A differentiated therapeutic approach to overactive bladder in elderly and senile women
The paper considers the main problems of diagnosis and rational therapy of overactive bladder (OAB) in elderly and senile women. It is known that age-related changes in the body can lead to pronounced changes in the pharmacokinetics of drugs, since the number, density, and sensitivity of receptors can be changed, which contributes to the strengthening or weakening of the main pharmacological effect. For many decades, anticholinergic drugs have been positioned among the first-line treatments. OAB is a syndrome that requires long-term, often lifelong treatment. At the same time, the long-term use of M-anticholinergics is frequently accompanied by an inadequate response and pronounced side effects in the group of elderly patients, which substantially limits their long-term use and had often led to discontinuation of the drug by the patient himself. At present, mirabegron, a beta-3-adrenergic receptor agonist that relaxes the detrusor is regarded as the first-line therapy in elderly and senile patients. Numerous randomized studies have proven the efficacy and good tolerability of the drug and the absence of its effect on cognitive functions.Apolikhina I.A., Teterina T.A.
Conclusion. Taking into account the age-related characteristics of homeostasis and metabolism in elderly women, Mirabegron 50 mg can be recommended as the drug of choice when blood pressure and pulse rate are controlled. In addition, local estrogen therapy is indicated for postmenopausal women with urgent urinary incontinence. Mirabegron is a selective beta-3-adrenergic agonist; therefore it does not cause side effects, such as dry mouth, elevated intraocular pressure, constipation, and impaired cognitive functions, or affect the parasympathetic stimulation of detrusor contraction and bladder emptying, and therefore, this drug, unlike antimuscarinic agents, may reduce the risk of acute urinary retention. In this connection, mirabegron is also recommended for the treatment of de novo urgency and OAB in women after sling urethropexy.
Keywords
overactive bladder
urgent urinary incontinence in elderly patients
elderly and senile women
dry OAB
wet OAB
M-anticholinergic agents
beta-3-agonists
mirabegron
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Received 02.09.2020
Accepted 10.09.2020
About the Authors
Inna A. Apolikhina, MD, professor, Head of the Department of Aesthetic gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation; Professor of the Department of Obstetrics, Gynecology, Perinatology, and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University; President of the Association of Aesthetic Gynecology Specialists (AAGS);President of this European Association for Genital Aesthetic Medicine and Plastic Surgery (EAGAMPS). E-mail: apolikhina@inbox.ru.
4, Oparina str., Moscow, 117997, Russian Federation; 8-2 Trubetskaya str., Moscow, 119991, Russian Federation.
Tatyana A. Teterina, PhD, obstetrician-gynecologist of the Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov National Medical Research Centre
for Obstetrics, Gynecology and Perinathology, Ministry of Health of Russia. 4, Oparina str., Moscow, 117997, Russian Federation.
For citation: Apolikhina I.A., Teterina T.A. A differentiated therapeutic approach to overactive bladder in elderly and senile women.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 9: 234-240 (in Russian).
https://dx.doi.org/10.18565/aig.2020.9.234-240
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