Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
J Urol. 2023 Apr;209(4):665-674. doi: 10.1097/JU.0000000000003209. Epub 2023 Feb 14.
The aim of this meta-analysis was to investigate the effect of pharmacotherapy for overactive bladder on the pathogenesis of urinary tract infection.
A comprehensive search was performed in MEDLINE and the Cochrane Library using terms for overactive bladder, antimuscarinic agents, and beta 3-adrenoceptor agonists. The primary end point was the emergence of urinary tract infection after pharmacotherapy for overactive bladder. The secondary end point was the emergence of urinary retention, dysuria, and/or increased residual urine volume after overactive bladder treatment. Meta-analyses were conducted using random-effects models.
A total of 35,939 patients in 33 trials (29 trials of antimuscarinic agents vs placebo, and 9 trials of beta 3-adrenoceptor agonists vs placebo) that included patients with overactive bladder were identified. At 1-3 months after treatment, the incidence of urinary tract infections was statistically significantly higher in the patients treated with antimuscarinic agents (RR: 1.23, 95% CI: 1.04, 1.45; = .013) than in the placebo control group. The incidence of urinary tract infections was not increased in the patients treated with beta 3-adrenoceptor agonists (RR: 1.04, 95% CI: 0.76, 1.42; = .796). Antimuscarinic agents also statistically significantly increased the risks of urinary retention, dysuria, and/or increased residual urine volume (RR: 2.88, 95% CI: 1.79, 4.63; < .001), whereas beta 3-adrenoceptor agonists did not (RR: 1.26, 95% CI: 0.38, 4.14; = .708).
This meta-analysis showed that antimuscarinic agents statistically significantly increased the incidences of urinary tract infection and lower urinary tract symptoms and dysfunction, but beta 3-adrenoceptor agonists did not. To prevent urinary tract infection emergence, beta 3-adrenoceptor agonists might be safer than antimuscarinic agents.
本荟萃分析旨在探讨治疗膀胱过度活动症的药物治疗对尿路感染发病机制的影响。
在 MEDLINE 和 Cochrane 图书馆中使用膀胱过度活动症、抗毒蕈碱药物和β3-肾上腺素能受体激动剂等术语进行全面检索。主要终点是膀胱过度活动症药物治疗后出现尿路感染。次要终点是治疗膀胱过度活动症后出现尿潴留、尿痛和/或残余尿量增加。使用随机效应模型进行荟萃分析。
共纳入 33 项试验的 35939 例患者（29 项抗毒蕈碱药物与安慰剂对照试验，9 项β3-肾上腺素能受体激动剂与安慰剂对照试验），包括膀胱过度活动症患者。治疗后 1-3 个月，抗毒蕈碱药物治疗组患者尿路感染发生率明显高于安慰剂对照组（RR：1.23，95%CI：1.04，1.45；=.013）。β3-肾上腺素能受体激动剂治疗组患者尿路感染发生率无增加（RR：1.04，95%CI：0.76，1.42；=.796）。抗毒蕈碱药物还明显增加了尿潴留、尿痛和/或残余尿量增加的风险（RR：2.88，95%CI：1.79，4.63；<.001），而β3-肾上腺素能受体激动剂则没有（RR：1.26，95%CI：0.38，4.14；=.708）。
本荟萃分析表明，抗毒蕈碱药物明显增加了尿路感染和下尿路症状和功能障碍的发生率，而β3-肾上腺素能受体激动剂则没有。为预防尿路感染的发生，β3-肾上腺素能受体激动剂可能比抗毒蕈碱药物更安全。
