The use of mirabegron in neurogenic bladder: a systematic review
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INVITED REVIEW
The use of mirabegron in neurogenic bladder: a systematic review Elie El Helou1 · Chris Labaki1 · Roy Chebel1 · Jeanine El Helou2 · Georges Abi Tayeh1 · Georges Jalkh2 · Elie Nemr1 Received: 4 October 2019 / Accepted: 25 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose To evaluate the use of mirabegron in patients with neurogenic bladder. Methods A systematic review of the literature was conducted using four databases (Medline via PubMed, Scopus, Cochrane, and EMBASE). Articles evaluating mirabegron in neurogenic bladder patients were collected, and assessment of the drug’s efficacy was reviewed according to clinical and urodynamic parameters. Results Seven studies were selected and a total of 302 patients with NB were evaluated, ranging from 15 to 66 patients per study. All of the patients had received antimuscarinics as a previous treatment modality. Mirabegron was used as a secondline treatment after antimuscarinics lacked efficacy or caused adverse effects. The duration of the treatments ranged from 4 to 12 weeks. Reported in two studies each, bladder compliance and maximal cystometric capacity were the most commonly improved urodynamic parameters. In the majority of the studies, positive outcomes were reported for clinical scores. Additionally, analysis of the IPSS subscores revealed an improvement of storage symptoms as opposed to voiding symptoms. In all of the studies, mirabegron was well tolerated. Conclusion Mirabegron appears to be an effective treatment in the management of neurogenic bladder unresponsive to antimuscarinics, particularly in patients presenting with storage symptoms. There is still no evidence concerning the use of mirabegron as a first-line therapy for neurogenic bladder. Keywords Neurogenic bladder · Mirabegron · Antimuscarinics · Urodynamics
Introduction Neurological diseases, whether involving the central, peripheral, or autonomic nervous systems (CNS, PNS, and ANS, respectively), can affect patients in many ways, resulting in multiple consequences. Involvement of the urinary system during the course of a neurological pathology most commonly results in the development of a neurogenic bladder (NB). This condition is characterized by a perturbation of the detrusor muscle and/or the sphincter function during the filling and/or voiding phase. Patients may, therefore, experience a variety of lower urinary tract symptoms (LUTS), the most frequent and bothersome being urgency and urge incontinence followed by pollakiuria, nocturia, and voiding * Elie El Helou [email protected] 1
Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
2
LUTS (slow stream, intermittency, straining to void, etc.) which can sometimes lead to urinary retention [1]. Moreover, urinary tract infections (UTIs) often complicate the course of the NB, with an incidence as high as 30% [1]. Consequently, the quality of life (QoL
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