The impact of erectile function in male overactive bladder patients treated with Mirabegron

Moderated Posters Session 1

3:05 PM - 3:50 PM

Doctor Tsung Hsien Wu (1)

(1) Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Mirabegron, a selective 3 adrenoceptor agonist, is widely used for treatment of overactive bladder (OAB) [1]. Mirabegron has been demonstrated to relax human and rat corpus cavernosum [2], which effect might be a potential benefit in male OAB patients with erectile dysfunction (ED). However, there was no report of the effect of Mirabegron on male erectile function in human male OAB clinical study. We aimed to evaluate the erectile function in male OAB patients treated with Mirabegron (50 mg) in daily urological practice.

AIMS

The evaluation of ED and OAB was based on a self-administered questionnaire containing International Index of Erectile Function (IIEF-5, score 5-25; no ED, 25-22; mild ED, 21-17; mild moderate ED, 16-12; moderate ED, 11-8, severe ED, 5-7) and OAB symptom score (OABSS, score 0-15; mild OAB, 3-5; moderate OAB, 6-11; severe OAB, 12-15), respectively [3]. In the present study, the patients with an OABSS urgency score of ≥2 and sum score of ≥3 were considered to have OAB. The study was a consecutive cohort of 128 male LUTS patients ≥ 40 years in a tertiary referral center between June 2018 to March 2019. Among the 128 patients, 81 patients have sexual activity and responded to both OABSS and IIEF-5 at baseline, and 34 OAB patients with evaluable OABSS and IIEF-5 received 50 mg of mirabegron daily. The therapeutic outcomes were assessed at baseline, 4, and 12 weeks. Concomitant alpha blocker or 5 alpha reductase inhibitor used in a stable condition before enrollment were allowed but we did not change the prescription during the study period. PDE 5 inhibitor was not allowed to use during the study period. Patients with active urinary tract infection, urinary tract stone, recent genitourinary tract operation within 3 months, stress urinary incontinence, and neurogenic detrusor overactivity were excluded.

METHODS

Mirabegron usage was associated with a statistically significant decrease in OABSS at 4-week (30.8% decrease, p<0.0001) and 12-week follow-up (26.0% decrease, p=0.006) without compromised voiding function. The patients with moderate and severe OAB can get persistent decrease of OABSS, but the therapeutic effect was not persistent in mild OAB group (Table II). IIEF-5 was decreased at 4-week (5.4% decrease, p=0.077) and 12-week follow-up (14.0% decrease, p=0.021) (Table I). The patients with higher baseline IIEF-5 (≥17) had lower OABSS (7.00±2.56) than the lower IIEF-5 (<17) group (8.73±3.24; p=0.0907), however, both groups showed significantly reduced OABSS (improved OAB symptoms). But erectile function in baseline IIEF-5 group (≥17) was significantly reduced from 20.37 ± 2.14 to 17.33 ± 5.60 (p=0.029) after mirabegron treatment at week 12. Patients with poor erectile function at baseline (IIEF-5 <17) has no significant change.

RESULTS

Overactive bladder is associated with erectile dysfunction and reduced sexual quality of life in men [4]. We expect that erectile function might improve or no harm with OAB treatment. On the contrary, the current results showed that Mirabegron treatment was effective in reducing male OAB symptoms, but erectile function became worse in patients with better baseline erectile function. There has been none mention of better erection or worse erection as side effect with Mirabegron treatment since it started human clinical research. Perhaps 3 adrenoceptor agonist helps a little in the resting filling phase in penis, as it does in bladder. During actual erection, like micturition contraction, 3 adrenoceptor agonist may not do anything. A slight relaxing of corpus cavernosum during resting is not noticeable or beneficial. The current finding of Mirabegron induced a decrease of erectile function might be worthy of further study.Mirabegron improves male OAB symptoms, but may alter the erectile function. Physicians need to discuss potential impact of erectile function in male OAB patients treated with mirabegron. Future research with placebo control study might provide evidence to elucidate the effect of mirabegron on erectile function in male OAB patients.

CONCLUSIONS

The impact of erectile function in male overactive bladder patients treated with Mirabegron

Non-Moderated Poster Session

12:30 PM - 1:30 PM

Doctor Tsung Hsien Wu (1), Doctor Wei-Chia Lee (1), doctor Yuan-Chi Shen (1), doctor Hung-Jen Wang (1), professor Yao-Chi Chuang (1)

(1) Kaohsiung Chang Gung Memorial Hospital, , Taiwan

Mirabegron, a selective 3 adrenoceptor agonist, is widely used for treatment of overactive bladder (OAB). Mirabegron has been demonstrated to relax human and rat corpus cavernosum. We aimed to evaluate the erectile function in male OAB patients treated with Mirabegron (50 mg) in daily urological practice.

AIMS

The evaluation of ED and OAB was based on a self-administered questionnaire containing International Index of Erectile Function (IIEF-5) and OAB symptom score (OABSS), respectively. In the present study, the patients with an OABSS urgency score of ≥2 and sum score of ≥3 were considered to have OAB. The study was a consecutive cohort of 128 male LUTS patients ≥ 50 years in a tertiary referral center. Among the 128 patients, 59 has sexual activity and responded to both OABSS and IIEF-5, and 34 OAB patients treated with mirabegron. The therapeutic outcomes were assessed at baseline, 4, and 12 weeks.

METHODS

Mirabegron usage was associated with a statistically significant decrease in OABSS at 4-week and 12-week follow-up, however, IIEF-5 was also decreased at 4-week and 12-week follow-up. The patients with higher IIEF-5 (≥17) had lower OABSS than the lower IIEF-5 (<17) group, however, both groups reduced OABSS and IIEF-5 after mirabegron treatment.

RESULTS

Mirabegron (25 mg) improves OAB symptoms, but may decrease the erectile function. We need to discuss potential impact of erectile function in male OAB patients treated with mirabegron.

CONCLUSIONS