对于膀胱过动症男性患者 行为治疗可和药物治疗匹敌


  【24drs.com】June 3, 2010 (加州旧金山) — 研究者在美国泌尿科协会(AUA)2010年科学会议中宣称,对于没有明显膀胱出口阻塞的膀胱过动症(overactive bladder,OAB)男性患者,综合行为治疗计画和抗毒蕈碱药物一样有效。
  
  阿拉巴马大学医学教授Kathryn L. Burgio博士向Medscape Urology指出,虽然有些照护者建议对男性和女性的OAB使用行为治疗,多数医师并未在其临床实务中提供这类疗法,例如骨盆底肌肉训练以及冲动压抑技术(urge-suppression techniques)。
  
  研究者将143名男性OAB患者随机分派接受一项为期8周的行为治疗或药物治疗。
  
  OAB定义为急尿和频尿(每天排尿大于8次),合并或未合并失禁,且无明显阻塞(单纯尿流量测量小于10 mL/s或排尿后残余尿液量大于150 mL )。
  
  在一个为期4周的磨合期中,所有研究对象在α阻断剂治疗后都还有持续的OAB症状。
  
  行为治疗为一个综合训练计画,包括骨盆底肌肉运动、延迟排尿、自我监测之膀胱日记、冲动压抑技术来抑制逼尿肌收缩和减少急尿、频尿和失禁 。
  
  指派到药物治疗组的病患接受标准的抗毒蕈碱药物治疗,起始剂量为10 mg缓释型oxybutynin,依据个人状况调整到每天5-30 mg。逐步增加剂量的目标是,帮助病患达到他们可以达成且无无法耐受之副作用的最有效剂量。
  
  研究对象在随机分组前7天以及最后疗程后7天进行膀胱日记,以计算24小时排尿频率、以及夜尿和失禁的改变。
  
  完成行为治疗的64名病患,每天平均排尿次数减少,从开始时的11.3次减少到治疗后的9.1次(P< .001),接受药物治疗的60名病患,则是从开始时的11.4次减少到治疗后的9.5次(P< .001)。统计分析显示,两组在治疗后的排尿频率效果相当(P< .001)。
  
  治疗8周之后,随机分组接受行为治疗的病患有36%、药物治疗的病患有30% 每天排尿小于等于8次(P= .48)。夜尿方面,行为治疗组平均每晚减少0.72次,药物治疗组减少0.32次(P= .04)。
  
  整体察觉改善方面,在治疗结束评估时,行为治疗组有38%表示他们「好很多」,药物治疗组则是有29% (P= .34)。在病患满意方面,行为治疗组有56%患者表示「完全满意」,药物治疗组则是有43%(P= .17)。
  
  Burgio博士表示,试验结果显示,骨盆底肌肉训练、延迟排尿、冲动压抑技术等行为治疗,可有效减少OAB男性的排尿频率,获得至少和药物治疗一样好的结果。
  
  她表示,行为治疗因为副作用少,可以适用为无阻塞之OAB男性的第一线治疗,而且,因为没有结果预测因子,对任何想尝试的非失智病患,我们仍无临床理由否定行为治疗。
  
  新墨西哥大学泌尿科主任、教授、AUA公共媒体委员会主席Anthony Y. Smith医师向Medscape Urology表示,虽然这是小型研究,其研究发现很有趣,药物和行为治疗之间没有大差异,表示行为治疗有其利益。
  
  他表示,虽然行为治疗看似有效,这方式仍是忧喜参半。显然地,行为治疗不会有一些OAB药物的副作用,但是,其缺点在于为病患设定一个治疗模式时的复杂度,因为你需要有人来教各种技术,然后你需要有人确保病患正确地执行这些技术,所以,行为治疗相当需要人力。
  
  退伍军人事务部、退伍军人健康管理局、复健研究与发展服务等机构资助该研究。Burgio博士报告与其研究团队和Pfizer、Asellas、Ferring, Alza与Johnson & Johnson有各种财务关系,Smith医师宣告没有相关资金上的往来。
  
  美国泌尿科协会(AUA)2010年科学会议:摘要1516。发表于2010年6月1日。

Behavioral Therapy Rivals Drug Treatment for Men With Overactive Bladder

By Jill Stein
Medscape Medical News

June 3, 2010 (San Francisco, California) — A comprehensive behavioral therapy program is as effective as antimuscarinic drug therapy for treating overactive bladder (OAB) in men without significant bladder outlet obstruction, investigators announced here at the American Urological Association (AUA) 2010 Annual Scientific Meeting.

"Although some providers recommend behavioral treatments for OAB in men and women, most clinicians do not offer such therapies, which can include pelvic floor muscle training and urge-suppression techniques, in their clinical practices," Kathryn L. Burgio, PhD, professor of medicine at the University of Alabama at Birmingham, told Medscape Urology.

The researchers randomized 143 men with OAB to an 8-week course of behavioral or drug therapy.

OAB was defined as urgency and frequent urination (>8 voids per day), with or without incontinence, and without significant obstruction (<10?mL/s on simple uroflowmetry or >150?mL postvoid residual urine).

All participants in the trial had persistent OAB symptoms after alpha-blocker therapy during a 4-week run-in period.

Behavioral therapy consisted of a comprehensive training program, which included pelvic floor muscle exercises, delayed voiding, self-monitoring with bladder diaries, and urge-suppression techniques to inhibit detrusor contraction and reduce urgency, frequency, and incontinence.

Patients assigned to drug therapy received standard antimuscarinic therapy consisting of individually titrated, extended-release oxybutynin, 5 to 30?mg daily, initiated at 10?mg. The goal of dose escalation was to help the patient reach the most effective dose they could achieve without intolerable adverse effects.

Seven-day bladder diaries completed by subjects prior to randomization and after the last treatment session were used to calculate changes in 24-hour frequency of urination, as well as nocturia and incontinence.

The 64 patients who completed behavioral treatment demonstrated a reduction in the mean number of voids per day, from 11.3 at baseline to 9.1 after treatment (P?< .001). The 60 patients who received drug therapy showed a reduction from 11.4 at baseline to 9.5 after treatment (P?< .001). Statistical analysis indicated that the posttreatment voiding frequencies were equivalent (P?< .001).

After 8 weeks of treatment, 36% of patients randomized to behavioral treatment and 30% assigned to drug therapy had 8 or fewer voids per day (P?= .48). Nocturia was reduced by a mean of 0.72 episodes per night in the behavior group and 0.32 episodes in the drug group (P?= .04).

On the global perception of improvement, assessed at the end of treatment, 38% of patients receiving behavioral therapy reported that they were "much better," compared with 29% of those receiving drug therapy (P?= .34). On the patient satisfaction question, 56% receiving behavioral therapy reported being "completely satisfied," compared with 43% receiving drug therapy (P?= .17).

The results of this trial demonstrate that behavioral treatment with pelvic floor muscle training, delayed voiding, and urge-suppression techniques are effective for reducing frequency of voiding in men with OAB, and yield outcomes at least as good as drug therapy, Dr. Burgio said.

"Given its lower side-effect profile, behavioral therapy is an appropriate first-line treatment for OAB in men without obstruction," she said. "Also, because no consistent predictors of outcome have been identified, we maintain that there is no clinical reason to deny behavioral treatment to any nondemented patient who wishes to try it."

"While the study was small, the findings are interesting, and the lack of a large difference between the medical and behavioral therapy groups suggests that there is some benefit with the behavioral therapy," Anthony Y. Smith, MD, chair of the AUA public media committee and professor and chief of the Division of Urology at the University of New Mexico in Albuquerque, told Medscape Urology.

Although behavioral therapy seems to be effective, the intervention is a mixed bag, he cautioned. "Obviously, behavioral therapy won't have the well-described side effects of some of the OAB medications, but the downside is the complexity of setting up a model to treat patients, because you need someone to teach the various techniques and then you need someone to make sure that the patients are performing the techniques correctly. So behavioral therapy can be very labor-intensive."

The study was funded by the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service. Dr. Burgio reports relevant financial relationships collectively for the research team with Pfizer, Asellas, Ferring, Alza, and Johnson & Johnson. Dr. Smith has disclosed no relevant financial relationships.

American Urological Association (AUA) 2010 Annual Scientific Meeting: Abstract?1516. Presented June?1, 2010.

    
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