Prostaglandin E2 and bethanechol in combination for treating detrusor underactivity
Prostaglandin E2 and bethanechol in combination for treating detrusor underactivity
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DOI：
10.1111/j.1464-410x.2004.04563.x
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发表时间：
2004-01-01
影响因子：
4.5
通讯作者：
Thomas, PJ
中科院分区：
文献类型：
--
作者：
Hindley, RG;Brierly, RD;Thomas, PJ
为了在一项前瞻性随机双盲研究中检验膀胱内前列腺素E-2（PGE（2））和口服氯氨甲酰胆碱（BC）联合使用在改善膀胱排空方面是相加还是协同作用的假设，因为它们已经单独用于治疗受损的逼尿肌收缩力，而临床益处很少。（17名男性和2名女性）符合条件，并随机接受两种治疗之一。所有患者的排尿后残余尿量（PVR）始终> 300 mL，大多数依赖于清洁间歇性自我导尿（CISC）。实验治疗组（9名患者）接受每周一次膀胱内PGE（2）（1.5 mg溶于20 mL 0.9%盐水）加BC 50 mg每日4次，共6周。第二组10名患者接受每周一次的生理盐水和安慰剂片剂滴注，同样持续6周。在治疗前，接受两种药物的患者的中值（四分位数范围）PVR为426（405-480）mL;在完成治疗后，其降低至325（290-352）mL（P < 0.015）。安慰剂组的相应值分别为576（539-777）和538（350-775）mL（P = 0.09）。四名接受活性组合的患者报告症状改善，并能够减少CISC的频率。CONCLUSION虽然有药理作用的证据，BC和PGE（2）与安慰剂相比，治疗效果有限。虽然我们不建议将这种治疗作为常规治疗，但可以考虑偶尔治疗逼尿肌活动不足的患者。
OBJECTIVETo test the hypothesis, in a prospective randomized double-blind study, that the combination of intravesical prostaglandin E-2 (PGE(2)) and oral bethanechol chloride (BC) are additive or synergistic in improving bladder emptying, as they have been used alone for treating impaired detrusor contractility with little clinical benefit.PATIENTS AND METHODS Nineteen patients with detrusor underactivity (17 men and two women) were eligible and randomized to one of two treatments. All had postvoid residual urine volumes (PVR) consistently of > 300 mL, most being reliant on clean intermittent self-catheterization (CISC). The experimental treatment group (nine patients) received once-weekly intravesical PGE(2) (1.5 mg in 20 mL 0.9% saline) plus BC 50 mg four times daily, for a total of 6 weeks. The second group of 10 patients received a once-weekly instillation of saline together with placebo tablets, again for 6 weeks.RESULTSBefore treatment the median (interquartile range) PVR was 426 (405-480) mL for those receiving both drugs; this decreased to 325 (290-352) mL after completing the treatment (P < 0.015). In the placebo group the respective values were 576 (539-777) and 538 (350-775) mL (P = 0.09). Four of the patients receiving the active combination reported symptomatic improvement and were able to reduce the frequency of CISC.CONCLUSIONAlthough there was evidence of a pharmacological effect, BC and PGE(2) had a limited therapeutic effect compared with placebo. Whilst we would not recommend this treatment as routine, it may be considered for the occasional treatment of a patient with detrusor underactivity.