nach oben

Erschienen in:

03.02.2020 | Original Article

Exploratory analysis of the effect of mirabegron on urodynamic sensation parameters and urethral pressure variations

verfasst von: Maxime T. M. Kummeling, Joost Egberts, Henk W. Elzevier, Gommert A. van Koeveringe, Hein Putter, Pieter M. Groenendijk

Erschienen in: International Urogynecology Journal | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

Urethral instability (URI) has in the past been defined by the International Continence Society (ICS), but was excluded from ICS terminology and definitions shortly after because of a lack of consensus about the clinical importance of this phenomenon. Recently, interest in URI and its possible role in overactive bladder (OAB) increased again. In the last decade, a beta 3 adrenoreceptor agonist (mirabegron) was approved for the treatment of OAB. The effect of mirabegron on urethral pressure during filling cystometry is unknown. The aim of this study was to assess the influence of mirabegron on urethral pressure variations during urodynamic investigation and the association of symptoms and voiding diary data before and during treatment.

Methods

This prospective study included 51 consecutive adult female patients, referred with OAB. Patients were evaluated using a voiding diary, two validated questionnaires and two urodynamic investigations, one before and one after 6 weeks of treatment with mirabegron. URI was defined as an urethral pressure drop exceeding 30 cmH₂O during filling cystometry.

Results

The prevalence of URI was 31% at initial urodynamic investigation, and 19% at second investigation. URI is more common than DO with 18% prevalence at initial evaluation. Treatment with mirabegron resulted in significant changes in symptoms and urodynamic sensory markers in patients with URI.

Conclusion

Urethral pressure variations are significantly reduced by treatment with mirabegron in patients with URI. URI seems to have a predictive value in treatment choices for OAB. Future research should elucidate this.

De Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015;5(1):327–96.PubMedPubMedCentral

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.PubMed

Lagro-Janssen T, Smits A, Van Weel C. Urinary incontinence in women and the effects on their lives. Scand J Prim Health Care. 1992;10(3):211–6.PubMed

Diokno AC. Epidemiology and psychosocial aspects of incontinence. Urol Clin North Am. 1995;22(3):481–5.PubMed

Dmochowski RR, Newman DK. Impact of overactive bladder on women in the United States: results of a national survey. Curr Med Res Opin. 2007;23(1):65–76.PubMed

Geirsson G, Fall M. Reflex interaction between the proximal urethra and the bladder. A clinical experimental study. Scand J Urol Nephrol. 1999;33(1):24–6.PubMed

Robain G, Combrisson H, Mazieres L. Bladder response to urethral flow in the awake ewe. Neurourol Urodyn. 2001;20(5):641–9.PubMed

Kummeling MT, Rosier PF, Elzevier HW, Groenendijk PM. Continuous urethral pressure measurements; measurement techniques; pressure variations; clinical interpretations; and clinical relevance. a systematic literature analysis. Neurourol Urodyn. 2017;36(1):51–6.PubMed

Kirschner-Hermanns R, Anding R, Rosier P, Birder L, Andersson KE, Djurhuus JC. Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction—ICI-RS 2014. Neurourol Urodyn. 2016;35(2):318–23.PubMedPubMedCentral

10.

Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, et al. A comprehensive review of overactive bladder pathophysiology: on the way to tailored treatment. Eur Urol. 2019;75(6):988–1000.PubMed

11.

Chapple C, Cruz F. Open to debate. The motion: antimuscarinics are the mainstay of therapy for overactive bladder. Eur Urol. 2008;54(1):226–30.PubMed

12.

Basra RK, Wagg A, Chapple C, Cardozo L, Castro-Diaz D, Pons ME, et al. A review of adherence to drug therapy in patients with overactive bladder. BJU Int. 2008;102(7):774–9.PubMed

13.

Wagg A, Compion G, Fahey A, Siddiqui E. Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience. BJU Int. 2012;110(11):1767–74.PubMed

14.

Sicras-Mainar A, Rejas J, Navarro-Artieda R, Aguado-Jodar A, Ruiz-Torrejon A, Ibanez-Nolla J, et al. Antimuscarinic persistence patterns in newly treated patients with overactive bladder: a retrospective comparative analysis. Int Urogynecol J. 2014;25(4):485–92.PubMed

15.

Thind P, Lose G, Colstrup H, Andersson KE. The influence of beta-adrenoceptor and muscarinic receptor agonists and antagonists on the static urethral closure function in healthy females. Scand J Urol Nephrol. 1993;27(1):31–8.PubMed

16.

Thind P, Lose G, Colstrup H, Andersson KE. The effect of pharmacological stimulation and blockade of autonomic receptors on the urethral pressure and power generation during coughing and squeezing of the pelvic floor in healthy females. Scand J Urol Nephrol. 1993;27(4):519–25.PubMed

17.

Chapple CR, Cardozo L, Nitti VW, Siddiqui E, Michel MC. Mirabegron in overactive bladder: a review of efficacy, safety, and tolerability. Neurourol Urodyn. 2014;33(1):17–30.PubMed

18.

Vecchioli Scaldazza C, Morosetti C. Comparison of therapeutic efficacy and urodynamic findings of Solifenacin succinate versus Mirabegron in women with overactive bladder syndrome: results of a randomized controlled study. Urol Int. 2016;97(3):325–9.PubMed

19.

Kummeling MT, Buijs JT, Wisse LJ, van Uhm JI, Elzevier HW, de Ruiter MC, Groenendijk PM. Initial report on distribution of beta3-adrenoceptor in the human female urethra. Neurourol Urodyn 2019; https://doi.org/10.1002/nau.24183.

20.

Sebastianelli A, Russo GI, Kaplan SA, McVary KT, Moncada I, Gravas S, et al. Systematic review and meta-analysis on the efficacy and tolerability of mirabegron for the treatment of storage lower urinary tract symptoms/overactive bladder: comparison with placebo and tolterodine. Int J Urol. 2018;25(3):196–205.PubMed

21.

Ruth KH, Ralf A, Nariman G, Ing G, Adele C, Nadine H. Urethral pressure variation: a neglected contributing factor in patients with overactive bladder syndrome? Int Braz J Urol. 2017;43(2):272–9.PubMed

22.

Groenendijk PM, Heesakkers JP, Lycklama ANAA. Urethral instability and sacral nerve stimulation-a better parameter to predict efficacy? J Urol. 2007;178(2):568–72.PubMed

Titel: Exploratory analysis of the effect of mirabegron on urodynamic sensation parameters and urethral pressure variations
verfasst von: Maxime T. M. Kummeling
Joost Egberts
Henk W. Elzevier
Gommert A. van Koeveringe
Hein Putter
Pieter M. Groenendijk
Publikationsdatum: 03.02.2020
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 1/2021
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04193-4

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Nodal-negativ nach neoadjuvanter Chemo: Axilladissektion verzichtbar?

03.05.2024 Mammakarzinom Nachrichten

Wenn bei Mammakarzinomen durch eine neoadjuvante Chemotherapie ein Downstaging von nodal-positiv zu nodal-negativ gelingt, scheint es auch ohne Axilladissektion nur selten zu axillären Rezidiven zu kommen.

Rezidivierender Peritonsillarabszess nach Oralsex

02.05.2024 Peritonsillarabszess Kasuistik

Die erotischen Dimensionen von Peritonsillarabszessen scheinen eng begrenzt zu sein. Das heißt aber nicht, solche Abszesse und Erotik hätten nichts miteinander gemein, wie ein Fallbericht verdeutlicht.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärzte und Psychotherapeuten.

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Exploratory analysis of the effect of mirabegron on urodynamic sensation parameters and urethral pressure variations