Benefits and harms of conservative, pharmacological, and surgical management options for women with bladder outlet obstruction: a systematic review from the European Association of Urology non-neurogenic female LUTS Guidelines Panel

Peyronnet B1, Lapitan M2, Omar I3, Tzelves L4, O'connor E5, Nic an riogh A5, Manso M6, Yuan C7, Arlandis S8, Bo K9, Costantini E10, Farag F11, Broen J12, Nambiar A13, Phé V14, van der vaart H15, Harding C13

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 73
Live Urogynaecology, Female & Functional Urology 2 - Management Pearls in SUI/POP/BOO
Scientific Podium Session 8
Saturday 16th October 2021
19:50 - 20:00
Live Room 1
Bladder Outlet Obstruction Female Pharmacology
1. university of rennes, 2. university of Manilia Philippines, 3. university of Aberdeen, 4. university of Athens, 5. university of Dublin, 6. university of porto, 7. university of mc master, 8. university of Valencia, 9. Norwegian school of sports science, 10. university of Perugia, 11. Sohag university, 12. Erasmus medical center, 13. Freeman Hospital, 14. Sorbonne university, 15. university of Utrecht
Presenter
Links

Abstract

Hypothesis / aims of study
While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analysis, no such evidence base exists for female BOO. The aim of this systematic review was to evaluate the benefits and harms of therapeutic interventions for the management of bladder outlet obstruction in women.
Study design, materials and methods
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and the principles outlined in the Cochrane Handbook for Systematic Reviews. The study protocol was registered with PROSPERO (CRD42020183839). A systematic literature search using the Medline, Embase and CENTRAL as well as clinicaltrial.gov was performed and updated by a research librarian in May 2020. The study population consisted of adult female patients (≥18 years) diagnosed with BOO. The therapeutic interventions considered for inclusion were conservative treatments (e.g. physiotherapy, and vaginal pessary) pharmacological treatments (e.g. alpha-blockers) or surgical interventions (e.g. sacral neuromodulation, urethroplasty, etc).
Results
Out of 6344 records, we identified 30 studies enrolling 963 participants, of which only five RCTs were found including a total of 417 participants. One prospective non-randomized comparative study and three retrospective comparative studies were also identified, and all the other included studies were prospective non-comparative case series. Most of the studies were of unclear or low methodological quality. One placebo-controlled cross-over randomized trial assessed the role of baclofen in 60 female patients with dysfunctional voiding. The trial met its primary endpoint with a significantly greater decrease in the number of voids/day in the baclofen group (-5.53 vs. -2.70; p=0.001). The adverse events were mild and comparable in both groups (25% vs. 20%). One placebo-controlled cross-over randomized trial assessed the role of sildenafil in 20 women with Fowler’s syndrome. There were significant improvements from baseline in Qmax, IPSS, and post-void residual (PVR) but with no statistically significant difference when compared with placebo. In a large RCT including 197 female patients with functional BOO, the alpha adrenoreceptor antagonist, alfusozin significantly improved IPSS, Qmax and PVR compared to baseline but the differences compared to the placebo group were not statistically significant. Several small single arm prospective series reported improvement of BOO related symptoms and voiding parameters with urethroplasty, sling revision, urethral dilation, vaginal pessary and pelvic organ prolapse repair.
Interpretation of results
The present systematic review is, to our knowledge, the first aiming to evaluate the evidence supporting all existing treatments for female BOO. We found that the vast majority of the therapeutic options currently used to treat female BOO is supported by scant and poor evidence.
Concluding message
Evidence to support the use of conservative, pharmacological and surgical treatments for either anatomical or functional BOO are scarce. Baclofen is the only treatment that demonstrated superior efficacy compared to placebo in female patients with functional BOO. Alpha-blockers and sildenafil improve voiding parameters in female with functional BOO but did not show superior efficacy when compared to placebo.  Urethroplasty, transurethral bladder neck incision, midurethral sling revision and urethral dilation are only supported by small sample single arm prospective series
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Disclosures
Funding This Systematic Review is carried out under the auspices of the European Association of Urology Guidelines Office Board Clinical Trial No Subjects None
26/11/2024 07:55:30