Antimuscarinic agents exhibit local inhibitory effects on muscarinic receptors in bladder-afferent pathways.
OBJECTIVE
To investigate the potential of antimuscarinic agents for sensory mechanisms in overactive bladder using intravesical instillation.


METHODS
Antimuscarinic agents were instilled intravesically in rats using two protocols. In the high-dose protocol, 5 mg atropine, oxybutynin, and dimethindene (M2-selective muscarinic receptor antagonist) were instilled into the bladder, and cystometric parameters, such as bladder capacity, intercontraction interval, pressure threshold, and maximal voiding pressure were monitored. In the low-dose protocol, 0.1 and 0.5 mug/mL oxybutynin, trospium, tolterodine, and dimethindene were continuously infused into the bladder. The doses chosen were based on the calculated urine-excreted concentrations of trospium typically achieved from human oral treatment of 40 mg/day. The effect of carbachol with and without the low-dose agents was then assessed.


RESULTS
With the high-dose protocol, bladder capacity, intercontraction interval, and pressure threshold were increased when atropine and oxybutynin were instilled, but not when dimethindene was used. The maximal voiding pressure was not affected by any of the agents tested. In the low-dose protocol, none of the cystometric parameters were altered with antimuscarinic agents alone. The intercontraction interval decreased with intravesical carbachol (65% +/- 0.1% compared with baseline), but this was prevented with concomitant antimuscarinic agents.


CONCLUSIONS
We have separated the local inhibitory effects of antimuscarinic agents during the storage phase from a decrease in voiding pressure. Intravesical instillation of antimuscarinic agents at clinically meaningful concentrations also suppressed carbachol-induced bladder overactivity. Antimuscarinic agents may be effective in treating overactive bladder, not only by suppression of muscarinic receptor-mediated detrusor muscle contractions, but also by blocking muscarinic receptors in bladder-afferent pathways.
Kim
YongTae
Y
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Yoshimura
Naoki
N
Masuda
Hitoshi
H
de Miguel
Fernando
F
Chancellor
Michael B
MB
D000109:Acetylcholine / Q000502:physiology; D000283:Administration, Intravesical; D000344:Afferent Pathways / Q000187:drug effects* / Q000502:physiology; D000818:Animals; D001285:Atropine / Q000008:administration & dosage / Q000494:pharmacology; D001559:Benzhydryl Compounds / Q000008:administration & dosage / Q000494:pharmacology; D001561:Benzilates; D002217:Carbachol / Q000037:antagonists & inhibitors; D003408:Cresols / Q000008:administration & dosage / Q000494:pharmacology; D004115:Dimethindene / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D007263:Infusions, Parenteral; D007322:Instillation, Drug; D008333:Mandelic Acids / Q000008:administration & dosage / Q000494:pharmacology; D018721:Muscarinic Agonists / Q000494:pharmacology; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D009119:Muscle Contraction / Q000187:drug effects* / Q000502:physiology; D009130:Muscle, Smooth / Q000187:drug effects / Q000294:innervation; D009662:Nortropanes / Q000008:administration & dosage / Q000494:pharmacology; D010665:Phenylpropanolamine / Q000008:administration & dosage / Q000494:pharmacology; D011312:Pressure; D051381:Rats; D017207:Rats, Sprague-Dawley; D011976:Receptors, Muscarinic / Q000187:drug effects*; D000068737:Tolterodine Tartrate; D001743:Urinary Bladder / Q000187:drug effects / Q000294:innervation*; D014563:Urodynamics / Q000187:drug effects
D001559:Benzhydryl Compounds; D001561:Benzilates; D003408:Cresols; D008333:Mandelic Acids; D018721:Muscarinic Agonists; D018727:Muscarinic Antagonists; D009662:Nortropanes; D011976:Receptors, Muscarinic; C003330:trospium chloride; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D004115:Dimethindene; D001285:Atropine; D002217:Carbachol; C005419:oxybutynin; D000109:Acetylcholine