A Clinical Experience with Dantrolene Sodium for External Urinary Sphincter Hypertonicity in Spinal Cord Injured Patients

Abstract

Significant bladder residual urine is secondary to pelvic floor skeletal muscle hypertonicity in some spinal cord injury patients with suprasacral or mixed lesions. Fifteen patients with residual urine volumes greater than 150 cc were treated with dantrolene sodium because of its ability to decrease skeletal muscle contractibility. All of the patients had urethral closure pressures greater than 100 cm. water. Of the 15 patients 8 benefited from dantrolene sodium therapy and were maintained on external condom urinary drainage. Five of these 8 patients required up to 600 mg. dantrolene sodium daily to affect this result. The residual urine volume decreased to less than 100 cc and the post-therapy decrease in urethral pressure averaged 77 cm. water (49 per cent). The patients in the failure group (residual urine greater than 150 cc) had an average decrease in urethral pressure of 21 cm. water (16 per cent). Detrusor hyporeflexia possibly contributed to the failure rate. In summary, dantrolene sodium seems to be beneficial in some patients with external urinary sphincter hypertonicity. However, it will not supplant external sphincterotomy in the more complete male spinal cord injury patient in whom reflex incontinence is of minimal concern. Dantrolene sodium could be an ideal treatment of patients with incomplete neurologic lesions in whom continence might be preserved. The drug will have to be effective at low doses to obviate the major side effect of over-all muscle weakness.

Memokath® stents for the treatment of detrusor sphincter dyssynergia (DSD) in men with spinal cord injury: The Princess Royal Spinal Injuries Unit 10-year experience

“…14 Centrally acting pharmacological therapy is ineffective for DSD 15 and agents such as dantrolene and baclofen not only have little effect but also potentially serious side effects (eg, fatal hepatotoxicity). 16,17 The use of endoluminal permanent wire mesh stents (UroLume s ) was first reported by Milroy et al, 18 in the treatment of bulbar urethral strictures. A 12-year review of wall stents for DSD in 12 patients by Hamid et al, 19 found them to be an effective alternative to sphincterotomy; however, in some, subsequent bladder neck dyssynergia emerged requiring further intervention.…”

“…The indications for insertion ( Figure 2) were for dysreflexic symptoms (15), high residual urine volumes and subsequent recurrent or persistent urinary tract infection (UTI) (17), for protection of the upper tracts (6) or to predict outcome following TUS (1). All stents ( Figure 1) were inserted under direct vision using a rigid (028T, 028TW, 045TW) or a flexible cystoscope (028SW).…”

The Forefront for Novel Therapeutic Agents Based on the Pathophysiology of Lower Urinary Tract Dysfunction: Pathophysiology of Voiding Dysfunction and Pharmacological Therapy

“…Dantrolene: Dantrolene (Dantrium) exerts its effects by a direct peripheral action on skeletal muscle. The drug has been reported to improve voiding function in some patients with classic detrusor-striated sphincter dyssynergia with a high risk of hepatotoxicity (46,47).…”

Cystometry and UPP Measurement under Fluoroscopic Visualization by means of X-Ray Television in Patients with a Traumatic Spinal Cord Lesion

“…However, the dyssynergia of this stadium is not directly indicated to transurethral sphincterotomy, this phenome non is transient in some cases, so we can expect that this dyssynergia would be alle viated with duration of urination training, and more, in some cases with these phenom ena, the spastic contraction of detrusor mus cles including pelvic muscles arises coinci dentally with a spasm of the lower limbs or abdomen. Under such circumstances, we can expect to reduce it by administration of new types of spasmolytic drugs, such as dantro lene sodium [7] and baclofen [8]; moreover, if autonomic hyperreflexia arises in such cases, administration of a-adrenolytic drugs and others must be indicated. On the other hand, there was an 'open state of the bladder neck' which was seen with autonomic waves on cystometry, but this opening was more re strained than the former, and it was not thought to be caused by active detrusor con traction, but that an insufficient sympathetic neural action to maintain the shut state of the bladder neck and inadequate pelvic muscles' tension to support the shut state of the blad der neck bring about this phenomenon.…”