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Neurogenic bladder treatment by doubling the recommended antimuscarinic dosage
Author(s) -
Horstmann M.,
Schaefer T.,
Aguilar Y.,
Stenzl A.,
Sievert K.D.
Publication year - 2006
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.20289
Subject(s) - tolterodine , medicine , tolerability , overactive bladder , urology , spinal cord injury , anesthesia , urinary incontinence , neurogenic bladder dysfunction , adverse effect , urinary bladder , spinal cord , alternative medicine , pathology , psychiatry
and Objectives 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. Materials and 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 × 4 mg (n = 11)] or 90 mg of Trospium [3 × 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. Conclusion The increased dosage of Tolterodine or Trospium is an effective treatment in patients with neurogenic bladder. Neurourol. Urodynam. © 2006 Wiley‐Liss, Inc.