下尿路症状问卷和 3 天频率容量图表参数的变化。
共有 13 例（16.9%）因不良反应（口干或视力模糊）退出，4 例因不明原因退出。最终，60 例患者完成了研究。首次排尿意愿时的膀胱容量、最大膀胱容量和膀胱顺应性分别增加了 29.2ml、79.9ml 和 22.2ml/cmH2O，差异有统计学意义（P=0.026，P<0.001 和 P<0.001）。51 例患者中有 12 例（23.5%）神经原性逼尿肌过度活动消失，首次非自愿收缩时的膀胱容量显著增加（P<0.001），最大逼尿肌收缩时显著减少（P<0.001）。在顺应性低的膀胱患者（逼尿肌无力但无神经原性逼尿肌过度活动；n=9）中，最大膀胱容量和膀胱顺应性显著增加（P=0.003 和 P=0.006）。治疗后，急迫性尿失禁症状评分、国际尿失禁咨询问卷-简短版、King's 健康问卷的大部分项目以及每日尿急发作次数和漏尿次数均显著减少。
非索罗定似乎是治疗神经原性逼尿肌过度活动和/或神经原性膀胱患者顺应性低的膀胱的有效治疗选择。
