Effective Treatment of Neurogenic Detrusor Dysfunction by Combined High-Dosed Antimuscarinics without Increased Side-Effects

Amend, Bastian; Hennenlotter, Jörg; Schäfer, Tobias; Horstmann, Marcus; Stenzl, Arnulf; Sievert, Karl‐Dietrich

doi:10.1016/j.eururo.2008.01.007

Cited by 123 publications

(69 citation statements)

References 30 publications

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“…Amend et al, 5 in a prospective study, showed that bitherapies associating tolterodine þ oxybutynin, tolterodine þ trospium or oxybutynin þ trospium were more effective than any anticholinergic monotherapies, with no significant increase in side effects. In our study, 97 SCI patients were on oxybutynin þ trospium, whereas 134 were on a single anticholinergic drug (oxybutynin or trospium).…”

Section: Discussionmentioning

confidence: 99%

“…2,4 The clinical and urodynamic efficacy of anticholinergic agents in SCI patients has been evaluated in a limited number of studies. [5][6][7][8][9] They all showed a significant decrease in the number of leakages per day with improved quality of life. Urodynamic testing showed significant improvement in maximum bladder capacity (BCmax) and significant reduction in amplitudes of IDC.…”

Section: Introductionmentioning

confidence: 99%

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Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients?

Hadiji¹,

Prévinaire

Benbouzid³

et al. 2014

Spinal Cord

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Objectives: To evaluate the efficacy of anticholinergic agents in the treatment of neurogenic overactive bladder (NOAB) and neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients on clean intermittent catheterisation (CIC). Methods: Chronic suprasacral SCI patients on CIC presenting with at least one urinary leakage a day were included. Urodynamics and voiding diaries were performed at baseline and 1 month follow-up. In case of NDO at baseline, an anticholinergic drug was prescribed. Results: The 231 SCI patients presented with one to five urinary leakages per day (mean 2.1). Urodynamics showed NDO in all patients. A new anticholinergic treatment was started in all, either in monotherapy (134 patients) or in association with the existing anticholinergic drug (oxybutynin þ trospium bitherapy, 97 patients). The mean maximum bladder capacity significantly increased from 225 to 441 ml, and the mean involuntary detrusor contractions (IDC) significantly decreased from 67 to 41 cm H 2 O. Only 75 SCI patients (32%) were fully continent. However, 25 out of these 75 patients showed persistent NDO, with amplitudes of IDC above 40 cm H 2 O in 12 patients. Incontinence was still found in 156 SCI patients (67%), with an average of 1,2 leakages a day. In 100 patients, amplitudes of IDC remained above 40 cm H 2 O. There was no statistical difference between patients on anticholinergic monotherapy or bitherapy at follow-up. Conclusion: Anticholinergic treatment is not always satisfactory in terms of control of NDO and rarely allows full continence. INTRODUCTIONThe quality of life of patients presenting with spinal cord injury (SCI) is frequently impaired by lower urinary tract dysfunction. In supra-sacral SCI lesions, neurogenic overactive bladder (NOAB) is common, with symptoms including urgency, with or without urge incontinence, frequency and nocturia. 1 Patients with NOAB are often found to have neurogenic detrusor overactivity (NDO), an urodynamic observation characterised by involuntary detrusor contractions (IDCs) during the filling phase that is either spontaneous or provoked. 2 Amplitudes of IDC greater than 40 cm H 2 O pose a threat to the upper urinary tract. 3 Oral antimuscarinic agents have been widely used as first-line treatment for patients with NDO. However, they are ineffective in some patients and are often associated with bothering side effects such as dry mouth, constipation and blurred vision. 2,4 The clinical and urodynamic efficacy of anticholinergic agents in SCI patients has been evaluated in a limited number of studies. [5][6][7][8][9] They all showed a significant decrease in the number of leakages per day with improved quality of life. Urodynamic testing showed significant improvement in maximum bladder capacity (BCmax) and significant reduction in amplitudes of IDC. However, these were mainly short-term studies, using different evaluation criteria, with different drugs at flexible doses. Surprisingly, patients presenting with daily leakages and persistence of IDC (as high as 35...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients?

Hadiji¹,

Prévinaire

Benbouzid³

et al. 2014

Spinal Cord

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“…26 Moreover, the same authors showed that 85% of patients nonresponsive to dosage-escalated monotherapy could be treated successfully by combined high-dose AM. 27 Various studies. Geirsson et al 30 investigated the onset of efficacy, following single doses of tolterodine IR, which manifested as early as 35 In a study with SCI patients comparing tolterodine and oxybutynin tolterodine …”

Section: Study Characteristicsmentioning

confidence: 99%

“…26 Two studies combined high-dose AM in patients nonresponsive to dosage-escalated monotherapy. 27,28 Various studies. Nine studies were grouped as various studies: one investigated short-term efficacy of trospium chloride IR, 29 one the onset of efficacy of tolterodine IR 30 and another tolterodine ER.…”

Section: Study Characteristicsmentioning

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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“…A study by Amend and colleagues (2008) 18 investigated whether a combination of antimuscarinic agents outperforms mono-therapy. Of the 27 patients included, 21 of them suffered from SCI, and they had previously been treated with double-dose antimuscarinic monotherapy.…”

Section: Antimuscarinic Receptor Antagonistmentioning

confidence: 99%

Controversy over the pharmacological treatments of storage symptoms in spinal cord injury patients: a literature overview

et al. 2011

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Study design: Our aim was to locate research and communicate the evidence found from scientific studies pertaining to the treatment of neurogenic detrusor overactivity (NDO) in the chronic stage of spinal cord injury (SCI). Objective: To address the controversy over the traditional (antimuscarinics) and the 'new' treatments for NDO and try to offer an insight on the rationale underlying the development of new drugs such as botulinum toxin (BTX), vanilloids, nociceptin/orphanin FQ. As a final point, to provide information on a new class of cation channels, the Degenerin/Epithelial Na + Channel (Deg/ENaC) Family that could be future targets for the management of NDO. Setting: International. Methods: Overview of English literature on drug management of NDO. Results: Agents that block the 'efferent' function of micturition reflex, such as antimuscarinics, are currently first-line therapy for NDO. They reach the highest level of evidence (1a) and grade of recommendation (A). However, many patients and physicians believe that the 'efferent' pharmacological management of NDO is not completely satisfactory. Consequently, research is trying to address issues of efficacy, tolerability and convenience of new therapeutic strategies targeting the 'afferent' function. Conclusion: Antimuscarinic therapy increases the bladder capacity and delays the initial urge to void. However, in some patients they fail to achieve the patient's therapeutic goals. New interesting approaches have been investigated in the last few years. BTX seems to be very promising in treating neurogenic overactive bladder (OAB), but other compounds are now on the horizon.

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Effective Treatment of Neurogenic Detrusor Dysfunction by Combined High-Dosed Antimuscarinics without Increased Side-Effects

Cited by 123 publications

References 30 publications

Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients?

Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients?

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

Controversy over the pharmacological treatments of storage symptoms in spinal cord injury patients: a literature overview

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