Browse > Article

The Effect of Bethanechol Chloride with an ${\alpha}$-adrenergic Blocker in Patients with Impaired Detrusor Contractility  

Kim, Ji-Young (Department of Urology, Sungkyunkwan University School of Medicine)
Hong, Jeong-Hee (Department of Urology, Dankook University College of Medicine)
Lee, Kyu-Sung (Department of Urology, Sungkyunkwan University School of Medicine)
Publication Information
Investigative and Clinical Urology / v.48, no.10, 2007 , pp. 1040-1043 More about this Journal
Abstract
Bethanechol enhances detrusor contraction and Ձ1-blockers reduce bladder outlet resistance. We evaluated the effects of bethanechol with doxazosin in patients with impaired detrusor contractility. Materials and Methods: Fifty-six patients that had confirmed detrusor underactivity with at least 150ml of postvoid residual urine volume(PVR) based on a urodynamic study were enrolled. The initial dosage of bethanechol given was 75mg/day, and the dosage was gradually increased to 150mg/day if necessary. Doxazosin gastro-intestinal therapeutic system(GITS)(4mg) was also given. The effect of the treatment was evaluated by a urine flow test, the amount of PVR, and frequency of clean intermittent catheterization(CIC). Results: The mean follow-up period was 6 months(range, 1 to 9 months). After treatment, the mean PVR decreased from 251.8±149.6ml to 136.4± 153.2ml(p＜0.001) and was less than 100ml in 22(39%) of the 38 patients that showed a decrease. The maximum flow rate(Qmax) increased from 8.7±4.7ml/s to 11.1±5.6ml/s(p=0.024) and was more than 5ml/s in 13 patients(23%). Five of the 18 patients that previously required CIC could discontinue this treatment and another nine patients showed a decrease in the frequency. The mean daily frequency of CIC was reduced from 3.2 to 1.5(p=0.004). Ten of the 12 patients that were not able to void became capable of voluntary voiding. Five patients(9%) complained of adverse reactions and four of them were taken off the medication. Conclusions: The combination therapy of bethanechol with doxazosin improved emptying ability in patients with impaired detrusor contractility.
Keywords
Neurogenic bladder; Bethanechol; Alpha-adrenergic blockers;
Citations & Related Records

Times Cited By SCOPUS : 0
연도 인용수 순위
  • Reference
1 Barrett DM. The effect of oral bethanechol chloride on voiding in female patients with excessive residual urine: a randomized double-blind study. J Urol 1981;126:640-2   DOI   PUBMED
2 Finkbeiner AE. Is bethanechol chloride clinically effective in promoting bladder emptying? A literature review. J Urol 1985;134:443-9   DOI   PUBMED
3 Schafer W. Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol 1995;13:47-58   PUBMED
4 Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourol Urodyn 2002;21:167-78   DOI   ScienceOn
5 Krane RJ, Olsson CA. Phenoxybenzamine in neurogenic bladder dysfunction. II. Clinical considerations. J Urol 1973; 110:653-6   DOI   PUBMED
6 Yamanishi T, Yasuda K, Kamai T, Tsujii T, Sakakibara R, Uchiyama T, et al. Combination of a cholinergic drug and an alpha-blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor. Int J Urol 2004;11:88-96   DOI   ScienceOn
7 Sullivan J, Abrams P. Alpha-adrenoceptor antagonists in neurogenic lower urinary tract dysfunction. Urology 1999;53(3 Suppl 3a):21-7   DOI   ScienceOn
8 Downie JW. Bethanechol chloride in urology-a discussion of issues. Neurourol Urodyn 1984;3:211-22   DOI
9 Khanna OP. Disorders of micturition: neuropharmacologic basis and results of drug therapy. Urology 1976;8:316-28   DOI   ScienceOn
10 Riedl CR, Stephen RL, Daha LK, Knoll M, Plas E, Pfluger H. Electromotive administration of intravesical bethanechol and the clinical impact on acontractile detrusor management: introduction of a new test. J Urol 2000;164:2108-11   DOI   ScienceOn
11 Scott MB, Morrow JW. Phenoxybenzamine in neurogenic bladder dysfunction after spinal cord injury. I. Voiding dysfunction. J Urol 1978;119:480-2   DOI   PUBMED
12 Starr I, Ferguson LK. Beta-methylcholine-urethane. Its action in various normal and abnormal conditions, especially postoperative urinary retention. Am J Med Sci 1940;200:372   DOI
13 Brown JH, Taylor P. Muscarinic receptor agonists and antagonists. In: Hardman JG, Limbird LE, editors. The pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill; 1996;141-60
14 Wein AJ, Malloy TR, Shofer F, Raezer DM. The effects of bethanechol chloride on urodynamic parameters in normal women and in women with significant residual urine volumes. J Urol 1980;124:397-9   DOI   PUBMED
15 Awad SA. Clinical use of bethanechol. J Urol 1985;134:523-4   DOI   PUBMED
16 Finkbeiner AE, Bissada NK. Drug therapy for lower urinary tract dysfunction. Urol Clin North Am 1980;7:3-16   PUBMED