Changes in the detrusor hyperactivity level with long-term administration of M-anticholinergic

Background. Detrusor overactivity (DHA) in patients with spinal disease remains an urgent problem due to the high risk of complications, eventually leading to renal failure. At the same time, the elimination of intravesical hypertension is not an easy task, since damage to the spinal cord pathways is chronic and requires long-term therapy; combination of a number of drugs using the liver enzyme system, requires the use of the safest and most reliable pharmacological options. The use of M-anticholinergics, which do not affect the central nervous system, while maintaining effectiveness for a long time, is particularly relevant in this regard.

Methods. Of the group of patients who were followed-up with a diagnosis of spinal disease, seven underwent invasive studies (liquid retrograde cystometry). The multichannel analytical urodynamic system «ALFA» and the «UROVEST» software version 8.1 were used for urodynamic examination. To correct DHA, a peripherally acting M-anticholinergic trospium chloride (Spasmex) was prescribed at a dose of 30 mg twice a day. Repeated urodynamic examination was scheduled after 4–9 weeks.

Results. The most interesting result of the study was a decrease in DHA under the influence of Spasmex. When recalculating the increase in «dynamic» tone with detrusor contraction, this parameter decreased by 22%, while the «static» tone of the bladder wall decreased from 26.8 mm H₂O at the end of the study to 6.4 mm H₂O. The pressure at the end of the filling stage also decreased.

Conclusion. The drug Spasmex (trospium chloride), having antispasmodic and M-anticholinergic effects, is an effective tool to reduce the intravesical hypertension level in patients with spinal disease. Long-term administration of the drug eliminates the risk of renal complications. The drug has the property of good compatibility in the management of patients with injuries of the spine and spinal cord, which allows it to be prescribed together with α-blockers, vitamins and nootropics.