Effectiveness of trospium chloride and doxazosin mesylate combination in neurogenic bladder patients with spinal cord injury

Year 2018, Volume: 4 Issue: 3, 157 - 161, 04.07.2018

Fazıl Kulaklı Kurtuluş Köklü Murat Ersöz Zuhal Özişler Canan Çulha Sumru Özel

https://doi.org/10.18621/eurj.349418

Abstract

Objective. The aim of this study was to compare the effects of trospium chloride
(TCL) and TCL + doxazosin (DXZ) combination to bladder capacity and residual
urine volume (RUV) in spinal cord injury (SCI) patients with neurogenic bladder.
Methods.
The study included 120 patients with SCI. Urodynamic data of patients were
reviewed retrospectively.
Changes in maximum cystometric capacity (MCC)
as well as RUV were determined in patients using 60-90 mg/day TCL (Group 1, n =
98) or 60-90 mg/day TCL + 4-6 mg/day DXZ (Group 2, n = 22). Results.
There was statistically significant increase in both MCC and RUV values in
both groups. There was no statistical difference in MCC and RUV values in Group
1 and Group 2 (p = 0.111 and p = 0.664, respectively). There was a
significant weak negative correlation between duration of injury and MCC values
(r = 0.185; p = 0.043), meaning as
the duration of injury increased, MCC decreased. There was no statistically
significant correlation between medication usage duration with MCC and RUV (r =
-0.129; p = 0.159 and r = -0.68; p = 0.462, respectively). Conclusions.
Anticholinergic treatment is currently the mainstay conservative
treatment of neurogenic detrusor overactivity. The impact of alfa blockers on
neurogenic bladder has been less well evaluated. We consider that, adding DXZ
to TCL has no additional benefit to increase bladder capacity and reduce RUV.
Further studies are needed to determine the location of DXZ treatment in SCI
patients with neurogenic bladder. 

Keywords

spinal cord injury, neurogenic bladder, doksazosin mesylate, trospium chloride

References

• [1] Weld KJ, Graney MJ, Dmochowski RR. Clinical significance of detrusor sphincter dyssynergia type in patients with post-traumatic spinal cord injury. Urology 2000;56:565-8.
• [2] Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol 2016;69:324-33.
• [3] Manack A, Motsko SP, Haag-Molkenteller C, Dmochowski RR, Goehring EL Jr, Nguyen-Khoa BA, et al. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn 2011;30:395-401.
• [4] Consortium for Spinal Cord Medicine. Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. J Spinal Cord Med 2006;29:527-73.
• [5] Madhuvrata P, Singh M, Hasafa Z, Abdel-Fattah M. Anticholinergic drugs for adult neurogenic detrusor overactivity: A systematic review and meta-analysis. Eur Urol 2012;62:816-30.
• [6] Singh-Franco D, Machado C, Tuteja S, Zapantis A. Trospium chloride for the treatment of overactive bladder with urge incontinence. Clin Ther 2005;27:511-30.
• [7] Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al; Standardisation Sub-Committee Of The International Continence Society. The Standardisation of terminology in lower urinary tract function: report From the standardisation sub-committee of the International Continence Society. Urology 2003;61:37-49.
• [8] Lidal IB, Snekkevik H, Aamodt G, Hjeltnes N, Biering-Sørensen F, Stanghelle JK. Mortality after spinal cord injury in Norway. J Rehabil Med 2007;39:145-51.
• [9] Wyndaele JJ. Conservative treatment of patients with neurogenic bladder. Eur Urol Suppl 2008;7:557-65.
• [10] Waleed AT, Raouf S. Neurogenic bladder in spinal cord injury patient. Res Rep Urol 2015;7:85-99.
• [11] Abrams, P, Amarenco G, Bakke A, Buczyński A, Castro-Diaz D, Harrison S, et al; European Tamsulosin Neurogenic Lower Urinary Tract Dysfunction Study Group. Tamsulosin: efficacy and safety in patients with neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury. J Urol 2003;170:1242-51.
• [12] Abrams P, Shah P, Stone A, Choas R. Bladder outflow obstruction treated with phenoxybenzamine. Br J Urol 1982;54:527-30.
• [13] Swierzewski SJ 3rd, Gormley EA, Belville WD, Sweetser PM, Wan J, McGuire EJ. The effect of terazosin on bladder function in the spinal cord injured patient. J Urol 1994;151:951-4.
• [14] Yasuda K, Yamanishi T, Kawabe K, Ohshima H, Morita T. The effect of urapidil on neurogenic bladder: A placebo controlled double-blind study. J Urol 1996;156:1125-30.
• [15] Stöhrer M, Bauer P, Giannetti BM, Richter R, Burgdörfer H, Mürtz G. Effect of trospium chloride on urodynamic parameters in patients with detrusor hyperreflexia due to spinal cord injuries. A multicentre placebo controlled double-blind trial. Urol Int 1991;47:138-43.