α1‐Blockers for the treatment of recurrent urinary tract infections in women with dysfunctional voiding: A prospective randomized study

Abstract

Objectives:To evaluate the therapeutic effects of tamsulosin on recurrent urinary tract infections in women with dysfunctional voiding. Methods: A total of 155 women with recurrent urinary tract infections and dysfunctional voiding were included and randomly assigned to the following groups: uroflowmetry biofeedback (group 1), α1-adrenoceptor antagonists (group 2), uroflowmetry biofeedback combined with α1-adrenoceptor antagonists (group 3) and no treatment (group 4). Patients were evaluated by the American Urological Association Symptom Index at 3, 6 and 12 months. Urodynamics was carried out in patients of groups 1, 2, and 3 at 3, 6 and 12 months, whereas urodynamics was only carried out at 12 months in group 4. All patients were followed up for 1 year with monthly urine cultures. Results: The incidence of storage and emptying symptoms decreased significantly at 3, 6 and 12 months. Mean flow rate, flow time and voiding volume increased significantly (with a better outcome in patients of group 3), whereas post-void residual urine decreased. Mean opening detrusor pressure and detrusor pressure at maximum flow decreased significantly (with a better outcome in patients of group 3). Mean urethral closure pressure and maximum urethral closure pressure decreased significantly with a more significant decrease for patients in group 3. The prevalence of urinary tract infection decreased significantly in all groups after treatment, and this decrease remained stable during the follow up. Conclusions: In women with dysfunctional voiding and recurrent urinary tract infection, tamsulosin associated with uroflowmetry biofeedback might be an effective and safe treatment option for improving urinary symptoms and quality of life.

Een α‑adrenerge receptorantagonist als behandeling van blaasontledigingsklachten bij vrouwen: Feit of fictie?

“…De mate van obstructie, gemeten met de PdetQmax ten opzicht van de Qmax, had geen invloed op de effectiviteit van de α1-adrenerge receptorantagonist [10]. In de vijf RCT's [15][16][17][18][19] werden vergelijkbare verbeteringen beschreven, maar in vier van de vijf van RCT's met een placebogroep verbeterden niet alle uitkomstmaten significant [16][17][18][19]. In de studie van Lepor en Theune verbeterde de AUASS bijvoorbeeld niet significant [18].…”

“…In de studie van Lepor en Theune verbeterde de AUASS bijvoorbeeld niet significant [18]. Minardi et al vonden op de AUASS wel een significant verschil, maar hun onderzoekspopulatie bestond uit patiënten met recidiverende urineweginfecties en een disfunctionele mictie in plaats van LUTS, en een AUASS die al bij inclusie hoger was [19]. In de twee andere RCT's, waarin patiënten middels de IPSS werden gevolgd, werd wel een significante verschil in daling op die score aangetoond in het voordeel van de interventiegroep [16,17].…”

“…In de twee andere RCT's, waarin patiënten middels de IPSS werden gevolgd, werd wel een significante verschil in daling op die score aangetoond in het voordeel van de interventiegroep [16,17]. De urodynamische onderzoeken toonden echter in drie van de vier placebogecontroleerde trials geen significant verschil, maar wel in het artikel met de langste follow-up (1 jaar) [19].…”

Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI‐RS2018?

“…Pelvic floor physiotherapy and biofeedback, to teach pelvic floor relaxation rather than contraction, have been shown to be effective and have become the first‐line treatment for women with DV . Researchers have also explored gamma‐aminobutyric acid receptor agonists, vaginal and oral benzodiazepine, botulinum toxin injected into the EUS, alpha‐adrenergic receptor blockers, and sacral neuromodulation as possible therapeutic options . Unfortunately, most of these treatments are aimed at intrinsic urethral striated muscle overactivity and not at pelvic floor overactivity.…”

“…33,34 Researchers have also explored gamma-aminobutyric acid receptor agonists, vaginal and oral benzodiazepine, botulinum toxin injected into the EUS, alpha-adrenergic receptor blockers, and sacral neuromodulation as possible therapeutic options. 9,35 Unfortunately, most of these treatments are aimed at intrinsic urethral striated muscle overactivity and not at pelvic floor overactivity. Therefore, none can be recommended with a high level of evidence for female DV.…”