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• W1964460003 abstract "No AccessJournal of UrologyAdult Urology1 Sep 2009Combination Drug Therapy Improves Compliance of the Neurogenic Bladderis accompanied byAssessing the Effects of Transforming Growth Factor-β1 on Bladder Smooth Muscle Cell Phenotype. I. Modulation of In Vitro ContractilityAssessing the Effects of Transforming Growth Factor-β1 on Bladder Smooth Muscle Cell Phenotype. II. Modulation of Collagen Organization Anne P. Cameron, J. Quentin Clemens, Jerilyn M. Latini, and Edward J. McGuire Anne P. CameronAnne P. Cameron Nothing to disclose. More articles by this author , J. Quentin ClemensJ. Quentin Clemens Financial interest and/or other relationship with Merck, Medtronic and Tengion. More articles by this author , Jerilyn M. LatiniJerilyn M. Latini Financial interest and/or other relationship with Tengion. More articles by this author , and Edward J. McGuireEdward J. McGuire Financial interest and/or other relationship with Novartis, Tengion, Astellas and Pfizer. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.05.038AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Typical management of increased bladder storage pressures and decreased compliance related to neurogenic bladder dysfunction consists of antimuscarinic therapy with or without clean intermittent catheterization. However, these measures are often unsuccessful. In this patient group we commonly use combination therapy consisting of antimuscarinics combined with imipramine and/or an α-blocker. Materials and Methods: A retrospective chart review was performed identifying all patients with neurogenic bladder dysfunction who were initially on no drug therapy or antimuscarinic therapy alone and were later switched to 2 or 3 drug therapy. Results: In the group initially on no therapy and subsequently on 2 drugs (22) mean bladder pressure at capacity decreased 52% and mean compliance increased 5.0-fold. Similarly in the group starting without therapy but ending up on 3 drugs (28) bladder pressure decreased 67% and compliance increased 9.7-fold. In the group initially on an antimuscarinic agent alone (27) triple drug therapy decreased bladder pressure 60% and compliance increased 3.0-fold (all p <0.01). There were also improvements in incontinence, vesicoureteral reflux, detrusor overactivity and detrusor sphincter dyssynergia. Conclusions: In this highly selected group of patients with neurogenic bladder dysfunction and poor bladder compliance combination medical therapy with 2 or 3 drugs improved compliance, decreased bladder pressures at capacity and improved clinical outcomes. Combination therapy requires further study of the side effect profile but these results suggest that it should be considered for patients in whom antimuscarinic agents alone fail. References 1 : Contemporary role of suprapubic cystostomy in treatment of neuropathic bladder dysfunction in spinal cord injured patients. Neurourol Urodyn2008; 27: 475. Google Scholar 2 : Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia: a followup study. J Urol1983; 129: 823. Link, Google Scholar 3 : Propiverine compared to oxybutynin in neurogenic detrusor overactivity–results of a randomized, double-blind, multicenter clinical study. Eur Urol2007; 51: 235. Google Scholar 4 : Urodynamic effects of oral oxybutynin chloride in children with myelomeningocele and detrusor hyperreflexia. Urology1998; 51: 94. Google Scholar 5 : Current practice patterns in the urologic surveillance and management of patients with spinal cord injury. Urology2003; 61: 893. 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Google Scholar 12 : Urodynamics-based evidence for the beneficial effect of imipramine on valve bladders in children. Eur J Pediatr Surg2005; 15: 347. Google Scholar 13 : The effect of terazosin on bladder function in the spinal cord injured patient. J Urol1994; 151: 951. Link, Google Scholar 14 : Muscarinic acetylcholine receptor subtypes mediating urinary bladder contractility and coupling to GTP binding proteins. J Pharmacol Exp Ther1995; 273: 959. Google Scholar 15 : Lower urinary tract symptoms (LUTS) and bladder afferent activity. Neurourol Urodyn2007; 26: 908. Google Scholar 16 : Human idiopathic and neurogenic overactive bladders and the role of M2 muscarinic receptors in contraction. Eur Urol2007; 52: 531. Google Scholar 17 : Alpha1-adrenergic receptor subtypes in human detrusor. J Urol1998; 160: 937. Link, Google Scholar 18 : The sympathetic innervation and adrenoreceptor function of the human lower urinary tract in the normal state and after parasympathetic denervation. Invest Urol1977; 14: 322. Google Scholar 19 : The pharmacology of paediatric incontinence. BJU Int2000; 86: 581. Google Scholar 20 : Differences in bladder compliance with time and associations of bladder management with compliance in spinal cord injured patients. J Urol2000; 163: 1228. Link, Google Scholar Department of Urology, University of Michigan, Ann Arbor, Michigan© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byMorin F, Blais A, Nadeau G, Moore K, Genois L and Bolduc S (2018) Dual Therapy for Refractory Overactive Bladder in Children: A Prospective Open-Label StudyJournal of Urology, VOL. 197, NO. 4, (1158-1163), Online publication date: 1-Apr-2017.Clemens J (2018) ConJournal of Urology, VOL. 187, NO. 6, (1963-1965), Online publication date: 1-Jun-2012.Related articlesJournal of Urology21 Jul 2009Assessing the Effects of Transforming Growth Factor-β1 on Bladder Smooth Muscle Cell Phenotype. I. Modulation of In Vitro ContractilityJournal of Urology21 Jul 2009Assessing the Effects of Transforming Growth Factor-β1 on Bladder Smooth Muscle Cell Phenotype. II. Modulation of Collagen Organization Volume 182Issue 3September 2009Page: 1062-1067 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsurodynamicsurinary bladder, neurogenicadrenergic alpha-antagonistsimipraminecholinergic antagonistsMetricsAuthor Information Anne P. Cameron Nothing to disclose. More articles by this author J. Quentin Clemens Financial interest and/or other relationship with Merck, Medtronic and Tengion. More articles by this author Jerilyn M. Latini Financial interest and/or other relationship with Tengion. More articles by this author Edward J. McGuire Financial interest and/or other relationship with Novartis, Tengion, Astellas and Pfizer. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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