Abstract
Introduction and hypothesis
Urethral instability (URI) has in the past been defined by the International Continence Society (ICS), but was excluded from ICS terminology and definitions shortly after because of a lack of consensus about the clinical importance of this phenomenon. Recently, interest in URI and its possible role in overactive bladder (OAB) increased again. In the last decade, a beta 3 adrenoreceptor agonist (mirabegron) was approved for the treatment of OAB. The effect of mirabegron on urethral pressure during filling cystometry is unknown. The aim of this study was to assess the influence of mirabegron on urethral pressure variations during urodynamic investigation and the association of symptoms and voiding diary data before and during treatment.
Methods
This prospective study included 51 consecutive adult female patients, referred with OAB. Patients were evaluated using a voiding diary, two validated questionnaires and two urodynamic investigations, one before and one after 6 weeks of treatment with mirabegron. URI was defined as an urethral pressure drop exceeding 30 cmH2O during filling cystometry.
Results
The prevalence of URI was 31% at initial urodynamic investigation, and 19% at second investigation. URI is more common than DO with 18% prevalence at initial evaluation. Treatment with mirabegron resulted in significant changes in symptoms and urodynamic sensory markers in patients with URI.
Conclusion
Urethral pressure variations are significantly reduced by treatment with mirabegron in patients with URI. URI seems to have a predictive value in treatment choices for OAB. Future research should elucidate this.
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Acknowledgements
The authors thank the patients and the staff of the urology outpatient clinic of HAGA for their cooperation. We would also express special gratitude to Dr. M. Mensink for coordination and inclusion of patients at HAGA.
Funding
This study was funded by Astellas unrestricted European research grant on Urogynecology 2013.
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MTMK received a speaker honorarium from Astellas; GAVK received a grant for a clinical trial from Astellas, is consultant for Solace Therapeutics and Boston Scientific, and performs clinical trials for Medtronic and Axonics; HWE received a speaker honorarium from Astellas; PMG received a speaker honorarium from Astellas; HP and JE have no conflicts of interest.
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Kummeling, M.T.M., Egberts, J., Elzevier, H.W. et al. Exploratory analysis of the effect of mirabegron on urodynamic sensation parameters and urethral pressure variations. Int Urogynecol J 32, 87–93 (2021). https://doi.org/10.1007/s00192-019-04193-4
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DOI: https://doi.org/10.1007/s00192-019-04193-4