Triple therapy in refractory detrusor overactivity: a preliminary study

Natalin, Ricardo A.; Reis, Leonardo Oliveira; Alpendre, Cristiano; Ikari, Lia Yumi; Prudente, Alessandro; D’Ancona, Carlos

doi:10.1007/s00345-009-0400-6

Cited by 18 publications

(7 citation statements)

References 39 publications

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“…71,72 Tricyclic antidepressant drugs, such as imipramine and amitriptyline, have an additional use in the treatment of bladder dysfunction. 73 They function to increase norepinephrine and serotonin levels and exhibit anticholinergic and direct muscle relaxant effects on the urinary bladder. 73,74 HEREDITARY PERIPHERAL NEUROPATHIES Hereditary peripheral neuropathies are genetically and phenotypically heterogeneous disorders.…”

Section: Hiv-associated Neuropathymentioning

confidence: 99%

“…73 They function to increase norepinephrine and serotonin levels and exhibit anticholinergic and direct muscle relaxant effects on the urinary bladder. 73,74 HEREDITARY PERIPHERAL NEUROPATHIES Hereditary peripheral neuropathies are genetically and phenotypically heterogeneous disorders. Charcot-Marie-Tooth (CMT) disease is the most common inherited peripheral neuropathy.…”

Section: Hiv-associated Neuropathymentioning

confidence: 99%

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Bladder dysfunction in peripheral neuropathies

et al. 2011

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Normal bladder function depends on the complex interaction of sensory and motor pathways. Bladder dysfunction can develop as a result of several neurological conditions. It can happen in a number of ways, including diabetic cystopathy, detrusor overactivity, bladder outlet obstruction, and urge and stress urinary incontinence. Diabetic neuropathy is the most common cause of peripheral neuropathy-associated bladder dysfunction. Guillain-Barré syndrome (GBS), human immunodeficiency virus (HIV)-associated neuropathy, chronic inflammatory demyelinating polyneuropathy (CIDP), and amyloid neuropathy are other major causes. The diagnosis of bladder dysfunction should be established by the history of neurological symptoms, neurological examination, and urological evaluation. Functional evaluation of the lower urinary tract includes cystometry, sphincter electromyography, uroflowmetry, and urethral pressure profilometry. Management of urinary symptoms in patients with bladder dysfunction is usually supportive. In some cases, alpha-blocker and/or anti-muscarinic agents are needed to help improve urinary dysfunction. Intermittent self-catheterization is needed occasionally for patients with slow and/or poor recovery.

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Section: Hiv-associated Neuropathymentioning

confidence: 99%

Section: Hiv-associated Neuropathymentioning

confidence: 99%

Bladder dysfunction in peripheral neuropathies

et al. 2011

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“…Antimuscarinics are the mainstay of treatment of overactive bladder, but they have also been studied in combination with biofeedback, alpha-blockers, tricyclic antidepressants and DDAVP. 15,19 Recently published guidelines by the American Urological Association on the management of DO in adults state that there is a paucity of literature addressing combination therapy of antimuscarinics with each other or with other classes of medication, such as tricyclics to recommend its use. 20 Despite the above concerns, 2 groups have reported on antimuscarinics combination for the treatment of overactive bladder in adults.…”

Section: Discussionmentioning

confidence: 99%

Double anticholinergic therapy for refractory neurogenic and non-neurogenic detrusor overactivity in children: Long-term results of a prospective open-label study

Nadeau

Schröeder

Moore

et al. 2014

CUAJ

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Introduction: In this study, we optimize pharmacotherapy in children who failed anticholinergic monotherapy by simultaneous administration of 2 anticholinergics (oxybutynin and/or tolterodine and/or solifenacin). Methods: This report is an update of our previously published study on double anticholinergic regimen in children with refractory incontinence due to neurogenic (NDO) and non-neurogenic (DO) detrusor overactivity. Patients with an insufficient response (clinically/urodynamically) to an optimized dose of a single anticholinergic (oxybutynin or tolterodine) received a second anticholinergic (tolterodine or solifenacin), in addition to the pre-existing medication. The primary end-point was efficacy (continence) and the secondary end-points were tolerability and safety. The Patient Perception of Bladder Condition (PPBC) scale was used to rate subjective improvement of patients. Results: In total, 56 patients with DO (n = 31) or NDO (n = 25) were enrolled at a mean age of 11.4 ± 3.5 years and were followed for a minimum of 3 months. The duration of double treatment was 36 ± 23 months. Our results found that 23 patients became dry, 18 improved significantly and 15 improved moderately. Urodynamic capacity improved from 158 ± 87 mL to 359 ± 148 mL and maximal pressure of contractions decreased from 76 ± 24 to 22 ± 22 cmH 2 O (p < 0.0001). The overall success rate was 82%, since 10 patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 28 patients, mild side effects by 20, moderate side effects by 8; 2 patients withdrew from the study due to their side effects. Of the 35 patients who voided spontaneously, 8 developed post-void residuals (>20%). Conclusions: With a larger cohort and prospective follow-up, we reiterated that double anticholinergic regimen in children with DO or NDO refractory to anticholinergic monotherapy is a feasible and efficient approach.

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“…Natalin et al [35] compared voiding diaries and urodynamics in 27 patients with refractory neurogenic DO before and after treatment with three-drug therapy consisting of an antimuscarinic, α-blocker, and tricyclic antidepressant. All voided spontaneously with refractory NGB symptoms despite taking an antimuscarinic.…”

Section: Multidrug Therapymentioning

confidence: 99%

Neurogenic Bladder: Current Pharmacologic Trends

Cameron

Latini

2010

Curr Bladder Dysfunct Rep

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Several studies have investigated the many pharmacologic therapies to treat neurogenic bladder. Our aim with this review is to provide an update on the current clinical and basic science literature pertaining to pharmacotherapy for this condition. Advances have been made in pediatric and adult pharmacotherapy. The most notable include the safety and effective use of tolterodine and transdermal oxybutynin in the treatment of pediatric neurogenic bladder. Also, recently, the safe and effective triple drug therapy consisting of an antimuscarinic, an α-blocker, and imipramine in combination has been shown to significantly improve bladder compliance and detrusor pressures.

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Triple therapy in refractory detrusor overactivity: a preliminary study

Abstract: Triple therapy may be an effective, easily employed and well-tolerated option to refractory DO treatment. More studies are necessary to achieve more consistent data on the matter.

Cited by 18 publications

References 39 publications

Bladder dysfunction in peripheral neuropathies

Bladder dysfunction in peripheral neuropathies

Double anticholinergic therapy for refractory neurogenic and non-neurogenic detrusor overactivity in children: Long-term results of a prospective open-label study

Neurogenic Bladder: Current Pharmacologic Trends

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