The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study

Article Abstract:

With increasing age the detrusor muscle, the muscle surrounding the bladder, can become weakened and cause urinary leakage (incontinence). Detrusor instability affects 30 percent of women over the age of 70 with lower urinary tract symptoms. It is caused by the involuntary spontaneous contraction of the bladder when it is filling with urine. Current treatments, which include improving the control of the voiding reflex and blocking the nerves supplying the muscle, are not very effective. The bladder contracts when neurotransmitting chemicals are released as stimulating messages are sent to the nerve supplying the bladder. Blocking the receptors that have a particular affinity for those chemicals could potentially treat detrusor instability. However, drugs that block these neurotransmitter chemicals (anticholinergic agents) act on all receptor sites and are not specifically designed to act on bladder receptors alone. Oxybutynin chloride (an anticholinergic agent) is an drug that relaxes muscles, produces local anesthesia and stops the release of neurotransmitting chemicals. Although oxybutynin is useful in decreasing urinary urgency, incontinence and frequency, it has many side effects. To see if postmenopausal women with detrusor instability benefit from treatment with oxybutynin chloride, women with lower urinary tract symptoms were studied. Women were given either oxybutynin four milligrams four times a day for two weeks (16 women) or a placebo (21 women). There followed a two-week washout period where no drugs were given, followed by a reversal of treatment regimens. There were 33 treated women and 21 placebo treated women who completed the study. Side effects experienced during the oxybutynin treatment arm of the study (particularly with the 20 milligrams dose) caused a total of 10 women to stop taking the medication. These included dry mouth, dry skin, blurred vision, nausea and constipation. Oxybutynin was effective in reducing symptoms of urinary urgency and urge incontinence and the intensity of the detrusor instability. However, there was more residual urine when oxybutynin was taken. The use of oxybutynin should not be abandoned since adjusting the dosage may help minimize side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Drug therapy, Postmenopausal women, Bladder, Bladder diseases

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The physiological and clinical effects of progesterone inhibition with mifepristone (RU 486) in the second trimester

Article Abstract:

Mifepristone (RU 486) is a drug that inhibits the action of progesterone, a hormone essential for maintaining pregnancy. It is believed that intensity of uterine contractions and the onset of labor depend on the balance of progesterone and prostaglandin, a hormone-like substance that acts on the smooth muscle of the uterus. Mifepristone in itself is thought to increase uterine contractions and sensitivity to prostaglandins. Most studies examining the effect of mifepristone on uterine contractions were conducted among women in the first three months of pregnancy. The effect of mifepristone on uterine contractions and sensitivity to prostaglandins has now been studied among women who were between 16 and 18 weeks pregnant. Ten women were given a single 600 milligram dose of mifepristone while 10 others were given a placebo 24 hours before they were to begin conventional (prostaglandin instillation) termination of pregnancy in the second trimester (between 12 and 24 weeks). Pressure within the uterus was measured before and after stimulating the uterus with either prostaglandin (PGE2) or oxytocin, agents that cause the uterus to contract. Uterine activity and sensitivity to prostaglandins and ergotamine (another agent that increases uterine contractions) but not oxytocin, were increased after mifepristone administration. The amount of prostaglandin by-products in the blood was similar in the mifepristone- and placebo-treated women. It took less time to achieve complete abortion in women receiving mifepristone than in the nontreated women (512 minutes versus 1,128 minutes). It is concluded that when the action of progesterone is inhibited, uterine contractibility increases and the uterus becomes more sensitive to agents that increase smooth muscle contractions (oxytocics). Mifepristone does not appear to increase uterine contractions, and decreases abortion times by increasing prostaglandins that are naturally produced by the body. Mifepristone may be useful in preparing the uterus prior to conventional prostaglandin-instilled second trimester abortion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Muscle contraction, Uterus, Uterine contractions, Mifepristone

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Detrusor instability associated with menstruation: case report

Article Abstract:

The detrusor muscle is a complex of fibers that form the outside muscle layer of the bladder. Detrusor instability, which is common in women, can cause varying degrees of urinary leakage (incontinence). An 18-year-old woman noticed urinary incontinence at the beginning of menstruation that began two years previously. Urine leakage occurred occasionally while she slept and occasionally when she laughed. There was no pain or difficulty urinating. The incontinence occurred primarily during the day. Results of a physical examination were normal. X-ray visualization of the kidney structures revealed an abnormal left kidney with an appearance similar to pyelonephritis, an infection in the kidney. The left kidney was contributing only 17 percent to the total kidney function. Urine culture grew Klebsiella bacteria, which was treated with trimethoprim. Since prostaglandins, hormone-like substances that act to stimulate smooth muscle, are released by the cells of the uterus during menstruation, it is thought that this caused the stimulation of detrusor muscle cells in the bladder. The patient was treated with mefenamic acid, an prostaglandin inhibitor, 500 mg three times a day for seven days, beginning three days before menstruation. This regimen resulted in a rapid resolution of symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Menstruation

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