Effective treatment of neurogenic detrusor dysfunction by combined high-dosed antimuscarinics without increased side-effects

Eur Urol. 2008 May;53(5):1021-8. doi: 10.1016/j.eururo.2008.01.007. Epub 2008 Jan 17.

Abstract

Objectives: Patients with neurogenic bladder dysfunction demonstrate an insufficient treatment outcome under dosage-escalated monotherapy. With the objectives of continence and normalised bladder pressure, safe and tolerable non-invasive treatment alternatives were evaluated by using combined antimuscarinics.

Methods: Twenty-seven patients who were previously registered in a doubled antimuscarinics study were enrolled in this study. The patients demonstrated urodynamic-proven neurogenic bladder dysfunction with incontinence, reduced bladder capacity, and increased intravesical pressure, resulting from spinal cord injury (n=21); spinal cord dysplasia (myelomeningocele; n=3); multiple sclerosis (n=2), and viral encephalomyelitis (n=1). On the basis of the initial study treatment, they were allocated into three groups and treated with two antimuscarinics. Before enrollment, at 4 wk, and at 6 mo, patients underwent urodynamics and recorded bladder diaries, including side-effects.

Results: In all three groups, significant changes were noted at the 4-wk follow-up. Incontinence events decreased from an average of 7 to 1 event per day. The average median bladder capacity (180-393 ml) and reflex volume (125-335 ml) increased; detrusor compliance also improved (average, 15-33 ml/cm H2O). Seven patients reported side-effects; two discontinued the successful treatment. Two other patients did not reach satisfactory amelioration of the detrusor dysfunction.

Conclusion: With combined high-dosage antimuscarinic medications, 85% of the patients who previously demonstrated unsatisfactory outcome with dosage-escalated monotherapy were treated successfully. The appearance of side-effects was comparable to that of normal-dosed antimuscarinics. Further studies are required to investigate the long-term pharmacological and physiological background of our findings.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Benzhydryl Compounds / administration & dosage
  • Benzilates
  • Cresols / administration & dosage
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mandelic Acids / administration & dosage
  • Middle Aged
  • Muscarinic Antagonists / administration & dosage*
  • Nortropanes / administration & dosage
  • Parasympatholytics / administration & dosage
  • Phenylpropanolamine / administration & dosage
  • Spinal Cord Diseases / complications
  • Tolterodine Tartrate
  • Treatment Outcome
  • Urinary Bladder, Neurogenic / drug therapy*
  • Urinary Bladder, Neurogenic / etiology
  • Urinary Bladder, Neurogenic / physiopathology
  • Urodynamics / drug effects*

Substances

  • Benzhydryl Compounds
  • Benzilates
  • Cresols
  • Mandelic Acids
  • Muscarinic Antagonists
  • Nortropanes
  • Parasympatholytics
  • trospium chloride
  • Phenylpropanolamine
  • Tolterodine Tartrate
  • oxybutynin