mirabegron and Urinary-Incontinence--Stress

To summarize recent data on the medical treatment of men with incontinence due to overactive bladder or to stress urinary incontinence published in peer-reviewed journals.. Previous randomized controlled trials have shown that both antimuscarinic drugs and α1-adrenoceptor blockers can be useful for treatment of male lower urinary tract symptoms, including the overactive bladder syndrome, and that combination of the two principles may offer additional benefits over monotherapy with either agent. This has been further confirmed in several recent studies. There seems to be an associated increase in postvoid residual urine volume by the combinations, but not a significantly increased risk of retention. The efficacy of other combinations, for example, α1-adrenoceptor blocker and 5α-reductase inhibitor, has also been further documented. Recent evidence supports the use of mirabegron, alone or in combination with solifenacin, as a treatment alternative of male overactive bladder syndrome. Monotherapy with phosphodiesterase 5 inhibitors seems to be as effective as α1-adrenoceptor blockers in male lower urinary tract symptoms. Only a few recent studies have been performed on the pharmacological treatment of male stress urinary incontinence, confirming that duloxetine had a modest positive effect in men with postprostatectomy incontinence.. For treatment of storage symptoms in men with lower urinary tract symptoms, combinations of antimuscarinics and α1-adrenoceptor blockers have produced the most promising results. Duloxetine exerts only modest relief of male stress urinary incontinence, but may be recommended in some patients.

Topics: 5-alpha Reductase Inhibitors; Acetanilides; Adrenergic alpha-1 Receptor Antagonists; Drug Therapy, Combination; Humans; Lower Urinary Tract Symptoms; Male; Muscarinic Antagonists; Quinuclidines; Solifenacin Succinate; Tetrahydroisoquinolines; Thiazoles; Urinary Bladder, Overactive; Urinary Incontinence, Stress; Urinary Incontinence, Urge; Urological Agents

In the United States, office visits for women seeking treatment for urinary incontinence more than doubled between 1994 and 2000, from 1845 per 100 000 women. This review article addresses treatment options for 2 common types of incontinence in women: stress urinary incontinence (SUI) and detrusor overactivity (DO), commonly referred to as urge urinary incontinence (UUI). In the past, those with SUI typically faced limited treatment options, such as Kegel exercises, pessaries, or major surgery (Burch or Marshall-Marchetti-Krantz operations). However, treatment options for women also included anticholinergic medications, behavioral therapy, and implantable neuromodulation. In recent years, more options have become available. For women with SUI, a variety of minimally invasive synthetic midurethral sling approaches (eg, retropubic, transobturator, and single incision) and office-based procedures (eg, periurethral injection of bulking agents and radiofrequency collagen denaturation [Renessa®; Novasys Medical]) are now offered. More outpatient options will hopefully be available soon, including an inflatable, free-floating balloon to act as a shock absorber, and injection of muscle-derived stem cells into the periurethral tissue. Women with UUI now have targeted options, such as posterior tibial nerve stimulation (PTNS) and intravesical injections of onabotulinumtoxinA (Botox®; Allergan, Inc.), in addition to nonoral systemic medications.

Topics: Acetanilides; Behavior Therapy; Botulinum Toxins, Type A; Catheter Ablation; Catheterization; Electric Stimulation Therapy; Exercise Therapy; Female; Humans; Neuromuscular Agents; Physical Therapy Modalities; Stem Cell Transplantation; Suburethral Slings; Thiazoles; Urinary Bladder, Overactive; Urinary Incontinence, Stress; Urologic Surgical Procedures

The objective of the study was immunohistochemical evaluation of distribution of various NO synthase fractions in the structural elements of the bladder wall under stress urinary incontinence and its overactivity prior and post Mirabegron, Spasmex, Quercetin therapies and their combinations with Testosterone and Estradiol. Using the immunohistochemical method, we studied the expression of the main fractions of NO synthase in experimental models of hyperactive bladder (OAB) and stress urinary incontinence (SUI). We found that OAB and SUI were characterized by emergence of expression of the inducible fraction (iNOS) predominantly in the interstitial cells of the muscular layer of the bladder and reduced expression of endothelial (eNOS) and neuronal (nNOs) NO synthase fractions. In contrast to Spasmex, Mirabegron and Quercetin in combination with Testosterone and Estradiol contributed to stabilization of eNOS and nNOs expression already at early observation phases, and reduced the level of iNOS expression with its further disappearance in the later observation period.

Topics: Acetanilides; Animals; Benzilates; Drug Therapy, Combination; Estradiol; Female; Nitric Oxide Synthase; Nitric Oxide Synthase Type I; Nitric Oxide Synthase Type II; Nitric Oxide Synthase Type III; Nortropanes; Quercetin; Rats; Testosterone; Thiazoles; Urinary Bladder; Urinary Bladder, Overactive; Urinary Incontinence, Stress