Medikamentozna terapija sindroma prekomjerno aktivnog mokraćnog mjehura

master's thesis

• Title (english): Medicamentous therapy of overactive bladder syndrome
• Author: Zrinka Čižmešija
• Mentor: Držislav Kalafatić (mentor)
• Committee member: Vladimir Banović (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Držislav Kalafatić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Urology

Abstract

Kontinencija mokraće definira se kao mogućnost zadržavanja mokraće u mokraćnom mjehuru između epizoda voljne mikcije. Rizičan faktor nastanka su sva stanja koja dovode do porasta intraabdominalnog tlaka, dob, produljen porod i neurološke bolesti. Sindrom prekomjerno aktivnog mokraćnog mjehura (PAMM) čini skupina simptoma urgencije s ili bez urgentne inkontinencije, učestalo mokrenje i nikturija. Dijagnoza PAMM se postavlja uzimanjem anamneze, fizikalnog pregleda, testovima urina i, ako je potrebno, urodinamskim testiranjima. Prema najnovijim AUA smjernicama za liječenje PAMM postoje tri linije liječenja. Prvu liniju čini promjena životnih navika i bihevioralna terapija (Kegelove vježbe, elektrostimulacija mišića dna zdjelice i PFMT). Drugu liniju liječenja čine antimuskarinici/antikolinergici i simpatomimetici/agonisti adrenergičnih receptora. U antimuskarinike spadaju oksibutinin, tolterodin, trospij klorid, propiverin, fezoterodin i solifenancin. Trospij klorid najveći učinak ima na periferiji jer jedini od gore navedenih lijekova ne prelazi krvno-moždanu barijeru i nema učinka na SŽS. Iako su antimuskarinici i dalje zlatni standard u liječenju PAMM, novi lijek na tržištu, simpatomimetik mirabegron jednako je učinkovit kao antimuskarinici, ima manje neželjenih učinaka, a pacijenti ga duže uzimaju. Treća linija liječenja se koristi kod pacijenta s refraktornim PAMM. Uključuje primjenu botulinum toksina A, stimulaciju n. sacralis i stimulaciju n. tibialis posterior.

Abstract (english)

Continence is defined as the ability of keeping urine in the bladder between episodes of voluntary micturition. Risk factors are all conditions which lead to increased intraabdominal pressure, especially age and prolonged labour; and neurological diseases. Overactive bladder syndrome is a term used to describe the symptom complex of urinary urgency with or without urge incontinence, usually with frequency and nocturia. Diagnosis of OAB besides medical history, physical exam, urin sample and lower limb neurological exam sometimes include urodynamic testing. According to the newest AUA’s clinical practice guidelines for OAB we have three lines of treatment. The first line of treatment includes conservative management with lifestyle changes and bihevioral therapy (Kegel’s exercises, electrostimulation of pelvic floor muscles and pelvic floor muscle training – PFMT) . The second line of treatment are antimuscarinic/anticholinergic drugs and sympathomimetic/adrenergic-agonist drugs. Antimuscarinics include oxybutynin, tolterodine, trosipum chloride, propiverine, fesoterodine and solifenancin. Trospium chloride’s activitiy is mostly located in the peripheria because it is the only medicament which doesn’t cross BBB and has minor effects on CNS. Whereas antimuscarinics are gold standard of medicamentous treatment of OAB, new sympathomimetic medicament called mirabegron is as efficient as antimuscarincs, has less side effects and better persistance. The third line of treatment is used for patients with refractory OAB. It includes botulinum toxin A, sacral nerve stimulation and posterioir tibial nerve stimulation.

• Keywords: PAMM; inkontinencija; antimuskarinici; simpatomimetici
• Keywords (english): OAB; incontinence; antimuscarinics; sympathomimetics
• Language: croatian
• URN:NBN: urn:nbn:hr:105:774377
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-08 11:04:19