Moro Christian, Phelps Charlotte, Veer Vineesha, Clark Justin, Glasziou Paul, Tikkinen Kari A O, Scott Anna M
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia.
Neurourol Urodyn. 2022 Jan;41(1):127-139. doi: 10.1002/nau.24839. Epub 2021 Nov 24.
Biological rationale suggests that parasympathomimetics (cholinergic receptor stimulating agents) could be beneficial for patients with underactive bladder. However, no systematic review with meta-analysis addressing potential benefits or adverse effects exists. The aim of this review was to assess the effectiveness, both benefits and harms, of using parasympathomimetics for the treatment of underactive bladder.
The protocol was registered in PROSPERO, and searches undertaken in PubMed, Embase, and CENTRAL, including randomized and non-randomized controlled trials of patients with underactive bladder, comparing parasympathomimetic to placebo, no treatment, or other pharmaceuticals. Risk ratios, odds ratios, and mean differences were calculated.
Twelve trials with 3024 participants were included. There was a significant difference between parasympathomimetics and comparators (favoring parasympathomimetics) in the number of patients with urinary retention (risk ratio 0.55, 95% confidence interval [CI] 0.3-0.98, p = 0.04, low quality of evidence). There was no difference in mean postvoid volume overall (MD -41.4 ml, 95% CI -92.0 to 9.1, p = 0.11, low quality of evidence). There was a significant difference at up to 1 week post-intervention, favoring parasympathomimetics (MD -77.5 ml, 95% CI -90.9 to -64.1, p < 0.001, low quality of evidence), but no difference at 1 month post-intervention. There was no difference in adverse events (odds ratio 1.19, 95% CI 0.62-2.28, p = 0.6, moderate quality of evidence).
The evidence supporting the use of parasympathomimetics is of low quality, with relatively short follow-up durations. Overall, it is not possible to draw clear evidence-based conclusions from the current literature, presenting the use of parasympathomimetics for treating underactive bladder as a key area that requires future well-controlled clinical trials.
生物学原理表明，拟副交感神经药（胆碱能受体刺激剂）可能对膀胱活动低下患者有益。然而，尚无针对潜在益处或不良反应的系统评价及荟萃分析。本综述的目的是评估使用拟副交感神经药治疗膀胱活动低下的有效性，包括益处和危害。
该方案已在国际前瞻性系统评价注册库（PROSPERO）登记，在PubMed、Embase和Cochrane中心对照试验注册库（CENTRAL）进行检索，纳入膀胱活动低下患者的随机和非随机对照试验，比较拟副交感神经药与安慰剂、不治疗或其他药物。计算风险比、比值比和均值差。
纳入12项试验，共3024名参与者。在尿潴留患者数量上，拟副交感神经药与对照药物（拟副交感神经药更具优势）之间存在显著差异（风险比0.55，95%置信区间[CI]0.3 - 0.98，p = 0.04，证据质量低）。总体上，排尿后残余尿量均值无差异（均值差 -41.4 ml，95% CI -92.0至9.1，p = 0.11，证据质量低）。干预后1周内存在显著差异，拟副交感神经药更具优势（均值差 -77.5 ml，95% CI -90.9至 -64.1，p < 0.
