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Treatment of urinary dysfunction
Medical expert of the article
Last reviewed: 06.07.2025
Advances in neuropharmacology and the emergence of new research methods have made it possible to narrow the range of previously performed surgical interventions for neurogenic bladder disorders and to treat urination disorders from new perspectives.
Physiologically, the urinary bladder performs two functions - accumulation and evacuation of urine. Therapeutic treatment of urination disorders is conveniently considered from the point of view of the disorder of these two functions.
Treatment of storage dysfunction
In case of detrusor hyperreflexia, agents that reduce its activity (anticholinergics) are used. Propantheline (an atropine-like drug) at a dose of 30-100 mg/day reduces the amplitude and frequency of uncontrolled contractions and increases the capacity of the bladder. If nocturia is the only symptom, propantheline is given once at night. Melipramine at a dose of 40-100 mg is useful not only for reducing detrusor hyperreflexia, but also for increasing the tone of the internal sphincter due to its peripheral adrenergic activity. However, it should not be used in case of bladder outlet obstruction. In case of a combination of detrusor hyperreflexia and internal sphincter asynergy, the use of an alpha-adrenergic blocker (prazosin) with propantheline (atropine) is indicated. In case of asynergy of the external sphincter, a combination of propantheline (atropine) and central muscle relaxants (GABA drugs, sodium oxybutyrate, seduxen, dantrolene) is recommended.
It should always be remembered that detrusor hyperreflexia is, in fact, paresis or weakness of the detrusor caused by damage to the upper motor neuron. Therefore, even if there is no relaxation of structures when using anticholinergic and antispasmodic drugs (no-shpa, platifillin), further weakening of the detrusor can lead to symptoms of obstruction. Therefore, it is important to monitor the volume of residual urine and, if it increases, also prescribe alpha-blockers.
In case of detrusor hyperreflexia, in order to relax the detrusor and prevent smooth muscle spasms, it is also recommended to use calcium channel antagonists: corinfar (nifedipine) 10-30 mg 3 times a day (maximum daily dose 120 mg/day), nimodipine (nimotop) 30 mg 3 times a day, verapamil (finoptin) 40 mg 3 times a day, terodiline 12.5 mg 2-3 times a day.
The combination of atropine and prazosin reduces symptoms such as nocturia, frequent urination, and imperative urges. Treatment of urinary incontinence due to weakness of the internal sphincter involves the use of adrenomimetics: ephedrine 50-100 mg/day or melipramine 40-100 mg/day.
Treatment of urinary evacuation disorders
Disorders of the evacuation function are caused mainly by three reasons: weakness of the detrusor, asynergy of the internal and asynergy of the external sphincter. To increase contractility of the detrusor, the cholinergic drug aceclidine (betanicol) is used. In atonic bladder, the use of aceclidine in a dose of 50-100 mg/day leads to a disorder of intravesical pressure, a decrease in bladder capacity, an increase in the maximum intravesical pressure at which urination begins, and a decrease in the amount of residual urine. In case of asynergy of the internal sphincter, alpha-adrenergic blockers (prazosin, dopegyt, phenoxybenzamine) are prescribed. In this case, the possibility of orthostatic hypotension should be taken into account. Long-term treatment of urination disorders reduces the effectiveness of these drugs.
A method is being developed for the injection of 6-hydroxydopamine into the neck and proximal urethra in case of asynergy of the internal sphincter, which "depletes sympathetic reserves". In case of asynergy of the external sphincter, GABA, seduxen, and direct muscle relaxants (dantrolene) are prescribed. If conservative treatment of urination disorders is ineffective, surgical intervention is used - transurethral sphincterotomy is performed to reduce resistance to urine drainage. If residual urine remains despite treatment of urination disorders, catheterization must be performed. Resection of the neck is performed in case of atony of the bladder or asynergy of its internal sphincter. Continence of urine remains possible due to the intactness of the external sphincter.
In cases of nocturnal enuresis, when non-drug treatment of urination disorders is ineffective, one of the following pharmacological drugs may be used. Tofranil (imipramine) is prescribed at night, gradually increasing or decreasing the dose if necessary. The course of therapy is no more than 3 months. For children under 7 years of age, Tofranil is prescribed in an initial dose of 25 mg, for children 8-11 years old - 25-50 mg, over 11 years old - 50-75 mg once at night. Anafranil (clomipramine) is initially prescribed 10 mg at night for 10 days. Then the dose can be increased: for children 5-8 years old - up to 20 mg, for 8-14 years old - up to 50 mg, over 14 years old - more than 50 mg once at night. The above drugs are not prescribed for children under 5 years of age. Tryptizol (amitriptyline) is recommended for children aged 7-10 years at 10-20 mg at night, 11-16 years - at 25-50 mg at night. In this case, the treatment of urinary disorders should not exceed 3 months. The drug is discontinued gradually. The use of serotonin reuptake inhibitors (Prozac, Paxil, Zoloft) in cases of enuresis has not yet been sufficiently studied.