OnabotulinumtoxinA Treatment for Overactive Bladder in the Elderly: Practical Points and Future Prospects

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• 作者：Hann-Chorng Kuo
• 刊名：Drugs & Aging
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：33
• 期：1
• 页码：1-9
• 全文大小：471 KB
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• 作者单位：Hann-Chorng Kuo (1)
  
  1. Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707, Section 3, Chung Yang Road, Hualien, Taiwan
  
• 刊物主题：Geriatrics/Gerontology; Pharmacotherapy; Pharmacology/Toxicology; Internal Medicine;
• 出版者：Springer International Publishing
• ISSN：1179-1969

文摘

Overactive bladder (OAB) increases with age. OAB in the elderly may be associated with increased risks of falls, fractures and mortality. Degeneration of the central nervous system in the elderly is proposed as one of the pathogenic factors for OAB. Recently, onabotulinumtoxinA (BoNT-A) 100 U has been demonstrated to be well tolerated, and it significantly improves all OAB symptoms and health-related quality of life in patients who are inadequately managed with anticholinergics. However, an increased risk of a large post-void residual volume and a lower long-term success rate were noted in frail elderly patients. Careful patient selection for BoNT-A injection treatment is important in elderly OAB patients. Patients who are frail, are elderly, have comorbidity or have a post-void residual volume >100 mL should be monitored carefully after BoNT-A injection treatment to prevent urinary retention and subsequent urinary tract infection. Use of liposomes to carry BoNT-A across the urothelial barrier decreases urgency–frequency episodes without compromising detrusor contractility and might avoid urinary tract infection. This treatment might prevent undesired detrusor underactivity after BoNT-A injection treatment, especially in elderly patients who have low detrusor contractility. For treatment of OAB in the elderly, clinicians should be aware of the balance between therapeutic efficacy and safety.