Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Urology
Published in: World Journal of Urology 1/2010

01-02-2010 | Original Article

Triple therapy in refractory detrusor overactivity: a preliminary study

Authors: Ricardo Natalin, Leonardo Oliveira Reis, Cristiano Alpendre, Lia Y. Ikari, Alessandro Prudente, Carlos A. L. D’Ancona

Published in: World Journal of Urology | Issue 1/2010

Login to get access

Abstract

Purpose

To evaluate in a prospective study the impact of the “three-drug therapy” (antimuscarinic, alpha-blocker and tricyclic antidepressants) on the treatment of refractory detrusor overactivity (DO).

Methods

Data from 27 consented patients with refractory DO were available for study. They were asked to complete a daily urinary chart and underwent urodynamic evaluation (UD) before and 60 days after treatment. Response to treatment was considered the presence of one or less involuntary detrusor contractions (IDC) on post-treatment UD. Statistical analysis was performed with Fisher and Mann–Whitney tests, besides Spearman’s correlation. P values <0.05 were considered significant.

Results

The mean follow-up was 15 months. The comparison of the daily urinary chart before and after treatment showed significant increase on bladder capacity and decreases on urgency, urge-incontinence and frequency. Objective data from UD showed that the mean maximum bladder capacity (MBC) ranged from 200 to 300 mL (P < 0.001) with treatment. The same trend was observed with the other UD variables. When compared to baseline, the questionnaire OAB-v8 showed significant improvement (P < 0.01). Main side effects comprised dry mouth and constipation (40%), with average scores of 5.16 and 3.08, respectively (visual scale from 0 to 10).

Conclusions

Triple therapy may be an effective, easily employed and well-tolerated option to refractory DO treatment. More studies are necessary to achieve more consistent data on the matter.
Literature
1.
Hashim H, Abrams P (2004) Drug treatment of overactive bladder: efficacy, cost and quality-of-life considerations. Drugs 64:1643–1656CrossRefPubMed
2.
Abrams P, Andersson KE (2007) Muscarinic receptor antagonists for overactive bladder. BJU Int 100:987–1006PubMed
3.
Abrams P, Cardozo L, Fall M et al (2003) The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 61:37–49CrossRefPubMed
4.
Brown JS, McGhan WF, Chokroverty S (2000) Comorbidities associated with overactive bladder. Am J Manag Care 6:574–579
5.
Kilic N, Balkan E, Akgoz S et al (2006) Comparison of the effectiveness and side-effects of tolterodine and oxybutynin in children with detrusor instability. Int J Urol 13:105–108CrossRefPubMed
6.
7.
Hawthorn MH, Chapple CR, Cock M et al (2000) Urothelium-derived inhibitory factor(s) influences on detrusor muscle contractility in vitro. Br J Pharmacol 129:416–419CrossRefPubMed
8.
Kim Y, Yoshimura N, Masuda H, de Miguel F, Chancellor MB (2005) Antimuscarinic agents exhibit local inhibitory effects on muscarinic receptors in bladder afferent pathways. Urology 65:238–242CrossRefPubMed
9.
Finney SM, Andersson KE, Gillespie JI et al (2006) Antimuscarinic drugs in detrusor overactivity and the overactive bladder syndrome: motor or sensory actions? BJU Int 98:503–507CrossRefPubMed
10.
Andersson KE, Yoshida M (2003) Antimuscarinics and the overactive detrusor—which is the main mechanism of action? Eur Urol 43:1–5CrossRefPubMed
11.
Kim Y, Yoshimura N, Masuda H et al (2006) Intravesical installation of human urine after oral administration of trospium, tolterodine and oxybutynin in a rat model of detrusor overactivity. BJU Int 97:400–403CrossRefPubMed
12.
MacDiarmid SA (2007) Maximizing anticholinergic therapy for overactive bladder: has the ceiling been reached? BJU Int 99:8–12CrossRefPubMed
13.
Dmochowski R (2002) Interventions for detrusor overactivity: the case for multimodal therapy. Rev Urol 4:19–27
14.
Ruggieri MR Sr, Braverman AS, Pontari MA (2005) Combined use of alpha-adrenergic and muscarinic antagonists for the treatment of voiding dysfunction. J Urol 174:1743–1748CrossRefPubMed
15.
Salvatore S, Soligo M, Proietti F et al (2005) Overactive bladder syndrome: considerations in pharmacotherapy and new perspectives. Eur J Obstet Gynecol Reprod Biol 120:129–133CrossRefPubMed
16.
Chen Q, Takahashi S, Zhong S et al (2005) Function of the lower urinary tract in mice lacking a1d-adrenoceptor. J Urol 174:370–374CrossRefPubMed
17.
Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49:651–659CrossRefPubMed
18.
Penttila J, Syvalahti E, Hinkka S et al (2001) The effects of amitriptyline, citalopram and reboxetine on autonomic nervous system. A randomised placebo-controlled study on healthy volunteers. Psychopharmacology (Berl) 154:343–349CrossRef
19.
20.
Sacco E, Pinto F, Bassi P (2008) Emerging pharmacological targets in overactive bladder therapy: experimental and clinical evidences. Int Urogynecol J 19:583–598CrossRef
21.
Miller KL, Dubeau CE, Bergmann M, Griffiths DJ, Resnick NM (2002) Quest for a detrusor overactivity index. J Urol 167:578–585CrossRefPubMed
22.
Sellers DJ, McKay N (2007) Developments in the pharmacotherapy of the overactive bladder. Curr Opin Urol 17:223–230CrossRefPubMed
23.
Witte LPW, Mulder WMC, de la Rosette JJMCH, Miche MC (2009) Muscarinic receptor antagonists for overactive bladder treatment: does one fit all? Curr Opin Urol 19:13–19CrossRefPubMed
24.
Andersson KE (2006) Treatment-resistant detrusor overactivity—underlying pharmacology and potential mechanisms. Int J Clin Pract 60:8–16CrossRef
25.
Novara G, Galfano A, Ficarra V et al (2006) Anticholinergic drugs in patients with bladder outlet obstruction and lower urinary tract symptoms: a systematic review. Eur Urol 50:675–683CrossRefPubMed
26.
Horstmann M, Schaefer T, Aguilar Y et al (2006) Neurogenic bladder treatment by doubling the recommended antimuscarinic dosage. Neurourol Urodyn 25:441–445CrossRefPubMed
27.
Menarini M, Del Popolo G, Di Benedetto P et al (2006) Trospium chloride in patients with neurogenic detrusor overactivity: is dose titration of benefit to the patients? Int J Clin Pharmacol Ther 44:623–632PubMed
28.
Amend B, Hennenlotter J, Schafer T, Horstmann M, Stenzl A, Sievert K (2008) Effective treatment of neurogenic detrusor dysfunction by combined high-dosed antimuscarinics without increased side-effects. Eur Urol 53:1021–1028CrossRefPubMed
29.
Payne CK, Kelleher C (2007) Redefining response in overactive bladder syndrome. BJU Int 99:101–106CrossRefPubMed
30.
Kobelt G, Borgstrom F, Mattiasson A (2003) Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia. BJU Int 91:190–195CrossRefPubMed
31.
Samuelsson E, Victor A, Tibblin G (1997) A population study of urinary incontinence and nocturia among women aged 20–59 years. Prevalence, well being and wish for treatment. Acta Obstet Gynecol Scand 76:74–80CrossRefPubMed
32.
Irwin DE, Milsom I, Kopp Z et al (2006) Impact of overactive bladder symptoms on employment, social interactions and emotional well being in six European countries. BJU Int 97:96–100CrossRefPubMed
33.
Fultz N, Girts T, Kinchen K et al (2005) Prevalence, management and impact of urinary incontinence in the workplace. Occup Med 55:552–557CrossRef
34.
35.
Brown JS, Vittinghoff E, Wyman JF et al (2000) Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 48:721–725PubMed
36.
Milsom I, Abrams P, Cardozo L et al (2001) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 87:760–766CrossRefPubMed
37.
Reeves P, Irwin D, Kelleher C et al (2006) The current and future burden and cost of overactive bladder in five European countries. Eur Urol 50:1050–1057CrossRefPubMed
38.
Serels S, Stein M (1998) Prospective study comparing hyoscyamine, doxazosin, and combination therapy for the treatment of urgency and frequency in women. Neurourol Urodyn 17:31–36CrossRefPubMed
39.
Staskin DR, MacDiarmid SA (2006) Using anticholinergics to treat overactive bladder: the issue of treatment tolerability. Am J Med 119:9–15CrossRefPubMed
40.
41.
Serrano Brambila EA, Quiroga Avila RG, Lorenzo Monterrubio JL et al (2000) Assessment of effectiveness of and tolerance to oxybutynin in the treatment of unstable bladder in women. Ginecol Obstet Mex 68:174–181PubMed
42.
43.
Witte LPW, Mulder WMC, de la Rosette JJMCH, Miche MC (2009) Muscarinic receptor antagonists for overactive bladder treatment: does one fit all? Curr Opin Urol 19:13–19CrossRefPubMed
Metadata
Title
Triple therapy in refractory detrusor overactivity: a preliminary study
Authors
Ricardo Natalin
Leonardo Oliveira Reis
Cristiano Alpendre
Lia Y. Ikari
Alessandro Prudente
Carlos A. L. D’Ancona
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 1/2010
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-009-0400-6

Other articles of this Issue 1/2010

World Journal of Urology 1/2010 Go to the issue

Topic Paper

Role of voiding and storage symptoms for the quality of life before and after treatment in men with voiding dysfunction

Original Article

Identification of urine PLK2 as a marker of bladder tumors by proteomic analysis

Original Article

Penile block is associated with less urinary retention than caudal anesthesia in distal hypospadia repair in children

Original Article

Factors predicting inguinal node metastasis in squamous cell cancer of penis

Original Article

Four-arm robotic partial nephrectomy for complex renal cell carcinoma

Original Article

Application of a temporary ureter clamp for retroperitoneal laparoscopic ureterolithotomy