Can pyridostigmine improve lower urinary tract symptoms and bladder function in patients with potentially-weak bladder contractility?
DOI:
https://doi.org/10.61841/j1ewah53Keywords:
Pyridostigmine, PVR, urological clinicAbstract
Materials and methods
A total of 60 patients with high urinary bladder volumes and significant urinary symptoms were included in this study. Patients were considered to have weak detrusor contractility (potentially suitable for pyridostigmine therapy) if they had clinical history of poor stream and/or subjective feeling of incomplete bladder emptying, confirmed by significant post-void residual urine (PVR) on ultrasound (Mindray DC30 hospital type), in the absence of clinically significant mechanical bladder outflow tract obstruction. Patients included were older patients with high bladder capacity and high PVR with persistent obstructive-like symptoms, such as females with high PVR with no urethral stricture or pelvic organ prolapse and males with high PVR on alpha blockers or those who failed to void after TURP and prostatectomy or did not show satisfactory symptomatic improvement or decrease in PVR after surgery. Baseline bladder volumes, both pre-void and post-void, were recorded and the measurements were repeated after 2 weeks of oral pyridostigmine 60 mg 3 times per day. Ultrasound measurements were obtained by a single experienced operator.
Those attending urological clinic in Al-Noman Teaching Hospital and Privet clinic.A written consent was obtained from all patients participating in this study after explaining to them the important and purpose of the study, emphasized that such study could not harm them, with ensure them about complete confidentiality of information sought and will not be used other than research purpose. Patients were provided with a direct phone number to call in case of any bothersome adverse effects during pyridostigmine therapy.
Results
A total of 60 patients aged 40 to 65 years (mean 61.1 years, 41.7% females) included in this study, there was a significant overall decrease in PVR and significant improvement in voiding symptoms after 2 weeks of pyridostigmine therapy (mean PVR before treatment, 290.23± cc…and after treatment, 81.1±c ..p <.0000001 and for symptom score before treatment 18.5± and after treatment 13.9± … P<0.0001 and for bladder volume before
treatment 349.93± and after treatment 302.48± …p <0,003 ) In only 4 patients (6.7%) there was no appreciable change in voiding symptoms or PVR on ultrasound. All patients tolerated the drug well without the need to discontinue the medication or reduce the dose during the 2 week period of the study.
Conclusion
Pyridostigmine is an effective and well-tolerated therapeutic option for patients with weak detrusor contractility. Further studies are needed to confirm the long-term benefit of pyridostigmine in a larger patient population.
Downloads
References
1. Abrams P, Cardozo L, Fall M, 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.
2. Chapple CR, et al. The Underactive Bladder: A New Clinical Concept? Eur Urol (2015), http:// dx.doi.org/10.1016/j.eururo.2015.02.030
3. Aldamanhori R., Chapple CR. Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors. Curr Opin Urol 2017, 27:293–299. doi:10.1097/MOU.0000000000000381
4. Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, Oh JJ, Lee SC, Jeong CW, Yoon CY, Hong SK, Byun SS, Lee SE. Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women. Korean J Urol. 2012 May;53(5):342-
348. https://doi.org/10.4111/kju.2012.53.5.342
5. Abarbanel J., Esther-Lee Marcus E.L. Impaired Detrusor Contractility in Community-Dwelling Elderly Presenting with Lower Urinary Tract Symptoms. Urology 2007;69,3:436-440. doi:10.1016/j.urology.2006.11.019.
6. Osman, Nadir I. et al. Detrusor Underactivity and the Underactive Bladder: A New Clinical Entity? A Review of Current Terminology, Definitions, Epidemiology, Aetiology, and Diagnosis. European Urology. 2012;65,2:389–398.
7. Barendrecht MM, Oelke M, Laguna MP, Michel MC. Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based? BJU Int. 2007;99:749–752
8. Giglio D1, Tobin G: Muscarinic receptor subtypes in the lower urinary tract.: Pharmacology. 2009;83(5):259-69. doi: 10.1159/000209255. Epub 2009 Mar 19.
9. Caoimhin S. Griffin, Keith D. Thornbury, Mark A. Hollywood, and Gerard P. Sergeant: Muscarinic receptor-induced contractions of the detrusor are impaired in TRPC4 deficient mice: Sci Rep. 2018; 8: 9264.Published online 2018 Jun 18. doi: 10.1038/s41598-018-27617-5
10. Andersson KE, Arner A. Urinary bladder contraction and relaxation: physiology and pathophysiology. Physiol Rev. 2004;84:935–86. doi: 10.1152/physrev.00038.2003.
11. Chai TC, Kudze T. New therapeutic directions to treat underactive bladder. Investig Clin Urol. 2017 Dec;58(Suppl 2):S99-S106. https://doi.org/10.4111/icu.2017.58.S2.S99
12. Manini ML1, Camilleri M2, Grothe R3, Di Lorenzo C :Application of Pyridostigmine in Pediatric Gastrointestinal Motility Disorders: A Case Series. Paediatr Drugs. 2018 Apr;20(2):173-180. doi: 10.1007/s40272-017-0277-6.
13. Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the Interna- tional Continence Society. Neurourol. Urodyn. 2002; 21: 167–78
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
