VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
combinations of mirabegron with 10 mg solifenacin are actually lower than the dry mouth rate reported with solifenacin alone. Hypertension rates varied, with 11.7% and 14.1% of patients taking 25 mg and 50 mg mirabegron alone, respectively, being recorded as having hypertension as opposed to 8.6% of those taking placebo. Interestingly the rates with 5 or 10 mg solifenacin were less than those recorded in the 50 mg mirabegron alone group. Studies of larger numbers of patients and fewer groups will obviously be necessary to confirm some of the suggestions made in this article. However, it certainly appears that the 2 agents can be combined with a minimum, if any, increase in adverse event profile and with an improvement in at least some efficacy parameters. It would seem that the goal would be to achieve the efficacy of high dose antimuscarinic therapy alone by combining a b-agonist with low dose antimuscarinic therapy, resulting in a lower incidence of adverse events than would be seen with higher dose antimuscarinic therapydan obvious advantage for patients, which might improve compliance with oral therapy for OAB. Alan J. Wein, MD, PhD (hon)
Re: Urodynamic Studies for Management of Urinary Incontinence in Children and Adults C. M. Glazener and M. C. Lapitan Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, Scotland Cochrane Database Syst Rev 2012; 1: CD003195.
Abstract available at http://jurology.com/ Editorial Comment: Here we go again. This is a noble effort by the Cochrane Collaboration to discover if treatment according to a urodynamic based diagnosis, compared to treatment based on history and examination, leads to more effective clinical care and better clinical outcomes. The authors concluded, “When women with incontinence are assessed using urodynamics in addition to clinical methods, they may be more likely to receive treatment, or to have their management plan changed. However, there was not enough evidence to show whether these differences in management resulted in differences in health outcomes, such as incontinence, quality of life or economic outcomes, compared to women who did not have urodynamic tests.” It was noted that insufficient data were available to evaluate the use of urodynamics in men, children or those with neurological diseases. Further randomized trials were recommended, and the comment was made that such trials would need about 400 people in each arm to have 80% power to detect a 10% difference in incontinence rates at a significance level of 5%. Such studies should include subjective and objective assessment of cure and improvement, adverse events, effect on clinical decision making, patient opinion and satisfaction, quality of life and economic outcome measures. Alan J. Wein, MD, PhD (hon)
Re: Biomarkers in Lower Urinary Tract Symptoms/Overactive Bladder: A Critical Overview T. Antunes-Lopes, C. D. Cruz, F. Cruz and K. D. Sievert Translational NeuroUrology, Institute for Molecular and Cell Biology, and Department of Experimental Biology, Faculty of Medicine of Porto, University of Porto and Department of Urology, Hospital de S. Joa˜o, Porto, Portugal, and Department of Urology, Eberhard-Karls University, Tubingen, Germany Curr Opin Urol 2014; 24: 352e357.
Abstract available at http://jurology.com/ Editorial Comment: To quote the authors, “Biomarkers are objectively measurable characteristics that may be used to define the presence of a condition (diagnostic biomarker), its severity and progression (prognostic biomarker) or the response to a particular treatment (predictive biomarker)”!
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combinations of mirabegron with 10 mg solifenacin are actually lower than the dry mouth rate reported with solifenacin alone. Hypertension rates varied, with 11.7% and 14.1% of patients taking 25 mg and 50 mg mirabegron alone, respectively, being recorded as having hypertension as opposed to 8.6% of those taking placebo. Interestingly the rates with 5 or 10 mg solifenacin were less than those recorded in the 50 mg mirabegron alone group. Studies of larger numbers of patients and fewer groups will obviously be necessary to confirm some of the suggestions made in this article. However, it certainly appears that the 2 agents can be combined with a minimum, if any, increase in adverse event profile and with an improvement in at least some efficacy parameters. It would seem that the goal would be to achieve the efficacy of high dose antimuscarinic therapy alone by combining a b-agonist with low dose antimuscarinic therapy, resulting in a lower incidence of adverse events than would be seen with higher dose antimuscarinic therapydan obvious advantage for patients, which might improve compliance with oral therapy for OAB. Alan J. Wein, MD, PhD (hon)
Re: Urodynamic Studies for Management of Urinary Incontinence in Children and Adults C. M. Glazener and M. C. Lapitan Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, Scotland Cochrane Database Syst Rev 2012; 1: CD003195.
Abstract available at http://jurology.com/ Editorial Comment: Here we go again. This is a noble effort by the Cochrane Collaboration to discover if treatment according to a urodynamic based diagnosis, compared to treatment based on history and examination, leads to more effective clinical care and better clinical outcomes. The authors concluded, “When women with incontinence are assessed using urodynamics in addition to clinical methods, they may be more likely to receive treatment, or to have their management plan changed. However, there was not enough evidence to show whether these differences in management resulted in differences in health outcomes, such as incontinence, quality of life or economic outcomes, compared to women who did not have urodynamic tests.” It was noted that insufficient data were available to evaluate the use of urodynamics in men, children or those with neurological diseases. Further randomized trials were recommended, and the comment was made that such trials would need about 400 people in each arm to have 80% power to detect a 10% difference in incontinence rates at a significance level of 5%. Such studies should include subjective and objective assessment of cure and improvement, adverse events, effect on clinical decision making, patient opinion and satisfaction, quality of life and economic outcome measures. Alan J. Wein, MD, PhD (hon)
Re: Biomarkers in Lower Urinary Tract Symptoms/Overactive Bladder: A Critical Overview T. Antunes-Lopes, C. D. Cruz, F. Cruz and K. D. Sievert Translational NeuroUrology, Institute for Molecular and Cell Biology, and Department of Experimental Biology, Faculty of Medicine of Porto, University of Porto and Department of Urology, Hospital de S. Joa˜o, Porto, Portugal, and Department of Urology, Eberhard-Karls University, Tubingen, Germany Curr Opin Urol 2014; 24: 352e357.
Abstract available at http://jurology.com/ Editorial Comment: To quote the authors, “Biomarkers are objectively measurable characteristics that may be used to define the presence of a condition (diagnostic biomarker), its severity and progression (prognostic biomarker) or the response to a particular treatment (predictive biomarker)”!
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