Effective treatment of neurogenic detrusor dysfunction by combined high-dosed antimuscarinics without increased side-effects

Objectives: Patients with neurogenic bladder dysfunction demonstrate an insufficient treatment outcome under dosage-escalated monotherapy. With the objectives of continence and normalised bladder pressure, safe and tolerable non-invasive treatment alternatives were evaluated by using combined antimuscarinics. Methods: Twenty-seven patients who were previously registered in a doubled antimuscarinics study were enrolled in this study. The patients demonstrated urodynamic-proven neurogenic bladder dysfunction with incontinence, reduced bladder capacity, and increased intravesical pressure, resulting from spinal cord injury (n = 21); spinal cord dysplasia (myelomeningocele; n = 3); multiple sclerosis (n = 2), and viral encephalomyelitis (n = 1). on the basis of the initial study treatment, they were allocated into three groups and treated with two antimuscarinics. Before enrolment, at 4 wk, and at 6 mo, patients underwent urodynamics and recorded bladder diaries, including side-effects. Results: in all three groups, significant changes were noted at the 4-wk follow-up. Incontinence events decreased from an average of 7 to 1 event per day. The average median bladder capacity (180-393 ml) and reflex volume (125-335 ml) increased; detrusor compliance also improved (average, 15-33 ml/cm H2O). Seven patients reported side-effects; two discontinued the successful treatment. Two other patients did not reach satisfactory amelioration of the detrusor dysfunction. Conclusion: With combined high-dosage antimuscarinic medications, 85% of the patients who previously demonstrated unsatisfactory outcome with dosage-escalated monotherapy were treated successfully. The appearance of side-effects was comparable to that of normal-dosed antimuscarinics. Further studies are required to investigate the long-term pharmacological and physiological background of our findings. (c) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.