title: Effective treatment of neurogenic detrusor dysfunction by combined high-dosed antimuscarinics without increased side-effects.
abstract: OBJECTIVE
  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 enrollment, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, University of Tuebingen, Germany.
authors.forename: Bastian
authors.initials: B
authors.lastname: Amend
authors.forename: Jörg
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: Tobias
authors.initials: T
authors.lastname: Schäfer
authors.forename: Marcus
authors.initials: M
authors.lastname: Horstmann
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Karl-Dietrich
authors.initials: KD
authors.lastname: Sievert
mesh_terms: D000293:Adolescent; D000328:Adult; D001559:Benzhydryl Compounds / Q000008:administration & dosage; D001561:Benzilates; D003408:Cresols / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage*; D009662:Nortropanes / Q000008:administration & dosage; D010276:Parasympatholytics / Q000008:administration & dosage; D010665:Phenylpropanolamine / Q000008:administration & dosage; D013118:Spinal Cord Diseases / Q000150:complications; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects*
chemical_list: D001559:Benzhydryl Compounds; D001561:Benzilates; D003408:Cresols; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D009662:Nortropanes; D010276:Parasympatholytics; C003330:trospium chloride; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C005419:oxybutynin