Pharmacotherapy for urinary bladder dysfunction in spinal cord injury patients

Abstract

Knowledge of the neurophysiology of the lower urinary tract has greatly increased in the last 10 years. The activity of the sympathetic, parasympathetic and somatic nerves on the detrusor muscle, the bladder outlet and the striated urethral sphincter has been studied in detail (EI Badawi, 1968, 1974). Modifications of the classical autonomic nervous system schemes have been summarised recently (Wein-Barrett, 1988). The changed sensitivity of smooth muscle to neurohumoral transmittors after denervation decentralisation has been described (Westfall, 1981). From a growing understanding of neurophysiology to the actual use of the pharmacological data in treatment has been but a step. Many more therapeutic possibilities are available nowadays in this aspect. But still many questions remain and much uncertainty still exists. In this article we will provide an overview of pharmacotherapy for urinary bladder dysfunction following spinal cord injury. Pharmacotherapy as part of the total urological treatment tries to achieve the following goals: preservation of the upper urinary tract; avoidance of urinary tract infection; adequate bladder emptying at low intravesical pressure; and prevention of incontinence; and all these in a socially and vocationally acceptable way. Pharmacological manipulation of lower urinary tract dysfunction should be based on a clear urodynamic diagnosis whenever possible. Pharmacological agents can easily be categorised according to their effect on the bladder and/or the lower urinary tract outlet. During spinal shock, parasympathomi­ metic and alpha-adrenergic blocking agents proved inefficient. No clinical effect on bladder areflexia has been shown (Tulloch-Rossier, 1977).

DOI: 10.1038/sc.1990.18

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@article{Wyndaele1990PharmacotherapyFU, title={Pharmacotherapy for urinary bladder dysfunction in spinal cord injury patients}, author={J. J. Wyndaele}, journal={Paraplegia}, year={1990}, volume={28}, pages={146-150} }