Anticholinergic Drugs for Adult Neurogenic Detrusor Overactivity: A Systematic Review and Meta-analysis

Madhuvrata, Priya; Singh, Manju; Hasafa, Zaid; Abdel‐Fattah, Mohamed

doi:10.1016/j.eururo.2012.02.036

Cited by 139 publications

(133 citation statements)

References 25 publications

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“…3 Bladder capacity evaluated by UDS was significantly different between neurogenic and nonneurogenic patients initially (p = 0.03), but not after (p = 0.95) treatment with solifenacin. 4 Detrusor contractions on UDS were significantly improved by solifenacin treatment; overall, neurogenic and non-neurogenic groups (p < 0.0001). SD: standard deviation; Before: mean number of incontinence episodes per day on 3-day voiding diary when initiating study; After: mean number of incontinence episodes per day on 3-day voiding diary at last follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…3 Seven different anticholinergics are currently marketed for the treatment of DO/NDO in adults (oxybutynin, tolterodine, trospium, darifenacin, solifenacin, propiverine and fesoterodine), but none of them has been shown superior to another. 4 Data about the safety and efficacy of newer agents in children are scarce. Although there have been reports about the use of tolterodine, 5-9 trospium 10 and propiverine 11,12 in children, to date only oxybutynin chloride has been officially approved for pediatric use by medical authorities in North America.…”

Section: Introductionmentioning

confidence: 99%

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Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study

Nadeau

Schröeder

Moore

et al. 2014

CUAJ

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Introduction: We evaluate the efficacy and safety of solifenacin to treat incontinence in children with non-neurogenic (DO) or neurogenic detrusor overactivity (NDO) refractory to oxybutinin or tolterodine. Methods: We updated and extended our previously published nonrandomized uncontrolled study on open-label use of adjusted-dose regimens of solifenacin (1.25-10 mg) in children with refractory incontinence. The follow-up included voiding diaries, post-void residuals, urine cultures, ultrasounds and urodynamic studies. Clinical data were updated as of September 2012. Subjective improvement was assessed with the Patient Perception of Bladder Condition (PPBC) scale. The primary end point was efficacy toward continence and secondary end points were tolerability and safety. Results: Overall, 244 patients (112 girls, 132 boys) were enrolled; 53 with NDO and 191 with DO. Minimal follow-up was 5 months, the mean duration of treatment was 21.0 months and the mean age at initiation was 9.2 years. Urodynamic capacity improved from 145 ± 76 mL to 339 ± 152 mL and the amplitude of uninhibited contractions decreased from 66 ± 26 to 20 ± 20 cmH 2 O (p < 0.0001). The overall success rate is 91%, and more specifically 94% for non-neurogenic and 79% for neurogenic, which is significantly different (p = 0.013). Twenty-three patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 175 patients, mild by 46, moderate by 9, and 14 withdrew due to their side effects. Ten patients developed post-void residuals of ≥20 mL. Conclusion: Although higher in the non-neurogenic group, high subjective and objective success rates were maintained over a longer follow-up with an adjusted-dose regimen of solifenacin to treat pediatric NDO or DO refractory to oxybutynin or tolterodine. Moreover, we found acceptable tolerability and safety profiles.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study

Nadeau

Schröeder

Moore

et al. 2014

CUAJ

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“…In the only meta-analysis focussing on NDO, Madhuvrata et al 5 restricted their approach to 16 randomized controlled trials (RCT), however, with a rather statistical than clinical approach and inclusion criteria deviant from our review. The review did not address issues such as bladder compliance, duration of detrusor contractions, IC, and function and morphology of the upper urinary tract.…”

Section: Introductionmentioning

confidence: 99%

Neurogenic detrusor overactivity in adults: a review on efficacy, tolerability and safety of oral antimuscarinics

Madersbacher

Mürtz²,

Stöhrer

2013

Spinal Cord

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Objectives: This review analyzed efficacy, tolerability and safety of oral antimuscarinic (AM) drugs in adults suffering from neurogenic detrusor overactivity (NDO). Methods: A comprehensive search of major literature bases was conducted to identify all references. Results: Thirty studies, thereof 16 randomized controlled trials (RCT), enrolling 1479 patients were identified and included in the review. Results were grouped in dose-finding, placebo-and active-controlled, flexible dose and combined high-dose AM drugs, and various studies. Key urodynamic outcome parameters, such as maximum detrusor pressure and maximum cystometric bladder capacity, demonstrated the efficacy of AM in NDO, following 2-3 weeks of treatment. Contrary to idiopathic detrusor overactivity (IDO), no placebo effects manifested. Other important parameters, such as impact on the upper urinary tract function and morphology, issues of continence, post-void residual urine, catheterisation, urinary tract infections and quality of life, were investigated to a limited extent only. Incidence rates of adverse events were comparable for NDO and IDO. Most of the studies, especially RCT, were undertaken with oxybutynin immediate release (IR), trospium chloride IR, propiverine IR and propiverine extended release. In NDO, these drugs are best investigated. Conclusions: AM drugs are effective in NDO, they normalize the intravesical pressure and increase cystometric bladder capacity. However, other important parameters are not adequately investigated so far and should be recognized in future studies.

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“…Neurogeninis šlapinimosi hiperaktyvumas yra bendras neurologinių ligų bruožas, pasireiškiantis skubiu, dažnu noru šlapintis ir ūmiu šlapimo nelaikymu [3]. Pirmo pasirinkimo vaistai gydant neurogeninę šlapimo pūslę yra anticholinerginiai medikamentai, bet daugumai pacientų jie yra nebeveiksmingi arba sukelia nepageidaujamų reiškinių, todėl pasirenkama alternatyvi gydymo metodika [4]. Botulino toksino A injekcijos -vienas iš galimų gydymo būdų pacientams, kuriems pirmo pasirinkimo gydymo metodai tampa neveiksmingi.…”

Section: įžAngaunclassified

“…Remiantis 2012 metų P. Madhuvrata metaanalize, anticholinerginė terapija mažina intravezikinį spaudimą, šlapimo nelaikymo epizodų dažnį ir padidina šlapimo pūslės talpą. Pagrindiniai šių vaistų neigiami poveikiai -konstipacija ir burnos sausėjimas [4]. Nors literatūroje šie nepageidaujami reiškiniai yra dažnai minimi, anticholingerginių vaistų nutraukimo dažnis nėra statistiškai reikšmingas, palyginti su placebo grupe [25-27].…”

Section: Gydymo Algoritmasunclassified

Šlapinimosi sutrikimai po stuburo traumų ir jų gydymas botulino toksino A endovezikinėmis injekcijomis

Černiauskienė¹,

Genytė²,

Jukna³

2017

LietChirur

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Neurogeninės kilmės šlapinimosi sutrikimai, atsiradę dėl stuburo traumos, yra aktuali problema. Sunkus stuburo pažeidimas gali sukelti padidėjusį šlapimo pūslės jautrumą, tuštinamojo pūslės raumens (detruzoriaus) hiperaktyvumą, o dėl to šlapimo nelaikymą kaupimo fazės metu. Praradus spinalinę kontrolę, kuri normaliai koordinuoja detruzoriaus susitraukimą ir šlaplės sfinkterio atsipalaidavimą šlapinantis, vystosi detruzoriaus ir sfinkterio sinerginis susitraukinėjimas arba, atvirkščiai -veziko sfinkterinė dissinergija, sukelianti fiziologiškai nenormalų šlapimo pasišalinimą. Šie pokyčiai gali pakenkti paciento gyvenimo kokybei, todėl taikomi įvairūs gydymo būdai. Pirmo pasirinkimo medikamentai yra anticholinerginiai vaistai. Jiems tapus nebeveiksmingais ir norint išvengti chirurginio gydymo, naudojamos botulino toksino A inkekcijos į šlapimo pūslės raumenį arba šlaplės sfinkterį. Botulino toksino A injekcijos -tai naujas gydymo metodas šlapinimosi sutrikimams gydyti. Jis yra veiks mingas ir sukelia mažai nepageidaujamų reiškinių, todėl ši procedūra vis dažniau atliekama klinikinėje praktikoje. Injekcijomis siekiama sumažinti slėgį pūslėje ir retinti šlapimo nelaikymo epizodų skaičių, be to, galima atlikti kartotines injekcijas. Reikšminiai žodžiai: stuburo trauma, šlapinimosi sutrikimai, botulino toksinas Neurogenic bladder in patients after spinal cord injury is a significant problem. A severe spinal cord injury might produce overactive bladder, detrusor's hyperactivity which results in urine leaking during storage phase. The loss of supraspinal control that normally coordinates detrusor contraction and sphincter relaxation during urination, can lead to segmental spinal cord reflexmediated simultaneous contractions of detrusor and sphincter or on the contrary to detrusorsphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These diseaserelated alterations may deteriorate patient's qual ity of life, therefore different approaches are being applied for patient's wellbeing. Anticholinergic medications are currently first choice for treatment of neurogenic detrusor overactivity. If anticholinergic drugs are not effective and surgery is not an option, injections of botulinum toxinA to detrusor or urethral sphincter can be chosen for lowering bladder pressure and decreasing the number of urinary incontinence episodes. Botulinum toxinA injections is a new highly efficient method with rare side effects, therefore this procedure is becoming a promising future in bladder dysfunction treatment. The botulinum toxinA treatment can be performed repeatedly.

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Anticholinergic Drugs for Adult Neurogenic Detrusor Overactivity: A Systematic Review and Meta-analysis

Cited by 139 publications

References 25 publications

Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study

Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study

Neurogenic detrusor overactivity in adults: a review on efficacy, tolerability and safety of oral antimuscarinics

Šlapinimosi sutrikimai po stuburo traumų ir jų gydymas botulino toksino A endovezikinėmis injekcijomis

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