1
|
Kimoto Y, Oshino S, Tani N, Hosomi K, Khoo HM, Fujita Y, Miura S, Iwata T, Emura T, Matsuhashi T, Onoda Y, Ishiuchi T, Yanagisawa T, Hirata M, Kishima H. Characteristics of Changes in Intrathecal Baclofen Dosage over Time due to Causative Disease. Neurol Med Chir (Tokyo) 2023; 63:535-541. [PMID: 37743509 PMCID: PMC10788484 DOI: 10.2176/jns-nmc.2022-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/13/2023] [Indexed: 09/26/2023] Open
Abstract
Intrathecal baclofen (ITB) therapy effectively treats spasticity caused by brain or spinal cord lesions. However, only a few studies compare the course of treatment for different diseases. We investigated the change in daily dose of baclofen per year and its associated adverse events in patients presenting with the three most common etiologies at our institute: hereditary spastic paraplegia, cerebral palsy, and spinal cord injury. The ITB pumps were implanted from July 2007 to August 2019, with a mean follow-up period of 70 months. In patients with hereditary spastic paraplegia, baclofen dosage was reduced after eight years following ITB introduction, and the treatment was terminated in one patient owing to disease progression. In patients with cerebral palsy, the dosage increased gradually, and became constant in the 11th year. Patients with spinal cord injury gradually increased their baclofen dosage throughout the entire observation period. Severity and adverse event rates were higher in patients with cerebral palsy than in others. The degree and progression of spasticity varied depending on the causative disease. Understanding the characteristics and natural history of each disease is important when continuing ITB treatment.
Collapse
Affiliation(s)
- Yuki Kimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Naoki Tani
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Yuya Fujita
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Shimpei Miura
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takamitsu Iwata
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takuto Emura
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | | | - Yuji Onoda
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takamasa Ishiuchi
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine
- Institute for Advanced Co-Creation Studies, Osaka University
| | - Masayuki Hirata
- Department of Neurosurgery, Osaka University Graduate School of Medicine
- Department of Neurological Diagnosis and Restoration, Osaka University Graduate School of Medicine
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| |
Collapse
|
2
|
Dietz N, Wagers S, Harkema SJ, D'Amico JM. Intrathecal and Oral Baclofen Use in Adults With Spinal Cord Injury: A Systematic Review of Efficacy in Spasticity Reduction, Functional Changes, Dosing, and Adverse Events. Arch Phys Med Rehabil 2023; 104:119-131. [PMID: 35750207 DOI: 10.1016/j.apmr.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the efficacy, dosing, and safety profiles of intrathecal and oral baclofen in treating spasticity after spinal cord injury (SCI). DATA SOURCES PubMed and Cochrane Databases were searched from 1970-2018 with keywords baclofen, spinal cord injury, and efficacy. STUDY SELECTION The database search yielded 588 sources and 10 additional relevant publications. After removal of duplicates, 398 publications were screened. DATA EXTRACTION Data were extracted using the following population, intervention, comparator, outcomes, and study designs criteria: studies including adult patients with SCI with spasticity; the intervention could be oral or intrathecal administration of baclofen; selection was inclusive for control groups, surgical management, rehabilitation, and alternative pharmaceutical agents; outcomes were efficacy, dosing, and adverse events. Randomized controlled trials, observational studies, and case reports were included. Meta-analyses and systematic reviews were excluded. DATA SYNTHESIS A total of 98 studies were included with 1943 patients. Only 4 randomized, double-blinded, and placebo-controlled trials were reported. Thirty-nine studies examined changes in the Modified Ashworth Scale (MAS; 34 studies) and Penn Spasm scores (Penn Spasm Frequency; 19 studies), with average reductions of 1.7±1.3 and 1.6±1.4 in individuals with SCI, respectively. Of these data, a total of 6 of the 34 studies (MAS) and 2 of the 19 studies (Penn Spasm Frequency) analyzed oral baclofen. Forty-three studies addressed adverse events with muscle weakness and fatigue frequently reported. CONCLUSIONS Baclofen is the most commonly-prescribed antispasmodic after SCI. Surprisingly, there remains a significant lack of large, placebo-controlled, double-blinded clinical trials, with most efficacy data arising from small studies examining treatment across different etiologies. In the studies reviewed, baclofen effectively improved spasticity outcome measures, with increased efficacy through intrathecal administration. Few studies assessed how reduced neural excitability affected residual motor function and activities of daily living. A host of adverse events were reported that may negatively affect quality of life. Comparative randomized controlled trials of baclofen and alternative treatments are warranted because these have demonstrated promise in relieving spasticity with reduced adverse events and without negatively affecting residual motor function.
Collapse
Affiliation(s)
- Nicholas Dietz
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Sarah Wagers
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Susan J Harkema
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Jessica M D'Amico
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY.
| |
Collapse
|
3
|
Asma A, Ulusaloglu AC, Howard JJ, Rogers KJ, Miller F, Shrader MW. Does the Addition of Intrathecal Baclofen Along with or After Soft-Tissue Hip Adductor Surgery Decrease the Need for Hip Reconstruction Compared with Soft-Tissue Surgery Alone for Children with Nonambulatory Cerebral Palsy? Indian J Orthop 2022; 56:2176-2181. [PMID: 36507212 PMCID: PMC9705619 DOI: 10.1007/s43465-022-00762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022]
Abstract
Purpose Intrathecal baclofen (ITB) is a well-known treatment option for cerebral palsy (CP) spasticity. The combination of soft-tissue release and ITB for spasticity is common. This study compared patients who had soft-tissue release before ITB (PRE-ITB), soft-tissue release at the same time as ITB (ST-ITB), and no ITB (NON-ITB) but had soft-tissue release at a similar age as PRE-ITB. Methods Inclusion criteria were a spastic or mixed nonambulatory CP diagnosis, prior hip adductor surgery, no prior reconstructive surgery, and at least a five-year post-operative follow-up. Thirty hips were identified as PRE-ITB, 20 hips as ST-ITB, and 43 hips as NON-ITB. The primary outcome variables were the subsequent hip surgery during the study period and/or a migration percentage ≥ 50% at the final follow-up defined as "unsuccessful hip." Results The mean follow-up duration was 9.0 years (SD 2.4) for PRE-ITB, 9.4 (SD 3.6) for ST-ITB, and 9.3 (SD 3) for NON-ITB. The odds of unsuccessful outcomes were not different between NON-ITB and PRE-ITB but were lower for the ST-ITB group. The need for subsequent osteotomies or revision adductor surgery was significantly higher in ST-ITB compared with PRE-ITB (p = 0.02) or NON-ITB (p = 0.015). The incidence of surgical site infection over the whole follow-up period was higher in ST-ITB (40%) compared with PRE-ITB (13.3%, p = 0.035) and NON-ITB (0, p < 0.001). Conclusion The addition of tone management with ITB did not reduce the need for later hip surgery but did increase the risk for surgical site infection.
Collapse
Affiliation(s)
- Ali Asma
- Department of Orthopaedics, Nemours Children’s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803 USA
- Investigation Performed at Nemours Children’s Hospital, Wilmington, DE USA
| | - Armagan Can Ulusaloglu
- Department of Orthopaedics, Nemours Children’s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803 USA
- Investigation Performed at Nemours Children’s Hospital, Wilmington, DE USA
| | - Jason J. Howard
- Department of Orthopaedics, Nemours Children’s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803 USA
- Investigation Performed at Nemours Children’s Hospital, Wilmington, DE USA
| | - Kenneth J. Rogers
- Department of Orthopaedics, Nemours Children’s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803 USA
- Investigation Performed at Nemours Children’s Hospital, Wilmington, DE USA
| | - Freeman Miller
- Department of Orthopaedics, Nemours Children’s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803 USA
- Investigation Performed at Nemours Children’s Hospital, Wilmington, DE USA
| | - Michael Wade Shrader
- Department of Orthopaedics, Nemours Children’s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803 USA
- Investigation Performed at Nemours Children’s Hospital, Wilmington, DE USA
| |
Collapse
|
4
|
Gober J, Seymour M, Miao H, Curry DJ, Thomas SP. Management of severe spasticity with and without dystonia with intrathecal baclofen in the pediatric population: a cross-sectional study. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000407. [DOI: 10.1136/wjps-2021-000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/19/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo investigate the differences in delivery mode, daily dose, and catheter tip location in pediatric patients using intrathecal baclofen (ITB) pumps with spasticity plus dystonia versus spasticity alone.MethodsA single-center, cross-sectional study was performed by collecting retrospective data from electronic medical records. Demographic and diagnostic information was obtained, comparing patients with spasticity with or without dystonia. The data were analyzed for group differences using a two-tailed Student’s t-test. Categorical data were analyzed for group differences using Pearson’s χ2 test.ResultsA total of 137 patients met the criteria. The majority (114) had spasticity plus dystonia whereas only 23 were documented as spasticity alone. Simple continuous dosing was the most common delivery mode, but flex dosing was used more than twice as frequently with spasticity plus dystonia compared with spasticity alone (42% vs 17%). Patients with spasticity plus dystonia also had more rostral catheter tip locations.ConclusionsWhile it has been discussed anecdotally, this study confirms the supposition that patients with spasticity plus dystonia have increased dose requirements when compared with those with spasticity alone. Although there are no clear standards of care when managing these patients, they are often on higher daily dosages, are more likely to require flexed dosing method, and have higher catheter placements. Still, there are few studies that demonstrate improvements in dystonia with the use of ITB. In general, these patients would benefit from the development of universal standardizations as well as the confirmation that this is an appropriate treatment.
Collapse
|
5
|
Gunnarsson S, Lemming D, Alehagen S, Berntsson S, Ertzgaard P, Samuelsson K. Dosing Patterns In Treatment of Disabling Spasticity With Intrathecal Baclofen. Rehabil Nurs 2021; 46:315-322. [PMID: 33788806 DOI: 10.1097/rnj.0000000000000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to describe and analyze dosing patterns for patients with ITB treatment over time and to identify possible subgroups demonstrating diversity in patterns. DESIGN A retrospective design. METHODS For 81 patients from six different hospitals, baclofen doses from the first 2 years of treatment were identified using medical records. Line graphs of each patient's doses were analyzed and grouped based on similarities in dosing pattern. FINDINGS The analyses of the dosing patterns resulted in four different subgroups classified as stable, slow increase, rapid increase, and fluctuating. CONCLUSION The results highlight the clinical challenge of predicting dose development over time. CLINICAL RELEVANCE TO REHABILITATION NURSING This study provides rehabilitation healthcare professionals with a better understanding of intrathecal baclofen dose development. Illustrations of the four subgroups can be used as an educational tool for patients, family, and caregivers.
Collapse
Affiliation(s)
- Stina Gunnarsson
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | | | | | | | | | | |
Collapse
|
6
|
Abstract
Intrathecal baclofen therapy is a well-established technique for spasticity management. This article briefly reviews the pharmacology of intrathecal baclofen as well as customary approach for utilization of this targeted drug delivery concept. Following these descriptions, four unusual presentations will be described, including the need for initial trialing, patient-directed boluses during chronic intrathecal baclofen therapy, use of medications other than baclofen for intrathecal therapy in spastic patients, and intraventricular baclofen delivery. These hypothetical cases are provided in an effort to expand the use of targeted drug delivery to larger population of spastic patients.
Collapse
Affiliation(s)
- Michael Saulino
- MossRehab, 60 Township Line Road, Elkins Park, PA 19027, USA; Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
7
|
Kannampalli P, Poli SM, Boléa C, Sengupta JN. Analgesic effect of ADX71441, a positive allosteric modulator (PAM) of GABA B receptor in a rat model of bladder pain. Neuropharmacology 2017; 126:1-11. [PMID: 28823612 DOI: 10.1016/j.neuropharm.2017.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/26/2017] [Accepted: 08/16/2017] [Indexed: 01/12/2023]
Abstract
Therapeutic use of GABAB receptor agonists for conditions like chronic abdominal pain, overactive bladder (OAB) and gastroesophageal reflux disease (GERD) is severely affected by poor blood-brain barrier permeability and potential side effects. ADX71441 is a novel positive allosteric modulator (PAM) of the GABAB receptor that has shown encouraging results in pre-clinical models of anxiety, pain, OAB and alcohol addiction. The present study investigates the analgesic effect of ADX71441 to noxious stimulation of the urinary bladder and colon in rats. In female Sprague-Dawley rats, systemic (i.p), but not intrathecal (i.t), administration of ADX71441 produced a dose-dependent decrease in viscero-motor response (VMR) to graded urinary bladder distension (UBD) and colorectal distension (CRD). Additionally, intra-cerebroventricular (i.c.v.) administration of ADX71441 significantly decreased the VMRs to noxious UBD. In electrophysiology experiments, the drug did not attenuate the responses of UBD-sensitive pelvic nerve afferent (PNA) fibers to UBD. In contrast, ADX71441 significantly decreased the responses of UBD-responsive lumbosacral (LS) spinal neurons in spinal intact rats. However, ADX71441 did not attenuate these LS neurons in cervical (C1-C2) spinal transected rats. During cystometrogram (CMG) recordings, ADX71441 (i.p.) significantly decreased the VMR to slow infusion without affecting the number of voiding contraction. These results indicate that ADX71441 modulate bladder nociception via its effect at the supra-spinal sites without affecting the normal bladder motility and micturition reflex in naïve adult rats.
Collapse
Affiliation(s)
- Pradeep Kannampalli
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sonia-Maria Poli
- Addex Therapeutics, 14 Chemin des Aulx, CH-1228 Plan-les-Ouates, Geneva, Switzerland
| | - Christelle Boléa
- Addex Therapeutics, 14 Chemin des Aulx, CH-1228 Plan-les-Ouates, Geneva, Switzerland
| | - Jyoti N Sengupta
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
8
|
Nagel SJ, Wilson S, Johnson MD, Machado A, Frizon L, Chardon MK, Reddy CG, Gillies GT, Howard MA. Spinal Cord Stimulation for Spasticity: Historical Approaches, Current Status, and Future Directions. Neuromodulation 2017; 20:307-321. [PMID: 28370802 DOI: 10.1111/ner.12591] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/08/2016] [Accepted: 01/03/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Millions of people worldwide suffer with spasticity related to irreversible damage to the brain or spinal cord. Typical antecedent events include stroke, traumatic brain injury, and spinal cord injury, although insidious onset is also common. Regardless of the cause, the resulting spasticity leads to years of disability and reduced quality of life. Many treatments are available to manage spasticity; yet each is fraught with drawbacks including incomplete response, high cost, limited duration, dose-limiting side effects, and periodic maintenance. Spinal cord stimulation (SCS), a once promising therapy for spasticity, has largely been relegated to permanent experimental status. METHODS In this review, our goal is to document and critique the history and assess the development of SCS as a treatment of lower limb spasticity. By incorporating recent discoveries with the insights gained from the early pioneers in this field, we intend to lay the groundwork needed to propose testable hypotheses for future studies. RESULTS SCS has been tested in over 25 different conditions since a potentially beneficial effect was first reported in 1973. However, the lack of a fully formed understanding of the pathophysiology of spasticity, archaic study methodology, and the early technological limitations of implantable hardware limit the validity of many studies. SCS offers a measure of control for spasticity that cannot be duplicated with other interventions. CONCLUSIONS With improved energy-source miniaturization, tailored control algorithms, novel implant design, and a clearer picture of the pathophysiology of spasticity, we are poised to reintroduce and test SCS in this population.
Collapse
Affiliation(s)
- Sean J Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Saul Wilson
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael D Johnson
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andre Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Leonardo Frizon
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Matthieu K Chardon
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chandan G Reddy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - George T Gillies
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
9
|
Maneyapanda MB, McCormick ZL, Marciniak C, Reger C. Long-Term Dosing of Intrathecal Baclofen in the Treatment of Spasticity After Acquired Brain Injury. PM R 2017; 9:556-562. [DOI: 10.1016/j.pmrj.2016.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 12/13/2016] [Accepted: 12/17/2016] [Indexed: 01/12/2023]
|
10
|
Meythaler JM, Peduzzi JD. Baclofen Solution for Low-Volume Therapeutic Delivery. Neuromodulation 2016; 20:392-396. [PMID: 27696596 DOI: 10.1111/ner.12528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/19/2016] [Accepted: 08/28/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Baclofen is a zwitterion molecule where increased ions in the excipient increase the solubility. We developed baclofen in a stable solution similar to cerebrospinal fluid (CSF) without bicarbonate and proteins to improve the solubility of the baclofen and to reduce the potential toxicity to the central nervous system (CNS) and subarachnoid space. The objective is to develop a solution of baclofen wherein baclofen is solubilized in a multivalent physiological ion solution such as artificial cerebrospinal fluid (aCSF) at a concentration from 2 mg/cc to 10 mg/cc. METHODS First, to determine the solubility of Baclofen in aCSF, solubility was determined at six different pH levels at 37°C, by the addition of aCSF to a known amount of Baclofen. The final concentrations were confirmed by high performance liquid chromatography (HPLC) analysis. Second, the stability of Baclofen at 4 mg/cc investigated in a test manufacturing batch utilizing standard methods of production of 1500 20 cc vials inverted for 18 months at 25°C at 60% humidity. The stability and purity of the baclofen was verified at 18 months by HPLC analysis. RESULTS Baclofen was initially soluble between pH of 6-8 above 7 mg/cc but fell back to 6.3-5.8 mg/cc level with time. Baclofen produced in vials with inversion were noted to be stable at 4 mg/cc at 18 months with less than 2% breakdown of the baclofen in solution. CONCLUSION Baclofen is much more soluble in artificial CSF than normal saline. The artificial CSF may also be less toxic to the subarachnoid space than saline.
Collapse
Affiliation(s)
- Jay M Meythaler
- Department of Physical Medicine and Rehabilitation-Oakwood, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jean D Peduzzi
- Department of Physical Medicine and Rehabilitation-Oakwood, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
11
|
Cohn JA, Brown ET, Reynolds WS, Kaufman MR, Dmochowski RR. Pharmacologic management of non-neurogenic functional obstruction in women. Expert Opin Drug Metab Toxicol 2016; 12:657-67. [PMID: 27095013 DOI: 10.1080/17425255.2016.1178239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Impaired bladder emptying in women without neurologic disease may be related to urethral obstruction and/or impaired bladder contractility. Mechanical obstruction generally requires surgical management and options are limited for impaired bladder contractility. However, functional obstruction from voiding dysfunction or primary bladder neck obstruction may present an opportunity for pharmacologic intervention. AREAS COVERED In this review, the authors extensively reviewed available literature regarding the use of off-label medications for functional bladder outlet obstruction in women. In addition, side effect profiles and pharmacology of these medications determined from on-label indications are reviewed. Specific medications reviewed include vaginal diazepam, baclofen, urethral botulinum toxin injection, and alpha-adrenergic blockers. EXPERT OPINION Alpha-blockers in particular have demonstrated promise in women with demonstrable or suspected bladder outlet obstruction with side effect profiles similar to those observed in men. However, lack of quality data hinders informed decision making with alpha-blockers or any of the other agents studied in women with non-neurogenic functional outlet obstruction. In the absence of well-designed, placebo-controlled multi-institutional trials, those prescribing these medications must be aware of special considerations and side effects associated with relatively unfamiliar treatments in the context of uncertain benefit.
Collapse
Affiliation(s)
- Joshua A Cohn
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| | - Elizabeth T Brown
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| | - W Stuart Reynolds
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| | - Melissa R Kaufman
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| | - Roger R Dmochowski
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| |
Collapse
|