CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2020; 09(01): 30-34
DOI: 10.1055/s-0040-1708571
Original Article

Role of Phosphodiesterase Inhibitors in Improving Urodynamic Parameters in Patients with Spinal Cord Injury: A Preliminary Report

Muzzain Iqbal
1   Department of Urology, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India
,
Sarbjit Singh Chhiber
2   Department of Neurosurgery, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India
,
Baldev Singh Wazir
1   Department of Urology, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India
,
Altaf Umar Ramzan
2   Department of Neurosurgery, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India
,
Mohammad Saleem Wani
1   Department of Urology, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India
› Author Affiliations
Source(s) of Support None.

Abstract

Objective To analyze role of phosphodiesterase 5 (PDE5) inhibitors on urodynamic parameters in patients with suprasacral spinal cord injury.

Materials and Methods This was a prospective observational hospital-based study conducted on a cohort of patients, aged between 18 and 65 years with suprasacral spinal cord injury, who were registered in Department of Neurosurgery/Urology. Cutoff period since injury was 2 years. After taking consent, baseline urodynamic study was performed, which was repeated 2 hours after taking single oral dose of 20 mg tadalafil. Urodynamic parameters such as maximum detrusor filling/voiding pressures, maximum bladder capacity, and bladder compliance before and after taking drug were compared for final results and conclusion.

Results Following administration of 20 mg of tadalafil, maximum bladder capacity in mL showed statistically significant improvement from 268.39 ± 130.0 to 298.55 ± 112.0.(p < 0.05). Bladder compliance improved from 18.68 ± 6.4 to 20.25 ± 7.5 mL/cm H2O (p > 0.05). Maximum detrusor filling pressure improved from 36.03 ± 20.54 to 32.90 ± 16.47 cm H2O (p > 0.05). Maximum detrusor voiding pressure improved from 64.65 ± 33.19 to 58.13 ± 20.7 cm H2O (0 > 0.05). In patients with injury above D6 spinal cord level, statistically significant improvement was seen in maximum bladder capacity and bladder compliance after 2 hours of single oral dose of tadalafil (p < 0.05).

Conclusion Our study suggests a positive role of PDE inhibitors in improving urodynamic parameters in patients with suprasacral spinal cord injury with improvement in parameters such as bladder capacity, detrusor pressures, and bladder compliance. Because this is a small study group, more studies such as this are required to reach to final conclusion.



Publication History

Article published online:
16 April 2020

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  • References

  • 1 Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001; 26 (Suppl. 24) S2-S12
  • 2 National Spinal Cord Injury Statistical Center. Annual Statistical Report. Birmingham, UK: University of Alabama; 2007
  • 3 Thietje R, Pouw MH, Schulz AP, Kienast B, Hirschfeld S. Mortality in patients with traumatic spinal cord injury: descriptive analysis of 62 deceased subjects. J Spinal Cord Med 2011; 34 (05) 482-487
  • 4 Wein AJ. Lower urinary tract dysfunction in neurologic injury and disease: diseases primarily involving the spinal cord. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. eds. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007
  • 5 Capoor J, Stein AB. Aging with spinal cord injury. Phys Med Rehabil Clin N Am 2005; 16 (01) 129-161
  • 6 Chou FH, Ho CH, Chir MB, Linsenmeyer TA. Normal ranges of variability for urodynamic studies of neurogenic bladders in spinal cord injury. J Spinal Cord Med 2006; 29 (01) 26-31
  • 7 Taie K, Moombeini H, Khazaeli D, Salari Panah Firouzabadi M. Improvement of urodynamic indices by single dose oral tadalafil in men with supra sacral spinal cord injury. Urol J 2010; 7 (04) 249-253
  • 8 Gacci M, Del Popolo G, Macchiarella A. et al. Vardenafil improves urodynamic parameters in men with spinal cord injury: results from a single dose, pilot study. J Urol 2007; 178 (05) 2040-2043, discussion 2044
  • 9 Vasiliadis AV. Epidemiology map of traumatic spinal cord injuries: a global overview. Int J Caring Sci 2012; 5 (03) 335-347
  • 10 DeVivo MJ, Black KJ, Stover SL. Causes of death during the first 12 years after spinal cord injury. Arch Phys Med Rehabil 1993; 74 (03) 248-254
  • 11 Lidal IB, Snekkevik H, Aamodt G, Hjeltnes N, Biering-Sørensen F, Stanghelle JK. Mortality after spinal cord injury in Norway. J Rehabil Med 2007; 39 (02) 145-151
  • 12 Whiteneck GG, Charlifue SW, Frankel HL. et al. Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia 1992; 30 (09) 617-630
  • 13 Gerridzen RG, Thijssen AM, Dehoux E. Risk factors for upper tract deterioration in chronic spinal cord injury patients. J Urol 1992; 147 (02) 416-418
  • 14 Gallien P, Nicolas B, Robineau S, Le Bot MP, Durufle A, Brissot R. Influence of urinary management on urologic complications in a cohort of spinal cord injury patients. Arch Phys Med Rehabil 1998; 79 (10) 1206-1209
  • 15 Cheng CL. Spinal cord injury-induced neurogenic bladder. LUTS 2009; 1: S7-S9
  • 16 Tanagho EA, Deng DY. Urodynamic studies. In: Tanagho EA, McAninch JW. eds. Smith’s General Urology. 17th ed. San Fransisco, CA: McGraw-Hill; 2008: 455-472
  • 17 Giuliano F. Phosphodiesterase type 5 inhibitors improve male lower urinary tract symptoms. Eur Urol 2008; 53 (06) 1121-1123, discussion 1123–1124
  • 18 Filippi S, Morelli A, Sandner P. et al. Characterization and functional role of androgen-dependent PDE5 activity in the bladder. Endocrinology 2007; 148 (03) 1019-1029
  • 19 Behr RD, Oger S, Tinel H, Sandner P, Giuliano F. PDE5 Gene expression and relaxant effects of vardenafil in male and female human and rat detrusor muscle. Eur Urol Suppl 2008; 7: 263
  • 20 Tinel H, Stelte-Ludwig B, Hütter J, Sandner P. Pre-clinical evidence for the use of phosphodiesterase-5 inhibitors for treating benign prostatic hyperplasia and lower urinary tract symptoms. BJU Int 2006; 98 (06) 1259-1263
  • 21 Andersson KE, de Groat WC, McVary KT. et al. Tadalafil for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: pathophysiology and mechanism(s) of action. Neurourol Urodyn 2011; 30 (03) 292-301
  • 22 Francis SH, Blount MA, Zoraghi R, Corbin JD. Molecular properties of mammalian proteins that interact with cGMP: protein kinases, cation channels, phosphodiesterases, and multi-drug anion transporters. Front Biosci 2005; 10: 2097-2117
  • 23 Forgue ST, Patterson BE, Bedding AW. et al. Tadalafil pharmacokinetics in healthy subjects. Br J Clin Pharmacol 2006; 61 (03) 280-288
  • 24 Porst H, Padma-Nathan H, Giuliano F, Anglin G, Varanese L, Rosen R. Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial. Urology 2003; 62 (01) 121-125, discussion 125–126