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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 李宏耕 | 擬副交感神經藥物治療膀胱功能低下之效果 | 2022/11/3 下午 07:58:27 | 0 |
| 原 文 | 題 目 | The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta‐analysis |
| 作 者 | Christian Moro, Charlotte Phelps, Vineesha Veer, Justin Clark, Paul Glasziou, Kari A O Tikkinen, Anna M Scott | |
| 出 處 | Neurourol Urodyn. 2022 Jan;41(1):127-139. | |
| 出版日期 | Epub 2021 Nov 24. | |
| 評 論 |
時至今日，膀胱功能低下 (underactive bladder, UAB) 仍是泌尿科醫師棘手的問題之一。國際尿失禁學會 (ICS) 將定義UAB為 a symptom complex characterized by a slow urinary stream (小便無力)、hesitancy (等一下才能尿出來)、and straining to void (小便費力)、with or without a feeling of incomplete bladder emptying (尿不乾淨)、sometimes with storage symptoms。用 parasympathomimetics 藥物增加膀胱收縮力，試圖把尿液排乾淨，似乎為一個合理的療法。本篇作者為 parasympathomimetics 藥物做 systemic review 及 meta-analysis 研究其用於治療 UAB 的效果及優缺點。
作者使用 PubMed、Embase、及 CENTRAL 等大型資料庫，搜尋 underactive bladder、parasympathomimetics 等關鍵字，收集 randomized 與 non-randomized trials，並比較 parasympathomimetics 與安慰劑、無治療、或其他藥物之治療效果。作者一共收錄 12 個 trial 3024 位病患，其中 parasympathomimetics 顯著減少尿滯留 (urinary retention) 比例 (p=0.04)。藥物治療組與對照組餘尿 (postvoid volume) 兩者 overall 無顯著差異。然而，如果區分用藥時間，用藥一週後 parasympathomimetics 組減少餘尿比對照組顯著 (p<0.001)，但用藥一個月後此顯著性消失。共有兩篇研究提到治療後尿流速的改善狀況，其中一篇顯示 parasympathomimetics 組顯著增加尿流速，而另一篇則認為使用 parasympathomimetics 與否，兩者尿流速無差異。值得注意的是，作者表示收錄的文獻異質性 (heterogeneity) 很大，病患表現差異也大，且納入分析的文獻篇數不夠，所以 review 的 quality of evidence 較低，無法藉由本篇 meta-analysis 做定論，而需更多 well-controlled trials 以佐證 parasympathomimetics 對於 UAB 的療效。 |
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| abstract |
Aims: 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.
Methods: 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. Results: 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). Conclusions: 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. Keywords: acetylcholine, bethanechol, carbachol, cholinergic, detrusor underactivity, muscarinic agonist, urinary bladder |
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