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Treatment of urination disorders
Last reviewed: 19.10.2021
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The achievements of neuropharmacology and the emergence of new research methods have made it possible to narrow the range of earlier operative interventions for neurogenic disorders of the bladder and to treat the urination disorders from new positions.
Physiologically, the bladder has two functions - the accumulation and evacuation of urine. Therapeutic treatment of urination disorders is convenient to consider in terms of the breakdown of these two functions.
Treatment of disturbances in the accumulation function
When hyperreflexive detrusor used drugs that reduce its activity (anticholinergics). Propanthelin (atropine-like drug) in a dose of 30-100 mg / day. Reduces the amplitude and frequency of uncontrolled contractions and increases the capacity of the bladder. If the only symptom is nocturia, propantheline is given once a night. Melipramine in 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 can not be used for obstruction of the exit from the bladder. In the case of a combination of detrusor hyperreflexia with internal sphincter asynergy, the use of an alpha-adrenoblocker (prazosin) with propanthelin (atropine) is indicated. At asynergia of the external sphincter, a combination of propanthelin (atropine) and central muscle relaxants (GABA preparations, sodium oxybutyrate, seduxen, dantrolene) is recommended.
It should always be remembered that the detrusor hyperreflexia is, in fact, the paresis or weakness of the detrusor, caused by the defeat of the upper motoneuron. Therefore, even if there is no relaxation of the structures with anticholinergic and antispasmodics (no-shpa, platifillin), further weakening of the detrusor may lead to symptoms of obstruction. Therefore, it is important to control the volume of residual urine and, when it increases, also prescribe a-adrenoblockers.
When hyperreflexive detrusor to relax and prevent smooth muscle spasms, calcium channel antagonists are also recommended: coronfar (nifedipine) 10-30 mg 3 times daily (maximum daily dose 120 mg / day), nimodipine (nimotope) 30 mg each 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, imperative urges. Treatment of urinary incontinence with urinary incontinence due to weakness of the internal sphincter consists in the use of adrenomimetics: ephedrine 50-100 mg / day. Or melipramine at 40-100 mg / day.
Therapy of urinary evacuation disorders
Disorder of the evacuation function is due mainly to three reasons: detrusor weakness, internal asynergia and asynergia of the external sphincter. To increase the detrusor contractility, cholesterol drug acekledin (betanicol) is used. With an atonic bladder, the use of acetylidine in a dose of 50-100 mg / day. Leads to a disorder of intravesical pressure, a decrease in the capacity of the bladder, an increase in the maximum intravesical pressure at which urination begins, and a decrease in the amount of residual urine. In the case of asynergia of the internal sphincter, alpha-adrenoblockers (prazosin, dopegit, phenoxybenzamine) are prescribed. In this case, the possibility of orthostatic hypotension should be considered. Long-term treatment of urination disorders reduces the effectiveness of these funds.
A method of injection into the neck and proximal part of the urethra is developed with the asynergia of the internal sphincter of the 6-hydroxydofamine preparation, which "depletes the sympathetic stores". With asynergia of the external sphincter prescribe drugs GABA, seduxen, direct muscle relaxants (dantrolene). If conservative treatment of urination disorders is ineffective, surgical intervention is used - perform transurethral sphincterotomy to reduce resistance to urinary diversion. If the residual urine remains, despite the treatment of urination disorders, residual catheterization is necessary. Resection of the neck is performed with atony of the bladder or asynergia of its internal sphincter. The retention of urine remains possible due to the intactness of the external sphincter.
In cases of nocturnal enuresis, when a non-drug treatment of urination is ineffective, one of the following pharmacological agents may be used. Tophranil (imipramine) is prescribed for the night, if necessary, gradually increasing or decreasing the dose. The course of therapy - no more than 3 months. For children up to 7 years of age, tofranil is prescribed in an initial dose of 25 mg, children 8-11 years old - 25-50 mg, over 11 years - 50-75 mg once a night. Anaphranil (clomipramine) is first prescribed at 10 mg per night for 10 days. Then the dose can be increased: children 5-8 years - up to 20 mg, 8-14 years - up to 50 mg, over 14 years - more than 50 mg once a night. Children up to 5 years of the above drugs are not prescribed. Tryptizol (amitriptyline) recommend children 7-10 years for 10-20 mg at night, 11-16 years - 25-50 mg per night. In this case, the treatment of urination disorders should not exceed 3 months. The drug is withdrawn gradually. The use of serotonin reuptake inhibitors (Prozac, Paxil, Zoloft) in cases of enuresis has not been sufficiently studied.