Neurogenic detrusor overactivity in adults: a review on efficacy, tolerability and safety of oral antimuscarinics

Abstract

Objectives: This review analyzed efficacy, tolerability and safety of oral antimuscarinic (AM) drugs in adults suffering from neurogenic detrusor overactivity (NDO). Methods: A comprehensive search of major literature bases was conducted to identify all references. Results: Thirty studies, thereof 16 randomized controlled trials (RCT), enrolling 1479 patients were identified and included in the review. Results were grouped in dose-finding, placebo-and active-controlled, flexible dose and combined high-dose AM drugs, and various studies. Key urodynamic outcome parameters, such as maximum detrusor pressure and maximum cystometric bladder capacity, demonstrated the efficacy of AM in NDO, following 2-3 weeks of treatment. Contrary to idiopathic detrusor overactivity (IDO), no placebo effects manifested. Other important parameters, such as impact on the upper urinary tract function and morphology, issues of continence, post-void residual urine, catheterisation, urinary tract infections and quality of life, were investigated to a limited extent only. Incidence rates of adverse events were comparable for NDO and IDO. Most of the studies, especially RCT, were undertaken with oxybutynin immediate release (IR), trospium chloride IR, propiverine IR and propiverine extended release. In NDO, these drugs are best investigated. Conclusions: AM drugs are effective in NDO, they normalize the intravesical pressure and increase cystometric bladder capacity. However, other important parameters are not adequately investigated so far and should be recognized in future studies.

Shifting to 4 × 1 intermittent catheterization without an early follow-up urodynamic study is possible in most patients with subacute spinal cord injury

“…9,10 In a review examining the results of 30 studies performed with a total of 1,479 patients with neurogenic detrussor overactivity, it was shown that antimuscarinic drugs (most commonly studied drugs; oxybutynin HCl, trospium chloride and propiverine) are effective after 2-3 weeks of therapy. 11 We also observed a significant increase in mean bladder capacity in our patients with SCI who had been put on 6/day IC and oral anticholinergic therapy for an overactive or hypocompliant detrusor. A retrospective study evaluating the effectiveness of anticholinergic drugs within a mean duration of 1 month (21-46 days) in 231 patients with overactive Table 2 Comparison of pre and post-treatment maximum cystometric capacities…”

Improving Outcomes in Patients With Refractory Idiopathic and Neurogenic Detrusor Overactivity: Management Strategies

“…These agents normalize intravesical pressure and increase cystometric bladder capacity. 55 They significantly reduce maximum detrusor pressure; however, reduction in detrusor overactivity persists only while the patient remains on the treatment. In addition, antimuscarinics are associated with several commonly noted adverse effects, particularly dry mouth and constipation, which can interfere with patient adherence to treatment.…”

“…Studies have demonstrated efficacy of at least 4 of them (oxybutynin, trospium chloride, tolterodine, darifenacin) in this patient population. 9,32,55,65 The detrusor muscle contains beta-adrenoceptors. Human bladder and urothelium contain beta1-, beta2-, and beta3-adrenoceptors 66 ; 97% of beta adrenoceptors in the human bladder are beta3.…”

Biomarkers of spinal cord injury and ensuing bladder dysfunction

“…The latter include antimuscarinic drugs [85] and botulinum toxin [86]. Nowadays, in developed countries, the life span of most SCI patients is long and approaches that of the general population.…”