| Abstrakt: |
Introduction & Objectives: There are a range of mechanisms and systems underlying urinary bladder contractions, with interactions between nerves, endogenously released chemicals and receptors all playing a part in the overall function1,2. However, when contraction is inhibited, such as with underactive bladder, it can be challenging to work out which mechanisms may be at fault. Nonetheless, it is feasible that parasympathomimetics (muscarinic agonists and acetylcholinesterase inhibitors) might be beneficial for enhancing contractions of the urinary bladder, which is of particular interest in the pharmaceutical treatment of underactive bladder. This study systematically reviewed and meta-analysed the current literature to assess the effectiveness of muscarinic agonists and acetylcholinesterase inhibitors for the treatment of underactive bladder. Methods: An a priori protocol was registered in PROSPERO, and database searches were undertaken within Embase, PubMed and CENTRAL. The study included both randomised and non-randomised controlled trials that incorporated patients with underactive bladder. Articles that compared any parasympathomimetic medication to a placebo, no treatment, or other pharmaceuticals were included. Risk ratios, mean differences and odds ratios were calculated from the extracted data. Results: 3024 participants were included across twelve trials. There were significant differences between selected comparators and parasympathomimetics (favouring parasympathomimetics) in the number of patients with urinary retention, although no overall difference was identified to mean postvoid volume. There was a significant difference at up to 1-week post-intervention, favouring parasympathomimetics, but no difference at 1-month post-intervention. There were no differences identified in adverse events. Conclusions: The literature is not clear as hypothesised regarding whether the prescription of parasympathomimetics is evidence-based for the treatment of underactive bladder3. The overall evidence is of low quality, and studies tended to end without long-term follow-ups. However, there are some observed benefits, with no major identified risk factors from parasympathomimetic prescriptions. Although it is not entirely possible to draw clear evidence-based conclusions from the current literature, this study has identified a clear need for well-controlled clinical trials to be conducted in the future. [ABSTRACT FROM AUTHOR] |
