Lack of effect of cholinergic blocking and alpha-adrenergic stimulation on nocturnal incontinence after ileocaecal bladder replacement. A controlled randomised study.

Abstract

A controlled randomised trial was carried out in 9 patients to examine the possibility of achieving nocturnal continence after ileocaecal bladder replacement by reducing the amplitude of the peristaltic contractions and by increasing the maximum urethral pressure pharmacologically. The trial consisted of 4 treatment periods, each of 2 weeks' duration: a single-blind placebo period was followed by 3 double-blind periods with phenylpropanolamine hydrochloride 50 mg bd (Kontexin), oxybutynin chloride 5 mg tid (Ditropan), and combined treatment. Each patient completed a frequency/volume chart before the trial and for the last 7 days of each treatment period. Filling and storage urethrocystometry was performed before treatment and at the end of each treatment period. Treatment with phenylpropanolamine and oxybutynin failed to reduce the nocturnal urine leak of about 600 ml. Treatment did not influence the maximum urethral closure pressure, which remained unchanged at about 16 cm of water with the bladder substitute at rest and filled to its maximum cystometric capacity. At storage urethrocystometry, the treatment resulted in a decrease in the amplitude of the peristaltic contractions of about 10 cm of water to approximately 45 cm of water. Accordingly, the effect of alpha-adrenergic stimulation and anticholinergic suppression was found to be insufficient to achieve nocturnal continence in patients with ileocaecal bladder replacement.