著者名:Dudley Robinson, Linda Cardozo.
文献タイトル:Antimuscarinic drugs to treat overactive bladder. 
雑誌名・書籍名:BMJ 2012;344:e2130 doi: 10.1136/bmj.e2130.
発行年:Published 27 March 2012


 ①systematic review: 32のRCT(計6800名): 治癒または改善効果 RR 1.41, 95%CI 1.29-1.54
 ②Cochrane review: 61のRCT(計11956名): 治癒または改善効果 RR 1.39, 95%CI 1.28-1.51, NNT 7
 ③最新のsystematic review: 83のRCT(計30699名, 6種類の異なる薬剤):
・排尿コントロール可能…RR 1.3-3.5
・失禁回数…0.4-1.1回減少, 排尿回数…0.5-1.3回減少, 尿意切迫…0.64-1.56回減少

 ①systematic review : 149の論文: 内服開始後30日以内に43-83%が中断
 ②meta-analysis: prospective randomized trials:
・最も多いのはめまい(oxybutynin 3%, propiderine 3.2%, tolterodine 1.8%, placebo 1.6%)

・排尿障害:男性はその増悪を考慮, 女性はまれ。そのため、ルーチンの残尿モニターは不要

・UK National Health Serviceの評価:solifenacinが最もQALYが高かった

・内服開始前に充分にその副作用や内服以外の方法(Tips for patients下に記載)について話し合うこと

Cochrane review: 13の研究(計1770名): 
・症状改善効果…抗ムスカリン薬 vs 膀胱トレーニング RR 0.73, 95%CI 0.59-0.90
・症状改善効果…抗ムスカリン薬+膀胱トレーニング vs 抗ムスカリン薬 RR 0.55(0.32-0.93)
vasopressin analogue:Table1

Tips for patients
Overactive bladder is a common and distressing condition?Bladder retraining, lifestyle advice, and pelvic floor exercises should help to improve the symptoms of overactive bladder
Think about fluid intake and try to avoid caffeinated drinks, artificially sweetened carbonated drinks, and alcohol. Try not to drink too much (generally no more than 1.5 litres a day), and limit your fluid intake before bed
Your local continence advisory service will be able to provide you with tips for coping strategies and advice about containment products such as continence pads
Antimuscarinic drugs may be useful in addition to conservative measures when trying to control your bladder symptoms; these may be required long term as overactive bladder is a chronic condition
Antimuscarinic drugs may be associated with a dry mouth. Try sucking a sweet or chewing gum to increase salivation Constipation may also be associated with taking antimuscarinic drugs: it may be necessary to alter your diet or consider laxatives