Owens R G, Karram M M
Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio, USA.
Drug Saf. 1998 Aug;19(2):123-39. doi: 10.2165/00002018-199819020-00004.
Drug therapy for incontinence and enuresis has met with varying degrees of success. Currently, there is no medication available that specifically targets the lower urinary tract without having untoward effects elsewhere in the body. Patients with urge incontinence are the most difficult group to treat. The agents most commonly used to treat urge incontinence, i.e. anticholinergics, musculotropics and tricyclic antidepressants, are limited in their effectiveness and have anticholinergic adverse effects. Other medications with theoretical treatment potential such as nonsteroidal anti-inflammatory drugs and calcium antagonists require more in depth clinical study before widespread use is appropriate. Although estrogen is well tolerated, its role in the treatment of incontinence in postmenopausal women may be limited. Medical treatment for stress incontinence is most successful in patients with a mild condition. Drugs with alpha-adrenergic activity alone or in combination with estrogen in postmenopausal women, are fairly effective and demonstrate few adverse effects at doses used to treat stress incontinence. Enuresis pharmacotherapy consists mainly of desmopressin and tricyclic antidepressants. Adverse effects are minimal with the doses commonly used. While the majority of patients improve with therapy, a significant portion relapse after treatment is terminated. Tolerability of a particular therapy depends on the effectiveness and adverse effects of the agent, the severity of incontinence and the general health of the patient. In general, patients are willing to accept a greater degree of inconvenience if a drug produces the desired effect. However, individualisation of therapy should be used to maximise compliance and outcome. Blinded, dose-titration studies are needed to better determine doses for optimum tolerability. Research into drugs specifically targeting the lower urinary tract may lead to more effective and well tolerated therapy for incontinence and enuresis.
用于治疗尿失禁和遗尿症的药物疗法取得了不同程度的成功。目前，尚无专门针对下尿路且无全身不良反应的药物。急迫性尿失禁患者是最难治疗的群体。最常用于治疗急迫性尿失禁的药物，即抗胆碱能药、促肌收缩药和三环类抗抑郁药，其疗效有限且有抗胆碱能不良反应。其他具有理论治疗潜力的药物，如非甾体抗炎药和钙拮抗剂，在广泛应用之前需要更深入的临床研究。尽管雌激素耐受性良好，但其在绝经后女性尿失禁治疗中的作用可能有限。压力性尿失禁的药物治疗在轻度患者中最为成功。单独具有α-肾上腺素能活性或与绝经后女性雌激素联合使用的药物相当有效，且在用于治疗压力性尿失禁的剂量下几乎没有不良反应。遗尿症的药物治疗主要包括去氨加压素和三环类抗抑郁药。常用剂量下不良反应最小。虽然大多数患者在治疗后有所改善，但很大一部分患者在治疗终止后会复发。特定疗法的耐受性取决于药物的有效性和不良反应、尿失禁的严重程度以及患者的总体健康状况。一般来说，如果药物产生预期效果，患者愿意接受更大程度的不便。然而，应采用个体化治疗以最大限度地提高依从性和治疗效果。需要进行盲法剂量滴定研究，以更好地确定最佳耐受性剂量。针对下尿路的药物研究可能会带来更有效且耐受性良好的尿失禁和遗尿症治疗方法。
