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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 阮雍順 | Intravesical Atropine Compared to Oral Oxybutynin for Neurogenic Detrusor Overactivity: A Double-Blind, Randomized Crossover Trial | 2007/7/24 下午 03:51:07 | 0 |
| 原 文 | 題 目 | Intravesical Atropine Compared to Oral Oxybutynin for Neurogenic Detrusor Overactivity: A Double-Blind, Randomized Crossover Trial |
| 作 者 | Mandy Fader, Scott Glickman, Veronica Haggar, Rachel Barton, Rodney Brooks and James Malone-Lee | |
| 出 處 | Journal of Urology | |
| 出版日期 | Volume 177, Issue 1, January 2007, Pages 208-213 | |
| 評 論 |
因為脊椎受傷、帕金森症以及多發性硬化症，常會造成神經性膀胱逼尿肌過度活動(neurogenic detrusor overactivity)，症狀以急尿、頻尿為主。對於治療神經性膀胱逼尿肌過度活動，目前仍以口服抗膽鹼藥物治療為主，但是口服抗膽鹼藥物在治療無效而須將劑量調高時，則多少會產生副作用，其中最明顯的副作用則是口乾。雖然目前有各種新型專一性抗膽鹼藥物以及長效型的抗膽鹼藥物發現，但仍無法避免全身系統性的副作用，利用其他途徑給予抗膽鹼藥物，也許是可以考慮的一個想法。 Atropine是古老的抗膽鹼藥物，目前較常使用在眼科的散朣劑以及麻醉前的使用。一般劑型為液體且相當便宜。本文作者Fader et al 等人以多發性硬化症的病人為治療對象，因為多發性硬化症的病人常需使用間歇性單導導尿。他們以6mg Atropine每天四次作膀胱灌注和口服每天兩次oxybutynin IR (immediate release)作比較，研究為期兩週，在研究時兩組都有給予安慰劑作為對照組。結果發現膀胱容量變化：口服oxybutynin IR膀胱容量增加55.5±67.26ml，Atropine膀胱灌注膀胱容量增加79.6±89.6ml，平均兩組差異值約24.1ml (95% CI-0.4, 49.7；p=0.053)。尿失禁則無顯著差異，但在口乾等副作用方面，總體而言以Atropine膀胱灌注較佳。他們的結論是Atropine膀胱灌注對於膀胱容量並不亞於口服oxybutynin，甚至更好；但在副作用方面則更少。 利用不同藥物投注方式，使膀胱局部藥物濃度增加並減少全身性的副作用，是目前泌尿科治療膀胱功能異常的一個新的思考模式，老藥新用也會有相當不錯的效果呢！ |
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| abstract |
Purpose: We tested the efficacy and side effect profiles of intravesical atropine compared to oxybutynin immediate release when used by individuals with multiple sclerosis. Materials and Methods: We performed a study to determine the most effective dose of atropine. Eight participants used increasing doses of intravesical atropine during a 12-day period. Bladder diary data showed that the instillation of 6 mg atropine 4 times daily was most effective for increasing bladder capacity (voided/catheter volumes). We then did a randomized, double-blind crossover trial. Participants received 14 days of treatment with oral oxybutynin or with intravesical atropine, followed by 14 days of alternative treatment. Participants recorded a bladder diary and rated side effects and quality of life. The primary outcome variable was bladder capacity. Results: A total of 57 participants with multiple sclerosis completed the study. Average change in bladder capacity was higher in the atropine arm. The mean ± SD oxybutynin change was 55.5 ± 67.2 ml, the mean atropine change was 79.6 ± 89.6 ml and the mean difference between arms was 24.1 ml (95% CI −0.4, 49.7; p = 0.053). Changes in incontinence events and voiding frequency were not statistically different between the arms. Changes in total side effect and dry mouth scores were significantly better in the atropine treatment arm. Conclusions: Intravesical atropine was as effective as oxybutynin immediate release for increasing bladder capacity and it was probably better with less antimuscarinic side effects. We recommend that intravesical atropine should be made available to patients with neurogenic detrusor overactivity and voiding problems requiring intermittent catheterization as an alternative to oral therapy, which often has troublesome side effects. |
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