Electromotive drug-administration: a pilot study for minimal-invasive treatment of therapy-resistant idiopathic detrusor overactivity

Abstract

Introduction: Electromotive drug-administration (EMDA) represents a minimal-invasive method of intravesical instillation of therapeutic agents. We examined the therapeutic effect of EMDA in patients suffering from therapy-resistant idiopathic detrusor overactivity (IDO) with respect to urodynamics, micturition charts and quality of life (Kings Health Questionnaire).

Methods: Patients suffering from urge syndrome with and without urge incontinence and non-responding to oral anticholinergic drugs underwent EMDA therapy (2000 mg lidocaine-HCl 4% (50 ml), 2 mg epinephrine [1:1000] (2 ml), 40 mg dexamethason-21-dihydrogen phosphat (10 ml) in a total volume of 100 ml). Over a 27 months period, 84 patients (median age 63.1 years; 72 female, 12 male) with urge syndrome and urodynamically-proven idiopathic detrusor overactivity (IDO) were treated with EMDA. Following urodynamic measurements, quality of life (QoL) was evaluated using Kings Health Questionnaire (KHQ) and a micturition chart over 48 h, EMDA was performed once in four weeks for a period of three months. Patients continued to document drinking and micturition data during this time. Before each EMDA session urodynamic examination and KHQ were repeated.

Results: All treated patients suffered from urge syndrome (25.6% OAB wet, 20.0% OAB dry and 54.4% mixed urinary incontinence). Mean daytime frequency (DF) was 14.1 +/- 7.7 per day and nocturia (N) 5.1 +/- 5.1 per night before EMDA. After two EMDA sessions, daytime frequency (DF) decreased to 9.4 +/- 6.2 per day (P < 0.0001) and 2.5 +/- 2.4 per night (P = 0.035). The use of pads could be lowered from 4.5 +/- 4.1 per 24 h to 1.8 +/- 2.4 (P < 0.0074). The first desire to void volume (FDV) assessed by urodynamics started at 94.0 +/- 60.5 ml before treatment and changed to 142.2 +/- 79.6 ml (P = 0.0064) after two sessions. Strong desire to void volume (SDV) was noticed at 155.6 +/- 84.8 ml filling of the bladder; after two EMDA sessions at 199.5 +/- 97.3 ml (P = 0.001). Uninhibited detrusor contractions (UIC) were seen in all patients before treatment and were reduced to 46.4% after two EMDA sessions (P < 0.001). Maximal cystometric bladder capacity (MCBC) increased from 192.3 +/- 106.6 ml to 239.6 +/- 114.9 ml (P = 0.018). Patient-documented bladder capacity (BC) as micturition volume increased from 186.0 +/- 108.7 ml to 234.2 +/- 134.2 ml (P = 0.043). A reduction of impact of Quality of Life (QoL) was observed from 11.8 +/- 0.4 to 7.0 +/- 0.3 (P < 0.001) during treatment. A fraction of 53.6% (45/84) of all patients reported a completely withdrawal of symptoms and 28.6% (24/84) indicated a remarkable reduction. Only 10.7% (9/84) of patients did not continue therapy after two sessions.

Conclusion: EMDA significantly improves urodynamic parameters, QoL and pad usages in patients with urge syndrome and therapy-resistant IDO. Therefore we offer EMDA therapy as an alternative treatment modality to the standard approaches.