Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Neurourol Urodyn. 2022 Nov;41(8):1967-1974. doi: 10.1002/nau.24965. Epub 2022 May 29.
Overactive bladder (OAB) disproportionally affects older adults in both incidence and severity. OAB pharmacotherapy is often problematic in the elderly due to polypharmacy, adverse side effect profiles and contraindications in the setting of multiple comorbidities, and concerns regarding the risk of incident dementia with anticholinergic use. The burden of OAB in older patients coupled with concerns surrounding pharmacotherapy options should motivate optimization of nonpharmacologic therapies in this population. At the same time, several aspects of aging may impact treatment efficacy and decision-making. This narrative review critically summarizes current evidence regarding third-line OAB therapy use in the elderly and discusses nuances and treatment considerations specific to the population.
We performed an extensive, nonsystematic evidence assessment of available literature via PubMed on onabotulinumtoxinA (BTX-A), sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS) for OAB, with a focus on study in elderly and frail populations.
While limited, available studies show all three third-line therapies are efficacious in older populations and there is no data to support one option over another. BTX-A likely has a higher risk of urinary tract infection and retention in older compared to younger populations, especially in the frail elderly. PTNS incurs the lowest risk, although adherence is poor, largely due to logistical burdens.
Advanced age and frailty should not preclude third-line therapy for refractory OAB, as available data support their efficacy and safety in these populations. Ultimately, treatment choices should be individualized and involve shared decision-making.
在发病率和严重程度方面，膀胱过度活动症（OAB）严重影响老年人。由于老年人同时服用多种药物、不良反应谱和多种合并症的禁忌证以及对使用抗胆碱能药物会导致新发痴呆的担忧，OAB 的药物治疗在老年人中通常存在问题。老年患者 OAB 的负担以及对药物治疗选择的担忧，应促使优化该人群的非药物治疗。与此同时，衰老的几个方面可能会影响治疗效果和决策。本叙述性综述批判性地总结了关于老年人三线 OAB 治疗的现有证据，并讨论了针对该人群的细微差别和治疗注意事项。
我们通过 PubMed 对肉毒杆菌毒素 A（BTX-A）、骶神经调节和经皮胫神经刺激（PTNS）治疗 OAB 的现有文献进行了广泛的非系统性证据评估，重点是对老年和虚弱人群的研究。
虽然可用的研究有限，但所有三种三线治疗方法在老年人群中均有效，没有数据支持一种方法优于另一种方法。与年轻人群相比，BTX-A 可能在老年人群中导致尿路感染和留置的风险更高，尤其是在体弱的老年人群中。PTNS 的风险最低，尽管由于后勤负担，其依从性较差。
高级别年龄和虚弱不应排除难治性 OAB 的三线治疗，因为现有数据支持这些人群的疗效和安全性。最终，治疗选择应个体化，并涉及共同决策。
