Detrusor Overactivity Incontinence Research Articles

Relationships Between Micturition Urgency and Involuntary Voiding Dynamics in Men With Urinary Incontinence From Idiopathic Detrusor Overactivity

In men with urinary incontinence from idiopathic detrusor overactivity we determined whether bladder voiding dynamics differs between those with and without urgent micturition. We retrospectively assessed urodynamic findings in 3 groups of 22 men each. Groups 1 and 2 had idiopathic detrusor overactivity with detrusor overactivity incontinence and with micturition urgency in group 1. Group 2 showed no urgency but felt a strong voiding desire just after the onset of involuntary micturition. Control group 3 included nonneurological unobstructed men undergoing urodynamic examination for mixed reasons who proved to be urodynamically normal. Patients with detrusor overactivity and controls were assessed by nonparametric statistics for significant differences in bladder voiding dynamics. Detrusor contraction strength proved to be increased in groups 1 and 2 with the highest levels in group 1. Detrusor contraction velocity had the highest levels in group 1 and it differed insignificantly in groups 2 and 3. Voiding contractions were equally well sustained in groups 1 and 3, and proved to be less well sustained in group 2. Detrusor overactivity involves enhanced detrusor contraction strength levels, particularly in patients who feel urgency. In urgency-free patients with detrusor overactivity detrusor contraction velocity differs insignificantly from that in controls and voiding detrusor contractions proved to be less well sustained than in controls and patients who experienced urgency. This suggests that detrusor contraction velocity may have a role in causing urgency and urgency may have a role in enhancing and sustaining involuntary voiding detrusor contractions in patients with detrusor overactivity.

The value of cystoscopy and bladder biopsy taken at the time of tension-free vaginal tape insertion

SummaryThe primary aim of this study was to determine if a cystoscopy performed at the time of a tension-free vaginal tape (TVT) insertion is useful in finding unexpected pathology. A secondary outcome measure was to assess whether a bladder biopsy and cystoscopy performed during the TVT operation provide useful information about the outcome of surgery. The findings in 100 consecutive women were reviewed. A total of 42 women demonstrated mixed detrusor overactivity (DO) and urodynamic stress incontinence (USI); 32 women had abnormal biopsies. Women with DO were no more likely to have abnormal bladder biopsies than women without DO (p > 0.05). An abnormal bladder biopsy or cystoscopy failed to predict postoperative irritable symptoms (p > 0.05). The presence of preoperative DO correctly predicted postoperative irritable symptoms (p < 0.01). Cystoscopic abnormalities were noted in 14 women including one carcinoma, and one case of dysplasia was discovered on biopsy. In five women, the cystoscopy showed a bladder perforation. Cystoscopy should be performed in all women undergoing continence procedures.

Nociceptin [orphanin FQ] is beneficial for patients with neurogenic detrusor overactivity incontinence,

Nociceptin [orphanin FQ] is beneficial for patients with neurogenic detrusor overactivity incontinence,

Daily Intravesical Instillation of 1 mg Nociceptin/Orphanin FQ for the Control of Neurogenic Detrusor Overactivity: A Multicenter, Placebo Controlled, Randomized Exploratory Study

We studied the feasibility, safety and efficacy of daily intravesical instillation of 1 mg of the endogenous peptide nociceptin/orphanin FQ in a selected group of patients who perform clean intermittent self-catheterization for neurogenic detrusor overactivity incontinence. A total of 18 patients with neurogenic detrusor overactivity incontinence and on clean intermittent self-catheterization were prospectively randomized to receive 1 mg nociceptin/orphanin FQ in 10 cc saline (9) or placebo (saline) solution (9) at the first morning catheterization for 10 days. All patients completed a voiding diary using a frequency/volume chart according to International Continence Society guidelines, and reported daily incontinence frequency. Mean changes in incontinence episode frequency and voiding diary mean bladder capacity from baseline throughout treatment were the primary outcome variables. Urodynamic parameters (cystomanometric bladder capacity, maximum bladder pressure) were also recorded at baseline and during the study. The 2 groups were well balanced and all patients completed the study. The urodynamic parameters recorded during the study showed an increase in cystomanometric bladder capacity and a decrease in maximum bladder pressure compared to baseline only in patients assigned to the nociceptin/orphanin FQ group. Mean daily urine leakage episodes during nociceptin/orphanin FQ treatment were 0.94 vs a pretreatment baseline of 2.18 (p < 0.05), while no significant changes were reported in the placebo group (2.06 vs 2.43 baseline). The total mean voiding diary bladder capacity increased from 171 +/- 70 to 294 +/- 107 ml in patients receiving nociceptin/orphanin FQ, while voiding diary mean bladder capacity remained unchanged in patients receiving placebo (from 182 +/- 55 to 178 +/- 23 ml). No significant problems related to feasibility of the procedure as well as significant side effects were reported by patients. This study showed that intravesical nociceptin/orphanin FQ but not placebo inhibited the micturition reflex in patients with neurogenic detrusor overactivity incontinence, and demonstrated the clinical efficacy of nociceptin/orphanin FQ during 10 days of treatment. These findings support the use of nociceptin/orphanin FQ peptide receptor agonists as an innovative therapeutic approach for controlling detrusor overactivity incontinence.

Neuromodulatory therapies in female pelvic medicine and reconstructive surgery: biological agents

In recent years, important improvements in the management of patients with neurogenic or non-neurogenic detrusor overactivity and urge incontinence have been brought about by the introduction of vanilloids and botulinum toxins in urology. In this review we introduce the new therapeutic options, provides basic information, and summarize the results experienced so far.

Can midurethral slings for stress urinary incontinence treat concomitant detrusor overactivity and urge incontinence?

Can midurethral slings for stress urinary incontinence treat concomitant detrusor overactivity and urge incontinence?

Efficacy of Botulinum Toxin A in the Treatment of Female Idiopathic Detrusor Overactivity Incontinence: Long-Term Results of a Prospective Nonrandomised Study

Objectives Botulinum toxin A (BoNTA) was investigated for the treatment of patients with idiopathic detrusor overactivity (IDO) in whom anticholinergic drugs have failed. Methods In this open-label, prospective, controlled, nonrandomised study, 26 women (mean age: 66 yr; range: 48–84) with IDO received 100 U BoNTA (as BOTOX) as 30 injections into the detrusor, sparing the trigone and base. Clinical and urodynamic evaluations were performed before and at 4, 12, and 36 weeks after injection. Results At 4, 12, and 36 weeks postinjection, complete continence was achieved by 69%, 96%, and 73% of patients, respectively. Maximum cystometric bladder capacity and bladder compliance were significantly increased, and cystometric detrusor contractions were significantly decreased at each follow-up compared with baseline. Two patients had a postvoid residual volume >100 ml at week 4, and nine patients with urinary infections had to be treated with antibiotics. Quality of life (assessed by the King's Health Questionnaire) was significantly improved at all follow-up visits. Conclusions BoNTA appears to be an effective, safe, and well-tolerated treatment for patients with IDO in whom anticholinergic medication has failed.

1293: Feasibility, Safety and Efficacy of Daily Intravesical Instillation of 1 Mg of Nociceptin/Orphanin FQ for the Treatment of Detrusor Overactivity Incontinence. A Placebo Controlled, Randomized Study

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 23, 2006, 1:00 - 4:00 pm1 Apr 20061293: Feasibility, Safety and Efficacy of Daily Intravesical Instillation of 1 Mg of Nociceptin/Orphanin FQ for the Treatment of Detrusor Overactivity Incontinence. A Placebo Controlled, Randomized Study Massimo Lazzeri, Damiano Turini, Patrizia Beneforti, Michele Spinelli, Girolamo Calò, Remo Guerrini, Severo Salvadori, and Domenico Regoli Massimo LazzeriMassimo Lazzeri More articles by this author , Damiano TuriniDamiano Turini More articles by this author , Patrizia BenefortiPatrizia Beneforti More articles by this author , Michele SpinelliMichele Spinelli More articles by this author , Girolamo CalòGirolamo Calò More articles by this author , Remo GuerriniRemo Guerrini More articles by this author , Severo SalvadoriSevero Salvadori More articles by this author , and Domenico RegoliDomenico Regoli More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33506-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1293: Feasibility, Safety and Efficacy of Daily Intravesical Instillation of 1 Mg of Nociceptin/Orphanin FQ for the Treatment of Detrusor Overactivity Incontinence. A Placebo Controlled, Randomized Study." The Journal of Urology, 175(4S), pp. 416–417 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 416-417 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Massimo Lazzeri More articles by this author Damiano Turini More articles by this author Patrizia Beneforti More articles by this author Michele Spinelli More articles by this author Girolamo Calò More articles by this author Remo Guerrini More articles by this author Severo Salvadori More articles by this author Domenico Regoli More articles by this author Expand All Advertisement PDF downloadLoading ...

Sacral Neuromodulation in Women With Idiopathic Detrusor Overactivity Incontinence: Decreased Overactivity but Unchanged Bladder Contraction Strength and Urethral Resistance During Voiding

We evaluated the effect of sacral (S3) nerve neuromodulation on voiding in women with idiopathic detrusor overactivity incontinence. Urodynamic measurements in all patients implanted in 1990 to 2003 were reconsidered. Patients were included if these measurements, which were done at baseline and after 6 months, could be analyzed completely and reliably. Maximum detrusor pressure, amplitude of the highest involuntary detrusor contraction and end fill volume were used as parameters characterizing the degree of detrusor overactivity. Urethral resistance and bladder contraction strength during voiding were characterized by the bladder outlet obstruction index, the urethral resistance factor, average pressure, the slope of the low pressure side of the pressure flow plot, the bladder contractility index and the bladder contraction strength parameter. A total of 33 women were included. Detrusor overactivity parameters were significantly improved at followup. In addition, the supine position of the patient during filling in followup measurements proved less provocative with respect to overactivity than the standing position in the majority of measurements at baseline. Consequently bladder volumes at which voiding was initiated were considerably higher at followup. Changes in the parameters characterizing urethral resistance and bladder contraction strength during voiding were not unambiguous. However, exactly those parameters that appeared volume independent in a previous study were not significantly different. Our study confirmed the depressant effect of sacral (S3) nerve neuromodulation on detrusor overactivity. No effect on urethral resistance and bladder contraction strength during voiding could be demonstrated using volume independent parameters.

Neurogenic bladder treatment by doubling the recommended antimuscarinic dosage

The dosage of the antimuscarinic drugs: Tolterodine ER or Trospium was increased to a higher-than-recommended dosage in patients where the manufacturer's recommended dosage had failed. All patients were suffering from neurogenic detrusor overactivity incontinence. Tolerability and success were evaluated in the present study. Twenty-one patients with neurogenic detrusor overactivity were evaluated: 17 with spinal cord injury, 3 with multiple sclerosis, and 1 with a meningomyelocele. All patients catheterized themselves or were catheterized. If neurogenic detrusor overactivity continued and the medication was well tolerated, the dosage was doubled to either 8 mg of Tolterodine ER [2 x 4 mg (n = 11)] or 90 mg of Trospium [3 x 30 mg (n = 10)]. The follow-up was monitored by a bladder diary and urodynamic evaluation. Sixteen patients significantly decreased their incontinence episodes from 8-12 episodes before to 0-2 episodes during the doubled treatment. The reflex volume increased from 202 +/- 68 to 332 +/- 50 ml (P < 0.001). Cystometric capacity enlarged from 290 +/- 56 to 453 +/- 63 ml (P < 0.001). One patient had to stop the medication because of intolerable side effects and five patients did not experience satisfactory benefit. The increased dosage of Tolterodine or Trospium is an effective treatment in patients with neurogenic bladder.

Chronic Pudendal Nerve Neuromodulation in Women With Idiopathic Refractory Detrusor Overactivity Incontinence: Results of a Pilot Study With a Novel Minimally Invasive Implantable Mini-Stimulator

No AccessJournal of UrologyUrological Survey: Voiding Function, Bladder Physiology and Pharmacology, and Female Urology Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology1 Dec 2005Chronic Pudendal Nerve Neuromodulation in Women With Idiopathic Refractory Detrusor Overactivity Incontinence: Results of a Pilot Study With a Novel Minimally Invasive Implantable Mini-Stimulator Alan J. WeinM.D. Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)68987-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Chronic Pudendal Nerve Neuromodulation in Women With Idiopathic Refractory Detrusor Overactivity Incontinence: Results of a Pilot Study With a Novel Minimally Invasive Implantable Mini-Stimulator." The Journal of Urology, 174(6), p. 2277 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 6December 2005Page: 2277 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement PDF downloadLoading ...

Botox May Cut Detrusor Overactivity Incontinence

Botox May Cut Detrusor Overactivity Incontinence

Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study)

During this prospective study we analyzed the effects of radical retropubic prostatectomy (RRP) on bladder and sphincter function by comparing preoperative and postoperative urodynamic data. The aim of the study was to determine the reason for urinary incontinence after RRP and explain why one group of patients will be immediately continent after catheter removal, while others need some time to reach complete continence. Urodynamic examination was performed in 63 patients 3-7 days before and 2 months after surgery. Forty-three (68.2%) and 53 (84.1%) patients regained continence at 2 and 9 months following RRP, respectively. Ten patients (15.9%) were immediately continent after catheter removal. Urodynamic stress incontinence was detected in 18 (28.6%), and detrusor overactivity incontinence in 2 (3.2%) patients 2 months after surgery. The amplitude of preoperative maximal voluntary sphincteric contractions was significantly higher in the postoperative continent group (125 vs. 96.5 cmH(2)O, P < 0.0001). The patients who were immediately continent following catheter removal had no lower urinary tract symptoms (LUTS) and urodynamic abnormality preoperatively, and they had significantly higher preoperative and postoperative maximum urethral closure pressure (at rest and during voluntary sphincter contraction) than those who became continent later on. These data suggest that the main cause of incontinence after RRP is sphincteric weakness. In the continent group, those who became immediately continent had significantly higher maximum urethral closure pressure values at rest and at voluntary sphincteric contraction even before the surgery.

Increased prevalence of interstitial cystitis in women with detrusor overactivity refractory to anticholinergic therapy

Objectives To estimate the prevalence of interstitial cystitis in women with detrusor overactivity refractory to anticholinergic medication using the potassium sensitivity test (PST). Methods Women with complaints of urinary frequency, urgency, and/or urge incontinence of 3 months’ duration or longer were referred to the urogynecology clinic. Between October 2003 and June 2004, 47 consecutive women were diagnosed with phasic, idiopathic detrusor overactivity after evaluation by history, physical examination, urinalysis, urine culture, urodynamic testing, and cystoscopy. Refractory detrusor overactivity was defined as a 50% or less improvement in urinary urgency, frequency, and/or urge incontinence episodes while taking anticholinergic medications. All women were offered the PST. Results All 47 women were included in the study; 18 (38.3%) had only detrusor overactivity incontinence and 29 (61.7%) also had concomitant urodynamic stress incontinence. Additionally, 19 women (40.4%) had pelvic pain. Of the 47 women, 31 agreed to undergo the PST. Of the 31 women, 25 had positive and 6 had negative PST result. Of the 31 women, 25 did not respond to therapy with one or more anticholinergic medications, and 24 (96%) of these 25 had had a positive PST. The remaining 6 women responded to treatment with oxybutynin, and only 1 (16.7%) had had a positive PST ( P = 0.0002). The odds ratio of a positive PST for women in whom anticholinergic therapy failed compared with women in whom it did not was 120.0 (95% confidence interval 6.4 to 2257.5; P = 0.0002). Conclusions These preliminary findings suggest that there is a high prevalence of interstitial cystitis in women with detrusor overactivity that does not respond to anticholinergic medication.

TREATMENT OF NEUROGENIC DETRUSOR OVERACTIVITY IN SPINAL CORD INJURED PATIENTS BY CONDITIONAL ELECTRICAL STIMULATION

The feasibility of automatic event driven electrical stimulation of the dorsal penile/clitoral nerve in the treatment of neurogenic detrusor overactivity (NDO) was evaluated in individuals with spinal cord injury. The study included 2 women and 14 men older than 18 years with NDO, bladder capacity below 500 ml and complete or incomplete suprasacral spinal cord injury. Detrusor pressure (Pdet) was recorded during ordinary, natural bladder filling. In a similar subsequent recording Pdet was used to trigger electrical stimulation when pressure exceeded 10 cm H2O. Of the 16 patients enrolled in this study 13 had increased bladder capacity together with a storage pressure decrease as a result of automatic, event driven electrical stimulation. In 2 patients stimulation could not inhibit the first undesired contraction, leakage occurred and finally 1 could not tolerate stimulation. During stimulated filling Pdet never exceeded 55 cm H2O. Thus, storage pressure was sufficiently low to prevent kidney damage. An average bladder capacity increase of 53% was achieved. This study demonstrates the feasibility of automatic, event driven electrical stimulation in the treatment of NDO. Although the setup in this experiment is not suitable in a clinical setting, the treatment modality is promising and it warrants further investigation.

Efficacy of botulinum-A toxin in the treatment of detrusor overactivity incontinence: A prospective nonrandomized study

This study was undertaken to investigate the efficacy and safety of botulinum-A toxin (BTX-A) treatment for non-neurogenic detrusor overactivity incontinence. This prospective nonrandomized ongoing study was performed in a tertiary referral urogynecology department. In 26 women with urge incontinence and urodynamically demonstrated detrusor overactivity incontinence resistant to conventional treatment 100 units of BTX-A were injected into the detrusor muscle at 30 sites. Clinical and urodynamic evaluations and a quality of life assessment were performed at baseline and 4, 12, and 36 weeks after BTX-A treatment. Of 26 women, 14 were dry after 4 weeks, 13 of 20 women after 12 weeks, and 3 of 5 women after 36 weeks. Two women failed to respond. Two women were on self-catheterization temporarily. There were no other complications besides 9 urinary tract infections within the 51 follow-up visits. BTX-A treatment seems to be a safe and efficacious new treatment option for patients with detrusor overactivity incontinence.

Chronic pudendal nerve neuromodulation in women with idiopathic refractory detrusor overactivity incontinence: Results of a pilot study with a novel minimally invasive implantable mini‐stimulator

To assess the results of chronic pudendal nerve neuromodulation with a novel technique in a pilot study on women with idiopathic refractory detrusor overactivity incontinence. A percutaneous screening test (PST) was performed in patients with urodynamically demonstrated detrusor overactivity incontinence. Such a test includes the performance of a cystometrogram without and with percutaneous pudendal nerve stimulation and is considered positive if stimulation results in a more than 50% increase in the bladder volume at the first involuntary detrusor contraction or the maximum cystometric capacity. Patients with a positive PST qualified for the implantation of a mini-neurostimulator with an integrated electrode, a so-called bion(R), adjacent to the pudendal nerve at Alcock's Canal. Five-day voiding-incontinence diaries were the main tool for the evaluation of therapy. A PST was performed in 14 women. Six patients responded positively and received a bion. The degree of incontinence decreased significantly in this group, which also included patients in whom sacral neuromodulation had failed. There were no severe adverse events. Chronic pudendal nerve stimulation may reduce the degree of detrusor overactivity incontinence, even in patients in whom sacral neuromodulation fails. Bion therapy is relatively simple and minimally invasive and is well tolerated by the patient.

A urodynamics protocol to optimally assess men with post‐prostatectomy incontinence

To propose a urodynamic protocol to comprehensively assess all parameters of post prostatectomy incontinence (PPI). Sixty men with a history of PPI after radical prostatectomy prospectively underwent a standardized video urodynamics protocol. A 7F urethral catheter was used for standard cystometry, abdominal leak point pressure (ALPP), and pressure flow measurements. The International Continence Society nomogram classified obstruction and further classification of obstruction was based on fluoro voiding cystourethrography and non-invasive flow rates (free Qmax). Twenty-four (40%) men had detrusor overactivity with 8 (13%) also having detrusor overactivity incontinence. Only one patient had impaired compliance. All men had urodynamic stress incontinence, but 21 (35%) men demonstrated it only after removal of the urethral catheter. For men leaking with and without the urethral catheter, the respective ALPP was significantly different, 86.3 and 67 cmH2O, respectively (P = 0.002). The men who leaked only in the absence of the urethral catheter had significantly higher ALPP measurements, P < 0.001. After reclassification using the fluoroscopic images of the bladder outlet and free Qmax, only 13.3% patients were obstructed. The proposed urodynamic protocol allows for an optimal assessment of bladder and sphincter dysfunction and outlet obstruction in men with PPI.

Video: Cystoscopic Intradetrusor Botulinum A Toxin Injection for the Treatment of Detrusor Overactivity Incontinence

OBJECTIVE: This video demonstrates our technique of cystoscopic intradetrusor injection of Botulinum A Toxin for the treatment of detrusor overactivity incontinence. METHODS: The patient is placed in dorsal lithotomy position in our office treatment room. Thirty mls of 1% lidocaine is instilled in the bladder 15 minutes prior to the procedure. Two hundred units of Botox is dissolved in 6 cc of sterile injectable saline and separated into two 3 cc syringes. A single drop of methylene blue is added to each syringe to assist in visualization of drug dispersion after delivery. Using the Wolf cystoscope injection system (Richard Wolf Medical Instruments Corp, Vernon Hills, IL), including a 17 Fr scope and 22 Fr sheath, routine cystoscopy is performed. After localization of the ureteral orifices, systematic injection of the bladder dome is performed under direct visualization starting in the midline above the level of the trigone. Injections are performed at a depth just below the bladder mucosa and into detrusor muscle superficial enough to create a wheal at the injection site. Gradually working outward to each side, injections are performed at 0.5 to 1 cm intervals. Visualization of dispersion of the methylene blue stained drug through the bladder mucosa is used to indicate prior injection sites and drug delivery. Treatment is completed when approximately 20 injections using a total of 200 U of Botox are performed throughout the posterior bladder wall. RESULTS: The procedure is well tolerated under local anesthesia. The patient is discharged to home and placed on 3 days of prophylactic urinary antibiotics. CONCLUSIONS: Office cystoscopic intra-detrusor Botulinum A toxin injection is technically feasible and well tolerated. This video illustrates a treatment technique in an office procedure room setting under local anesthesia.

Urodynamic effects of intravesical nociceptin/orphanin FQ in neurogenic detrusor overactivity: a randomized, placebo-controlled, double-blind study

Objectives To evaluate the acute urodynamic effects of the neuropeptide nociceptin/orphanin FQ (N/OFQ) in a selected group of patients with neurogenic detrusor overactivity incontinence in a randomized, placebo-controlled, double-blind study. Methods The study involved 14 patients who presented with neurogenic detrusor overactivity due to spinal cord injury. They were randomized to receive intravesical infusion of 1 μM N/OFQ or the same dose of [desPhe 1]N/OFQ (the placebo). The urodynamic parameters were the bladder capacity, volume threshold for the appearance of detrusor overactivity, and the maximal bladder pressure. The study was performed on a double-blind basis: neither the patients nor the doctors who performed the instillation could distinguish the solution containing N/OFQ from that containing [desPhe 1]N/OFQ. Data are expressed as the mean ± SD of seven determinations. Data were statistically analyzed using the Student t test for paired or unpaired data and P <0.05 was set as the criterion for a statistically significant difference. Results The two groups were well balanced with respect to mean age, male/female ratio, etiology of spinal cord disease, and years from the lesion. Also, the baseline mean values of bladder capacity, volume threshold for the appearance of detrusor overactivity, and maximal bladder pressure were similar. The intravesical infusion of the solution containing 1 μM N/OFQ produced the following changes: bladder capacity and volume threshold for the appearance of detrusor overactivity significantly increased from 139 ± 48 mL to 240 ± 61 mL, and from 84 ± 32 mL to 201 ± 68 mL, respectively. Maximal bladder pressure decreased from 81 ± 25 cm H 2O to 66 ± 12 cm H 2O; however, this difference was not statistically significant. The intravesical infusion of the solution containing 1 μM [desPhe 1]N/OFQ did not produce any statistically significant modification of the urodynamic parameters. Conclusions The results of this study confirm and extend previous results showing that N/OFQ, but not the placebo, elicits a robust acute inhibitory effect on the micturition reflex in patients with a neurogenic bladder. These findings apply nociceptin orphan peptide receptor agonists as potential novel drugs for the treatment of neurogenic urinary incontinence.