Electromotive drug-administration: a pilot study for minimal-invasive treatment of therapy-resistant idiopathic detrusor overactivity.
BACKGROUND
Electromotive drug-administration (EMDA) represents a minimal-invasive method of intravesical instillation of therapeutic agents. We examined the therapeutic effect of EMDA in patients suffering from therapy-resistant idiopathic detrusor overactivity (IDO) with respect to urodynamics, micturition charts and quality of life (Kings Health Questionnaire).


METHODS
Patients suffering from urge syndrome with and without urge incontinence and non-responding to oral anticholinergic drugs underwent EMDA therapy (2000 mg lidocaine-HCl 4% (50 ml), 2 mg epinephrine [1:1000] (2 ml), 40 mg dexamethason-21-dihydrogen phosphat (10 ml) in a total volume of 100 ml). Over a 27 months period, 84 patients (median age 63.1 years; 72 female, 12 male) with urge syndrome and urodynamically-proven idiopathic detrusor overactivity (IDO) were treated with EMDA. Following urodynamic measurements, quality of life (QoL) was evaluated using Kings Health Questionnaire (KHQ) and a micturition chart over 48 h, EMDA was performed once in four weeks for a period of three months. Patients continued to document drinking and micturition data during this time. Before each EMDA session urodynamic examination and KHQ were repeated.


RESULTS
All treated patients suffered from urge syndrome (25.6% OAB wet, 20.0% OAB dry and 54.4% mixed urinary incontinence). Mean daytime frequency (DF) was 14.1 +/- 7.7 per day and nocturia (N) 5.1 +/- 5.1 per night before EMDA. After two EMDA sessions, daytime frequency (DF) decreased to 9.4 +/- 6.2 per day (P < 0.0001) and 2.5 +/- 2.4 per night (P = 0.035). The use of pads could be lowered from 4.5 +/- 4.1 per 24 h to 1.8 +/- 2.4 (P < 0.0074). The first desire to void volume (FDV) assessed by urodynamics started at 94.0 +/- 60.5 ml before treatment and changed to 142.2 +/- 79.6 ml (P = 0.0064) after two sessions. Strong desire to void volume (SDV) was noticed at 155.6 +/- 84.8 ml filling of the bladder; after two EMDA sessions at 199.5 +/- 97.3 ml (P = 0.001). Uninhibited detrusor contractions (UIC) were seen in all patients before treatment and were reduced to 46.4% after two EMDA sessions (P < 0.001). Maximal cystometric bladder capacity (MCBC) increased from 192.3 +/- 106.6 ml to 239.6 +/- 114.9 ml (P = 0.018). Patient-documented bladder capacity (BC) as micturition volume increased from 186.0 +/- 108.7 ml to 234.2 +/- 134.2 ml (P = 0.043). A reduction of impact of Quality of Life (QoL) was observed from 11.8 +/- 0.4 to 7.0 +/- 0.3 (P < 0.001) during treatment. A fraction of 53.6% (45/84) of all patients reported a completely withdrawal of symptoms and 28.6% (24/84) indicated a remarkable reduction. Only 10.7% (9/84) of patients did not continue therapy after two sessions.


CONCLUSIONS
EMDA significantly improves urodynamic parameters, QoL and pad usages in patients with urge syndrome and therapy-resistant IDO. Therefore we offer EMDA therapy as an alternative treatment modality to the standard approaches.
Bach
Peter
P
Department of Urology, Klinikum Niederberg Velbert, Academic Hospital, University of Duisburg-Essen, Velbert, Germany. bach@klinikum-niederberg.de
Wormland
Renate T
RT
Möhring
Cornelia
C
Goepel
Mark
M
D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D004338:Drug Combinations; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011788:Quality of Life; D012076:Renal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D001743:Urinary Bladder; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D053202:Urinary Incontinence, Urge / Q000188:drug therapy; D014554:Urination / Q000502:physiology; D014563:Urodynamics / Q000502:physiology
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D018680:Cholinergic Antagonists; D004338:Drug Combinations; D004364:Pharmaceutical Preparations; D012076:Renal Agents; D003907:Dexamethasone; D008012:Lidocaine; D003894:Deamino Arginine Vasopressin