A Prospective Paired Comparison Trial of Mirabegron and Anticholinergics in Patients With Low Bladder Compliance.

IF 2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Neurourology Journal Pub Date : 2025-09-01 Epub Date: 2025-09-30 DOI:10.5213/inj.2550050.025

Hee Seo Son, Jang Hwan Kim

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引用次数: 0

Abstract

Purpose: Low bladder compliance (BC) poses a significant clinical challenge. Nevertheless, studies exploring pharmacological mechanisms to improve BC remain limited. We investigated the efficacy of a β3-adrenoceptor agonist, mirabegron, on BC in comparison with anticholinergics.

Methods: This prospective single-arm paired comparison trial included 14 patients with low BC (≤20 mL/cm H2O) despite anticholinergics treatment. After a 2-week anticholinergics-washout period, patients were treated with mirabegron for 8 weeks and then returned to 8 weeks of anticholinergics. Major treatment effect was assessed with urodynamic studies performed at baseline, 8 weeks after mirabegron treatment, and 8 weeks after consecutive anticholinergics treatment (McNemar test, Paired t-test; mean [95% confidence intervals]).

Results: Following mirabegron, 71.43% of patients exhibited a BC of >20 mL/cm H₂O, compared to 54.55% after switching back to anticholinergics (P=0.317). BC improved significantly from 12.02 (9.52-14.52) to 39.67 (21.60-57.73) mL/cm H2O after mirabegron treatment (P=0.007), but subsequently declined to 20.94 (15.78-26.10) mL/cm H₂O after reintroduction of anticholinergics (P=0.075). Maximum cystometric capacity increased from 352.21 (282.78-421.65) to 442.71 (348.95-536.48) mL after mirabegron (P=0.091), but decreased to 402.00 (315.92-488.08) mL after returning to anticholinergics (P=0.218). Notably, detrusor pressure at end-filling decreased significantly with mirabegron, from 30.50 (25.61-35.39) to 14.43 (10.79-18.06) cm H2O (P<0.001), while increasing to 20.36 (16.26-24.46) cm H2O after returning to anticholinergics (P=0.056).

Conclusion: A β3-adrenoceptor agonist, mirabegron, was more effective than anticholinergics in improving BC. Among the two components of improved BC-increased bladder volume and reduced detrusor filling pressure-the β3-adrenoceptor agonist showed a more pronounced effect on lowering detrusor filling pressure, compared to anticholinergics. These findings suggest that β3-adrenoceptor agonists might play an important role in reducing the tension of the bladder wall by controlling detrusor muscle tone, and this may be an important target for future research.

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Mirabegron和抗胆碱能药物在低膀胱顺应性患者中的前瞻性配对比较试验。

目的：低膀胱顺应性（BC）是一个重大的临床挑战。然而，探索改善BC的药理学机制的研究仍然有限。我们研究了β3-肾上腺素能受体激动剂mirabegron与抗胆碱能药物相比对BC的疗效。方法：这项前瞻性单臂配对比较试验纳入了14例经抗胆碱能药物治疗的低BC（≤20 mL/cm H2O）患者。在2周的抗胆碱能药物洗脱期后，患者接受mirabegron治疗8周，然后返回8周的抗胆碱能药物治疗。主要治疗效果通过基线、mirabegron治疗后8周和连续抗胆碱能药物治疗后8周的尿动力学研究进行评估（McNemar检验，配对t检验；平均值[95%置信区间]）。结果：使用mirabegron后，71.43%的患者BC为bbb20 mL/cm H₂O，而改用抗胆碱能药物后为54.55% （P=0.317）。mirabegron治疗后，BC由12.02 (9.52 ~ 14.52)mL/cm H2O显著改善至39.67 (21.60 ~ 57.73)mL/cm H2O (P=0.007)，但再次引入抗胆碱能药物后，BC降至20.94 (15.78 ~ 26.10)mL/cm H2O （P=0.075）。mirabegron治疗后最大膀胱容量由352.21 (282.78 ~ 421.65)mL增加至442.71 (348.95 ~ 536.48)mL (P=0.091)，而恢复抗胆碱能治疗后则降至402.00 (315.92 ~ 488.08)mL （P=0.218）。值得注意的是，mirabegron可显著降低灌胃末逼尿肌压力，从30.50 (25.61-35.39)cm H2O降至14.43 (10.79-18.06)cm H2O。结论：β3-肾上腺素能受体激动剂mirabegron在改善BC方面比抗胆碱能药物更有效。在改善bc的两种成分——膀胱容量增加和逼尿肌充盈压力降低中，β3-肾上腺素能受体激动剂在降低逼尿肌充盈压力方面的作用比抗胆碱能药物更明显。这些发现提示，β3-肾上腺素能受体激动剂可能通过控制逼尿肌张力在降低膀胱壁张力方面发挥重要作用，这可能是未来研究的重要目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Neurourology Journal UROLOGY & NEPHROLOGY-

CiteScore

4.40

自引率

21.70%

发文量

审稿时长

4 weeks

期刊介绍： The International Neurourology Journal (Int Neurourol J, INJ) is a quarterly international journal that publishes high-quality research papers that provide the most significant and promising achievements in the fields of clinical neurourology and fundamental science. Specifically, fundamental science includes the most influential research papers from all fields of science and technology, revolutionizing what physicians and researchers practicing the art of neurourology worldwide know. Thus, we welcome valuable basic research articles to introduce cutting-edge translational research of fundamental sciences to clinical neurourology. In the editorials, urologists will present their perspectives on these articles. The original mission statement of the INJ was published on October 12, 1997. INJ provides authors a fast review of their work and makes a decision in an average of three to four weeks of receiving submissions. If accepted, articles are posted online in fully citable form. Supplementary issues will be published interim to quarterlies, as necessary, to fully allow berth to accept and publish relevant articles.