A differentiated therapeutic approach to overactive bladder in elderly and senile women


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Abstract

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 longterm, 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. 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.

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About the authors

Inna A. Apolikhina

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: apolikhina@inbox.ru
MD, Head of the Department of Aesthetic Gynecology and Rehabilitation

Tatyana A. Teterina

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: t_teterina@oparina4.ru
PhD, obstetrician-gynecologist of the Department of Aesthetic Gynecology and Rehabilitation

Ekaterina A. Atamanova

JSC «Astellas Pharma»

Email: ekaterina.atamanova@astellas.com
MD, PhD, Medical Advisor

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