Kanya Kaga1, Tomohiko Kamasako1, Mayuko Kaga1, Miki Fuse1, Mitsuru Ishizuka2 and Tomonori Yamanishi1*
1Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
2Department of Surgery, Continence Center, Dokkyo Medical University, Tochigi, Japan
Background and Objective: We previously examined the contractile effect of pilocarpine on pig and human isolated bladder smooth muscle. The present study exploratorily investigated the efficacy and safety of pilocarpine for the treatment of voiding difficulty due to detrusor underactivity. Methods: Patients with voiding symptoms, maximum urinary flow rate (Qmax) ≤ 10 mL/s, and Post-Void Residual urine volume (PVR) ≥ 50 mL, and diagnosed with detrusor underactivity in a pressure-flow study, were treated with pilocarpine (a dose of 5 mg 3 times daily) for 8 weeks. The primary endpoint was the change in Qmax vs. baseline. The secondary endpoints were changes in the International Prostate Symptom Score (IPSS; total IPSS, voiding symptoms including sensation of incomplete emptying), Quality of Life (QOL) score, and average urinary flow rate (Qave). Results: In uroflowmetry, significant changes were demonstrated (Qmax, 9.1 ± 4.6 to 12.9 ± 5.5 ml/s, P=0.0313; Qave, 6.1 ± 5.3 to 8.8 ± 6.3 ml/s, P=0.0039; voided volume, 158.8 ± 114.5 to 186.8 ± 110.0 ml, P=0.0273; and PVR, 222.7 ± 122.3 to 102.4 ± 92.9 ml, P=0.0020). IPSS total score and IPSS voiding symptom score were significantly decreased after the treatment (IPSS total score, 15.8 ± 9.4 to 12.1 ± 9.0 points, P=0.0039; voiding symptom subtotal score, 9.3 ± 6.1 to 7.3 ± 5.7 points, P=0.0469). Conclusion: Pilocarpine improved voiding symptoms scores and urinary flow rates, decreasing PVR. Pilocarpine appeared to be safe and effective for the treatment of detrusor underactivity in patients with voiding difficulty due to detrusor underactivity.
Kaga K, Kamasako T, Kaga M, Fuse M, Ishizuka M, Yamanishi T. Efficacy and Safety of Pilocarpine Hydrochloride in the Treatment of Voiding Difficulty in Patients with Detrusor Underactivity. Clin Surg. 2020; 5: 2899..