How effective are drugs in the management of bladder dysfunction?

Updated: Jan 04, 2019
  • Author: Gregory T Carter, MD, MS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Several studies have investigated the efficacy of intravesical administration of capsaicin, a neurotoxin for C-afferent fibers, for treatment of detrusor hyperreflexia. The results of 1 study showed improvement in manifestations of bladder disorders, including decreased voiding frequency, fewer leakages, and increased cystometric capacity. Similarly, resiniferatoxin acts on C-afferent fibers to limit detrusor muscle hyperactivity. Like capsaicin, it is administered intravesically and thus tends to cause less pain as an adverse effect.

At present, both capsaicin and resiniferatoxin are still considered experimental agents in this setting. Nevertheless, it is already clear that they have the advantage of causing fewer adverse systemic effects than the more traditional oral agents do. [22, 23, 24]

A retrospective study, Gutiérrez-Martin et al found that in patients with neurogenic detrusor hyperactivity secondary to SCI, intradetrusor injection of botulinum toxin type A (BoNT-A) produced positive urodynamic results for an extended period. The investigators, who reviewed results from 70 patients, found significant increases in cystomanometric bladder capacities, in bladder volumes of the first involuntary detrusor contraction, and in postvoid residues, with 50% of the patients maintaining increased vesical capacity for over 32 months. Treatment was found to be negatively affected by indwelling urinary catheters. [25]

A study by Komesu et al indicated that in women with refractory urgency urinary incontinence, treatment with onabotulinumtoxinA or sacral neuromodulation is more effective in patients under age 65 years than in those aged 65 years or older. In the study’s onabotulinumtoxinA treatment group, for example, the chance that urgency urinary incontinence episodes would decrease by 75% or more was 3.3-fold higher in women under 65 years than in the older patients. Moreover, for women undergoing either of the two therapies, posttreatment symptom bother scores, as measured with the Overactive Bladder Questionnaire Short Form, were reduced by 7.49 points more in the under-65 patients. In addition, urinary tract infections following onabotulinumtoxinA or neuromodulation treatment were more frequent in the older women. However, no age-related differences were found with regard to quality of life improvement. [26]

A study by Faure Walker et al reported that while quality-of-life measures improved significantly in men who underwent intradetrusor onabotulinumtoxinA therapy for refractory overactive bladder with idiopathic detrusor overactivity, women appeared to experience even greater improvement. While men’s scores on the Urogenital Distress Inventory-6 and the Incontinence Impact Questionnaire-7 dropped by 4.2 and 6.0, respectively, the women’s scores fell by 6.0 and 11.1, respectively. [27]

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