report from overactive bladder committee - 台灣尿 …"#$%&'()*+, detailed history...
TRANSCRIPT
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Report from Overactive Bladder Committee
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�� !"#$%&'()*+,-./0Eoveractive bladder, OABF�
�� !"#$%&'Overactive bladder — from bench to bedside ��
�� !"#$ Evaluation and management of overactive bladder — from
community to bedside�� !"#$%&Treatment of overactive bladder
�� !"#$%&Management of overactive bladder�� !"#$%
� Consensus of Taiwanese guidelines for overactive bladder�� !"#
�� !"#$#%&'()*+,-./$012"3+45 #6
�� !"#$%&'()*+,-./012%345
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�� !"#$%&'()*+,-./012345Eurge urinary
incontinence, UUIF�� !"#$%&'(Emixed urinary incontinenceF�
�� !"#$%&'()*Estress urinary incontinence, SUIFE� 1F
xAbrams et al, 2005z�� !"#$%&#'()*+,-EurgencyF��
�� !"2006��J Urol�� !"#$%&'()*+,-./0
�� !"#$%&'!()*xHung et al, 2006z�� !"#$%&'
�� !"#$%&'�EfrequencyF�� EnocturiaF�� !"#$!%
�� !"#$%xWein and Rovner, 2002z�
�� !"#2004�� !"#$%&'()*+,-./01-
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�� !"#$Equality of lifeF�� !"Evoiding diaryF�� !"#$
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�� !"#$Eurodynamic F�� !"#$%&'()*+,-
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Edaytime frequencyF�� !"#$%&'�()*+'�,-./01
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Esymptom scoreF�� !"#$%xChaliha et al, 2004z�� !"#$%
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�� !"#$%&'()*+,-./01Efunction bladder capacityF�
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�� !xAbrams and Klevmark, 1996; Baily et al, 1990; IUGA Guidelinw
for Research and Practicw, 2004z�� !"#$%&'3�� !"#$
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�� !"#$%&'()ETCS OAB GuidelineF�� !"#$%&
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�� !"#$%&'(�)*+,-./0EincontinenceF�� !"
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�� !"Overactive bladder questionnaire=EOAB-qF=� Primary OAB
symptom questionnaire=EPOSQF=xMatza et al, 2005; Coyne et al, 2005z��
�� !"#$%&'()*+,Urgency questionnaire=EUQF�Indevus
urgency severity scale=EIUSSF�Overactive bladder symptom composite score
EOAB-SCSFxZinner et al, 2005z�� !Dr. Homma�� !Overactive
bladder symptom score=EOABSSF�� !"#$%&'()*+,-.
OABSS�� !"#$%&'()*+,-. OABSS�� !"�
��E�F�� !"!#0-2��E�F�� !"#$#%0-3��E�F�
�� !"#$%&'(115�� !"# 87 � �� !"#$%&'(�� !" E-mail: [email protected] � 1. Spectrum of overactive bladder.
Overactive Bladder
SUI
MixedSymptoms
Frequency•Daytime•NighttimeUrgency
UUI
Mixed(UUI+SUI)
SUI=stress urinary incontinenceUUI=urge urinary incontinence
NNQ
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2009; Homma et al, 2005; Homma et al, 2006z�� !"#$%&'()
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xMuhlstein and Deval, 2008z�� !"#$%&'()*+ Evidence-
based medicine=EEBMF�� !"#$%&'E� 2F�� !"#$%&
��Antimuscarinic�� !"#$%&'( )*+,-.$Level 1I
grade A�� !"#$%&'Oxybutynin�Tolterodine�Propiverine�
� NK �� !""#$%xYamaguchi et al, 2009; Homma et al, 2005; Homma et al, 2006z
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NNR
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Trospium�Darifenacin��Solifenacin�� Darifenacin�� !"#
�xAbrams and Andersson, 2007z�� !"#$%&"'()Oxybutynin
�� !" Tolterodine � Trospium � Propiverine � Solifenacin �
Darifenacin�� !"#$%&'()*EBM�� !"#$%&'(
�� !"#$%&'()xAndersson KE, 2004z��2004 ICI assessment
�� !"#$%&'()#*Level, 1 grade AxAndersson KE, 2004z�
�� Dr. K-E Andersson � ICI International Scientific Committee=E� 3F�
�� !"#$%&'() *+ Desmopressin �� Level 1 � grade
A�� !" Resiniferatoxin � Indomethacin�� ! Level 2=� grade
C�� !"#!$Ebotulinum toxinF�� ! Level 2 � grade B
xAndersson KE, 2004z�� !"#$%&'(#&%)*+,-./0
�� !"#$%&'()*+,"-./Oxybutynin�Propiverine�
Tolterodine � Trospium � Solifenacin � grade A�� ! Flavoxate �
Imipramine � Tryptanol � Anafranil � Resiniferatoxin � Capsaicin �
Botulinum Toxin �� grade C � Dr. Wein � 2006 � J Urol�� !"
Darifenacin � Solifenacin � Tolterodine � Oxybutynin � Propiverine �
Desmopressin�Level 1�grade A�� !"xWein and Rackley, 2006z�
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2007; Yamaguchi et al, 2007z�
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� 3. ICS International Scientific committee[Andersson KE, 2004]
Antimuscarinic drug Level of evidence Grade of recommendation
Tolterodine 1 ATrospium 1 ASolifenacin 1 ADarifenacin 1 APropantheline 2 BAtropine, hyoscyamine 3 C
Drugs with mixed actionsOxybutynin 1 APropiverine 1 ADicyclomine 3 CFlavoxate 2 D
AntidepressantsImipramine 3 C
Alpha-AR antagonistsAlfuzosin 3 CDoxazosin 3 CPrazosin 3 CTerazosin 3 CTamsulosin 3 C
Beta-AR antagonistsTerbutaline 3 CSalbutamol 3 C
COX-inhibitorsIndomethacin 2 CFlurbiprofen 2 C
Other drugsBaclofen* 3 CCapsaicin** 2 CResiniferatoxin** 2 CBotulinum toxin*** 2 BEstrogen 2 CDesmopressin**** 1 A
*intrathecal; **intravesical; ***bladder wall; ****nocturia
� 2. EBM (ICI assessment 2004: Oxford guidelines (modified))[AnderssonKE, 2004]
Levels of evidenceLevel 1: Systematic reviews, meta-analyses, good quality randomizedcontrolled clinical trials (RCTs)Level 2: RCTs, good quality prospective cobort studiesLevel 3: Case-control studies, case seriesLevel 4: Expert opinion
Grades of recommendationGrade A: Based on level 1 evidence (highly recommended)Grade B: Consistent level 2 or 3 evidence (recommended)Grade C: Level 4 studies or “majority evidence” (optional)Grade D: Evidence inconsistent/inconclusive (no recommendation possible)
NNS
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Detailed historyQuestionnaires: OAB-V8/KHQ/OAG-q/OABSS (option)Voiding diary (3-day diary) (option)Physical examinationUrinalysisAssess PVR: physical examination/bladder scan/ultrasound/catheterizationUroflowmetry (option)
PVR > 100 mls and/or reduced flowrate and/or bladder emptying symptoms
Life style modification/bladder training/BiofeedbackElectrical stimulation/magnetic field stimulation/oral medication
Failure to improveafter initial treatment
Evaluate bladder capacity
Urodynamics:Uroflowmetry/cystometry/Electromyography/videoUDS/cystoscopy
Specialized managementNeuromodulationIntravesical vanilloids (under investigation)Botulinum toxin treatment (under investigation)Urinary diversionBladder augmentation/substitution
Success to improveafter initial treatment
Complete treatmentcourse/maintain
Further evaluate the problemsother than OAB (ex: pelvicorgan prolapse, GSI, BOO,neurogenic bladder, etc)
OAB No Yes
� 2. Evaluation and management of overactive bladder.
� 4. Drug therapy forms the basis of treatment for overactive bladder (OAB)
Generic Name Trade Name Available Doses Mode of Delivery
Oxybutynin Chloride Cystrin; Ditropan IR: 2.5 mg; 3 mg; 5 mg OralLyrinel XL ER: 5 mg, 10 mg, 5 mg OralOxytrol 36 mg/patch (3.9 mg/d) Transdermal
Tolterodine Tartrate Detrusitol; Detrol LA IR: 1 mg or 2 mg OralDetrusitol XL ER: 2 mg, 4 mg Oral
Trospium Chloride Regurin; Sanctura 20 mg OralPropiverine Hydrochloride Detrunorm 15 mg OralSolifenacin Succinate Vesicare 15 mg or 10 mg Oral
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� 3. Management of overactive bladder.
Overactive bladder
Life style interventionsBladder trainingBiofeedbackElectrical stimulation/magnetic field stimulationoral medication
Specialized management:NeuromodulationIntravesical vanilloids (under investigation)Botulinum toxin treatment (under investigation)Urinary diversionBladder augmentation/substitution
Complete treatmentcourse/maintain
failed success
NNU
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