What to do when the previous anticholinergic therapy in management of neuropathic bladder is ineffective?
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Lidia Skobejko-Włodarska, Karina Felberg, Piotr Gastoł, Małgorzata Baka-Ostrowska

Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie

summary

Introduction.

Neurogenic bladder dysfunction needs optimal and apprioprate treatment with reduction of high intravesical pressure and enlargment of bladder volume what improves continence and saves kidneys. The first line of management is pharmacotherapy with using anticholinergic agents.

Objectives.

Evaluating the efficacy of solifenacin in patients with neuropathic bladder in case of inefficient earlier pharmacotherapy

Materials and methods.

Thirty six patients with neuropathic bladder aged 3 to 23 (medium age 12.7) required change of previous anticholinergic therapy with application of oxybutynin and tolterodine due to its side-effects in 2 and low efficacy in reducing of high intravesical pressure and increasing of small bladder volume in other. The reason of central nervous system deterioration was myelomeningocele in 27, sacrum hypoplasia in 6, sacrococcygeal tumor with lumbar spina bifida in 1, purulent cerebrospinal meningitis in 1 and polineuropathy in other. The urodynamic examination showed high intravesical pressure with small bladder volume in 31 patients and only small bladder volume in 3 other. In all applied solifenacin therapy in initial dose 5 mg daily. First urodynamic evaluation of intravesical pressure was done after 1 month and

next after 2 months.

Results.

The patients’ follow-up is ranged from 6 to 20 months. Fifteen patients out 36 treated by solifenacin required increase of its dose to 10 mg. Regularly repeated urodynamic examination showed significant decrease of intravesical pressure from 62.2 to 34.8 cm H2O in 34 and mild increase of bladder volume in 31 patients. Three patients with only small bladder volume succeeded its enlargement on the average from 143.3 to 253.3 ml.

Conclusions.

Solifenacin is effective for treatment of neuropathic bladder which is resistant for other anticholinergic agents. Its introduction allows to increase of assortment of medicaments in management with neuropathic dysfunction.