Pharmacological Management of Detrusor Instability

Robinson, Dudley; Khullar, Vik; Cardozo, Linda

doi:10.1007/pl00004037

Cited by 7 publications

(4 citation statements)

References 66 publications

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“…Women with mixed urinary incontinence can be treated with anticholinergics, 17 and prior to continence surgery anticholinergic drugs are used to treat OAB symptoms. The rational for this order of treatment is that firstly, the irritative symptoms are controllable with anticholinergics and may indicate the severity of the detrusor overactivity, the less severe detrusor overactivity is controlled by the drug therapy.…”

Section: Discussionmentioning

confidence: 99%

Pre‐operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre‐operative mixed urinary incontinence

Panayi

Duckett

Digesu

et al. 2008

Neurourology and Urodynamics

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Section: Discussionmentioning

confidence: 99%

Pre‐operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre‐operative mixed urinary incontinence

Panayi

Duckett

Digesu

et al. 2008

Neurourology and Urodynamics

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“…This conclusion, although robust, might be further strengthened by an in vivo assessment of erectile function after HTZ treatment that additional studies should address. Smooth muscle tone and agonist-elicited responses are influenced by levels of endogenous cyclooxygenase products 33, 34, 35. Inhibition of cyclooxygenases by diclofenac (50 mg) or rofecoxib (25 mg) significantly decreases the diuretic-natriuretic effect of HTZ in humans, indicating a possible role for prostaglandins in the renal effects of thiazides 36 .…”

Section: Discussionmentioning

confidence: 99%

Hydrochlorothiazide Potentiates Contractile Activity of Mouse Cavernosal Smooth Muscle

et al. 2016

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IntroductionHydrochlorothiazide has a negative influence on penile erection but little is known about the mechanism(s) involved.AimsTo characterize the effects of this diuretic on mouse corpus cavernosum (CC) smooth muscle in vitro and ex vivo.MethodsCC strips of C57BL/6 mice (12–16 weeks old) were mounted in organ baths containing Krebs-Henseleit solution and tissue reactivity was evaluated. Expression of genes encoding diuretic targets and enzymes involved in penile erection were evaluated by polymerase chain reaction.Main Outcome MeasuresStimulation-response curves to phenylephrine (10 nmol/L–100 μmol/L) or to electrical field stimulation (1–32 Hz) were constructed, with or without hydrochlorothiazide. Strips of CC from mice after long-term hydrochlorothiazide treatment (6 mg/kg/day for 4 weeks) with or without amiloride (0.6 mg/kg/day for 4 weeks) in vivo also were studied. Nitric oxide and Rho-kinase pathways were evaluated.ResultsHydrochlorothiazide (100 μmol/L) increased the maximum response to phenylephrine by 64% in vitro. This effect was unaffected by the addition of indomethacin (5 μmol/L) but was abolished by N(ω)-nitro-L-arginine methyl ester (100 μmol/L). Hydrochlorothiazide (100 μmol/L) potentiated electrical field stimulation-induced contraction in vitro, but not ex vivo. Long-term treatment with hydrochlorothiazide increased the maximum response to phenylephrine by 60% and resulted in a plasma concentration of 500 ± 180 nmol/L. Amiloride (100μmol/L) caused rightward shifts in concentration-response curves to phenylephrine in vitro. Long-term treatment with hydrochlorothiazide plus amiloride did not significantly increase the maximum response to phenylephrine (+13%). Reverse transcriptase polymerase chain reaction did not detect the NaCl cotransporter in mouse CC. Hydrochlorothiazide did not change Rho-kinase activity, whereas amiloride decreased it in vitro and ex vivo (approximately 18% and 24% respectively). A 40% decrease in Rock1 expression also was observed after long-term treatment with hydrochlorothiazide plus amiloride.ConclusionHydrochlorothiazide potentiates contraction of smooth muscle from mouse CC. These findings could explain why diuretics such as hydrochlorothiazide are associated with erectile dysfunction.

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“…16 There are experimental non-anticholinergic treatments for overactive bladder such as intravesical capsaicin and resiniferatoxin that selectively inhibit reflexic bladder contractions. 19 Botulinum A toxin injections into the bladder neck or detrusor have been used to control bladder spasms in spinal cord injured patients. 20 Nimodipine (smooth muscle relaxant) is not effective.…”

Section: Overactive Bladdermentioning

confidence: 99%