Aşırı aktif mesanesi olan kadın hastalarda trospium klorid ve intravajinal elektrik stimülasyon tedavilerinin karşılaştırılması
Küçük Resim Yok
Tarih
2005
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
7. ÖZET Aşırı aktif mesane, Uluslararası Kontinans Derneği tarafından, klinik olarak pollaküri, noktüri, sık idrar yapma, sıkışma ve urge inkontinansian oluşan semptom kompleksi olarak tanımlanmıştır (15). Prevelansı %18 olan bu durum hastaların yaşam kalitesini olumsuz etkilemektedir (81). Aşırı aktif mesane tanısında işeme günlüğü, ürodinamik incelemeler, öykü ve değerlendirme anketleri kullanılmaktadır, ilk basamak tedavisi konservatif olan bu durum için en çok kullanılan ilaçlar antikolinerjik ajanlardır (96). Trospium klorid de etkili ve güvenli bir antikolinerjiktir (4). Aşırı aktif mesane sendromunda elektrik stimülasyon tedavisi de kullanılan alternatif tedavi yöntemlerindendir (5). Bu çalışmanın amacı aşırı aktif mesanesi olan hastalarda trospium klorid ve elektrik stimülasyon yöntemlerinin etkinliğini araştırmak ve maliyetlerini karşılaştırmaktır. Bu amaçla çalışmamıza alınan 35 kadın hasta, 6 hafta boyunca elektrik stimülasyonu uygulanmak veya trospium klorid (TCI) kullanmak üzere 2 gruba ayrıldı. TCL grubuna alınan 17 hasta 6 hafta süre ile 45mg/gün dozunda ilaç kullandı. Vajinal elektrik stimülasyonu (ES) ise 18 hastaya, 20 dakikalık seanslar halinde, haftada 3 gün, toplam 18 seans olacak şekilde bifazik, simetrik akım, 5Hz frekansında, 100musn süreyle, devamlı modda uygulandı. Hastalar tedavi öncesi ve sonrasında, tedaviden 1 ve 3 ay sonra ürodinamik inceleme, işeme günlüğü, Inkontinans Etki Anketi-7, vizüel analog skala ile inkontinans şiddeti, sıkışma şiddeti ve tedavi memnuniyeti, Beck Depresyon Anketi ve SF-36 yaşam anketi ile değerlendirilip, tedavi memnuniyetleri sorgulandı. Çalışmaya alınan hastalardan 4'ü çalışmadan ayrılarak (TCI:2, ES:2); TCI grubundan 15, ES grubundan 16 hasta tedaviyi tamamladı. Tedavi sonrası 1. ay değerlendirme grup i'den 2 hastanın, grup H'den 4 hastanın; tedavi sonrası 3. ay değerlendirme ise grup İ'den 5 hastanın, grup H'den ise 7 hastanın henüz tamamlanamamıştır. 77Altı haftalık tedavinin sonunda TCL grubunda tüm ürodinamik parametrelerde anlamlı gelişmeler gözlenirken, elektrik stimülasyon grubunda maksimum detrusor basıncı dışındaki parametrelerde anlamlı gelişme gözlendi. Tedaviyle her 2 grupta da idrar yapma sıklığı, sıkışma atakları ve inkontinans sayısında azalma gözlendi. ES grubunda, miksiyonda saptanan değişimler tedavi sonrası 3 ay devam etti, TCI ile ise tedavi bırakıldıktan sonra belirgin bozulma saptandı. Ayrıca İnkontinans Etki Anketi, Beck Depresyon Anketi ve vizüei analog skala ile inkontinans ve sıkışma şiddeti değerlendirmesinde de benzer sonuçlar elde edildi. Tedavi sonunda ES grubunda %87,5, TC! grubunda ise %93,3 oranında hasta tedaviden "memnun-çok memnun" olduklarını belirtti. Hastalara sorulduğunda idrar kaçırma şikayetlerinin ">%25-100 oranında düzelme" ES grubunda %93,7 ve TCI grubunda %93,3 oldu. Hastaların büyük çoğunluğu bu tedaviyi bir başkasına tavsiye edebileceklerini bildirdiler. Her 2 tedavi yöntemi de hastalar tarafından iyi tolere edildi. TCI kullanan grupta %47, ES grubunda ise %27,7 oranında yan etki gözlendi. Tedavi maliyetleri karşılaştırıldığında, 6 haftalık TCI kullanımının ES tedavisine göre daha uygun fiyatlı olduğu saptanırken, ES tedavisinin uzun süren etkisi göz önüne alındığında ES yöntemi daha ekonomik bulundu. Sonuç olarak bu çalışma bize trospium kloridin aşın aktif mesanede, yan etki profili düşük ve etkin bir ajan olduğunu göstermekle beraber elektrik stimülasyonunun da antikolinerjik ajanları tolere edemeyen hastalarda uygun, pratik, ekonomik ve en az 3 ay süre ile etkinliğini koruyan bir tedavi seçeneği olduğu düşündürdü. ES bizce aşırı aktif mesane tedavisinde daha uzun takipli geniş serilerde değerlendirilmesi gereken, umut verici bir tedavi yöntemidir. 78
8. SUMMARY Overactive bladder is described by International Continence Society as urgency, with urge incontinence, usually with frequency and nocturia (15). The prevelance of this condition is %18 among Caucasians (81). It is a burdensome problem that has a negative impact on patients' quality of life. First line therapy in overactive bladder syndrome is conservative treatment. Anticholinergic agents are the most widely used drugs in the treatment of this syndrome (96). The efficency and safety of trospium chloride was demonstrated in large series in the treatment of overactive bladder (4). Vaginal electrical stimulation is an alternative treatment method used for this condition (5). The purpose of our study was to investigate the efficiency of trospium chloride and vaginal electrical stimulation in patients with overactive bladder and compare their costs. A total of 35 patients with overactive bladder, were enrolled and divided into 2 groups; 17 patient for trospium chloride (TCi) and 18 for electrical stimulation (ES) treatment group. TCL was used 2 times daily for 6 weeks, with a total dose of 45 mg per day. Electrical stimulation parameters consisted of symmetric, biphasic currents with a frequency of 5Hz, 100usn pulse width in a continuous form, for 20 minutes per session, 3 sessions per week, for 6 weeks. The patients were evaluated by filling cystometry, voiding diary, Incontinence Impact Questionnaire-?, Beck Depression inventory, Short Form-36 Health Quality Assessment, incontinence and urgency severity by a 0-1 00mm visual analog scale at start of the study, at the end of the treatment and 1 and 3 months after cessation of the treatment. Also patient satisfaction was asked at the end of the treatment. There were 4 drop-outs from the study; 1 5 patients of TCi group and 16 of ES group were able to complete the treatment protocol. Six patients (TCI: 13, ES:12) have not been evaluated at 1 month after the therapy yet. 79Also the folllow-up at the 3rd month after the cessation of the therapy has not been completed for 5 patients of TCI group and for 7 patients of ES group. After 6 weeks of treatment, both groups, especially TCI group showed significant changes in the urodynamic variables. Maximum cystometric bladder capacity and the volume at first desire to void was improved significantly in the ES group. Also there were significant improvements in both of the groups in urinary frequency, urgency episodes, leaks, scores of incontinence impact questionnaire-? and visual analog measurements. Most of the objective and subjective improvements in TCI group detonated after the cessation of the therapy. The clinical improvement in the ES group continued for 3 months. The satisfaction from the therapy was evaluated at the end of the treatment; and 93,3% in the TCI group and 87,5% in the ES group reported their satisfaction as satisfied-much satisfied. The overall improvement above 25% to 100% was 93,3% in TCI group and 93,7% in the ES group. Most of the patients reported that they would recommend the treatment to another one. There were 47,0% adverse events in TCI group and %27,7 in ES group. The adverse events were well tolerated in both groups. The costs of the treatment was lower for TCI compared with ES. However, as we consider the clinical improvement with ES would be longer than TCI, the savings will be much more with electrical stimulation therapy. As a result, TCI is a safe and effective drug in the treatment of overactive bladder. ES is also an effective therapy with less side effect profile and therapy costs compared to anticholinergic therapy. ES may be a convenient therapy for the patients with overactive bladder that can not tolerate anticholinergic drugs. Therefore, ES can be considered as a promising therapy which must be evaluated in randomised clinical trials with larger series and longer follow-ups in the treatment of overactive bladder. 80
8. SUMMARY Overactive bladder is described by International Continence Society as urgency, with urge incontinence, usually with frequency and nocturia (15). The prevelance of this condition is %18 among Caucasians (81). It is a burdensome problem that has a negative impact on patients' quality of life. First line therapy in overactive bladder syndrome is conservative treatment. Anticholinergic agents are the most widely used drugs in the treatment of this syndrome (96). The efficency and safety of trospium chloride was demonstrated in large series in the treatment of overactive bladder (4). Vaginal electrical stimulation is an alternative treatment method used for this condition (5). The purpose of our study was to investigate the efficiency of trospium chloride and vaginal electrical stimulation in patients with overactive bladder and compare their costs. A total of 35 patients with overactive bladder, were enrolled and divided into 2 groups; 17 patient for trospium chloride (TCi) and 18 for electrical stimulation (ES) treatment group. TCL was used 2 times daily for 6 weeks, with a total dose of 45 mg per day. Electrical stimulation parameters consisted of symmetric, biphasic currents with a frequency of 5Hz, 100usn pulse width in a continuous form, for 20 minutes per session, 3 sessions per week, for 6 weeks. The patients were evaluated by filling cystometry, voiding diary, Incontinence Impact Questionnaire-?, Beck Depression inventory, Short Form-36 Health Quality Assessment, incontinence and urgency severity by a 0-1 00mm visual analog scale at start of the study, at the end of the treatment and 1 and 3 months after cessation of the treatment. Also patient satisfaction was asked at the end of the treatment. There were 4 drop-outs from the study; 1 5 patients of TCi group and 16 of ES group were able to complete the treatment protocol. Six patients (TCI: 13, ES:12) have not been evaluated at 1 month after the therapy yet. 79Also the folllow-up at the 3rd month after the cessation of the therapy has not been completed for 5 patients of TCI group and for 7 patients of ES group. After 6 weeks of treatment, both groups, especially TCI group showed significant changes in the urodynamic variables. Maximum cystometric bladder capacity and the volume at first desire to void was improved significantly in the ES group. Also there were significant improvements in both of the groups in urinary frequency, urgency episodes, leaks, scores of incontinence impact questionnaire-? and visual analog measurements. Most of the objective and subjective improvements in TCI group detonated after the cessation of the therapy. The clinical improvement in the ES group continued for 3 months. The satisfaction from the therapy was evaluated at the end of the treatment; and 93,3% in the TCI group and 87,5% in the ES group reported their satisfaction as satisfied-much satisfied. The overall improvement above 25% to 100% was 93,3% in TCI group and 93,7% in the ES group. Most of the patients reported that they would recommend the treatment to another one. There were 47,0% adverse events in TCI group and %27,7 in ES group. The adverse events were well tolerated in both groups. The costs of the treatment was lower for TCI compared with ES. However, as we consider the clinical improvement with ES would be longer than TCI, the savings will be much more with electrical stimulation therapy. As a result, TCI is a safe and effective drug in the treatment of overactive bladder. ES is also an effective therapy with less side effect profile and therapy costs compared to anticholinergic therapy. ES may be a convenient therapy for the patients with overactive bladder that can not tolerate anticholinergic drugs. Therefore, ES can be considered as a promising therapy which must be evaluated in randomised clinical trials with larger series and longer follow-ups in the treatment of overactive bladder. 80
Açıklama
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Anahtar Kelimeler
Fiziksel Tıp ve Rehabilitasyon, Physical Medicine and Rehabilitation
