Neurogenic bladder treatment by doubling the recommended antimuscarinic dosage.
OBJECTIVE
The dosage of the antimuscarinic drugs: Tolterodine ER or Trospium was increased to a higher-than-recommended dosage in patients where the manufacturer's recommended dosage had failed. All patients were suffering from neurogenic detrusor overactivity incontinence. Tolerability and success were evaluated in the present study.


METHODS
Twenty-one patients with neurogenic detrusor overactivity were evaluated: 17 with spinal cord injury, 3 with multiple sclerosis, and 1 with a meningomyelocele. All patients catheterized themselves or were catheterized. If neurogenic detrusor overactivity continued and the medication was well tolerated, the dosage was doubled to either 8 mg of Tolterodine ER [2 x 4 mg (n = 11)] or 90 mg of Trospium [3 x 30 mg (n = 10)]. The follow-up was monitored by a bladder diary and urodynamic evaluation.


RESULTS
Sixteen patients significantly decreased their incontinence episodes from 8-12 episodes before to 0-2 episodes during the doubled treatment. The reflex volume increased from 202 +/- 68 to 332 +/- 50 ml (P < 0.001). Cystometric capacity enlarged from 290 +/- 56 to 453 +/- 63 ml (P < 0.001). One patient had to stop the medication because of intolerable side effects and five patients did not experience satisfactory benefit.


CONCLUSIONS
The increased dosage of Tolterodine or Trospium is an effective treatment in patients with neurogenic bladder.
Horstmann
M
M
Department of Urology, University of Tübingen, Tübingen, Germany.
Schaefer
T
T
Aguilar
Y
Y
Stenzl
A
A
Sievert
K D
KD
D000293:Adolescent; D000328:Adult; D001559:Benzhydryl Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D001561:Benzilates; D003408:Cresols / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D009122:Muscle Hypertonia / Q000188:drug therapy* / Q000209:etiology; D009662:Nortropanes / Q000008:administration & dosage / Q000009:adverse effects; D010276:Parasympatholytics / Q000008:administration & dosage / Q000009:adverse effects; D010665:Phenylpropanolamine / Q000008:administration & dosage* / Q000009:adverse effects; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000209:etiology; D014563:Urodynamics / Q000187:drug effects
D001559:Benzhydryl Compounds; D001561:Benzilates; D003408:Cresols; D018727:Muscarinic Antagonists; D009662:Nortropanes; D010276:Parasympatholytics; C003330:trospium chloride; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate