Janet Erickson

Intravesical Resiniferatoxin for Refractory Detrusor Hyperreflexia: A Multicenter, Blinded, Randomized, Placebo-Controlled Trial

Abstract Objective: Resiniferatoxin (RTX) is an analogue of capsaicin with more than 1,000 times its potency in desensitizing C-fiber bladder afferent neurons. This study investigated the safety and efficacy of intravesical RTX in patients with refractory detrusor hyperreflexia (DH). Methods: Thirty-six (22 males, 14 females) neurologically impaired patients (20 spinal cord injury, 7 multiple sclerosis, 9 other neurologic diseases) with urodynamically verified DH and intractable urinary symptoms despite previous anticholinergic drug use were treated prospectively with intravesical RTX using dose escalation in a double-blind fashion at 4 centers. Patients received a single instillation of 100 ml of placebo (n = 8 patients) or 0.005, 0.025, 0.05 , 0.10 , 0.2, 0.5, or 1.0 fLM of RTX (n = 4 each group). A visual analog pain scale (VAPS) (0-10; 10 = highest level of pain) was used to quantify discomfort of application. Treatment effect was monitored using a bladder diary and cystometric bladder capacity at weeks 1, 3, 6, and 1 2 posttreatment. Results: Mean VAPS scores revealed minimal to mild discomfort with values of 2.85 and 2.28 for the 0.5-j-LM and 1.0-j-LM RTX treatment groups, respectively. Due to the small sample size, there were no statistically significant changes in mean cystometric capacity (MCC) or incontinence episodes in each treatment dose group. However, at 3 weeks, MCC increased by 53% and 48% for the 0.5-j-μM and 1.0-j-μM RTX treatment groups, respectively. Patients in the 0.5-j-μM and 1.0-j-μM groups with MCC < 300 ml at baseline showed greater improvements in MCC at 120.5% and 48%, respectively. In some patients, MCC increased up to 500% over baseline, despite a low RTX dose. Incontinence episodes decreased by 51.9% and 52.7% for the 0.5-j-LM and 1.0-j-LM RTX treatment groups, respectively. There were no long-term complications. Conclusion: Intravesical RTX administration, in general, is a well-tolerated new therapy for DH. This patient group was refractory to all previous oral pharmacologic therapy, yet some patients responded with significant improvement in bladder capacity and continence function shortly after RTX administration. Patients at risk for autonomic dysreflexia require careful monitoring during RTX therapy.

Bladder and sexual function among women with multiple sclerosis.

Objective: Genitourinary dysfunction is common in women with multiple sclerosis (MS), yet few studies have evaluated the association between bladder and sexual dysfunction in these women. The aim of this study was to determine factors, including demographic and bladder function, associated with sexual dysfunction in a sample of women with MS. Methods: One hundred and thirty-three women with MS completed questionnaires related to overall heath status, bladder function and sexual function. Response frequencies and percentages were calculated for questionnaire responses. Multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. Results: Sixty-one per cent of the sample indicated that they had a problem with bladder control. Forty-seven per cent of respondents indicated that their neurological problems interfered with their sex life. Over 70% of the sample reported that they enjoyed, felt aroused and experienced orgasm during sexual activity. Not having a sexual partner and the indication of bothersome neurological problems were the best predictors of sexual dysfunction. Interestingly, patients bothered by their urge incontinence had higher levels of orgasm compared to women not bothered by urge incontinence. Conclusions: Although over half of the women reported voiding symptoms, most still enjoyed, felt aroused and could experience orgasm. Neurological symptoms and lacking a sexual partner emerged as the best predictors of sexual dysfunction. Urge incontinence may not be a risk factor for anorgasm. Our findings elucidate the complex nature of sexual dysfunction in women with MS.

Effect Of Controlled-Release Oxybutynin On Neurogenic Bladder Function In Spinal Cord Injury

Abstract Objective: This study evaluated the effects and tolerability of extended-release oxybutynin chloride on the frequency of voiding and catheterization and urodynamic capacity in spinal cord injury (SCI) patients with defined detrusor hyperreflexia. Methods: This was a 1 2-week, prospective, dose-titration study of extended-release oxybutynin (oxybutynin XL) . SCI patients with urodynamically defined detrusor hyperreflexia were recruited for this study. Following a 7 -day washout period, patients were evaluated via video-urodynamic study and then treatment was initiated at a dosage of 1 0 mg per day. Dosage was increased in weekly intervals to a maximum of 30 mg per day. Micturation frequency diaries and urodynamics were completed at baseline and repeated at week 1 2. Tolerability information was collected at each follow-up visit. Results: Ten patients (mean age = 49 years) with complete or incomplete SCI were enrolled. Participants reported clinical improvement (decreased urinary frequency and fewer incontinence episodes) with oxybutynin therapy following titration to 30 mg per day. All patients chose a final effective dosage of greater than 1 0 mg, with 4 patients taking the maximum of 3 0 mg per day. Mean cystometric bladder capacity increased from 2 7 4 mL to 3 80 mL (P = 0.008). No patient experienced serious adverse events during the 12-week study. Conclusion: Oxybutynin XL is safe and effective in patients with detrusor hyperreflexia secondary to SCI. The onset of clinical efficacy occurs within 1 week, and daily dosages up to 30 mg are well tole rated.

Botulinum toxin urethral sphincter injection resolves urinary retention after pubovaginal sling operation.

Abstract: The management of prolonged urinary retention following pubovaginal sling surgery typically involves transvaginal urethrolysis for anatomical urethral obstruction. Brubaker [1] recently reported on urethral sphincter abnormalities as a cause of postoperative urinary retention following either Burch suspension or a pubovaginal sling procedure. We report a case of functional urethral obstruction and detrusor acontractility following pubovaginal sling surgery that was successfully treated by botulinum A toxin urethral sphincter injection.

Changes in Voiding Patterns in Patients With MS and Extended-Release Oxybutynin

We evaluated the effects and tolerability of extended-release oxybutynin chloride on the voiding and catheterization frequency of multiple sclerosis (MS) patients with neurogenic bladder. This was a 12-week, prospective, dose-titration study of extended-release oxybutynin (oxybutynin XL). MS patients were recruited for this study from the University of Pittsburgh School of Medicines MS clinic. Entry criteria included a postvoid residual urine volume of less than 200 mL (in noncatheterized subjects). Previous urodynamic testing was not required. Exclusion criteria included individuals with urine results indicating pyuria in the presence of a positive urine culture. These tests were repeated at six and 12 weeks. After a seven-day washout period, patients recorded episodes of voiding or catheterization and incontinence for three consecutive days. Patients received initial daily doses of 10 mg oxybutynin XL in the first week. Doses were increased at weekly or biweekly intervals to a maximum of 30 mg/d. Toler...

Neurovesical Dysfunction in Postural Tachycardia Syndrome (POTS)

This is the first report of neurovesical dysfunction in a woman with postural tachycardia syndrome (POTS). The patient had both symptoms and urodynamic findings diagnostic of detrusor hyperreflexia. Management consisted of anticholinergic medication and timed voiding. Lower urinary tract dysfunction may be underrecognized in POTS.

342: Relationship Between Overactive Bladder (OAB) and Sexual Activity in Women

Study design, materials and methods Seventy-eight women diagnosed with OAB self-completed the Urinary Distress Inventory (UDI) and Personal Experiences Questionnaires (PEQ). The UDI questionnaire evaluated the presence and degree of bother associated with symptoms of urge incontinence (UI) and stress incontinence (SI). The PEQ measured sexual function with regard to sexual frequency, arousal, frequency of orgasm, and pain during intercourse. Kendall’s tau-b correlation coefficients were computed to describe the relationship between bladder and sexual function.