Display options
Cite
Moro C, Phelps C, Veer V, et al. The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta-analysis. Neurourol Urodyn. 2021;41(1):127-139doi: 10.1002/nau.24839.
Moro, C., Phelps, C., Veer, V., Clark, J., Glasziou, P., Tikkinen, K. A. O., & Scott, A. M. (2022). The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta-analysis. Neurourology and urodynamics, 41(1), 127-139. https://doi.org/10.1002/nau.24839
Moro, Christian, et al. "The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta-analysis." Neurourology and urodynamics vol. 41,1 (2022): 127-139. doi: https://doi.org/10.1002/nau.24839
Moro C, Phelps C, Veer V, Clark J, Glasziou P, Tikkinen KAO, Scott AM. The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta-analysis. Neurourol Urodyn. 2022 Jan;41(1):127-139. doi: 10.1002/nau.24839. Epub 2021 Nov 24. PMID: 34816481.
Copy Download .nbib Format: NLM
Share it on

Neurourol Urodyn. 2022 Jan;41(1):127-139. doi: 10.1002/nau.24839. Epub 2021 Nov 24.

The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta-analysis.

Neurourology and urodynamics

Christian Moro, Charlotte Phelps, Vineesha Veer, Justin Clark, Paul Glasziou, Kari A O Tikkinen, Anna M Scott

Affiliations

  1. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
  2. Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia.
  3. Department of Urology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
  4. Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland.

PMID: 34816481 DOI: 10.1002/nau.24839

Abstract

AIMS: Biological rationale suggests that parasympathomimetics (cholinergic receptor stimulating agents) could be beneficial for patients with underactive bladder. However, no systematic review with meta-analysis addressing potential benefits or adverse effects exists. The aim of this review was to assess the effectiveness, both benefits and harms, of using parasympathomimetics for the treatment of underactive bladder.

METHODS: The protocol was registered in PROSPERO, and searches undertaken in PubMed, Embase, and CENTRAL, including randomized and non-randomized controlled trials of patients with underactive bladder, comparing parasympathomimetic to placebo, no treatment, or other pharmaceuticals. Risk ratios, odds ratios, and mean differences were calculated.

RESULTS: Twelve trials with 3024 participants were included. There was a significant difference between parasympathomimetics and comparators (favoring parasympathomimetics) in the number of patients with urinary retention (risk ratio 0.55, 95% confidence interval [CI] 0.3-0.98, p = 0.04, low quality of evidence). There was no difference in mean postvoid volume overall (MD -41.4 ml, 95% CI -92.0 to 9.1, p = 0.11, low quality of evidence). There was a significant difference at up to 1 week post-intervention, favoring parasympathomimetics (MD -77.5 ml, 95% CI -90.9 to -64.1, p < 0.001, low quality of evidence), but no difference at 1 month post-intervention. There was no difference in adverse events (odds ratio 1.19, 95% CI 0.62-2.28, p = 0.6, moderate quality of evidence).

CONCLUSIONS: The evidence supporting the use of parasympathomimetics is of low quality, with relatively short follow-up durations. Overall, it is not possible to draw clear evidence-based conclusions from the current literature, presenting the use of parasympathomimetics for treating underactive bladder as a key area that requires future well-controlled clinical trials.

© 2021 Wiley Periodicals LLC.

Keywords: acetylcholine; bethanechol; carbachol; cholinergic; detrusor underactivity; muscarinic agonist; urinary bladder

References

  1. Stoffel JT, Peterson AC, Sandhu JS, Suskind AM, Wei JT, Lightner DJ. AUA white paper on nonneurogenic chronic urinary retention: consensus definition, treatment algorithm, and outcome end points. J Urol. 2017;198(1):153-160. doi:10.1016/j.juro.2017.01.075 - PubMed
  2. Chapple CR, Osman NI, Birder L, et al. The underactive bladder: a new clinical concept? Eur Urol. 2015;68(3):351-353. doi:10.1016/j.eururo.2015.02.030 - PubMed
  3. Dewulf K, Abraham N, Lamb LE, et al. Addressing challenges in underactive bladder: recommendations and insights from the Congress on Underactive Bladder (CURE-UAB). Int Urol Nephrol. 2017;49(5):777-785. doi:10.1007/s11255-017-1549-3 - PubMed
  4. Li X, Liao L. Updates of underactive bladder: a review of the recent literature. Int Urol Nephrol. 2016;48(6):919-930. doi:10.1007/s11255-016-1251-x - PubMed
  5. Vale L, Jesus F, Marcelissen T, et al. Pathophysiological mechanisms in detrusor underactivity: Novel experimental findings. LUTS: Lower Urinary Tract Symptoms. 2019;11(3):92-98. doi:10.1111/luts.12257 - PubMed
  6. Chapple CR, Osman NI, Birder L, et al. Terminology report from the International Continence Society (ICS) Working Group on Underactive Bladder (UAB). Neurourol Urodyn. 2018;37(8):2928-2931. doi:10.1002/nau.23701 - PubMed
  7. Chancellor MB, Bartolone SN, Lamb LE, Ward E, Zwaans BMM, Diokno A. Underactive bladder; review of progress and impact from the International CURE-UAB initiative. Int Neurourol J. 2020;24(1):3-11. doi:10.5213/inj.2040010.005 - PubMed
  8. Barendrecht MM, Oelke M, Laguna MP, Michel MC. Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based? BJU Int. 2007;99(4):749-752. doi:10.1111/j.1464-410X.2006.06742.x - PubMed
  9. Osman NI, Esperto F, Chapple CR. Detrusor underactivity and the underactive bladder: a systematic review of preclinical and clinical studies. Eur Urol. 2018;74(5):633-643. doi:10.1016/j.eururo.2018.07.037 - PubMed
  10. Osman NI, Chapple CR. Are there pharmacotherapeutic options for underactive bladder? Eur Urol Focus. 2018;4(1):6-7. doi:10.1016/j.euf.2018.03.012 - PubMed
  11. Moro C, Uchiyama J, Chess-Williams R. Urothelial/lamina propria spontaneous activity and the role of M3 muscarinic receptors in mediating rate responses to stretch and carbachol. Urology. 2011;78(6):1442.e9-15. doi:10.1016/j.urology.2011.08.039 - PubMed
  12. Chess-Williams R. Muscarinic receptors of the urinary bladder: detrusor, urothelial and prejunctional. Autonomic Autacoid Pharmacol. 2002;22(3):133-145. - PubMed
  13. Patel NM, Dewaswala N. Parasympathomimetic medications. StatPearls. StatPearls Publishing LLC; 2021. - PubMed
  14. Kim DK. Current pharmacological and surgical treatment of underactive bladder. Investig Clin Urol. 2017;58(Suppl 2):S90-S98. doi:10.4111/icu.2017.58.S2.S90 - PubMed
  15. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097 - PubMed
  16. Clark JM, Sanders S, Carter M, et al. Improving the translation of search strategies using the Polyglot Search Translator: a randomized controlled trial. J Med Lib Assoc: JMLA. 2020;108(2):195-207. doi:10.5195/jmla.2020.834 - PubMed
  17. Higgins JP, Savović J, Page MJ, Elbers RG & Sterne JA Assessing risk of bias in a randomized trial. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ & Welch VA eds. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. John Wiley & Sons; 2019;205-228. doi:10.1002/9781119536604.ch8 - PubMed
  18. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898 - PubMed
  19. Schünemann H, Brozek J, Guyatt G & Oxman A Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. GRADE Working Group. Accessed July 2, 2021. https://gdt.gradepro.org/app/handbook/handbook.html#h.svwngs6pm0f2 - PubMed
  20. Barrett DM. The effect of oral bethanechol chloride on voiding in female patients with excessive residual urine: a randomized double-blind study. J Urol. 1981;126(5):640-642. - PubMed
  21. Bowers FJ, Hartmann R, Khanduja KS, Hardy TG Jr., Aguilar PS, Stewart WR. Urecholine prophylaxis for urinary retention in anorectal surgery. Dis Colon Rectum. 1987;30(1):41-42. - PubMed
  22. Burger DH, Kappetein AP, Boutkan H, Breslau PJ. Prevention of urinary retention after general surgery: a controlled trial of carbachol/diazepam versus alfusozine. J Am Coll Surg. 1997;185(3):234-236. - PubMed
  23. El Dahab HA, Samir R, Menesy T, Adel G, Habib E. Adding neostigmine to morphine epidurally lessens the incidence of postoperative urine retention: a comparative study 2011;27(2):89-94. doi:10.1016/j.egja.2011.03.002 - PubMed
  24. Fleming AR. The use of urecholine in the prevention of postpartum urinary retention; final report. Am J Obstet Gynecol. 1957;74(3):569-571. - PubMed
  25. Kemp B, Kitschke HJ, Goetz M, Heyl W. Prophylaxis and treatment of bladder dysfunction after Wertheim-Meigs operation: the positive effect of early postoperative detrusor stimulation using the cholinergic drug betanecholchloride. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(3):138-141. - PubMed
  26. Madeiro AP, Rufino AC, Sartori MG, Baracat EC, Lima GR, Girão MJ. The effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. A randomized, double-blind, placebo-controlled study. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(3):248-252. - PubMed
  27. Manchana T, Prasartsakulchai C. Bethanechol chloride for the prevention of bladder dysfunction after radical hysterectomy in gynecologic cancer patients: a randomized controlled trial study. Int J Gynecol Cancer. 2011;21(4):730-736. doi:10.1111/IGC.0b013e3181f7d6de - PubMed
  28. Rusan MS. Bethanechol chloride and urinary retention in anorectal surgery: a prospective randomised study. Jordan Med J. 1984;18(1):99-104. - PubMed
  29. Savona-Ventura C, Grech ES, Saliba I. Pharmacological measures to prevent post-operative urinary retention; a prospective randomized study. Eur J Obstet Gynecol Reprod Biol. 1991;41(3):225-229. - PubMed
  30. Senapathi TGA, Wiryana M, Subagiartha IM, et al. Effectiveness of intramuscular neostigmine to accelerate bladder emptying after spinal anesthesia. Ther Clin Risk Manag. 2018;14:1685-1689. doi:10.2147/TCRM.S176281 - PubMed
  31. Uy BJG, Yu BAM, Torillo MRL, Romero DAS. Bethanechol chloride for the prevention of postoperative urinary retention after anal surgery under spinal anesthesia. Philipp J Surg Spec. 2011;66(2):68-73. - PubMed
  32. Cho KJ, Kim JC. Management of urinary incontinence with underactive bladder: a review. Int Neurourol J. 2020;24(2):111-117. doi:10.5213/inj.2040076.038 - PubMed
  33. Jiang Y-H, Lee C-L, Jhang J-F, Kuo H-C. Current pharmacological and surgical treatment of underactive bladder. Ci Ji Yi Xue Za Zhi. 2017;29(4):187-191. doi:10.4103/tcmj.tcmj_122_17 - PubMed
  34. Taylor P. Anticholinesterase agents. In: Brunton L, Lazo J, Parker K, eds. Goodman and Gilman's the Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill Companies, Inc; 2006:211-212. - PubMed
  35. Malde S, Umbach R, Wheeler JR, et al. A systematic review of patients' values, preferences, and expectations for the diagnosis and treatment of male lower urinary tract symptoms. Eur Urol. 2021;79(6):796-809. doi:10.1016/j.eururo.2020.12.019 - PubMed
  36. Mancini V, Tarcan T, Serati M, Wyndaele M, Carrieri G, Abrams P. Is coexistent overactive-underactive bladder (with or without detrusor overactivity and underactivity) a real clinical syndrome? ICI-RS 2019. Neurourol Urodyn. 2020;39(S3):S50-S59. doi:10.1002/nau.24311 - PubMed

Publication Types