USE OF UROFLOW PARAMETERS ASANTIMUSCARINIC TREATMENT MONITORING IN OAB PATIENTS - PRELIMINARYREPORT OF MULTICENTER STUDY
K. FUTYMA1, L.NOWAKOWSKI 1, K. STANGEL-WOJCIKIEWICZ 2, A.ZIETEK 1, L. FUTYMA 3, D. GODLEWSKI 4,A. ABRAMCZYK 5, T. RECHBERGER 1;
12ndDept. of Gynecology, Med. Univ. of Lublin, Lublin, Poland, 2Dept.of Gynaecology and Oncology, Collegium Medicum at the JagiellonianUniv., Krakow, Poland, Krakow, Poland, 3Department ofUrology and Urological Oncology, State Hosp. No 1, Rzeszów, Poland,4Department of Urology and Urological Oncology, StateHosp. No 1, Rzeszow, Poland, 5Department of Urology, St.John's of God Hosp., Lublin, Poland.
Introduction: The prevalence ofoveractive bladder symptoms (OAB) increases with age and isapproximately 30% in women over 65 years of age. The differences inmode of action between tolterodine and solifenacin might result indiverse clinical effectiveness and urodynamic parameters. Correlationof clinical efficacy, adverse effects and urodynamic changes beforeand during the OAB treatment may be helpful in choosing the mostsuitable pharmacological mode of treatment. The Flow Index wasrecently introduced and proposed as a potential marker confirming OABsymptoms. It also might be helpful in assigning patients with mixedsymptoms to the proper first line treatment. According to authors, anFI value of less than 0.47 may be used as a simple and objective OABmarker with reasonable sensitivity (69.8%) and specificity (69.9%) asa potential marker confirming OAB symptoms .
Objective:The aim of the study was to determine if uroflowmetric parameters,including Flow Index, may be used as a tool for monitoring ofantimuscarinics treatment efficacy in OAB patients.
Methods:The Local Ethics Committee approved the study concept and allpatients signed informed consent. 20 OAB patients were assigned tothe tolterodine 4 mg ER and solifenacin 10 mg treatment. All womenwere fully evaluated and uroflowmetry was performed before treatmentand follow-up visit after 4 weeks. Statistical analysis was performedusing Statistica 13PL package.
Results: Both treatmentswere equally effective in decreasing urgency and nocturia episodes(tolterodine: p=0.003 and p=0.007, respectively;solifenacin: p<0.001 and p=0.01,respectively). Some uroflowmetric parameters of OAB patients changedsignificantly on treatment with antimuscarinics (table 1). It iscontrary to the results reported previously, in which no statisticaldifferences in uroflowmetric parameters were found in healthyvolunteers . The possible reason for such discrepancy is thatantimuscarinics do not influence on healthy bladder as on overactivebladder. In paper published in 2011 the influence of antimuscarinictreatment on urodynamic parameters was also investigated . Some ofthose results are similar to ours. First, the FI value for thatpatients is ≤ 0.5, which confirms that the patients with OAB havelower FI values than patients with stress UI [1, 3]. Similarly,increase in post void residual volume was also lower on solifenacin 5mg treatment compared to tolterodine 4 mg ER (Δ+6.5 ml and Δ+23.5ml respectively). On the contrary, authors did not find significantdifferences in maximal and average urethral flow rates on bothtreatments .
Conclusions: Both treatments decreasedmaximal urethral flow significantly but Flow Index value did notchanged significantly on solifenacin 10 mg treatment. Interestingly,on treatment post void residual volume was significantly higher ontolterodine compared to solifenacin which may be important inpatients with detrusor underactivity presenting OAB symptoms. Ourresults suggests that both antimuscarinics are effective in OABtreatment but solifenacin does not influence negatively on bladderemptying.In order to draw more significant conclusion our resultsmust be confirmed on larger group of patients but the preliminaryresults are encouraging.
References: 1. Neurourol Urodyn.2017; 36:198-202. 2. Neurourol Urodyn. 2010; 29:464-469.3. J ObstetGynaecol Res. 2011; 37:1084-91.