Comparison the treatment of using Propiverine 45 mg with using Propiverine 30 mg and Mirabengron combined treatments’ residual urine volume amount, risk of acute urinary retantion and success in reducing symptoms in the patients with overactive bladder wh
Comparison the treatment of using Propiverine 45mg with using Propiverine 30 mg and Mirabengron combined treatments
Abstract
INTRODUCTION: Anticholinergic drugs have been used in the medical treatment of bladder overactivity fort he patients who don’t benefit first line treatment like lifestyle changes, behavioural modifications, use of pelvic floor muscles. Although many anticholinergic drugs with different effects have been developed in the medical treatment of bladder overactivity, mirabegron, which has an agonistic effect on the beta 3 adrenergic receptor, has been developed in the treatment of bladder overactivity in order to reduce many side effects that limit the usege of anticholinergic drugs, especially acute urinary retention. The usege of mirabegron in combination treatment with anticholinergics has been shown to be a safe treatment method and increases treatment success. In addition, anticholinergic therapies have been developed that reduce bladder overactivity with similar side effects and higher efficacy with lower doses such as sustained release, high dose propiverine 45 mg.
MATERIAL and METHODS: In this study, 66 adult male patients with bladder overactivity, who were given 30mg propiverine for a month, didn’t benefit, and had no obstructive symptoms were included. We have collected the data of 35 patients(group I) of these who propiverine was started on propiverine 45mg instead of propiverine 30 mg treatment and other 31 patients(group II) who were added mirabegron 50mg on propiverine 30mg treatment. Patients were called for control at 1 and 6 months; adherence and persistence were questioned, their residual urine volumes was measured by ultrasonography and complaints were evaluated using the OAB-V8 Overactive Bladder Questionnaire.
RESULTS: In our study, when the ages and chronic diseases of the patients in both groups were compared, it was seen that there was no significant difference between the groups. It was observed that there was no significant difference between the two groups in persistence the first month(45.71%vs.32.26%; p=0.267) and the sixth month after treatment(25.71%vs.22.58%; p=0.875), as well as adherence the first month(62.86%vs.64.52%; p=0.889) and the sixth month after the treatment(40.00%vs.41.94%; p=0.891). The questions in OAB-V8 forms were compared with each question and total scores of the form between the two groups groups were similar in their reports of frequent urination during the daytime hours(4.64±0.59vs.4.43±0.90; p=0.288), an uncomfortable urge to urinate(4.36±0.80vs.4.17±0.91; p=0.359), a sudden urge to urinate with little or no warning(4.31±0.95vs.4.13±0.86; p=0.447), accidental loss of small amounts of urine(2.22±1.90vs.2.20±1.60; p=0.960), night-time urination(3.22±1.25vs.3.00±1.53; p=0.518), waking up at night to urinate(2.72±1.49vs.2.40±1.73; p=0.419), an uncontrollable urge to urinate(3.89±1.09vs.3.63±1.10; p=0.348) and urine loss associated with a strong desire to urinate(2.22±1.90vs.2.17±1.60; p=0.899). In the internal analysis of groups, in the group using propiverine 45mg treatment, the adherence(62.86%vs.42.86%; p=0.008) and persistence(45.71%vs.25.71%; p=0.016) rates decreased significantly in the sixth month of the treatment compared to the first month of the treatment. In the group using combined propiverine 30mg and mirabegron treatment, the adherence rate(64.52%vs.38.71%; p=0.016) decreased significantly in the sixth month of the treatment compared to the first month, while the decrease in the persistence rate(32.26%vs.22.58%; p=0.250) was not statistically significant. Also post-voiding residual urine volume, side effects especially dry mouth and, and it was found that there was no statistically significant difference.
CONCLUSION: In male patients with bladder overactivity who did not benefit from low-dose anticholinergic treatment, propiverine 45mg monotherapy or propiverine 30mg and mirabegron combined treatment can be safely preferred in the suitable patient group with similar efficacy and limitations.
