From the Guidelines
Medications for neurogenic bladder retention should include anticholinergics, alpha-blockers, botulinum toxin injections, and beta-3 adrenergic agonists, with treatment individualized based on the underlying neurological condition, urodynamic findings, and patient-specific factors. When managing neurogenic bladder retention, the goal is to improve bladder emptying and reduce symptoms while minimizing side effects and optimizing quality of life 1.
Medication Options
- Anticholinergics such as oxybutynin (5-10 mg 2-3 times daily), solifenacin (5-10 mg daily), tolterodine (2-4 mg daily), and trospium chloride (20 mg twice daily) work by blocking acetylcholine receptors, reducing bladder muscle contractions and increasing storage capacity.
- Alpha-blockers like tamsulosin (0.4 mg daily), alfuzosin (10 mg daily), and doxazosin (1-8 mg daily) relax the bladder neck and prostate smooth muscle, decreasing outlet resistance and improving emptying.
- Botulinum toxin (Botox) injections into the detrusor muscle (typically 100-300 units) can provide relief for 6-9 months by preventing muscle contractions, and is often used in patients with inadequate response to oral medications.
- Mirabegron (25-50 mg daily), a beta-3 adrenergic agonist, offers an alternative mechanism by relaxing the detrusor muscle during storage.
Considerations
- Patients should be monitored for side effects including dry mouth, constipation, blurred vision with anticholinergics, and potential urinary retention with botulinum toxin.
- Clean intermittent catheterization may be necessary alongside medication therapy to ensure complete bladder emptying.
- Treatment decisions should be made in a shared decision-making manner with the patient, taking into account their quality of life, cognitive function, hand function, mobility, and social support 1.
Guideline Recommendations
The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction recommends a comprehensive approach to treatment, considering the patient's urologic symptoms, urodynamic findings, and individual factors 1. By prioritizing the patient's quality of life and individual needs, clinicians can develop an effective treatment plan for neurogenic bladder retention, using a combination of medications and other interventions as needed.
From the FDA Drug Label
Bethanechol Chloride Tablets, USP are indicated for the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention. The medication used to manage neurogenic bladder retention is bethanechol.
- Key points:
- Indication: neurogenic atony of the urinary bladder with retention
- Drug Name: bethanechol (PO) 2
From the Research
Medications for Neurogenic Bladder Retention
Medications used to manage neurogenic bladder retention include:
- Alpha adrenergic antagonists to help with difficulty emptying 3
- Antimuscarinics, which are the mainstay for overactive bladder symptoms 3, 4
- Beta agonists, which can be used when antimuscarinics are not tolerated or are ineffective 3
- Phosphodiesterase inhibitors, which can be used when antimuscarinics are not tolerated or are ineffective 3
- Tricyclic antidepressants, which can be used when antimuscarinics are not tolerated or are ineffective 3, 4
- Gamma aminobutyric acid (GABA)-B agonist baclofen, which can be used when antimuscarinics are not tolerated or are ineffective 3
- Bethanechol chloride, which can be used in patients with certain types of neurogenic bladder dysfunction 5
- Cholinergic agents, which can be used for pathological post-voiding residual urine or urinary retention 6
- Alpha-blockers, which can be used for pathological post-voiding residual urine or urinary retention 6
Treatment Approaches
Treatment approaches for neurogenic bladder retention may involve:
- Pharmacologic treatment, which is the mainstay in the management of bladder dysfunction 3
- Lifestyle changes, which can be used in conjunction with pharmacologic treatment 3
- Surgical interventions, which may be necessary in some cases 3
- Clean, intermittent self-catheterization, which can be used for pathological post-voiding residual urine or urinary retention 6