Bladder outflow obstruction

Urinary retention Administer ER tablets with caution to patients with clinically significant bladder outflow obstruction because of the risk of urinary retention. Renal/Hepatic function impairment Use ER tablets with caution in patients with hepatic or renal impairment. 

GU effects Cholinomimetics may cause bladder outflow obstruction. 

L/- Although this was not observed in clinical trials with galantamine, cholinomimetics may cause bladder outflow obstruction. 

Gl Cholinesterase inhibitors may be expected to increase gastric acid secretion because of increased cholinergic activity. Monitor patients closely for symptoms of active or occult Gl bleeding, especially those at increased risk for developing ulcers. GU Cholinomimetics may cause bladder outflow obstruction. 

Contraindica- tions Severe hepatic or renal impairment Cautions Moderately impaired renal/hepatic function History of ulcer disease, those on concurrent NSAIDs, asthma, COPD, bladder outflow obstruction supraventricular cardiac conduction conditions... 

Dewan PA (1996) A study of the relationship between syrin-goceles and Cobb s collar. Eur Urol 30 119-124 Dhillon HK, Yeung CK, Duffy PG et al (1993) Cowper s glands cysts-a cause of transient intra-uterine bladder outflow obstruction. Fetal Diagn Ther 8 51-55 Diard F, EklOf O, Lebowitz RL et al (1981) Urethral obstruction in boys caused by prolapse of simple ureterocele. Pediatr Radiol 11 139-142... 

Speakman MJ, Bradling AF, Gilpin CJ (1987) Bladder outflow obstruction a cause of denervation supersensitivity. JUrol 138 1461-1466... 

Most work on the SR and diseased smooth muscle has concerned vascular smooth muscle in hypertensive animals, and bladders from animal models of outflow obstruction. The tools used to study SR function are mainly indirect, and include recording tension or intracellular [Ca2+] with fluorescent probes, measuring Ca2+ fluxes with 45Ca, and investigating the effects of drugs known to block SERCA or activate store release. More directly, some measurement of the activity of SERCA in microsomal preparations has been undertaken (e.g. Zderic et al 1996). 

Placebo-controlled urodynamic studies in men with BPH have unequivocally demonstrated that finasteride produces objective improvement in bladder oudet obstruction (Tammela and Kontturi, 1993 Kirby et al., 1992 Abrams et al., 1999 Schaffer et al., 1999). Singlecenter studies using detrusor pressure to measure outflow obstruction demonstrated that the majority of finasteride-treated patients were shifted out of the obstructed range as compared with placebo patients over a 3- to 6-month study period (Tammela and Kontturi, 1993 Kirby et al., 1992). Similar results were reported in a 1-year multicenter study in men with BPH (Abrams et al., 1999). Moreover, this study demonstrated that the magnitude of the improvement in bladder oudet obstruction and maximal urinary flow rate with finasteride over placebo increases with increasing prostate volume. Long-term (1-year), open-label follow-up evaluation for this study demonstrated further reductions in bladder oudet obstruction with chronic finasteride therapy (Schaffer etal, 1999). 

Drug therapy may also cause renal insufficiency due to lower urinary tract obstruction. Ureteral obstruction can be caused by calculi or retroperitoneal fibrosis. Bladder dysfunction with urinary outflow obstruction can result, particularly in males with prostatic hypertrophy, from anticholinergic drugs including tricyclic antidepressants and disopyramide. Bladder outlet and ureteral obstruction may result from bladder fibrosis following hemorrhagic cystitis with cyclophosphamide or ifosfamide therapy. Concurrent treatment with mesna can prevent cystitis and this complication. 

If hemorrhagic cystitis occurs, the goals of treatment are to decrease exposure to the offending etiology, establish and maintain urine outflow, avoid obstruction and renal compromise, and maintain blood and plasma volume. Restoration of normal bladder function is the ultimate goal following acute treatment. 

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