目的比较口服抗胆碱能药与新型β3受体激动药治疗女性OAB患者的药物安全性。方法通过检索PubMed、Embase、Web of Science和Cochrane Library数据库,筛选自各数据库建库以来至2020年2月28日有关口服抗胆碱能药与新型β3受体激动药治疗女...目的比较口服抗胆碱能药与新型β3受体激动药治疗女性OAB患者的药物安全性。方法通过检索PubMed、Embase、Web of Science和Cochrane Library数据库,筛选自各数据库建库以来至2020年2月28日有关口服抗胆碱能药与新型β3受体激动药治疗女性OAB患者国外相关文献,提取疗效、不良反应指标,基于频率学对各药物的疗效及安全性进行优劣排序,并通过多变量Meta分析进一步对新型β3受体激动药的各种不良反应进行分析。结果本研究共检索1487篇相关文献,最终纳入13篇随机对照试验文献,包含3339例OAB患者。经非一致性检验无统计学意义,并基于频率学网状Meta分析对疗效及安全性进行排序。结果显示,索利那新疗效最好,其他依次为达非那新、米拉贝隆、安慰剂、索拉贝隆,疗效最差的为托特罗定;安全性最高的是米拉贝隆,其他依次为索拉贝隆、安慰剂、托特罗定、索利那新、达非那新。结论新型β3受体激动药米拉贝隆可作为OAB患者的首选治疗药物,米拉贝隆在确保安全性的同时,疗效仅次于索利那新及达非那新。但在应用新型β3受体激动药治疗OAB患者时应结合患者的身体素质综合,考虑对女性患者心、脑血管方面的影响。展开更多
Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in thi...Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.展开更多
文摘目的比较口服抗胆碱能药与新型β3受体激动药治疗女性OAB患者的药物安全性。方法通过检索PubMed、Embase、Web of Science和Cochrane Library数据库,筛选自各数据库建库以来至2020年2月28日有关口服抗胆碱能药与新型β3受体激动药治疗女性OAB患者国外相关文献,提取疗效、不良反应指标,基于频率学对各药物的疗效及安全性进行优劣排序,并通过多变量Meta分析进一步对新型β3受体激动药的各种不良反应进行分析。结果本研究共检索1487篇相关文献,最终纳入13篇随机对照试验文献,包含3339例OAB患者。经非一致性检验无统计学意义,并基于频率学网状Meta分析对疗效及安全性进行排序。结果显示,索利那新疗效最好,其他依次为达非那新、米拉贝隆、安慰剂、索拉贝隆,疗效最差的为托特罗定;安全性最高的是米拉贝隆,其他依次为索拉贝隆、安慰剂、托特罗定、索利那新、达非那新。结论新型β3受体激动药米拉贝隆可作为OAB患者的首选治疗药物,米拉贝隆在确保安全性的同时,疗效仅次于索利那新及达非那新。但在应用新型β3受体激动药治疗OAB患者时应结合患者的身体素质综合,考虑对女性患者心、脑血管方面的影响。
文摘Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.
