Prophylaxis and treatment of bladder dysfunction after Wertheim-Meigs operation: the positive effect of early postoperative detrusor stimulation using the cholinergic drug betanecholchloride

Kemp, B.; Kitschke, H. J.; Goetz, M L; Heyl, W.

doi:10.1007/bf02764845

Cited by 13 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The early use of agents that act pharmacologically on the bladder in the postoperative period of radical hysterectomy was advocated in another study [24], in which a shorter hospital stay, earlier removal of a suprapubic catheter and lower postvoid residual volume were observed in patients taking bethanechol. However, no urodynamic evaluation was performed in these patients.…”

Section: Discussionmentioning

confidence: 99%

The effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. A randomized, double-blind, placebo-controlled study

et al. 2005

View full text Add to dashboard Cite

To evaluate the effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. In this double-blind, placebo-controlled study, 79 patients with cervical cancer were randomized to receive bethanechol (30 mg/day), cisapride (30 mg/day), bethanechol combined with cisapride (same doses) and placebo. Urodynamic study was performed, including flowmetry, cystometry, pressure-flow study and urethral pressure profile before radical hysterectomy. Medication was administered postoperatively during 30 days. At the end of this period, urodynamic evaluation was repeated. There was an increase in both the maximum cystometric capacity and bladder capacity at first desire to void in the placebo group compared to the other groups. The rate of detrusor instability was higher in the group that used bethanechol combined with cisapride. Detrusor pressure at maximum flow was significantly higher when cisapride was used. There was a significant increase in postvoid residual volume in the placebo group. In patients undergoing radical hysterectomy, bethanechol and cisapride determined lower cystometric capacity and decreased bladder capacity at first desire to void, a higher maximum flow rate and higher detrusor pressure at maximum flow, with lower postvoid residual volumes. The early use of bethanechol and cisapride after radical hysterectomies positively modified urodynamic parameters, determining a more efficient detrusor function.

show abstract

Section: Discussionmentioning

confidence: 99%

The effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. A randomized, double-blind, placebo-controlled study

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Les deux autres études contrôlées, menées versus abstention thérapeutique et non versus placebo, rapportent des résultats divergeant sur l'intérêt préventif du BC dans la rétention urinaire postopératoire ou postobstétricale [19,20]. La première, menée chez 40 patientes ayant subi une chirurgie utérine pour néoplasie du col, suggère l'intérêt préventif d'un traitement oral précoce par BC [19].…”

Section: Méthodologieunclassified

“…La première, menée chez 40 patientes ayant subi une chirurgie utérine pour néoplasie du col, suggère l'intérêt préventif d'un traitement oral précoce par BC [19]. Dans ce travail, les patientes étaient réparties entre un groupe « préventif » recevant au troisième jour postopératoire 150 mg/j de BC en trois prises (16 patientes) et un groupe « curatif » ne recevant de BC que s'il persistait au dixième jour postopératoire un RPM supérieur à 50 ml (24 patientes).…”

Section: Méthodologieunclassified

“…Dans ce travail, les patientes étaient réparties entre un groupe « préventif » recevant au troisième jour postopératoire 150 mg/j de BC en trois prises (16 patientes) et un groupe « curatif » ne recevant de BC que s'il persistait au dixième jour postopératoire un RPM supérieur à 50 ml (24 patientes). Les critères d'évaluation, représentés par la durée du drainage urinaire postopératoire, de l'hospitalisation et de la disparition des RPM apparaissaient tous significativement plus améliorés dans le groupe « préventif » que « curatif », avec des valeurs moyennes respectives de 9,6 versus 13,3 jours, 15,5 versus 18,6 jours, et 8 versus 13 jours et 18,8 versus 25 % dans ces deux groupes [19].…”

Section: Méthodologieunclassified

See 1 more Smart Citation

Traitement médical de l’hypoactivité vésicale

et al. 2007

View full text Add to dashboard Cite

L'hypoactivité du détrusor, définie par l'existence d'une contraction détrusorienne, réduite en force ou en durée déterminant une vidange vésicale prolongée ou un défaut de vidange complète dans un temps habituel [1,2], demeure un problème thérapeutique imparfaitement résolu. Les différentes classes pharmacologiques ayant fait l'objet d'application thérapeutique dans l'hypoactivité du détrusor (HOD), agonistes cholinergiques, anticholinestérasiques et prostaglandines visent à renforcer les capacités contractiles cholinodépendantes du détrusor. La médiation non adrénocholinergique du réflexe mictionnel n'a pas fait l'objet de développement thérapeutique dans cette indication. Cette mise au point corrige les résultats des travaux cliniques contrôlés évaluant l'intérêt clinique et/ou urodynamiques des agents cholinomimétiques dans l'hypoactivité vésicale (HOV). Leur pertinence thérapeu-tique, préventive ou curative, en monothérapie n'apparaît pas établie et l'intérêt de la combinaison d'agents pharmacologiques reste à confirmer.Abstract: Detrusor underactivity, defined as contraction of reduced strength or duration resulting in prolonged bladder emptying or failure to achieve complete bladder emptying within a normal time frame [1,2], remains challenging for pharmacological management. Several pharmacological agents have been proposed in the treatment of this condition, all targeting the cholinergic component of detrusor contractility. These include direct and indirect cholinergic drugs, anticholinesterasic agents and prostaglandin. Non-adrenocholinergic control of the micturition reflex is given little importance in the medical treatment of detrusor underactivity. This literature review focuses on data from controlled studies evaluating its pharmacological treatment. The preventive or curative efficacy of cholinomimetic drugs has not been established, and the effectiveness of combined therapy remains to be proved.

show abstract

“…Die Autoren zeigten, dass nach oraler Applikation von Betanechol unmittelbar nach der Operation in der Verumgruppe die Katheterverweildauer reduziert,die Restharnabnahme beschleunigt und die Zystitisrate verringert werden konnte [10]. Auch später konnte durch die Medikation bei einem gemischten gynäkologischen und urologischen Patientengut noch eine Verbesserung des Miktionsdruckes und eine Erhöhung der Harnflussrate erzielt werden [19].…”

Section: Introductionunclassified

Blasendysfunktion und Operationen im kleinen Becken

Schönberger

2003

Der Urologe A

View full text Add to dashboard Cite

The more extensive a surgical procedure in a small pelvis, the higher the risk for the lower urinary tract with its nerve supply and nerve plexus. This concerns mainly the sympathetic chains, the parasympathetic structures and, rarely, the visceral supply of the pelvic floor. Direct trauma to the bladder and its vascular supply as well as indirect injury by displacement of the bladder need to be seriously considered. Problems with micturition and impaired storage capacity of the bladder are the result. Complete urodynamic examination and follow-up can help in differentiating between temporary and persisting disturbances and in taking therapeutical decisions. The most evident postoperative complication is disturbed micturition, managed initially by suprapubic urinary diversion, followed as soon as possible by intermittent self-catheterisation. This is the only way to avoid overstretching of the bladder, recurring urinary tract infection and damage to the upper urinary tract. Restoration of spontaneous micturition can be supported by drug treatment with parasympatholytics and/or alpha-blockers if the measured bladder pressure and residual urine are within tolerable limits. For electrostimulation of micturition, intravesical therapy, although timeconsuming, is best suited because it can easily be done on an outpatient basis. More promising seems bilateral sacral neuromodulation, which, however, is a rather complicated and expensive procedure. Surgical procedures to reduce the voiding resistance of the bladder involve the risk of postoperative incontinence because the sphincter function in those patients is often disturbed too. Persisting problems with bladder storage capacity as a result of tumor surgery in the small pelvis are frequently secondary to retention of urine (overflow incontinence). In these cases, regular evacuation of the bladder by intermittent self-catheterisation can lead to social acceptance. Reduced bladder compliance and lowering of the urethral leak pressure point may result in stress and urge incontinence, which, according to the established rules, should be managed by physiotherapy and behaviour therapy as well as drug therapy and only in exceptional cases by surgical measures. Prevention of postoperative bladder dysfunction can be tried by tissue- and nerve-sparing surgical techniques, but is always determined by oncological aspects.

show abstract

Prophylaxis and treatment of bladder dysfunction after Wertheim-Meigs operation: the positive effect of early postoperative detrusor stimulation using the cholinergic drug betanecholchloride

Cited by 13 publications

References 13 publications

The effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. A randomized, double-blind, placebo-controlled study

The effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. A randomized, double-blind, placebo-controlled study

Traitement médical de l’hypoactivité vésicale

Blasendysfunktion und Operationen im kleinen Becken

Contact Info

Product

Resources

About