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Pharmacotherapy for Bladder Outlet Obstruction in Females

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Female Bladder Outlet Obstruction and Urethral Reconstruction

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Abstract

Lower urinary tract is richly innervated by autonomic and somatic nervous system. The interactions between end-organs and central nervous system happen through an array of neurotransmitters. Acetylcholine (through both muscarinic and nicotinic), norepinephrine, nitric oxide, adenosine triphosphate, serotonin, glutamate, glycine, and gamma-aminobutyric acid are major neurotransmitters. These neurotransmitters are natural targets for pharmacotherapy of voiding dysfunction.

Pharmacotherapeutic agents for VD can be broadly categorized into those three: (1) agents for improvement of bladder contractility, (2) agents for relaxation of internal sphincter/bladder neck, (3) agents for relaxation of external sphincter/pelvic floor. Alpha-1 adrenoceptor blockers are the most widely studied and are clinically used. Onabotulinum toxin A is a neurotoxin that inhibits release of acetylcholine from neuromuscular junction. In small studies on men and women with dysfunctional voiding BoNT injection into external sphincter has shown significant improvement.

There is no FDA-approved agent for management of voiding dysfunction in women. Nevertheless, several agents are clinically being used based on results of small-scale studies in women and experience of use in similar pathologies in men. High-quality randomized controlled trials are warranted in this nascent and orphaned area.

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References

  1. Miyazato M, Yoshimura N, Nishijima S, Sugaya K. Roles of glycinergic and gamma-aminobutyric-ergic mechanisms in the micturition reflex in rats. LUTS Low Urin Tract Symptoms. 2009;1(S1):S70–3.

    Article  CAS  Google Scholar 

  2. Canda AE, Cinar MG, Turna B, Sahin MO. Pharmacologic targets on the female urethra. Urol Int. 2008;80(4):341–54.

    Article  CAS  Google Scholar 

  3. Yamanishi T, Yasuda K, Kamai T, et al. 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. Int J Urol. 2004;11(2):88–96.

    Article  CAS  Google Scholar 

  4. De Wachter S, Van Meel TD, Wyndaele JJ. Study of the afferent nervous system and its evaluation in women with impaired detrusor contractility treated with bethanechol. Urology. 2003;62(1):54–8.

    Article  Google Scholar 

  5. Finkbeiner AE. Is bethanechol chloride clinically effective in promoting bladder emptying? A literature review. J Urol. 1985;134(3):443–9.

    Article  CAS  Google Scholar 

  6. Andersson KE, Wein AJ. Pharmacology of the lower urinary tract: basis for current and future treatments of urinary incontinence. Pharmacol Rev. 2004;56(4):581–631.

    Article  CAS  Google Scholar 

  7. Hindley RG, Brierly RD, Thomas PJ. Prostaglandin E2 and bethanechol in combination for treating detrusor underactivity. BJU Int. 2004;93(1):89–92.

    Article  CAS  Google Scholar 

  8. Andersson K-E, Wein AJ. Pharmacologic management of lower urinary tract storage and emptying failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh urology. 11th ed. Philadelphia: Elsevier; 2016. p. 1967–2002.e14.

    Google Scholar 

  9. Reitz A, Haferkamp A, Kyburz T, Knapp PA, Wefer B, Schurch B. The effect of tamsulosin on the resting tone and the contractile behaviour of the female urethra: a functional urodynamic study in healthy women. Eur Urol. 2004;46(2):235–40.

    Article  CAS  Google Scholar 

  10. Schwinn DA, Price DT, Narayan P. α1-adrenoceptor subtype selectivity and lower urinary tract symptoms. Mayo Clin Proc. 2004;79(11):1423–34.

    Article  CAS  Google Scholar 

  11. Meyer LE, Brown JN. Tamsulosin for voiding dysfunction in women. Int Urol Nephrol. 2012;44(6):1649–56.

    Article  CAS  Google Scholar 

  12. Pummangura N, Kochakarn W. Efficacy of tamsulosin in the treatment of lower urinary tract symptoms (LUTS) in women. Asian J Surg. 2007;30(2):131–7.

    Article  Google Scholar 

  13. Lee KS, Han DH, Lee YS, et al. Efficacy and safety of tamsulosin for the treatment of non-neurogenic voiding dysfunction in females: a 8-week prospective study. J Korean Med Sci. 2010;25(1):117–22.

    Article  CAS  Google Scholar 

  14. Low BY, Liong ML, Yuen KH, et al. Terazosin therapy for patients with female lower urinary tract symptoms: a randomized, double-blind, placebo controlled trial. J Urol. 2008;179(4):1461–9.

    Article  CAS  Google Scholar 

  15. Kessler TM, Studer UE, Burkhard FC. The effect of terazosin on functional bladder outlet obstruction in women: a pilot study. J Urol. 2006;176(4):1487–92.

    Article  CAS  Google Scholar 

  16. Kumar A, Mandhani A, Gogoi S, Srivastava A. Management of functional bladder neck obstruction in women: use of Α-blockers and pediatric resectoscope for bladder neck incision. J Urol. 1999;162(6):2061–5.

    Article  CAS  Google Scholar 

  17. Wilde MI, Fitton A, McTavish D. Alfuzosin: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in benign prostatic hyperplasia. Drugs. 1993;45(3):410–29.

    Article  CAS  Google Scholar 

  18. D'Armiento M, Damiano R, De Sio M, Perdonà S, Santonastaso C, Mattace RD. Ruolo dell’alfuzosina nei disturbi di vuotamento funzionali nella donna [Role of alfuzosin in the treatment of functional voiding disorders in women]. Arch Ital Urol Androl. 1997;69(Suppl 1):43–5.

    PubMed  Google Scholar 

  19. Athanasopoulos A, Gyftopoulos K, Giannitsas K, Perimenis P. Effect of alfuzosin on female primary bladder neck obstruction. Int Urogynecol J. 2009;20(2):217–22.

    Article  CAS  Google Scholar 

  20. Lee YS, Lee KS, Choo MS, et al. Efficacy of an alpha-blocker for the treatment of nonneurogenic voiding dysfunction in women: an 8-week, randomized, double-blind, placebo-controlled trial. Int Neurourol J. 2018;22(1):30–40.

    Article  Google Scholar 

  21. Schilit S, Benzeroual KE. Silodosin: a selective α1A-adrenergic receptor antagonist for the treatment of benign prostatic hyperplasia. Clin Ther. 2009;31(11):2489–502.

    Article  CAS  Google Scholar 

  22. Villa L, Capogrosso P, Capitanio U, et al. Silodosin: an update on efficacy, safety and clinical indications in urology. Adv Ther. 2019;36(1):1–18.

    Article  CAS  Google Scholar 

  23. Jung JH, Kim J, Macdonald R, Reddy B, Kim MH, Dahm P. Silodosin for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2017;11(11):CD012615.

    PubMed  Google Scholar 

  24. Matsubara Y, Kanazawa T, Kojima Y, et al. Pharmacokinetics and disposition of silodosin (KMD-3213). Yakugaku Zasshi. 2006;126(special issue):237–45.

    Article  CAS  Google Scholar 

  25. McNicholas TA, Speakman MJ, Kirby RS. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh urology. 11th ed. Philadelphia: Elsevier; 2016. p. 2463–503.

    Google Scholar 

  26. Rogalski MJ, Kellogg-Spadt S, Hoffmann AR, Fariello JY, Whitmore KE. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J. 2010;21(7):895–9.

    Article  Google Scholar 

  27. Crisp CC, Vaccaro CM, Estanol MV, et al. Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. Int Urogynecol J Pelvic Floor Dysfunct. 2013;24(11):1915–23.

    Article  Google Scholar 

  28. Holland MA, Joyce JS, Brennaman LM, Drobnis EZ, Starr JA, Foster RT. Intravaginal diazepam for the treatment of pelvic floor hypertonic disorder. Female Pelvic Med Reconstr Surg. 2019;25(1):76–81.

    Article  Google Scholar 

  29. Chen CH, Hsiao SM, Chang TC, Wu WY, Lin HH. Clinical and urodynamic effects of baclofen in women with functional bladder outlet obstruction: preliminary report. J Obstet Gynaecol Res. 2016;42(5):560–5.

    Article  CAS  Google Scholar 

  30. Xu D, Qu C, Meng H, et al. Dysfunctional voiding confirmed by transdermal perineal electromyography, and its effective treatment with baclofen in women with lower urinary tract symptoms: a randomized double-blind placebo-controlled crossover trial. BJU Int. 2007;100(3):588–92.

    Article  CAS  Google Scholar 

  31. He Y, Brunstrom-Hernandez JE, Thio LL, et al. Population pharmacokinetics of oral baclofen in pediatric patients with cerebral palsy. J Pediatr. 2014;164(5):1181.

    Article  CAS  Google Scholar 

  32. Stetkarova I, Brabec K, Vasko P, Menel L. Intrathecal baclofen in spinal spasticity: frequency and severity of withdrawal syndrome. Pain Physician. 2015;18(4):E633–41.

    PubMed  Google Scholar 

  33. Malanga G, Reiter RD, Garay E. Update on tizanidine for muscle spasticity and emerging indications. Expert Opin Pharmacother. 2008;9(12):2209–15.

    Article  CAS  Google Scholar 

  34. Hoogstraten MC, van der Ploeg RJO, vd Burg W, Vreeling A, van Marle S, Minderhoud JM. Tizanidine versus baclofen in the treatment of spasticity in multiple sclerosis patients. Acta Neurol Scand. 1988;77(3):224–30.

    Article  CAS  Google Scholar 

  35. Bass B, Weinshenker B, Rice GPA, et al. Tizanidine versus baclofen in the treatment of spasticity in patients with multiple sclerosis. Can J Neurol Sci. 1988;15(1):15–9.

    Article  CAS  Google Scholar 

  36. Groves L, Shellenberger MK, Davis CS. Tizanidine treatment of spasticity: a meta-analysis of controlled, double-blind, comparative studies with baclofen and diazepam. Adv Ther. 1998;15(4):241–51.

    CAS  PubMed  Google Scholar 

  37. El-Hefnawy AS, Helmy T, El-Assmy MM, Sarhan O, Hafez AT, Dawaba M. Doxazosin versus tizanidine for treatment of dysfunctional voiding in children: a prospective randomized open-labeled trial. Urology. 2012;79(2):428–33.

    Article  Google Scholar 

  38. Henney HR, Chez M. Pediatric safety of tizanidine: clinical adverse event database and retrospective chart assessment. Pediatr Drugs. 2009;11(6):397–406.

    Article  Google Scholar 

  39. Kuo HC. Botulinun A toxin urethral sphincter injection for neurogenic or nonneurogenic voiding dysfunction. Tzu Chi Med J. 2016;28(3):89–93.

    Article  Google Scholar 

  40. Kuo HC. Botulinum a toxin urethral injection for the treatment of lower urinary tract dysfunction. J Urol. 2003;170(5):1908–12.

    Article  CAS  Google Scholar 

  41. Davids HR, Moberg-Wolff EA. What is the median lethal dose (LD50) of botulinum toxin? https://www.medscape.com/answers/325574-179844/what-is-the-median-lethal-dose-ld50-of-botulinum-toxin. Published 2019.

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Authors and Affiliations

  1. Urology and Kidney Transplant Surgery, Medanta Hospital, Lucknow, Uttar Pradesh, India

    Mayank Mohan Agarwal

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  1. Mayank Mohan Agarwal
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Editors and Affiliations

  1. Female Urology, Reconstructive Urology and Neurovesical Dysfunction, Medanta, The Medicity, Gurugram, India

    Nikhil Khattar

  2. Department of Urology, All India Institute of Medical Sciences, New Delhi, India

    Rishi Nayyar

  3. Urology and Renal Transplantation, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India

    Arabind Panda

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Agarwal, M.M. (2021). Pharmacotherapy for Bladder Outlet Obstruction in Females. In: Khattar, N., Nayyar, R., Panda, A. (eds) Female Bladder Outlet Obstruction and Urethral Reconstruction. Springer, Singapore. https://doi.org/10.1007/978-981-15-8521-0_11

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  • DOI: https://doi.org/10.1007/978-981-15-8521-0_11

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  • Online ISBN: 978-981-15-8521-0

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