Other Pharmaceutical Treatments for SCI-Related Detrusor Overactivity

Author Year
Country
Score
Research Design
Total Sample Size

Methods

Outcome

Phosphodiesterase-5 Inhibitors

Taie et al.
2010
Iran
Pre-Post
N=20

Population: Male patients with supra sacral SCI.
Treatment: 20mg of oral tadalafil.
Outcome Measures: Urodynamic variables

  1. A significant increase in bladder compliance (p<0.001) and bladder capacity (p<0.001) was observed.
  2. Maximum voiding detrusor pressure (p<0.001) and maximum detrusor filling pressure (p<0.001) decreased significantly after a single dose.

Gacci et al. 2007
Italy
RCT
PEDro=6
N=25

Population: Mean age: 34.9 yr (range= 24-60 yr); Gender: males=25, females=0; ASIA severity: A=18, B=n=7.
Treatment:  Subjects received either a 20 mg vardenafil injection (n=15) or placebo (n=10).
Outcome Measures: Maximum detrusor pressure (MDP), maximum cystometric capacity (MCC), detrusor overactivity volume (VDO).

  1. Compared to placebo, vardenafil significantly decreased MDP, MCC, and VDO (p<0.001 for all).
Intrathecal Baclofen

Steers et al. 1992
USA
PEDro=8
RCT
Ninitial=10; Nfinal=9

Population: SCI: Age range=24-61 yr; Gender: males=7, females=3; Time since injury=1-12 yr.
Treatment: Intrathecal bolus of baclofen or saline at L3 to L4.
Outcome Measures: Reduction in spasticity, urodynamics.

  1. Post bolus intrathecal:Increase in bladder volume at first sensation and bladder compliance at 2 hrs (p<0.05), and Ashworth decrease >2.
  2. Pre-Post continuous intrathecal baclofen:Increased volume, volume at first sensation, compliance, residual volume: p<0.05; decreased maximum urethral pressure, voiding pressure: p<0.05 and a change in bladder symptoms reported at or after 48 hr.
  3. Dosages ranged from 94-372 ug (mean 220ug) and followup ranged from 12-23 mo (mean 18).
Clonidine

Chartier-Kastler et al.
2000a
France
Case Series
N=9

Population: Gender: males=6, females=3; Level of injury: paraplegia; Severity of injury: complete, incomplete.
Treatment: All underwent surgery to have a catheter implanted allowing intrathecal injections of clonidine.
Outcome Measures: Complications.

  1. No statistical results reported.
  2. 6 of 9 subjects elected to have permanent pump implantation for the treatment of severe detrussor hyperreflexia.
  3. No complication or infections reported.
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