Adrenergic drugs for urinary incontinence in adults

 

Abstract

Background

Adrenergic drugs have been used for the treatment of urinary incontinence. However, they have generally been considered to be ineffective or to have side effects which may limit their clinical use.

Objectives

To determine the effectiveness of adrenergic agonists in the treatment of urinary incontinence in adults.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 15 September 2010) and the reference lists of relevant articles.

Selection criteria

Randomised or quasi-randomised controlled trials in adults with urinary incontinence which included an adrenergic agonist drug in at least one arm of the trial.

Data collection and analysis

Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions.

Main results

Twenty-two eligible randomised trials were identified, of which 11 were crossover trials. The trials included 1099 women with 673 receiving an adrenergic drug (phenylpropanolamine in 11 trials, midodrine in two, norepinephrine in three, clenbuterol in another three, terbutaline in one, eskornade in one and Ro 115-1240 in one). No trials included men.

The limited evidence suggested that an adrenergic agonist drug is better than placebo in reducing the number of pad changes and incontinence episodes, as well as improving subjective symptoms. In two small trials, the drugs also appeared to be better than pelvic floor muscle training, possibly reflecting relative acceptability of the treatments to women but perhaps due to differential withdrawal of women from the trial groups. There was not enough evidence to evaluate the use of higher compared to lower doses of adrenergic agonists nor the relative merits of an adrenergic agonist drug compared with oestrogen, whether used alone or in combination.

Over a quarter of women reported adverse effects. There were similar numbers of adverse effects with adrenergics, placebo or alternative drug treatment. However, when these were due to recognised adrenergic stimulation (insomnia, restlessness and vasomotor stimulation) they were only severe enough to stop treatment in 4% of women.

Authors' conclusions

There was weak evidence to suggest that use of an adrenergic agonist was better than placebo treatment. There was not enough evidence to assess the effects of adrenergic agonists when compared to or combined with other treatments. Further larger trials are needed to identify when adrenergics may be useful. Patients using adrenergic agonists may suffer from minor side effects, which sometimes cause them to stop treatment. Rare but serious side effects, such as cardiac arrhythmias and hypertension, have been reported.

 

Plain language summary

Adrenergic drugs for urinary incontinence in adults

Urinary incontinence is the leakage of urine, and when caused by coughing or exercising it is called stress incontinence. It may be caused by damage to muscles either holding up the bladder or holding the bladder neck closed. Adrenergic agonist drugs may help the bladder neck muscle to contract more strongly. This review of 22 trials involving 673 women and seven different adrenergic drugs found weak evidence that adrenergic agonists may help stress urinary incontinence. Side effects do occur but are usually minor. Rarely, more serious adverse effects such as high blood pressure can occur. More evidence is needed to compare adrenergic drugs with other drugs for stress incontinence and also with pelvic floor muscle exercises.

 

摘要

背景

擬腎上腺素藥物之於成人尿失禁的效用

擬腎上腺素藥物被用來治療尿失禁已有一段時間。然而，它們在臨床上的使用也因有人認為其對治療尿失禁並無實質上的效果及其副作用而有所限制。

目標

為了確定擬腎上腺素致效劑在治療尿失禁的效用。

搜尋策略

搜尋Cochrane Incontinence Group Specialised Trials Register 及其參考文獻與相關文章。

選擇標準

選擇的標準是以有利用擬腎上腺素藥物治療成人尿失禁為其中一部分治療元素的隨機化或半隨機化的臨床試驗。

資料收集與分析

2名檢閱人分別評估各個試驗的品質和資料收取方式來確保其合格性。當中的資料也必須依照“Cochrane Handbook for Systematic Reviews of Interventions”的要求來做處理。

主要結論

我們總共回顧了符合標準的22篇隨機試驗，這些試驗總共收取了1099名婦女的資料，而當中有673位婦女是接受擬腎上腺素藥物的治療(有11篇試驗使用phenylpropanolamine，2篇使用midodrine，3篇使用norepinephrine，3篇使用clenbuterol，1篇使用terbutaline，1篇使用eskornade，1篇使用Ro 115 – 1240)。我們並不收納治療男性尿失禁的資料。有一些資料表示使用擬腎上腺素藥物在棉墊更換以及發生尿失禁的頻率上會比安慰劑有較好的效果。在當中兩篇小型試驗表示擬腎上腺素藥物比骨盆底肌肉運動有更好的效果，但這也有可能是因為對於受試著，藥物相對上有較高的可接受度與不同退出試驗比例的影響。我們沒有充分的證據能夠支持較高劑量與較低劑量擬腎上腺素藥物的作用差異，也沒有辦法評估擬腎上腺素藥物單獨使用或是合併使用雌激素的效用差異。有超過四分之一的受試者表示有受到副作用的影響，不過當中在使用擬腎上腺素藥物或是安慰劑或是其他藥物治療的受試者所感受的副作用數目並沒有太大的差異。然而，只有4%的女性受試者會因為無法忍受擬腎上腺素藥物的副作用(諸如失眠、坐立不安…等)而停止參與試驗。

作者結論

並沒有強烈的證據支持使用擬腎上腺素藥物在治療尿失禁這方面比安慰劑會有更好的效果。其中，我們也沒有較充分的證據去評估擬腎上腺素藥物在單方或副方使用時其個別的實際效果。若要確定擬腎上腺素藥物的治療效果則是需要更大型、更進一步的試驗研究。擬腎上腺素藥物的輕微副作用有時會讓病人因不適而停止接受治療。也有些少見但嚴重的副作用諸如心律不整、高血壓曾經被發表過。

翻譯人

本摘要由中國醫藥大學附設醫院蔡宛真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

擬腎上腺素藥物在治療成人尿失禁這方面主要是被使用在應力性尿失禁(因腹部用力的活動像是咳嗽而有漏尿的情形)這部分。應力性尿失禁的成因被認為是因為膀胱或膀胱頸的肌肉受損而無法有效的維持膀胱體積以及關閉膀胱頸而致。擬腎上腺素藥物被認為在增強膀胱頸擴約肌收縮力應該會有所助益。回顧了22個試驗，總共有673名婦女受試以及7種不同的擬腎上腺素藥物被使用，並沒有強烈證據支持擬腎上腺素藥物對尿失禁會有所幫助。而一些藥物雖然少見但卻嚴重的副作用像是高血壓也被發表出來。我們需要更多的證據來證明擬腎上腺素藥物會比其他的藥物以及骨盆底肌肉運動在治療尿失禁方面來的更有效果。