nach oben

Erschienen in:

01.02.2010 | Original Article

Triple therapy in refractory detrusor overactivity: a preliminary study

verfasst von: Ricardo Natalin, Leonardo Oliveira Reis, Cristiano Alpendre, Lia Y. Ikari, Alessandro Prudente, Carlos A. L. D’Ancona

Erschienen in: World Journal of Urology | Ausgabe 1/2010

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate in a prospective study the impact of the “three-drug therapy” (antimuscarinic, alpha-blocker and tricyclic antidepressants) on the treatment of refractory detrusor overactivity (DO).

Methods

Data from 27 consented patients with refractory DO were available for study. They were asked to complete a daily urinary chart and underwent urodynamic evaluation (UD) before and 60 days after treatment. Response to treatment was considered the presence of one or less involuntary detrusor contractions (IDC) on post-treatment UD. Statistical analysis was performed with Fisher and Mann–Whitney tests, besides Spearman’s correlation. P values <0.05 were considered significant.

Results

The mean follow-up was 15 months. The comparison of the daily urinary chart before and after treatment showed significant increase on bladder capacity and decreases on urgency, urge-incontinence and frequency. Objective data from UD showed that the mean maximum bladder capacity (MBC) ranged from 200 to 300 mL (P < 0.001) with treatment. The same trend was observed with the other UD variables. When compared to baseline, the questionnaire OAB-v8 showed significant improvement (P < 0.01). Main side effects comprised dry mouth and constipation (40%), with average scores of 5.16 and 3.08, respectively (visual scale from 0 to 10).

Conclusions

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.

Hashim H, Abrams P (2004) Drug treatment of overactive bladder: efficacy, cost and quality-of-life considerations. Drugs 64:1643–1656CrossRefPubMed

Abrams P, Andersson KE (2007) Muscarinic receptor antagonists for overactive bladder. BJU Int 100:987–1006PubMed

Abrams P, Cardozo L, Fall M et al (2003) The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 61:37–49CrossRefPubMed

Brown JS, McGhan WF, Chokroverty S (2000) Comorbidities associated with overactive bladder. Am J Manag Care 6:574–579

Kilic N, Balkan E, Akgoz S et al (2006) Comparison of the effectiveness and side-effects of tolterodine and oxybutynin in children with detrusor instability. Int J Urol 13:105–108CrossRefPubMed

Wein AJ (1998) Pharmacologic options for the overactive bladder. Urology 51:43–47CrossRefPubMed

Hawthorn MH, Chapple CR, Cock M et al (2000) Urothelium-derived inhibitory factor(s) influences on detrusor muscle contractility in vitro. Br J Pharmacol 129:416–419CrossRefPubMed

Kim Y, Yoshimura N, Masuda H, de Miguel F, Chancellor MB (2005) Antimuscarinic agents exhibit local inhibitory effects on muscarinic receptors in bladder afferent pathways. Urology 65:238–242CrossRefPubMed

Finney SM, Andersson KE, Gillespie JI et al (2006) Antimuscarinic drugs in detrusor overactivity and the overactive bladder syndrome: motor or sensory actions? BJU Int 98:503–507CrossRefPubMed

10.

Andersson KE, Yoshida M (2003) Antimuscarinics and the overactive detrusor—which is the main mechanism of action? Eur Urol 43:1–5CrossRefPubMed

11.

Kim Y, Yoshimura N, Masuda H et al (2006) Intravesical installation of human urine after oral administration of trospium, tolterodine and oxybutynin in a rat model of detrusor overactivity. BJU Int 97:400–403CrossRefPubMed

12.

MacDiarmid SA (2007) Maximizing anticholinergic therapy for overactive bladder: has the ceiling been reached? BJU Int 99:8–12CrossRefPubMed

13.

Dmochowski R (2002) Interventions for detrusor overactivity: the case for multimodal therapy. Rev Urol 4:19–27

14.

Ruggieri MR Sr, Braverman AS, Pontari MA (2005) Combined use of alpha-adrenergic and muscarinic antagonists for the treatment of voiding dysfunction. J Urol 174:1743–1748CrossRefPubMed

15.

Salvatore S, Soligo M, Proietti F et al (2005) Overactive bladder syndrome: considerations in pharmacotherapy and new perspectives. Eur J Obstet Gynecol Reprod Biol 120:129–133CrossRefPubMed

16.

Chen Q, Takahashi S, Zhong S et al (2005) Function of the lower urinary tract in mice lacking a1d-adrenoceptor. J Urol 174:370–374CrossRefPubMed

17.

Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49:651–659CrossRefPubMed

18.

Penttila J, Syvalahti E, Hinkka S et al (2001) The effects of amitriptyline, citalopram and reboxetine on autonomic nervous system. A randomised placebo-controlled study on healthy volunteers. Psychopharmacology (Berl) 154:343–349CrossRef

19.

Andersson KE (2000) Treatment of overactive bladder: other drug mechanisms. Urology 55:51–57CrossRefPubMed

20.

Sacco E, Pinto F, Bassi P (2008) Emerging pharmacological targets in overactive bladder therapy: experimental and clinical evidences. Int Urogynecol J 19:583–598CrossRef

21.

Miller KL, Dubeau CE, Bergmann M, Griffiths DJ, Resnick NM (2002) Quest for a detrusor overactivity index. J Urol 167:578–585CrossRefPubMed

22.

Sellers DJ, McKay N (2007) Developments in the pharmacotherapy of the overactive bladder. Curr Opin Urol 17:223–230CrossRefPubMed

23.

Witte LPW, Mulder WMC, de la Rosette JJMCH, Miche MC (2009) Muscarinic receptor antagonists for overactive bladder treatment: does one fit all? Curr Opin Urol 19:13–19CrossRefPubMed

24.

Andersson KE (2006) Treatment-resistant detrusor overactivity—underlying pharmacology and potential mechanisms. Int J Clin Pract 60:8–16CrossRef

25.

Novara G, Galfano A, Ficarra V et al (2006) Anticholinergic drugs in patients with bladder outlet obstruction and lower urinary tract symptoms: a systematic review. Eur Urol 50:675–683CrossRefPubMed

26.

Horstmann M, Schaefer T, Aguilar Y et al (2006) Neurogenic bladder treatment by doubling the recommended antimuscarinic dosage. Neurourol Urodyn 25:441–445CrossRefPubMed

27.

Menarini M, Del Popolo G, Di Benedetto P et al (2006) Trospium chloride in patients with neurogenic detrusor overactivity: is dose titration of benefit to the patients? Int J Clin Pharmacol Ther 44:623–632PubMed

28.

Amend B, Hennenlotter J, Schafer T, Horstmann M, Stenzl A, Sievert K (2008) Effective treatment of neurogenic detrusor dysfunction by combined high-dosed antimuscarinics without increased side-effects. Eur Urol 53:1021–1028CrossRefPubMed

29.

Payne CK, Kelleher C (2007) Redefining response in overactive bladder syndrome. BJU Int 99:101–106CrossRefPubMed

30.

Kobelt G, Borgstrom F, Mattiasson A (2003) Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia. BJU Int 91:190–195CrossRefPubMed

31.

Samuelsson E, Victor A, Tibblin G (1997) A population study of urinary incontinence and nocturia among women aged 20–59 years. Prevalence, well being and wish for treatment. Acta Obstet Gynecol Scand 76:74–80CrossRefPubMed

32.

Irwin DE, Milsom I, Kopp Z et al (2006) Impact of overactive bladder symptoms on employment, social interactions and emotional well being in six European countries. BJU Int 97:96–100CrossRefPubMed

33.

Fultz N, Girts T, Kinchen K et al (2005) Prevalence, management and impact of urinary incontinence in the workplace. Occup Med 55:552–557CrossRef

34.

Hashim H, Abrams P (2007) Overactive bladder: an update. Curr Opin Urol 17:231–236CrossRefPubMed

35.

Brown JS, Vittinghoff E, Wyman JF et al (2000) Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 48:721–725PubMed

36.

Milsom I, Abrams P, Cardozo L et al (2001) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 87:760–766CrossRefPubMed

37.

Reeves P, Irwin D, Kelleher C et al (2006) The current and future burden and cost of overactive bladder in five European countries. Eur Urol 50:1050–1057CrossRefPubMed

38.

Serels S, Stein M (1998) Prospective study comparing hyoscyamine, doxazosin, and combination therapy for the treatment of urgency and frequency in women. Neurourol Urodyn 17:31–36CrossRefPubMed

39.

Staskin DR, MacDiarmid SA (2006) Using anticholinergics to treat overactive bladder: the issue of treatment tolerability. Am J Med 119:9–15CrossRefPubMed

40.

Andersson KE, Chapple CR (2001) Oxibutinin and the overactive bladder. World J Urol 19:319–323CrossRefPubMed

41.

Serrano Brambila EA, Quiroga Avila RG, Lorenzo Monterrubio JL et al (2000) Assessment of effectiveness of and tolerance to oxybutynin in the treatment of unstable bladder in women. Ginecol Obstet Mex 68:174–181PubMed

42.

Brostrom S, Hallas J (2009) Persistence of antimuscarinic drug use. Eur J Clin Pharmacol. doi: 10.1007/s00228-008-0600-9

43.

Witte LPW, Mulder WMC, de la Rosette JJMCH, Miche MC (2009) Muscarinic receptor antagonists for overactive bladder treatment: does one fit all? Curr Opin Urol 19:13–19CrossRefPubMed

Titel: Triple therapy in refractory detrusor overactivity: a preliminary study
verfasst von: Ricardo Natalin
Leonardo Oliveira Reis
Cristiano Alpendre
Lia Y. Ikari
Alessandro Prudente
Carlos A. L. D’Ancona
Publikationsdatum: 01.02.2010
Verlag: Springer-Verlag
Erschienen in: World Journal of Urology / Ausgabe 1/2010
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-009-0400-6

Neu im Fachgebiet Urologie

25.04.2024 | Nierenkarzinom | Nachrichten

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Triple therapy in refractory detrusor overactivity: a preliminary study

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Stufenschema weist Prostatakarzinom zuverlässig nach

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Urologie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2010

Identification of urine PLK2 as a marker of bladder tumors by proteomic analysis

Partners agree that the treatment of LUTS reduces patients’ bother and improves their quality of life: prospective 12 years follow-up study

Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction

Four-arm robotic partial nephrectomy for complex renal cell carcinoma

Factors predicting inguinal node metastasis in squamous cell cancer of penis

Current status of 5α-reductase inhibitors in the management of lower urinary tract symptoms and BPH

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Stufenschema weist Prostatakarzinom zuverlässig nach

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Urologie