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The study population included 21996 eligible patients. In the unmatched analysis, the median time-to-discontinuation was significantly longer for mirabegron (169 d, interquartile range [IQR] 41-not reached) compared to tolterodine ER (56 d, IQR 28-254; adjusted hazard ratio [HR] 1.55, 95% confidence interval 1.41-1.71; p<0.0001) and other antimuscarinics (range 30-78 d; adjusted HR range 1.24-2.26, p<0.0001 for all comparisons). The 12-mo persistence rates and MPR were also significantly greater with mirabegron than with all the antimuscarinics. Limitations include the retrospective design, use of prescription records to estimate outcomes, and inability to capture reasons for discontinuation.
• To describe the level of persistence for patients receiving antimuscarinics for overactive bladder (OAB) over a 12-month period based on real prescription data from the UK. • To investigate patterns of persistence with oral antimuscarinic drugs prescribed for OAB, across different age groups.
Many of the drugs considered in trials in this review are no longer used in clinical practice (and this includes the most commonly tested - flavoxate). There is inadequate evidence as to determine whether any of the available drugs are better or worse than anticholinergic medications. Larger randomised controlled trials in clinical settings are required to further establish the role of these medications in the management of overactive bladder syndrome.
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The National Institutes of Health (NIH) category IIIa chronic prostatitis syndromes (non bacterial chronic prostatitis) were common disorders but with few effective therapies. Alpha-blockers and bioflavonoids had recently been reported in randomized controlled trials to improve the symptom of these disorders in a significant proportion of men. The aim of this study was to confirm these findings in a prospective randomized, placebo-controlled trial.
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Forty inpatient men and women, between 50 and 80 years of age, with nocturia due to bladder instability, resorption of postural edema, or senile involution were admitted to a clinical trial designed to test the possibility of reducing or eliminating nocturnal voidings by means of a single evening dose of rociverine or flavoxate. This six-day crossover trial was divided into three periods of two days each: pretrial, treatment with one drug, and treatment with the other drug. Either 20 mg of rociverine or 200 mg of flavoxate was given at 8 PM in randomized sequence. For each night of the study, the following data were recorded: interval between drug administration and first voiding, volume of first voiding, total volume of nocturnal urine, total volume of nocturnal urine plus volume of urine passed on waking, and total number of nocturnal voidings. The outcome was a significant reduction of the number of nocturnal voidings together with a marked lengthening of the interval between drug administration and first voiding, with no noteworthy differences between the two drugs. Considering the efficacy of rociverine and, even more important, the excellent tolerance of elderly patients to the drug, further study of rociverine in nocturia and in urinary incontinence seems indicated.
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A 65-year-old woman with adult Still's disease developed adult respiratory distress syndrome (ARDS), a fatal pulmonary complication. Intravenous administration of cyclophosphamide, 500 mg/d for three days, was much more effective than high doses of corticosteroids in the patient. Interestingly, hypersensitivity to flavoxate hydrochloride seemed to be a precipitating factor, but not a cause, for both a series of characteristic manifestations of adult Still's disease and development of ARDS in our patient. The association of ARDS with adult Still's disease has not yet been reported. Physicians should be aware of this fatal complication in adult Still's disease, especially in the presence of drug hypersensitivities.
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The inclusion criteria included studies of interventions for the non-surgical management of all grades of late radiation cystitis.
Flavoxate hydrochloride is a flavone derivative with smooth muscle relaxing activity. The product has a broad range of indications and has found one major application in the treatment of urge incontinence. Information on different forms of incontinence and epidemiologic data are summarized. Differences between the myolytic agent flavoxate and anticholinergics are highlighted. The vast amount of information deriving from some 20 years of clinical experience is analysed and major conclusions are drawn. The compound has valid therapeutic efficacy and excellent tolerability. By this token flavoxate is the agent of choice for therapy of disorders caused by smooth muscle spasms.
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From the available evidence we cannot advocate the use of anticholinergics in MS.
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To develop the first Canadian guidelines for the management of adult urinary incontinence (UI).
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A 22-year-old man was referred to us complaining of enuresis. The excretory urogram and cystogram were almost normal. Spina bifida was not present. The results of the urodynamic examination including uroflowmetry, cystometry, urethral pressure profile, electromyogram and sensory threshold of external urethral sphincter were within normal limits. Amitriptyline hydrochloride and flavoxate hydrochloride showed no effects. Because we found a positive spike wave on the electroencephalogram, the patient was referred to a psychopathologist, and was diagnosed as being in the early stage of schizophrenia. He complained of enuresis as his olfactive hallucination of urine. Psychopathological treatment for 1 year and 2 months resulted in disappearance of his complaining of enuresis.