The document discusses treatments for overactive bladder (OAB). It finds:
1) The prevalence of OAB was 7.2% in 2013 and is projected to increase 48.1% by 2027, being highest in those over 74, white individuals, and urban dwellers.
2) Treatment options for OAB include behavioral interventions, medications, injections, nerve stimulation, and surgery. Common medications are anticholinergics/antimuscarinics and the beta-3 adrenergic drug mirabegron.
3) Combination therapy with an antimuscarinic like solifenacin and mirabegron provides better efficacy than monotherapy with fewer side effects, especially in
Myrbetriq is a beta3 agonist approved for treatment of overactive bladder. It is indicated for patients unable to tolerate anticholinergic agents or whose quality of life is significantly impaired by overactive bladder symptoms. The Scorpio trial found Myrbetriq 50mg and 100mg significantly reduced daily urinary frequency and incontinence episodes compared to placebo. Common side effects include hypertension, urinary tract infections, and nasopharyngitis. Dosage adjustments may be needed in patients with hepatic or renal impairment.
Role of Mirabegron in Treating Overacting Bladder.Poly Begum
Dr. Poly Begum presented on the role of mirabegron in treating overactive bladder (OAB). She defined OAB and discussed its prevalence among elderly women. She explained that mirabegron is a newer agent that works as a β3 adrenergic agonist to relax the bladder detrusor muscle. Its mode of action involves agonizing the β3 receptors in the bladder to inhibit abnormal detrusor contraction and reduce OAB symptoms. Dr. Begum recommended an initial dose of 25mg mirabegron once daily for OAB treatment.
The document discusses overactive bladder (OAB) and its prevalence, symptoms, diagnosis, and treatment. It provides the following key points:
- OAB symptoms like urgency, frequency, and nocturia are common, affecting over half of men and women aged 40-59.
- Diagnosis is usually based on patient history and symptoms. A bladder diary can help assess frequency and episodes. Physical exam and urinalysis rule out other causes.
- Conservative treatments include behavioral changes, pelvic floor therapy, and medications. Anticholinergic drugs and beta-3 agonists like mirabegron and solifenacin are commonly used oral pharmacologic options.
- More invasive treatments for refract
This document discusses the management of overactive bladder. It begins by describing the normal bladder functions of storage and emptying. It then discusses overactive bladder, noting it is defined by symptoms of urgency and frequency. Causes can be neurologic or myogenic defects. Evaluation involves history, exam, urodynamics and cystoscopy. Treatment begins with lifestyle changes and pharmacotherapy using antimuscarinic drugs to inhibit bladder contractions. For refractory cases, options include intravesical injections, botulinum toxin, neuromodulation or urinary reconstruction. Overall understanding of overactive bladder pathophysiology and treatment options has improved.
Overactive bladder, DR Sharda Jain Lifecare Centre Lifecare Centre
OAB OAB is not synonymous with detrusor overactivity as the former is a symptom based diagnosis whilst the latter is an urodynamic diagnosis.
It has been estimated that 64% of patients with OAB have urodynamically proven detrusor overactivity and that 83% of patient with detrusor overactivity have symptoms suggestive of OAB.
Over Active Bladder ‘an enigma’ Dr Jyoti Agarwal Dr Sharda Jain Lifecare Centre
This document discusses overactive bladder (OAB), a condition that affects quality of life. It defines OAB based on symptoms as a syndrome characterized by urgency, usually with frequency and nocturia, in the absence of infection or other pathology. OAB is common but underreported and undertreated. Treatment involves behavioral modifications, pharmacotherapy such as antimuscarinics or the newer drug Mirabegron, which is better tolerated. While OAB was previously poorly understood, recent research has improved diagnosis and management, though it remains a challenging condition to treat.
This document discusses overactive bladder (OAB). It defines OAB as a clinical syndrome of urgency, usually with frequency and nocturia. It can occur with or without urge incontinence. The prevalence of OAB increases with age and it affects both men and women. Treatment progresses from behavioral modifications and oral medications to minimally invasive procedures like botulinum toxin injections or sacral nerve stimulation for refractory cases. More invasive treatments like augmentation cystoplasty or urinary diversion are reserved for cases that fail less invasive options.
This document discusses Dr. Santosh Agrawal's background and credentials as a urologist and kidney transplant surgeon. It then provides information on overactive bladder (OAB), including definitions, prevalence statistics, quality of life impacts, incidence being underreported, and OAB classification systems. Diagnosis of OAB is discussed, covering patient history, physical exam, lab tests, bladder diaries, and urodynamics. Conservative management options like behavioral modification, bladder training, pelvic floor muscle therapy, and pharmacologic therapies are summarized. Specific drugs for treating detrusor overactivity like tolterodine are also mentioned.
Myrbetriq is a beta3 agonist approved for treatment of overactive bladder. It is indicated for patients unable to tolerate anticholinergic agents or whose quality of life is significantly impaired by overactive bladder symptoms. The Scorpio trial found Myrbetriq 50mg and 100mg significantly reduced daily urinary frequency and incontinence episodes compared to placebo. Common side effects include hypertension, urinary tract infections, and nasopharyngitis. Dosage adjustments may be needed in patients with hepatic or renal impairment.
Role of Mirabegron in Treating Overacting Bladder.Poly Begum
Dr. Poly Begum presented on the role of mirabegron in treating overactive bladder (OAB). She defined OAB and discussed its prevalence among elderly women. She explained that mirabegron is a newer agent that works as a β3 adrenergic agonist to relax the bladder detrusor muscle. Its mode of action involves agonizing the β3 receptors in the bladder to inhibit abnormal detrusor contraction and reduce OAB symptoms. Dr. Begum recommended an initial dose of 25mg mirabegron once daily for OAB treatment.
The document discusses overactive bladder (OAB) and its prevalence, symptoms, diagnosis, and treatment. It provides the following key points:
- OAB symptoms like urgency, frequency, and nocturia are common, affecting over half of men and women aged 40-59.
- Diagnosis is usually based on patient history and symptoms. A bladder diary can help assess frequency and episodes. Physical exam and urinalysis rule out other causes.
- Conservative treatments include behavioral changes, pelvic floor therapy, and medications. Anticholinergic drugs and beta-3 agonists like mirabegron and solifenacin are commonly used oral pharmacologic options.
- More invasive treatments for refract
This document discusses the management of overactive bladder. It begins by describing the normal bladder functions of storage and emptying. It then discusses overactive bladder, noting it is defined by symptoms of urgency and frequency. Causes can be neurologic or myogenic defects. Evaluation involves history, exam, urodynamics and cystoscopy. Treatment begins with lifestyle changes and pharmacotherapy using antimuscarinic drugs to inhibit bladder contractions. For refractory cases, options include intravesical injections, botulinum toxin, neuromodulation or urinary reconstruction. Overall understanding of overactive bladder pathophysiology and treatment options has improved.
Overactive bladder, DR Sharda Jain Lifecare Centre Lifecare Centre
OAB OAB is not synonymous with detrusor overactivity as the former is a symptom based diagnosis whilst the latter is an urodynamic diagnosis.
It has been estimated that 64% of patients with OAB have urodynamically proven detrusor overactivity and that 83% of patient with detrusor overactivity have symptoms suggestive of OAB.
Over Active Bladder ‘an enigma’ Dr Jyoti Agarwal Dr Sharda Jain Lifecare Centre
This document discusses overactive bladder (OAB), a condition that affects quality of life. It defines OAB based on symptoms as a syndrome characterized by urgency, usually with frequency and nocturia, in the absence of infection or other pathology. OAB is common but underreported and undertreated. Treatment involves behavioral modifications, pharmacotherapy such as antimuscarinics or the newer drug Mirabegron, which is better tolerated. While OAB was previously poorly understood, recent research has improved diagnosis and management, though it remains a challenging condition to treat.
This document discusses overactive bladder (OAB). It defines OAB as a clinical syndrome of urgency, usually with frequency and nocturia. It can occur with or without urge incontinence. The prevalence of OAB increases with age and it affects both men and women. Treatment progresses from behavioral modifications and oral medications to minimally invasive procedures like botulinum toxin injections or sacral nerve stimulation for refractory cases. More invasive treatments like augmentation cystoplasty or urinary diversion are reserved for cases that fail less invasive options.
This document discusses Dr. Santosh Agrawal's background and credentials as a urologist and kidney transplant surgeon. It then provides information on overactive bladder (OAB), including definitions, prevalence statistics, quality of life impacts, incidence being underreported, and OAB classification systems. Diagnosis of OAB is discussed, covering patient history, physical exam, lab tests, bladder diaries, and urodynamics. Conservative management options like behavioral modification, bladder training, pelvic floor muscle therapy, and pharmacologic therapies are summarized. Specific drugs for treating detrusor overactivity like tolterodine are also mentioned.
Ovarian stimulation for ovulatory disorders and assisted reproduction. From simple induction with oral medications till the controlled ovarian stimulation including different protocols.
tirzepatide once weekly for the treatment of obesity.pptxssuser1abbaa
Tirzepatide is a once-weekly injectable peptide that targets GIP and GLP-1 receptors for the treatment of obesity. This phase 3 trial evaluated the efficacy and safety of tirzepatide in adults with obesity or overweight without diabetes. It found that all three doses of tirzepatide (5mg, 10mg, and 15mg) led to clinically meaningful weight loss compared to placebo over 72 weeks. Weight loss exceeded 20% for those receiving the highest dose. The most common side effects were nausea, diarrhea, vomiting, and constipation. However, treatment discontinuation due to adverse events was low.
This document discusses the role of progesterone in pregnancy and preventing preterm birth. It begins by outlining the problem of preterm birth globally, noting that 15 million babies are born preterm each year. It then discusses various trials investigating the use of progesterone supplementation to prevent preterm birth, including the large NICHD/MFMU trial which found that weekly injections of 17α-hydroxyprogesterone caproate reduced preterm birth rates. The document also notes vaginal progesterone trials have shown benefits but results are more mixed in high-order multiples and women with a short cervix may benefit most.
Role of Dydrogesterone in repeated pregnancy lossNiranjan Chavan
Dydrogesterone has been shown to effectively treat recurrent pregnancy loss by modulating the immune system. It shifts the balance from a pro-inflammatory Th1 response towards an anti-inflammatory Th2 response by [1] inhibiting the production of Th1 cytokines IFN-γ and TNF-α and [2] inducing production of the Th2 cytokines IL-4 and IL-6. This results in improved pregnancy outcomes by supporting embryonic development. Clinical studies demonstrate dydrogesterone significantly reduces miscarriage rates in women with recurrent pregnancy loss.
This document summarizes a clinical trial that compared the uric acid lowering efficacy and safety of febuxostat to allopurinol in treating hyperuricemia in gout patients. The trial found that febuxostat 80mg daily was more effective at lowering uric acid levels than either febuxostat 40mg or allopurinol 300/200mg, especially in patients with mild to moderate kidney impairment. Febuxostat 40mg and allopurinol 300/200mg showed equivalent uric acid lowering efficacy. The safety profiles of febuxostat and allopurinol were found to be comparable.
Overactive bladder (OAB) is a common condition characterized by urgency, frequency, and urge incontinence. Behavioral therapies are recommended as first-line treatment, with antimuscarinic drugs and beta-3 agonists as pharmacologic options. Combination therapy with drugs from different classes may provide improved efficacy over monotherapy. Newer drugs like mirabegron, vibegron and combinations of existing drugs show promise based on clinical trial results demonstrating reductions in OAB symptoms and improvements in quality of life. However, OAB likely encompasses different phenotypes, supporting a shift towards more personalized treatment approaches tailored to individual patient characteristics.
ATOSIBAN a New Hope in Preterm Labour Dr. Sharda jain DGFPublicAwareness
Atosiban is a novel tocolytic agent that acts as an oxytocin receptor antagonist, specifically targeting the myometrium to delay preterm birth. It has the best safety profile of available tocolytics as it does not affect other tissues. Atosiban is the only licensed tocolytic and is recommended as the first-line treatment for preterm labor. It provides uterine relaxation within 10 minutes of administration with minimal maternal and neonatal side effects. Atosiban has been shown to not alter uterine or fetal blood flow and its use is not associated with any serious adverse drug reactions.
The document discusses the management of overactive bladder for gynecologists. It defines overactive bladder based on symptoms of urgency, with or without urge incontinence, usually with frequency and nocturia. It notes that overactive bladder significantly impacts quality of life through physical, psychological, social, sexual, and occupational problems. Treatment options include lifestyle changes, behavioral therapy, medications, minimally invasive procedures, and surgery. Common medications used are anticholinergic agents like trospium chloride, oxybutynin, tolterodine, solifenacin, and darifenacin.
Overactive bladder (OAB) is a common condition that affects millions of people. Overactive bladder isn't a disease. It's the name of a group of urinary symptoms. The most common symptom of OAB is a sudden urge to urinate that you can't control. Some people will leak urine when they feel the urge.
This document outlines the department of urology at a hospital in Chennai, India. It lists the professors and assistant professors in the department. It then provides information on overactive bladder, including its prevalence, symptoms, potential causes like neurological conditions, medications, and idiopathic factors. It discusses various theories for the causes of overactive bladder, including neurogenic, myogenic, and autonomous bladder theories. It also outlines the role of the urothelium, afferent nerves, suburothelial interstitial cells, and potential pathophysiological factors like damage to intrinsic neurons that may contribute to overactive bladder.
The document is a lecture on the treatment of endometriosis-associated infertility according to 2022 ESHRE guidelines. It discusses various treatment options including medical treatment with hormonal therapies, surgery, assisted reproductive technologies (ART), and fertility preservation. Key recommendations include that ovarian suppression should not be used to improve fertility. Surgery and ART may be considered depending on the stage of endometriosis and patient factors. Extensive counseling is recommended when discussing fertility preservation options.
Febuxostat for treatment of chronic goutChoying Chen
Febuxostat is a xanthine oxidase inhibitor approved for the treatment of chronic gout. It has been shown in clinical trials to be more effective at lowering uric acid levels compared to allopurinol and is generally well-tolerated. However, febuxostat has been associated with increased rates of liver function abnormalities and cardiovascular events compared to allopurinol. It is recommended that liver function and symptoms of cardiovascular events be monitored in patients taking febuxostat. Febuxostat provides an alternative treatment option for patients who do not achieve target uric acid levels or experience adverse effects with allopurinol.
This document summarizes information about GLP-1 receptor agonists for treating diabetes. It reviews the pharmacology and mechanism of action of GLP-1 receptor agonists, comparing the advantages and disadvantages of the class. Specific products are discussed, including dosing and side effects. Head-to-head clinical trials comparing different GLP-1 receptor agonists are summarized. Safety issues like the black box warning for thyroid cancer risk are also addressed. The document provides an overview of GLP-1 receptor agonists for non-insulin treatment of diabetes.
This document provides an overview of overactive bladder (OAB). It defines OAB and its main symptoms of urgency, frequency, and nocturia. It discusses the prevalence of OAB increasing with age and being similar between genders. The document outlines the bladder anatomy and physiology, as well as theories around the etiology and pathophysiology of OAB. It describes the diagnosis and clinical evaluation of OAB through medical history, physical exam, urinalysis, and other tests. Finally, it covers treatment approaches for OAB including behavioral modifications, medications, injections, and surgeries.
This document discusses progesterone and its role in female reproduction. It begins by explaining that fertility and menstruation are controlled by hormones, including estrogen and progesterone. Progesterone prepares the uterine lining for pregnancy and supports gestation. Dydrogesterone is then introduced as a synthetic progestogen used to treat gynecological disorders caused by low progesterone levels, such as premenstrual syndrome and recurrent miscarriage. Its mechanism of action, pharmacokinetics, indications, and dosage are described. Finally, a randomized controlled trial is summarized that found dydrogesterone to be as effective as micronized progesterone for luteal support during in vitro fertilization, with the benefit of oral versus vaginal administration.
Dydrogesterone का नया अवतार (Part 1) Dr Sharda Jain Lifecare Centre
This document provides an overview of endometriosis, including:
1. Definitions, symptoms, prevalence, risk factors, and theories of pathogenesis. Chronic inflammation plays a key role in the development and progression of endometriosis.
2. Diagnosis is based on clinical history and laparoscopic inspection with biopsy. Staging uses the ASRM or ENZIAN classification systems. Early diagnosis is important to mitigate symptoms and disease progression.
3. Endometriosis is associated with infertility due to factors like lesions, cysts, inflammation, and hormonal imbalances that create an adverse pelvic environment.
4. Medical therapy is essential as endometriosis cannot be cured,
Anticholinergic and Mirabegron in Detrusor Overactivity Siddesh Dhanraj
1) Mirabegron and antimuscarinics are both effective treatment options for overactive bladder, with mirabegron offering fewer anticholinergic side effects such as dry mouth.
2) Combination therapy with solifenacin and mirabegron provides greater improvement in overactive bladder symptoms compared to monotherapy, though it is associated with more anticholinergic side effects.
3) Efficacy and safety of solifenacin, mirabegron, and their combination is maintained in elderly patients over 65 years old with overactive bladder, with combination therapy demonstrating the greatest benefit.
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Ovarian stimulation for ovulatory disorders and assisted reproduction. From simple induction with oral medications till the controlled ovarian stimulation including different protocols.
tirzepatide once weekly for the treatment of obesity.pptxssuser1abbaa
Tirzepatide is a once-weekly injectable peptide that targets GIP and GLP-1 receptors for the treatment of obesity. This phase 3 trial evaluated the efficacy and safety of tirzepatide in adults with obesity or overweight without diabetes. It found that all three doses of tirzepatide (5mg, 10mg, and 15mg) led to clinically meaningful weight loss compared to placebo over 72 weeks. Weight loss exceeded 20% for those receiving the highest dose. The most common side effects were nausea, diarrhea, vomiting, and constipation. However, treatment discontinuation due to adverse events was low.
This document discusses the role of progesterone in pregnancy and preventing preterm birth. It begins by outlining the problem of preterm birth globally, noting that 15 million babies are born preterm each year. It then discusses various trials investigating the use of progesterone supplementation to prevent preterm birth, including the large NICHD/MFMU trial which found that weekly injections of 17α-hydroxyprogesterone caproate reduced preterm birth rates. The document also notes vaginal progesterone trials have shown benefits but results are more mixed in high-order multiples and women with a short cervix may benefit most.
Role of Dydrogesterone in repeated pregnancy lossNiranjan Chavan
Dydrogesterone has been shown to effectively treat recurrent pregnancy loss by modulating the immune system. It shifts the balance from a pro-inflammatory Th1 response towards an anti-inflammatory Th2 response by [1] inhibiting the production of Th1 cytokines IFN-γ and TNF-α and [2] inducing production of the Th2 cytokines IL-4 and IL-6. This results in improved pregnancy outcomes by supporting embryonic development. Clinical studies demonstrate dydrogesterone significantly reduces miscarriage rates in women with recurrent pregnancy loss.
This document summarizes a clinical trial that compared the uric acid lowering efficacy and safety of febuxostat to allopurinol in treating hyperuricemia in gout patients. The trial found that febuxostat 80mg daily was more effective at lowering uric acid levels than either febuxostat 40mg or allopurinol 300/200mg, especially in patients with mild to moderate kidney impairment. Febuxostat 40mg and allopurinol 300/200mg showed equivalent uric acid lowering efficacy. The safety profiles of febuxostat and allopurinol were found to be comparable.
Overactive bladder (OAB) is a common condition characterized by urgency, frequency, and urge incontinence. Behavioral therapies are recommended as first-line treatment, with antimuscarinic drugs and beta-3 agonists as pharmacologic options. Combination therapy with drugs from different classes may provide improved efficacy over monotherapy. Newer drugs like mirabegron, vibegron and combinations of existing drugs show promise based on clinical trial results demonstrating reductions in OAB symptoms and improvements in quality of life. However, OAB likely encompasses different phenotypes, supporting a shift towards more personalized treatment approaches tailored to individual patient characteristics.
ATOSIBAN a New Hope in Preterm Labour Dr. Sharda jain DGFPublicAwareness
Atosiban is a novel tocolytic agent that acts as an oxytocin receptor antagonist, specifically targeting the myometrium to delay preterm birth. It has the best safety profile of available tocolytics as it does not affect other tissues. Atosiban is the only licensed tocolytic and is recommended as the first-line treatment for preterm labor. It provides uterine relaxation within 10 minutes of administration with minimal maternal and neonatal side effects. Atosiban has been shown to not alter uterine or fetal blood flow and its use is not associated with any serious adverse drug reactions.
The document discusses the management of overactive bladder for gynecologists. It defines overactive bladder based on symptoms of urgency, with or without urge incontinence, usually with frequency and nocturia. It notes that overactive bladder significantly impacts quality of life through physical, psychological, social, sexual, and occupational problems. Treatment options include lifestyle changes, behavioral therapy, medications, minimally invasive procedures, and surgery. Common medications used are anticholinergic agents like trospium chloride, oxybutynin, tolterodine, solifenacin, and darifenacin.
Overactive bladder (OAB) is a common condition that affects millions of people. Overactive bladder isn't a disease. It's the name of a group of urinary symptoms. The most common symptom of OAB is a sudden urge to urinate that you can't control. Some people will leak urine when they feel the urge.
This document outlines the department of urology at a hospital in Chennai, India. It lists the professors and assistant professors in the department. It then provides information on overactive bladder, including its prevalence, symptoms, potential causes like neurological conditions, medications, and idiopathic factors. It discusses various theories for the causes of overactive bladder, including neurogenic, myogenic, and autonomous bladder theories. It also outlines the role of the urothelium, afferent nerves, suburothelial interstitial cells, and potential pathophysiological factors like damage to intrinsic neurons that may contribute to overactive bladder.
The document is a lecture on the treatment of endometriosis-associated infertility according to 2022 ESHRE guidelines. It discusses various treatment options including medical treatment with hormonal therapies, surgery, assisted reproductive technologies (ART), and fertility preservation. Key recommendations include that ovarian suppression should not be used to improve fertility. Surgery and ART may be considered depending on the stage of endometriosis and patient factors. Extensive counseling is recommended when discussing fertility preservation options.
Febuxostat for treatment of chronic goutChoying Chen
Febuxostat is a xanthine oxidase inhibitor approved for the treatment of chronic gout. It has been shown in clinical trials to be more effective at lowering uric acid levels compared to allopurinol and is generally well-tolerated. However, febuxostat has been associated with increased rates of liver function abnormalities and cardiovascular events compared to allopurinol. It is recommended that liver function and symptoms of cardiovascular events be monitored in patients taking febuxostat. Febuxostat provides an alternative treatment option for patients who do not achieve target uric acid levels or experience adverse effects with allopurinol.
This document summarizes information about GLP-1 receptor agonists for treating diabetes. It reviews the pharmacology and mechanism of action of GLP-1 receptor agonists, comparing the advantages and disadvantages of the class. Specific products are discussed, including dosing and side effects. Head-to-head clinical trials comparing different GLP-1 receptor agonists are summarized. Safety issues like the black box warning for thyroid cancer risk are also addressed. The document provides an overview of GLP-1 receptor agonists for non-insulin treatment of diabetes.
This document provides an overview of overactive bladder (OAB). It defines OAB and its main symptoms of urgency, frequency, and nocturia. It discusses the prevalence of OAB increasing with age and being similar between genders. The document outlines the bladder anatomy and physiology, as well as theories around the etiology and pathophysiology of OAB. It describes the diagnosis and clinical evaluation of OAB through medical history, physical exam, urinalysis, and other tests. Finally, it covers treatment approaches for OAB including behavioral modifications, medications, injections, and surgeries.
This document discusses progesterone and its role in female reproduction. It begins by explaining that fertility and menstruation are controlled by hormones, including estrogen and progesterone. Progesterone prepares the uterine lining for pregnancy and supports gestation. Dydrogesterone is then introduced as a synthetic progestogen used to treat gynecological disorders caused by low progesterone levels, such as premenstrual syndrome and recurrent miscarriage. Its mechanism of action, pharmacokinetics, indications, and dosage are described. Finally, a randomized controlled trial is summarized that found dydrogesterone to be as effective as micronized progesterone for luteal support during in vitro fertilization, with the benefit of oral versus vaginal administration.
Dydrogesterone का नया अवतार (Part 1) Dr Sharda Jain Lifecare Centre
This document provides an overview of endometriosis, including:
1. Definitions, symptoms, prevalence, risk factors, and theories of pathogenesis. Chronic inflammation plays a key role in the development and progression of endometriosis.
2. Diagnosis is based on clinical history and laparoscopic inspection with biopsy. Staging uses the ASRM or ENZIAN classification systems. Early diagnosis is important to mitigate symptoms and disease progression.
3. Endometriosis is associated with infertility due to factors like lesions, cysts, inflammation, and hormonal imbalances that create an adverse pelvic environment.
4. Medical therapy is essential as endometriosis cannot be cured,
Anticholinergic and Mirabegron in Detrusor Overactivity Siddesh Dhanraj
1) Mirabegron and antimuscarinics are both effective treatment options for overactive bladder, with mirabegron offering fewer anticholinergic side effects such as dry mouth.
2) Combination therapy with solifenacin and mirabegron provides greater improvement in overactive bladder symptoms compared to monotherapy, though it is associated with more anticholinergic side effects.
3) Efficacy and safety of solifenacin, mirabegron, and their combination is maintained in elderly patients over 65 years old with overactive bladder, with combination therapy demonstrating the greatest benefit.
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
This document discusses medical management options for dysfunctional uterine bleeding (DUB). It begins by defining DUB and outlining treatment goals of controlling bleeding, correcting related conditions, preventing recurrence, and improving quality of life. First line treatment is recommended to be a levonorgestrel-releasing intrauterine system. Other options discussed include tranexamic acid, NSAIDs, combined oral contraceptives, and various progestogen therapies. Ormeloxifene is presented as an ideal selective estrogen receptor modulator for DUB due to its tissue-specific effects and safety profile. Studies demonstrate its effectiveness in reducing bleeding and improving outcomes for women with DUB.
A benign tumor of muscular and fibrous tissues, typically developing in the wall of the uterus.
Prevalence varies among studies and countries (4.5-68.6%)
Nearly 20-30% Indian women in reproductive age group have fibroid uterus
At any given time, nearly 15-25 million Indian women have fibroid uterus
Understand fibroids in a better way
Dr. Sharda Jain, Dr. Jyoti Agarwal, and Dr. Jyoti Bhaskar presented an interactive session on the medical management of dysfunctional uterine bleeding (DUB) in 2014. Ormeloxifene, a selective estrogen receptor modulator, was discussed as a non-steroidal treatment option for DUB that has shown efficacy in several pilot studies and randomized controlled trials. Ormeloxifene has advantages of a convenient dosing schedule and few side effects, and has been used to successfully treat over 700 patients with DUB. Feedback was encouraged from participants on experiences treating DUB.
Medical management of dub – new modalities dr. jyoti bhaskar lecture 4Lifecare Centre
This document discusses treatment options for dysfunctional uterine bleeding (DUB). It begins by defining heavy menstrual bleeding and noting the goals of treatment. It recommends a woman-centered approach. The NICE guidelines recommend levonorgestrel-releasing intrauterine system (LNG-IUS) as first-line treatment, followed by tranexamic acid or NSAIDs as second-line options. Third-line includes oral or injected progestogens. It also discusses the use of oral contraceptives, progestational agents like medroxyprogesterone acetate, and the potential role of selective estrogen receptor modulators like ormeloxifene. Surgical and medical management are compared.
This document discusses treatments for detrusor overactivity (OAB), including anticholinergic/antimuscarinic drugs and mirabegron. It provides statistics on the prevalence and projected increase of OAB worldwide. Anticholinergics work by blocking muscarinic receptors in the bladder to reduce contractions. Mirabegron is a beta-3 adrenergic agonist that works differently by activating beta-3 receptors to relax the detrusor muscle. The document reviews the mechanisms and side effect profiles of various anticholinergic drugs and mirabegron as alternatives or additions for treating OAB.
This document provides a summary of recent multiple sclerosis (MS) research updates presented by Dr. Monique Canonico at the University of Hawaii John A. Burns School of Medicine. It discusses: 1) New oral medications approved by the FDA to treat MS, including Aubagio, Gilenya, and Tecfidera; 2) Ongoing clinical trials investigating new treatments and the potential role of diet and exercise in managing MS symptoms; and 3) Resources for patients, including assistive technology centers and support organizations.
This study compared the effectiveness of febuxostat and allopurinol in lowering serum urate levels using data from a large U.S. managed care organization. The study included over 16,000 patients taking febuxostat or allopurinol for gout. After matching patients based on demographics, clinical characteristics, and other factors, febuxostat was found to be more effective than allopurinol at reducing serum urate levels and achieving treatment targets. A higher proportion of febuxostat users reached targets of less than 6 mg/dL and less than 5 mg/dL, and they reached the targets faster than allopurinol users. Febuxostat was also more effective in overall
This document summarizes research on the effects of alternative hormonal treatments, including bazedoxifene, on various tissues in humans. It discusses preclinical and clinical data on the effects of ospemifene, tamoxifen, raloxifene, and bazedoxifene on the endometrium, vagina, breast, and bone. It then summarizes results from several clinical trials, known as the SMART trials, that evaluated the efficacy and safety of a combination of conjugated estrogens and bazedoxifene for vasomotor symptoms, quality of life, vaginal health, and bone mineral density and fracture risk reduction.
This clinical trial involved 245 patients with type 2 diabetes who were randomized to receive either insulin degludec once daily, insulin degludec three times per week, or insulin glargine once daily, all in combination with metformin. The primary outcome was change in HbA1c levels after 16 weeks of treatment. The results showed that HbA1c levels were reduced from baseline in all treatment groups, with reductions of 1.3-1.5% and no significant differences between the groups. Fasting glucose levels and body weight changes were also similar across groups. This trial demonstrated that insulin degludec provided glycemic control comparable to insulin glargine with no increased safety risks, including with a dos
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 )Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 ) MODERATOR
DR SHARDA JAIN
DR ILA GUPTA
DR DIPTI NABH
panelist
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
The use of bisphosphonate for patients on glucocorticoid therapy for the prev...sara_abudahab
This document summarizes two meta-analyses on the use of bisphosphonates for patients on glucocorticoid therapy. The first analysis from 2013 found bisphosphonates reduced the risk of vertebral fractures and increased bone mineral density. Prevention trials had greater benefits than treatment trials. The second 2016 analysis also found bisphosphonates reduced vertebral fractures and increased bone mineral density, with high certainty for fractures and moderate certainty for bone mineral density. It found low certainty of effect on non-vertebral fractures and serious adverse events. Both analyses support the use of bisphosphonates to reduce fractures and treat glucocorticoid-induced bone loss.
12 fischer best use of 5-as_as immunomodulator agentsangel4567
1) 5-ASAs are strongly recommended for inducing remission in mild-to-moderate UC but are not recommended for Crohn's disease.
2) Immunomodulators like azathioprine and 6-MP are recommended for maintaining remission in UC and Crohn's disease but not for inducing remission.
3) Diet, probiotics, and antibiotics like rifaximin show some promise in treating IBD but require more research to determine their effectiveness. Maintaining the right balance of gut microbiota may help manage symptoms.
LNG-IUS: heavy menstrual bleeding What is new??? Dr. Jyoti Agarwal / Dr. Sha...Lifecare Centre
The document discusses the use of levonorgestrel-releasing intrauterine systems (LNG-IUS), such as Mirena, for treating heavy menstrual bleeding. It provides an overview of LNG-IUS, including how it works locally in the uterus to reduce bleeding. Studies show LNG-IUS reduces bleeding by over 90% and is more effective than oral treatments. It is recommended as the first-line treatment for heavy bleeding by international guidelines and has fewer side effects than other options like endometrial ablation or hysterectomy. LNG-IUS is found to improve quality of life more than surgical treatments and is more cost-effective in the long run.
This study compared the efficacy and safety of non-immunogenic staphylokinase versus alteplase in patients with acute ischemic stroke. The FRIDA trial was a randomized, open-label, multicenter, non-inferiority trial. The primary outcome was good functional recovery at 90 days, as measured by a modified Rankin Scale score of 0-1. Results showed that staphylokinase was non-inferior to alteplase, with 50% of staphylokinase patients and 41% of alteplase patients having a good recovery. Staphylokinase also had a lower rate of symptomatic intracranial hemorrhage compared to alteplase
This document discusses several studies on the use of gabapentin and pregabalin in orthopedics:
1) A study of 100 low back pain patients found that gabapentin significantly reduced pain severity and improved sleep quality compared to baseline. 62% of patients were extremely satisfied with gabapentin.
2) A review of 3 randomized controlled trials found that GABA derivatives like gabapentin were effective and safe for osteoarthritis pain management, though more research is needed.
3) A study comparing gabapentin and amitriptyline for radiculopathy pain found that gabapentin significantly reduced pain scores more than amitriptyline after 12 weeks and had better efficacy and safety.
Ormeloxifene is an effective and safe treatment for dysfunctional uterine bleeding. A study of 60 women found that ormeloxifene significantly reduced menstrual blood loss and increased hemoglobin levels after both 3 and 6 months of treatment. It also significantly decreased endometrial thickness. The majority of women reported marked improvement in symptoms and found ormeloxifene acceptable with minimal side effects. Ormeloxifene is thus a good alternative for managing dysfunctional uterine bleeding.
Similar to Anticholinergic and mirabegron in detrusor overactivity (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
2. • In the 2013 dataset, the prevalence of OAB was 7.2%
(Male: 7.7%; Female: 6.7%).
• Prevalence was the highest among those aged more
than 74 years (9.3%), identifying as White (7.4%), and
residing in urban areas (7.5%).
• By 2027, OAB is projected to increase by 48.1%
https://www.researchgate.net/publication/333411220_The_Prevalence_and_Forecast_Prevalence_of_Overactive_Bladder_in_the_Medicare_Population
8. O
A
B
Diagnostics Assessment
History (Bladder diary in selected patients)
Physical Exam
Women: Cough test for stress incontinence
Men: Non-invasive flow rate
Measurement of voiding flow rate
Post void residual volume determination
Urinanalysis
9. O
A
B
Treatment Options
Behavioural interventions
• Pelvic floor muscle exercises.
• Healthy weight.
• Scheduled toilet trips
• Intermittent catheterization
• Absorbent pads
• Bladder training
Medications
Bladder injections (OnabotulinumtoxinA)
Nerve stimulation
Surgery
• Surgery to increase bladder capacity.
• Bladder removal.
10. Medication available for the treatment of OAB -
• Antimuscarinics/Anticholinergic
• Beta-3 adrenergic
• Antispasmodic
• Hormones
• OnabotulinumtoxinA (Botox)
12. Muscarinic receptors are
distributed to most of the
organs in the body.
Antimuscarinics have
important sites of action
outside the bladder that
cause effects limiting
their clinical use.
14. Antimuscarinic AE’s-
1. Treatment for overactive bladder using antimuscarinics in adults
aged 65 or older resulted in significant increases in risk for several
AEs compared to placebo including anticholinergic and non-
anticholinergic AEs. (Arch Gerontol Geriatr.2017;69:77-96).
2. Heart rate significantly increased in OAB patients treated with non-
selective antimuscarinic drugs. Trospium chloride, tolterodine tartrate,
fesoterodine fumarate and propiverine hydrochloride seem to have the
most unfavorable properties with regard to increased heart rate side
effect when compared to the other antimuscarinic drugs (darifenacin
hydrobromide, solifenacin succinate and oxybutynin hydrochloride).
• Int Urol Nephrol. 2019;51(3):417-424.
3. Which anticholinergic is best for people with overactive bladders? A
network meta-analysis
(Int Urogynecol J.2019;30(10):1603-1617).
All the anticholinergic drugs were better than placebo but apart from
dry mouth were similar in effect. Transdermal oxybutynin caused less
dry mouth than the other treatments, so may be worth considering as
the first treatment.
15. Beta-3 adrenergic drug for the treatment of OAB -
Mirabegron: clinical considerations in OAB*
First b3-adrenoceptor agonist approved for OAB
Once-daily oral administration
Reduces the frequency of micturition, incontinence
and urgency and improves HR-QOL
Sustains these improvements over 52 weeks’ therapy
Generally well tolerated
16. Beta-3 adrenergic drug MOA* - • Sympathetic and parasympathetic
innervation diametrically regulates the
function of the lower urinary tract.
• Sympathetic nerve activity triggers the
release of noradrenaline (NA),which relaxes
the detrusormuscle and promotes
contraction of the urethra, thereby
promoting the storage of urine.
• During urination, parasympathetic nerve
activity predominates; the release of nitric
oxide (NO) inhibits contraction of the
urethra, and acetylcholine (ACh) release
triggers contraction of the detrusor muscle.
• Like noradrenaline, mirabegron acts on the
β3-adrenoreceptor, triggering detrusor
muscle relaxation and improved urine
storage
* Br J Clin Pharmacol-2015,80:4; 762–764
17. Possible utilisation of Mirabegron in the treatment
of patients with OAB -*
Patients with OAB
Anticholinergic/
Antimuscarinic drugs
β3 – adrenoceptor agonist
(Mirabegron)
Effective and Tolerate
treatment
1. Insufficient efficacy
2. Poor tolerability
Anticholinergic/
Antimuscarinic drugs *BJU Int. 2015 Jan;115(1):32-40. doi: 10.1111/bju.12730. Epub 2014 Jul 27.
18. Diagnosis & Treatment Algorithm: AUA/SUFU Guideline on
Non-Neurogenic Overactive Bladder in Adults*-2019
Pharmacologic Management
Consider dose modification or alternate
medication if initial treatment is effective but
adverse events or other considerations preclude
continuation; consider combination therapy
with an anti-muscarinic and ß3-adrenoceptor
agonist for patients refractory to monotherapy
with either.
*https://www.auanet.org/guidelines/overactive-bladder-(oab)-guideline
19. Possible utilisation of Mirabegron in the treatment
of patients with OAB -*
1. Impact of body mass index on treatment efficacy of mirabegron
for overactive bladder in females* (Eur J Obstet Gynecol Reprod Biol. 2016 Jan;196:64-8).
CONCLUSIONS:
This study provides evidence in support of documented data obtained do
not confirm hypothesis that the body weight influences the treatment
outcome of mirabegron.
2. The β3-adrenergic receptor agonist mirabegron improves glucose
homeostasis in obese humans* (J Clin Invest.2020 Jan 21).
CONCLUSION:
Mirabegron treatment significantly improves glucose tolerance in
obese, insulin resistant humans. Since β-cells and skeletal muscle do not
express β3-ARs, these data suggest that the beiging of SC WAT
(subcutaneous white adipose tissue) by mirabegron reduces adipose
tissue dysfunction, which enhances muscle oxidative capacity and
improves β-cell function.
Diabetes Mellitus Type 2
* (Eur J Obstet Gynecol Reprod Biol. 2016 Jan;196:64-8).
* (J Clin Invest.2020 Jan 21).
21. Efficacy and safety of combinations of Mirabegron and solifenacin compared with monotherapy
and placebo in patients with overactive bladder (SYNERGY study) - BJU Int 2017; 120: 562–575.
Objective
To evaluate the potential of solifenacin 5 mg combined with Mirabegron 25 or 50 mg to deliver superior efficacy
compared with monotherapy, with acceptable tolerability, in the general overactive bladder (OAB) population with
urinary incontinence (UI).
Conclusion
• In the largest OAB study to date, combined therapy with solifenacin 5 mg + mirabegron 25 mg and solifenacin 5
mg + mirabegron 50 mg provided consistent improvements in efficacy compared with the respective
monotherapies across most of the outcome parameters, with effect sizes generally consistent with an additive
effect
• Most effects of combined therapy vs monotherapy were observable by week 4.
• The clinical relevance of the improvements seen with combined therapy for several objective OAB outcome
measures was also supported by the improvements of combined therapy vs monotherapy in the responder
analyses.
22. Efficacy and Tolerability of Mirabegron Compared with Antimuscarinic Monotherapy or Combination Therapies
for Overactive Bladder: A Systematic Review and Network Meta-analysis -Eur Urol. 2018 Sep;74(3):324-333.
Objective:
To assess efficacy and tolerability of mirabegron 50 mg versus antimuscarinic monotherapies
and combination therapies.
Patient summary:
This study assessed the efficacy and tolerability of different drug treatments for
OAB. Mirabegron 50 mg was as effective as antimuscarinic therapy, with fewer common, bothersome
side effects such as dry mouth, constipation, and urinary retention. Combination treatment of
solifenacin 5 mg plus mirabegron 25 or 50 mg was more effective than mirabegron 50 mg alone,
but with more anticholinergic side effects.
Conclusion
The relief of key OAB symptoms produced by mirabegron 50 mg is significantly better than placebo, and similar to a
range of common antimuscarinics, with the benefit of significantly fewer bothersome anticholinergic side effects
such as dry mouth. Combination treatment of solifenacin 5 mg plus mirabegron 25 or 50 mg appears to provide an
efficacy benefit compared with mirabegron 50 mg, with the expected side effects of individual antimuscarinics.
23. Treating Overactive Bladder in Older Patients with a Combination of Mirabegron and Solifenacin:
A Prespecified Analysis from the BESIDE Study - Eur Urol Focus.2017 Dec;3(6):629-638.
Objective: To ensure efficacy and safety is maintained in older patients (>65 yr), who usually experience greater symptom
severity and comorbidities, a prespecified subanalysis stratified by age group was conducted.
Design, setting, and participants: Patients remaining incontinent (episode during 3-d diary) following 4-wk single-blind
daily solifenacin 5 mg were randomized 1:1:1 to a daily double-blind combination (solifenacin 5 mg and mirabegron 25 mg,
increased to 50 mg at wk 4), solifenacin 5 mg or 10 mg for 12 wk. Four cohorts stratified by age (<65 yr, 65 yr and
< 75 yr, 75 yr) were investigated.
Conclusion
Efficacy and safety in the overall population is maintained in older ( 65 yr) and elderly ( 75 yr) patients treated
with a combination of solifenacin and mirabegron, or solifenacin monotherapy; irrespective of age, combination was
associated with the greatest improvement in overactive bladder symptoms.
Patient summary: This study investigated the effectiveness and safety of a combination of two different treatments
(mirabegron 50 mg and solifenacin 5 mg) or solifenacin (5 mg or 10 mg) alone in patients aged <65 yr or 65 yr,
and <75 yr or 75 yr with overactive bladder. Symptoms of overactive bladder, such as the urgent need to visit the
toilet, incontinence, and frequent urination, were improved with all treatments regardless of the patient’s age, but
combination treatment demonstrated the greatest benefit, and was well tolerated.
24. Sites of action and mechanisms of therapeutic agents used for the treatment
of neurogenic overactive bladder - Mov Disord. 2018 Mar; 33(3): 372–390.
Cholinergic pelvic nerves release acetylcholine
(ACh), which, via activation of muscarinic M3
receptors, induce contraction of the detrusor
muscle and emptying of the bladder.
Anti-muscarinic agents (e.g., solifenacin) block the
muscarinic receptor and reduce detrusor muscle
contractions. Hypogastric adrenergic nerves release
norepinephrine (NE), which causes urinary
retention by activating β3-adrenergic receptors in
the detrusor muscle and alpha-adrenergic
receptors in the internal sphincter of the urethra.
Mirabegron, a β3-adrenergic receptor agonist,
reduces bladder contractions in patients with
neurogenic detrusor overactivity.
Of note, the classical nomenclature of the sacral
autonomic outflow has been recently challenged
25. Treatment Recommended dosing regimen Adverse events Receptor selectivity CNS penetration
Anticholinergic agents
Darifenacin 7.5 or 15 mg/day Constipation, dry mouth, urinary retention M3 selective Low
Trospium
20 mg twice a day
60 mg/day (extended release form)
Constipation, dry mouth, dry eyes, headache, urinary
retention
Non-selective Low
Solifenacin 5 or 10 mg/day
Constipation, dry mouth, blurred vision, nausea,
dyspepsia, urinary retention
M3 and M1 selective Moderate
Oxybutinin
5 mg up to 4 times/day
5-30 mg/day (extended release form)
3 pumps once a day (gel)
1 patch every 3-4 days (patch)
Constipation, dry mouth, blurred vision, nausea,
dyspepsia, urinary retention
M3 and M1 selective Moderate
Tolterodine
2 mg twice a day
2 or 4 mg/day (long acting form)
Constipation, dry mouth, dyspepsia, dizziness, blurry
vision, urinary retention
Non-selective Moderate
Fesoterodine 4 or 8 mg
Constipation, dry mouth, dyspepsia, dizziness, blurry
vision, urinary retention
Non-selective Moderate
β3-adrenergic agonists
Mirabegron 25 or 50 mg/day
Hypertension, irregular heart rate, abdominal or pelvic
pain, worsening dyskinesias in PD (one case report)
β3-selective Low
Pharmacological treatments for neurogenic detrusor overactivity
Mov Disord. 2018 Mar; 33(3): 372–390.
26. β3-adrenergic agonists-
β3-adrenergic receptors contribute to detrusor muscle relaxation.
Mirabegron, a selective β3-adrenergic receptor, elicits relaxation of the detrusor muscle during the
storage phase, thereby improving bladder capacity without impeding bladder voiding.
Mirabegron is available in most countries.
Oral mirabegron administered once daily (25-50 mg) is effective to improve urinary frequency,
urgency, and incontinence in patients with overactive bladder.
Mirabegron is devoid of anticholinergic adverse events but can cause urinary retention,
pelvic/abdominal pain, and hypertension
27. Antimuscarinic agents-
Antimuscarinic drugs improve symptoms of detrusor overactivity by reducing cholinergic output to the bladder
and, thus, relaxing the detrusor muscle and reducing the urge to urinate.
Antimuscarinic agents can worsen the post-void residual volume and cause urinary retention, dry mouth, dry
eyes, gastroparesis and constipation.
There are several antimuscarinic agents, the majority of which are available in most world regions: they share
mechanism of action but differ in selectivity of M3 receptors, and CNS permeability.
Centrally acting antimuscarinic (e.g., atropine or scopolamine) or predominantly peripheral with CNS penetrance
(oxybutynin, fesoterodine) can cause/aggravate cognitive impairment and should be avoided.
Peripherally acting antimuscarinics with low CNS penetrance (e.g., trospium, darifernacine) are preferable.
Only solifenacin 5-10 mg daily has been specifically studied in a randomized placebo-controlled trial of patients
with PD showing a significant reduction in urinary frequency compared to placebo.
28. Other treatments-
Alpha-adrenergic blockers (Tamsulosin, Silodosin) should be used very cautiously, or not at all, in patients with
autonomic dysfunction as they can aggravate OH and increase the risk of falls and syncope.
Open label studies showed that intramural botulinum toxin injections in the bladder can improve refractory
neurogenic detrusor overactivity in patients with PD and MSA; potential adverse events include urinary
retention.198-200 Nocturnal natriuresis in patients with supine hypertension and nOH should be distinguished
from neurogenic detrusor overactivity.
29. Treatment of detrusor underactivity-
Incomplete bladder emptying as a consequence of detrusor underactivity is common in MSA (multiple system
atrophy) and seldom reported in patients with PD (Parkinson disease), DLB (dementia with Lewy bodies) or PAF
(pure autonomic failure).
Estimation of the post-void residual (PVR) bladder volume is a simple and useful test in patients with MSA; even
though their urinary complaints may be limited to urinary urgency or frequency, patients are usually unaware
that their bladders do not empty completely. PVR can be measured by ultrasound echography or transurethral
catheterization.
If the patient has a PVR > 100 ml, clean intermittent self-catheterization must be recommended. Either the
patient or the caregiver can usually perform this after education is provided. In patients with advanced disease
and severe neurological disability, a permanent indwelling catheter, usually suprapubic, may be required.
Antimuscarinic or β3-adrenergic treatment to reduce bladder overactivity should be added regardless of the
PVR. The caveats are the same as with the treatment of overactive bladder. Replaceable remote-controlled intra-
urethral prosthesis for women with underactive bladder have been recently approved by the U.S. FDA;209 these
do not require surgery, increase quality of life, and reduce the risk of urinary complications, although the
experience in patients with MSA is still limited
30. Algorithm for the management of underactive bladder in patients with synucleinopathies
Mov Disord. 2018 Mar; 33(3): 372–390.
Incomplete bladder emptying as a consequence of detrusor
underactivity is common in multiple system atrophy (MSA)
but seldom reported in patients with other synucleinopathies.
Estimation of the post-void residual (PVR) bladder volume is
a simple and useful test in patients with MSA; even though
their urinary complaints may be limited to urinary urgency or
frequency, patients are usually unaware that their bladders do
not empty completely.
PVR can be measured by ultrasound echography or
transurethral catheterization. If the patient has a PVR > 100
ml, clean intermittent self-catheterization must be
recommended. Either the patient or the caregiver can usually
perform this after education is provided. In patients with
advanced disease and severe neurological disability, a
permanent indwelling catheter, usually suprapubic, may be
required. Antimuscarinic or β3-adrenergic treatment to
reduce bladder overactivity should be added regardless of the
PVR. (*) Replaceable remote-controlled intra-urethral
prosthesis for women with underactive bladder have been
recently approved by the Food and Drug Administration. Our
experience in women with MSA, although limited, is very
positive.