title: Combination drug therapy improves compliance of the neurogenic bladder.
abstract: OBJECTIVE
  Typical management of increased bladder storage pressures and decreased compliance related to neurogenic bladder dysfunction consists of antimuscarinic therapy with or without clean intermittent catheterization. However, these measures are often unsuccessful. In this patient group we commonly use combination therapy consisting of antimuscarinics combined with imipramine and/or an alpha-blocker.
  
  
  METHODS
  A retrospective chart review was performed identifying all patients with neurogenic bladder dysfunction who were initially on no drug therapy or antimuscarinic therapy alone and were later switched to 2 or 3 drug therapy.
  
  
  RESULTS
  In the group initially on no therapy and subsequently on 2 drugs (22) mean bladder pressure at capacity decreased 52% and mean compliance increased 5.0-fold. Similarly in the group starting without therapy but ending up on 3 drugs (28) bladder pressure decreased 67% and compliance increased 9.7-fold. In the group initially on an antimuscarinic agent alone (27) triple drug therapy decreased bladder pressure 60% and compliance increased 3.0-fold (all p <0.01). There were also improvements in incontinence, vesicoureteral reflux, detrusor overactivity and detrusor sphincter dyssynergia.
  
  
  CONCLUSIONS
  In this highly selected group of patients with neurogenic bladder dysfunction and poor bladder compliance combination medical therapy with 2 or 3 drugs improved compliance, decreased bladder pressures at capacity and improved clinical outcomes. Combination therapy requires further study of the side effect profile but these results suggest that it should be considered for patients in whom antimuscarinic agents alone fail.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-5330, USA. annepell@med.umich.edu
authors.forename: Anne P
authors.initials: AP
authors.lastname: Cameron
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
authors.forename: Jerilyn M
authors.initials: JM
authors.lastname: Latini
authors.forename: Edward J
authors.initials: EJ
authors.lastname: McGuire
mesh_terms: D000293:Adolescent; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D012189:Retrospective Studies; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000317:Adrenergic alpha-Antagonists; D004338:Drug Combinations; D018727:Muscarinic Antagonists