Mirabegron in the treatment of neurogenic detrusor overactivity: pharmacological and clinical aspects

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Abstract

The main cause of the impaired storage function of the bladder in patients with neurogenic dysfunctions of the lower urinary tract is detrusor overactivity, clinically manifested by symptoms of an overactive bladder. The article presents data on the epidemiology, pathogenesis, clinical course and modern approaches to the treatment of detrusor overactivity in neurological patients. It is emphasized that the most important aspect of the clinical course of neurogenic detrusor overactivity is the high risk of upper urinary tract dysfunction, and reducing the threat of kidney damage is the main goal of treating such patients. Pharmacological and clinical aspects of the use of the β3-adrenoreceptor agonist mirabegron in patients with neurogenic bladder dysfunctions are presented. The results of experimental and clinical studies of its use in the treatment of neurogenic detrusor overactivity are presented. A high safety profile of the drug is noted. It is shown that the mechanisms of the therapeutic effect of mirabegron in neurogenic detrusor overactivity include a decrease in detrusor tone, inhibition of spontaneous myocyte contractions, and a decrease in myogenic and urotheliogenic mechanosensory afferent activity. The features of the clinical and urodynamic effects of mirabegron in patients with neurogenic detrusor overactivity in various neurological diseases — multiple sclerosis, Parkinson’s disease, spinal cord injury — are highlighted. The leading role of the results of urodynamic research in choosing the treatment tactics for patients with neurogenic detrusor overactivity is emphasized.

About the authors

Igor V. Kuzmin

Academician I.P. Pavlov First St. Petersburg State Medical University

Author for correspondence.
Email: kuzminigor@mail.ru
ORCID iD: 0000-0002-7724-7832
SPIN-code: 2684-4070

Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

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2. Fig. 1. Localization of β3-adrenoceptors in the bladder wall.

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3. Fig. 2. Mechanism of the therapeutic effect of β3-adrenoceptor agonists in patients with detrusor overactivity and overactive bladder.

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