Long-term safety and efficacy of two different antimuscarinics, imidafenacin and solifenacin, for treatment of overactive bladder: a prospective randomized controlled study.

OBJECTIVE: The aim of this study was to assess the efficacy and safety of long-term treatment with two different antimuscarinics, imidafenacin and solifenacin, in patients with overactive bladder (OAB). PATIENTS AND METHODS: Male or female patients 20 years of age or older who had urgency (more than 1 episode in 24 h) were randomized into two groups: group I, imidafenacin (0.1 mg twice daily), and group S, solifenacin (5 mg once daily) for a 12-month treatment regimen. Subjective and objective symptoms were assessed before, and 1, 3, 6 and 12 months after treatment. RESULTS: A total of 109 patients, including 55 (mean age: 72.0 years) in group I and 54 (mean age: 70.4 years) in group S, were treated. Subjective symptoms were significantly improved in group I and S after treatment. Dry mouth significantly worsened in both groups. However, the duration of dry mouth in group I was significantly shorter than that in group S. Three (5.8%) and 7 (13.5%) patients discontinued treatment due to adverse events in group I and group S, respectively. CONCLUSIONS: Imidafenacin and solifenacin were efficacious, safe, and well-tolerated treatments for OAB. As for adverse events, group I had fewer than group S.

[Association with relative nocturnal polyuria using BNP (brain natriuretic peptide) in eldely patients with nocturia].

OBJECTIVE: In addition to overactive bladder (OAB) and sleep disorders (disturbance of additional sleep induction), nocturnal polyuria has been reported as an etiology of nocturia in elderly people. To investigate the influence of heart function on nocturnal polyuria in elderly people, we examined the association with nocturnal polyuria using brain natoriuretic peptide (BNP), which are useful for evaluating the prognosis of heart failure. PATIENTS AND METHODS: The patients were 128 patients (92 males, 36 females) who were treated for nocturia in Kohsei general hospital and other relative hospital between October 2002 and September 2005. We measured BNP levels at physical examination. Simultaneously, the patients were instructed to write a frequency volume chart (FVC) for 4 days. 24-hour urine volume, Daytime urine volume, nocturnal (sleep) urine volume, nocturnal polyuria index (NPi) were calculated from FVC. The association was examined. However, alphal-blockers or anticholinergic agents that had been prescribed to treat urination disorders were continuously administered. RESULTS: Overall, the mean BNP level was high, 46.3+/-39.6 pg/ml. The mean 24-hour urine volume was 1,555+/- 458 ml. The mean daytime urine volume was 935+/-322 ml. The mean nocturnal urine volume was 624+/-251 ml. The mean nocturnal urine volume rate was high, 40.1 - 10.5%. However, there was a close association between BNP and the 24-hour urine volume (p = 0.0215), the daytime urine volume (p = 0.0004), the NPi (p = 0.0003). The daytime urine volume decreased with the BNP level. The NPi increased with the BNP level. Patients were divided into 2 groups, a group with a BNP level less than 50 pg/ml and a group with a BNP level of 50 pg/ml or more. In the group with a BNP level less than 50 pg/ml, the nocturnal urine volume rate was 38.14+/-10.07%. In the group with a BNP level of 50 pg/ml or more, the rate was significantly higher (43.97+/-10.48%, p<0.0029). CONCLUSIONS: These results suggest that many elderly patients latently have mild heart failure, and that relative nocturnal polyuria reduces cardiac load. Therefore, in patients with a high BNP level, administration of antidiuretic hormone to decrease nocturnal urine volume is risky. Administration of diuretics during the afternoon or evening may be safer.

Efficacy of preoperative donation of autologous blood in patients undergoing radical retropubic prostatectomy.

BACKGROUND: Radical retropubic prostatectomy (RRP) has resulted in substantial blood loss and the frequent need for homologous blood transfusion. In this study, the efficacy of autologous blood transfusion, from medical and financial perspectives, was evaluated in patients undergoing RRP. METHODS: Between 1994 and 2000, 80 patients with localized prostate cancer underwent RRP in our institute. Based on informed consent, preoperative donation of autologous blood (PDA) was performed in 65 out of 80 patienets. Four or six units were donated during the first 3 years; however, donation units were reduced to a maximum of 4 units since 1997 onwards. The discard rate of donated blood and frequency of homologous transfusion were examined. Changes of hematocrit (Ht) and hemoglobin (Hb) levels through donation and surgery and important factors that may affect postoperative levels of Ht and Hb were evaluated in 56 patients receiving 4-unit donations. RESULTS: Overall, 2 or 4 units of donated blood were discarded in four patients and homologous transfusion was required in two patients. In 56 patients receiving 4-unit donation, the mean Ht level at predonation was 43.3%. Following donation, this decreased to 35.7%. The administration of recombinant human erythropoietin (rHuEpo) relieved declining Ht levels following donation, but changes in Ht levels after surgery were minor. Important factors related to postoperative decline of Ht and Hb levels were operative time and blood loss. CONCLUSIONS: The program of 4-unit PDA can be performed safely without rHuEpo injection, and it is useful to reduce the risk of requiring homologous transfusion. However, more efficient programs to relieve patient burden and to reduce medical cost are needed.