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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 張尚仁 | 對於患有膀胱過動症的停經女性病人，除了給予抗乙醯膽鹼藥物之外，多給予女性賀爾蒙藥膏塗抹有效嗎？ | 2009/9/25 下午 06:17:45 | 0 |
| 原 文 | 題 目 | Is There a Synergistic Effect of Topical Oestrogens When Administered with Antimuscarinics in the Treatment of Symptomatic Detrusor Overactivity? |
| 作 者 | 佛教慈濟醫院台北分院泌尿科主治醫師張尚仁醫師 | |
| 出 處 | European Urology | |
| 出版日期 | Volume 55, Issue 3, March 2009, Pages 713-720 | |
| 評 論 |
根據國際尿失禁醫學會的建議，對於患有尿失禁的停經婦女應先給予第一線治療包括了：行為治療，骨盆底肌肉運動及女性賀爾蒙補充。雖然最近已經有很多臨床試驗證實乙醯膽鹼藥物對於婦女膀胱過動症的療效，國際尿失禁醫學會還是將抗乙醯膽鹼藥物則被放在第二線治療。本篇研究則是希望評估乙醯膽鹼藥物及女性賀爾蒙的藥膏這兩種藥物是否有協同作用。他們給予患有膀胱過動症的停經女病人乙醯膽鹼藥物（tolterodine 4mg QD治療，並將病人分配為兩組：一組給予局部陰道女性賀爾蒙的藥膏塗抹（oestriol cream, QD），一組則不給予藥膏。結果在十二週的治療後再評估兩組病人症狀改善的程度，發現兩組之間的治療效果並沒有差異 而對於治療沒有反應的危險因子則有兩個：一為有性高潮時發生尿失禁的病人二為有誘發性逼尿機過動的女病人。 結論：對於患有膀胱過動症的停經女病人給予乙醯膽鹼藥物治療時再多給予局部陰道女性賀爾蒙塗抹似乎並沒有多大助益。 |
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| abstract |
Background No authors have investigated whether the administration of local oestrogens in addition to antimuscarinics could have a synergistic effect in the therapy of overactive bladder (OAB). Objectives To compare the efficacy of antimuscarinics alone versus antimuscarinics in combination with local oestrogens for OAB; to verify whether risk factors for lower antimuscarinic efficacy can be overcome by the concomitant use of local oestrogens.Design, setting, and participants. Some 229 postmenopausal women with symptomatic urodynamically proven detrusor overactivity were prospectively enrolled at a tertiary levelurogynaecology centre and divided into two groups. Intervention Women in group 1 (n = 129) were prescribed tolterodine extended release (ER) 4 mg once daily; women in group 2 (n = 100) were prescribed both tolterodine ER 4 mg and concomitant oestriol cream application once daily. Measurements All women underwent clinical evaluation and urodynamics in accordance with the Good Urodynamic Practices Guidelines. After 12 wk of treatment the two groups were compared in terms of subjective efficacy for OAB symptom improvement using a three-point scale.Nonresponders were compared to the patients who improved or were cured in order to identify risk factors for resistance to therapy. Results and limitations There was no significant difference between the two groups in terms of efficacy of therapy: 80.6% in group 1 versus 82% in group 2 (p = 0.86). Patients with urodynamically proven detrusor overactivity (DO) occurring during provocative manoeuvres and patients with coital incontinence during orgasm reported a higher failure rate both in the overall study population and in group 2. A possible limitation of the study is the nonrandomised design. Conclusions No synergistic effect of local oestrogens and antimuscarinics in the treatment of OAB was found. Antimuscarinic treatment has lower cure rates in women with symptomatic DO complaining of incontinence at orgasm or in patients with DO following provocative manoeuvres. The association of local oestrogens does not influence the role of the two mentioned risk factors. |
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