Article

This review analyzed efficacy, tolerability and safety of oral
antimuscarinic (AM) drugs in adults suffering from neurogenic detrusor
overactivity (NDO).Methods:A comprehensive search of major literature bases was
conducted to identify all references.Results:Thirty studies, thereof 16
randomized controlled trials (RCT), enrolling 1479 patients were identified and
included in the review. Results were grouped in dose-finding, placebo- and
active-controlled, flexible dose and combined high-dose AM drugs, and various
studies. Key urodynamic outcome parameters, such as maximum detrusor pressure and
maximum cystometric bladder capacity, demonstrated the efficacy of AM in NDO,
following 2-3 weeks of treatment. Contrary to idiopathic detrusor overactivity
(IDO), no placebo effects manifested. Other important parameters, such as impact
on the upper urinary tract function and morphology, issues of continence,
post-void residual urine, catheterisation, urinary tract infections and quality
of life, were investigated to a limited extent only. Incidence rates of adverse
events were comparable for NDO and IDO. Most of the studies, especially RCT, were
undertaken with oxybutynin immediate release (IR), trospium chloride IR,
propiverine IR and propiverine extended release. In NDO, these drugs are best
investigated.Conclusions:AM drugs are effective in NDO, they normalize the
intravesical pressure and increase cystometric bladder capacity. However, other
important parameters are not adequately investigated so far and should be
recognized in future studies.

Langue : ANGLAIS