Efficacy of fesoterodine for prevention of autonomic dysreflexia in patients with neurogenic dysfunction of the bladder after spinal cord injury

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Abstract

Aim: to evaluate the effectiveness of fesoterodine for the prevention of autonomic dysreflexia (AD) in patients with neurogenic bladder dysfunction (NBD) after spinal cord injury (SCI).

Materials and methods: a total of 53 patients with AD were included in the study. In the main group (n=33) patients received fesoterodine 4 mg per day for 12 weeks as a treatment for neurogenic bladder dysfunction and prevention of AD. In the control group (n=20), patients were monitored for 12 weeks without specific treatment. The assessment was based on the results of ADFSCI and NBSS questionnaires, daily blood pressure monitoring with the completion of a self-observation diary, cystometry with simultaneous monitoring of blood pressure and heart rate.

Results: In the main group there was a significant decrease in episodes and severity of AD according to ADFSCI questionnaire and an improvement in the quality of life according to NBSS questionnaire compared to the control group (p<0.001). Also, in the main group, the number of episodes of AD and systolic blood pressure decreased. The maximum bladder capacity and bladder compliance increased (p<0.001), and the maximum detrusor pressure and systolic blood pressure when the cystometric capacity was reached, decreased significantly (p<0.001) in the main group compared in comparison with the control group.

Conclusion: Fesoterodine at a dosage of 4 mg for 12 weeks reduced the severity of symptoms of AD in patients with SCI and NBD, which was manifested by the stabilization of blood pressure and a decrease in the number of episodes of AD, which significantly improved the quality of life. Also, the drug led to a significant improvement in urodynamic parameters during cystometry, in the form of a decrease in detrusor pressure and an increase in cystometric capacity. We can conclude that fesoterodine is effective in the prevention of AD in patients with NBD after SCI.

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About the authors

R. V. Salyukov

«Russian X-radiology Research Center» of the Ministry of Healthcare of the Russian Federation; Pirogov Russian National Research Medical University

Author for correspondence.
Email: salyukov2012@yandex.ru
ORCID iD: 0000-0002-7128-6400

Ph.D., researcher, associate professor of the Department of Medical Rehabilitation

Russian Federation, Moscow; Moscow

A. A. Kamalov

Lomonosov Moscow State University

Email: priemnaya@mc.msu.ru
ORCID iD: 0000-0003-4251-7545

Ph.D., MD, professor, Academician of the RAS, Head of the Department of Urology and Andrology, Faculty of Fundamental Medicine, Director of Medical Scientific and Educational Center

Russian Federation, Moscow

D. A. Okhobotov

Lomonosov Moscow State University

Email: 14072003m@gmail.com
ORCID iD: 0000-0002-6768-9004

Ph.D., associate professor, Department of Urology and Andrology, Faculty of Fundamental Medicine

Russian Federation, Moscow

M. E. Chalyi

Lomonosov Moscow State University

Email: chalyy@bk.ru
ORCID iD: 0000-0003-1736-9085

Ph.D. MD, professor, Leading Researcher at the Research and Educational Center

Russian Federation, Moscow

M. V. Frolova

Lomonosov Moscow State University

Email: mary.froloy@yandex.ru
ORCID iD: 0000-0002-5198-288X

Ph.D. student, Department of Urology and Andrology, Faculty of Fundamental Medicine

Russian Federation, Moscow

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Supplementary files

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2. Fig.1. The level of damage to spinal cord segments in patients of the main and control groups

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3. Fig.2. Dynamics of scores on the AFFSCI questionnaire in the control and main groups

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4. Fig.3. Quality of life according to Qql in patients of the control and main groups

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