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Combination of a cholinergic drug and an α‐blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor

2004; Wiley; Volume: 11; Issue: 2 Linguagem: Inglês

10.1111/j.1442-2042.2004.00753.x

1442-2042

Tomonori Yamanishi, Kosaku Yasuda, Takao Kamai, Toshihiko Tsujii, Ryuji Sakakibara, Tomoyuki Uchiyama, Ken-ichiro Yoshida,

Prostate Cancer Diagnosis and Treatment

Abstract Aim: The aim of the present study was to compare the effectiveness of a cholinergic drug, an α‐blocker and combinations of the two for the treatment of underactive detrusor. Methods: One hundred and nineteen patients with underactive bladder were assigned to three groups: the cholinergic group, consisting of 40 patients taking bethanechol chloride (60 mg/day) or distigmine bromide (15 mg/day); the α‐blocker group, consisting of 38 patients taking urapidil (60 mg/day); and the combination group, consisting of 41 patients taking both a cholinergic drug and an α‐blocker. The effectiveness of each therapy was assessed 4 weeks after initialization of the therapy. Results: Total urinary symptom scores (International Prostate Symptom Score, IPSS) remained unchanged after the cholinergic therapy, but were significantly lower after the α‐blocker treatment ( P = 0.0001) and the combination therapy ( P = 0.0001). With regard to the total IPSS, there were significant differences between the cholinergic and the α‐blocker groups ( P = 0.0008), and also between the cholinergic and combination groups ( P = 0.0033), in favor of the latter. The average and maximum flow rates did not increase significantly after monotherapy with either the cholinergic drug or the α‐blocker, but they significantly increased after combination therapy compared to baseline values ( P = 0.0033 and P = 0.0004, respectively). Postvoid residual volume did not decrease significantly after the cholinergic drug therapy, but decreased significantly after the α‐blocker ( P = 0.0043) and the combination therapies ( P = 0.0008). The percentage of residual urine decreased significantly after therapy in all groups ( P = 0.0005, P = 0.0176 and P = 0.0001, respectively). Conclusion: Combination therapy with a cholinergic drug and an α‐blocker appears to be more useful than monotherapy for the treatment of underactive detrusor.