Combination Therapy for Bladder Dysfunction in Patients with Neurogenic Detrusor Overactivity

Amy Nemirovsky, Rena D. Malik, Philippe Zimmern

Research output: Contribution to journalReview article

Abstract

Purpose of Review: Neurogenic bladder is a common condition and top health priority present in 20–70% of patients with neurologic diseases including multiple sclerosis (MS), Parkinson’s disease (PD), spinal cord injury (SCI), and cerebrovascular accidents (CVA). Current gold-standard medications for overactive bladder (OAB), such as anti-muscarinics, have undesirable side effects, or have limited data in neurogenic patients. Combining therapy for urinary urge incontinence (UUI) has shown the potential to increase efficacy while maintaining or improving tolerability of treatment. Our objective was to review and synthesize recent combination therapy studies for UUI in patients with neurogenic detrusor overactivity (NDO). Recent Findings: Non-pharmacologic and pharmacologic combination therapies have been investigated for UUI in patients with NDO. Adding intravaginal neuromuscular electrical stimulation (IVES) or transcutaneous tibial stimulation (TTNS) may not be superior to pelvic floor muscle training (PFMT) on its own. Recent studies on dual therapies have focused on combining drugs with different mechanisms. In adults, a combination of desmopressin with mirabegron showed superior efficacy compared to either drug alone or solifenacin. In children, combination studies have focused on adding gabapentin to drug regimens with promising safety and efficacy. Overall, there are few combination therapy trials for OAB in neurogenic patients compared to those in patients with idiopathic OAB. Summary: There is an unmet medical need for combination therapies in patients with UUI due to neurogenic bladder. It is important to gather practice patterns and encourage providers to share their experiences. In addition, more rigorous clinical studies are needed to explore new combinations.

Original languageEnglish (US)
JournalCurrent Bladder Dysfunction Reports
DOIs
StateAccepted/In press - Jan 1 2019

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Urinary Bladder
Urge Urinary Incontinence
Overactive Urinary Bladder
Pharmaceutical Preparations
Deamino Arginine Vasopressin
Neurogenic Urinary Bladder
Gold
Cholinergic Agents
Muscle
Accidents
Therapeutics
Health
Transcutaneous Electric Nerve Stimulation
Health Priorities
Pelvic Floor
Nervous System Diseases
Spinal Cord Injuries
Multiple Sclerosis
Parkinson Disease
Stroke

Keywords

  • Combination therapy
  • Dual therapy
  • Mirabegron
  • Muscarinic antagonists
  • Neurogenic bladder
  • Urge urinary incontinence

ASJC Scopus subject areas

  • Biochemistry
  • Molecular Biology

Cite this

Combination Therapy for Bladder Dysfunction in Patients with Neurogenic Detrusor Overactivity. / Nemirovsky, Amy; Malik, Rena D.; Zimmern, Philippe.

In: Current Bladder Dysfunction Reports, 01.01.2019.

Research output: Contribution to journalReview article

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