From the Guidelines
Mirabegron is not routinely necessary after Holmium Laser Enucleation of the Prostate (HoLEP) surgery, but it may be considered in patients with persistent storage symptoms after treatment with alpha-1 blocker monotherapy. According to the 2023 European Association of Urology guidelines on the management of non-neurogenic male lower urinary tract symptoms 1, the use of beta-3 agonists, such as mirabegron, is recommended in men with moderate-to-severe LUTS who mainly have bladder storage symptoms. However, this recommendation is rated as weak, indicating that the evidence is not as strong as for other treatments.
The guidelines suggest that alpha-1 blockers should be offered to men with moderate-to-severe LUTS 1, and combination treatment with an alpha-1 blocker and a 5-ARI should be offered to men with moderate-to-severe LUTS and an increased risk of disease progression 1. The use of mirabegron in combination with an alpha-1 blocker is only recommended in patients with persistent storage LUTS after treatment with alpha-1 blocker monotherapy 1.
Key points to consider when deciding whether to use mirabegron after HoLEP include:
- The patient's specific post-operative symptoms and overall recovery
- The presence of persistent storage symptoms despite treatment with alpha-1 blocker monotherapy
- The potential benefits and risks of mirabegron treatment, including its effects on urinary symptoms and potential side effects
- The patient's individual preferences and values, including their willingness to try additional medication to manage symptoms
In general, the decision to use mirabegron after HoLEP should be made on a case-by-case basis, taking into account the patient's unique needs and circumstances. As stated in the guidelines, the use of combination treatment of an alpha-1 blocker with mirabegron in patients with persistent storage LUTS after treatment with alpha-1 blocker monotherapy is a weak recommendation 1, indicating that the evidence is not as strong as for other treatments.
From the Research
Mirabegron (Myrbetriq) Necessity after Holmium Laser Enucleation of the Prostate (HoLEP)
There are no direct research papers provided to answer whether mirabegron (Myrbetriq) is necessary after Holmium Laser Enucleation of the Prostate (HoLEP). However, the provided studies discuss the efficacy, safety, and tolerability of mirabegron in treating overactive bladder (OAB) symptoms.
Efficacy and Safety of Mirabegron
- Mirabegron has been shown to be effective in treating OAB symptoms, including micturition frequency, urgency incontinence, and urgency 2, 3.
- The drug has a favorable safety and tolerability profile, particularly compared to antimuscarinics, with a lower incidence of dry mouth, constipation, and CNS effects 2, 3, 4.
- Mirabegron has been found to be well-tolerated in patients with OAB, including those who are elderly or have previously discontinued antimuscarinic therapy 2, 3.
Patient Populations and Mirabegron Treatment
- Mirabegron may be a valuable treatment option for patients who are unsuitable for antimuscarinics or have previously struggled with antimuscarinic side effects 3.
- The drug has been found to be effective in treating OAB symptoms in various patient populations, including men, elderly patients, and those with poor tolerability to antimuscarinics 4.
- A study found that most patients with successfully-treated symptoms of OAB who discontinue mirabegron treatment can only do so temporarily, with a worsening of symptoms occurring rather rapidly 5.
Treatment Guidelines and Recommendations
- A review of the literature suggests that mirabegron represents a new treatment option for a broad range of patients with OAB 4.
- Guidelines for choosing appropriate medication for OAB suggest starting with antimuscarinic agents, but considering mirabegron 50 mg for patients with risk of cognitive dysfunction, constipation, dry mouth, or urinary retention 6.
- For elderly patients with low detrusor contractility, central nervous system lesions, or men with benign prostatic hyperplasia, starting with 25 mg mirabegron is recommended, with the option to increase the dose to 50 mg if necessary 6.