Table 3.
Summary of studies evaluating the use of electromotive drug administration in overactive bladder
| Study | Inclusion criteria | Treatment regime | Outcome | Adverse events |
|---|---|---|---|---|
| Bach 2009 | Refractory urge syndrome with/without urge incontinence | EMDA 2000 mg lidocaine-HCl 4% (50 ml), 2 mg epinephrine 2 ml, 40 mg dexamethason-21 - dihydrogen phosphate 10 ml in total volume 100 ml, once every 4 weeks for 3 months | Improvement in frequency from 14.1 per day and 5.1 per night to 9.4 per day and 2.5 per night; FDV and SDV improved from 94 ml to 142.2 ml and 155.6 ml to 199.5 ml; Reduced uninhibited detrusor contractions; maximal cystometric bladder capacity increased from 192.3 ml to 239.6 ml; 53.6% reported complete resolution of symptoms, 28.6% improvement in symptoms | 10.7% did not continue therapy after 2 sessions |
| Di Stasi 2001 | Refractory detrusor hyperreflexia unresponsive to standard oral and intravesical oxybutynin regimens | EMDA oxybutynin 5 mA (5 mg in 100 ml) for 30 min versus Passive intravesical oxybutynin 5 mg in 100 ml for 60 min versus Oxybutynin 5 mg orally | Reduced number, duration and amplitude of uninhibited detrusor contractions after EMDA compared to no change with oral or passive intravesical oxybutynin | Systemic side effects seen in oral administration, but none with intravesical or EMDA All EMDA treatments resulted in transient erythema of skin underlying electrodes |
| Gauruder- Burmester 2008 | Refractory overactive bladder | EMDA 15-25 mA 100 ml 4% lidocaine, 100 ml distilled water, 40 mg dexamethasone, 2 ml epinephrine retained in bladder for 20-25 min. 3 treatment cycles each with 3 treatments at 2 weeks intervals | Bladder capacity improved by mean 109 ml in 71% patients. Number of micturitions per day decreased from 19 to 7 | 7/72 reactive hypertension which returned to normal without intervention 21/72 dysuria and hematuria 10 had UTI 1 developed urinary retention |
| Kajbafzadeh 2011 | Refractory neurogenic detrusor overactivity (children) | EMDA botulinum toxin type A 10 mA (10 IU/kg) for 15 min | Increased mean reflex volume and maximal bladder capacity from 99 ml to 216 and 121 ml to 262; Decreased mean maximal detrusor pressure and end-fill pressure from 75 cm H2O to 39 cm H2O, and 22 cm H2O to 13 cm H2O; Urinary incontinence improved in 80% patients | Skin erythema and burning in 6/12 |
| Ladi-Seyedian 2018 | Refractory neurogenic detrusor overactivity (children) | EMDA botulinum toxin type A 10-15 mA (10 IU/kg) for 20 min | After a single treatment: 87.5% completely dry between 2 consecutive CICs after 6 months, 75%, 45.5%, 37.5%, 33%, 29.1% dry between 2 CICs at 1, 2, 3, 5 and 6 years, respectively | No major adverse effects |
| Riedl 1998a | Refractory detrusor hyperreflexia and/or urge incontinence | EMDA oxybutynin hydrochloride 15 mA (15-50 mg in 100 ml 0.3% saline) for 20 min | Improvement >1 week in 27%, <1 week in 36.5%, no improvement in 36.5% | No local or systemic side effects observed in this cohort |
| Koh 2019 | Refractory neurogenic detrusor overactivity (children) | EMDA Botox (Allergan) 10 mA (3.3 IU/kg) for 15 min (5 patients) EMDA Botox (Allergan) 15 mA (10 IU/Kg) for 25 min (5 patients) EMDA Botox (Dysport) 10 IU/Kg (4 patients) | EMDA with either Botox or Dysport did not significantly change maximal cystometric capacity, bladder compliance or pDetmax 3/10 reported transient symptomatic benefit with Botox lasting a few days 3/4 reported transient symptomatic benefit with Dysport lasting a few days | All patients reported temporary redness at the site of the abdominal wall electrodes which resolved within 2 h No other adverse effects were reported |
CICs: Clean-intermittent catheterizations, EMDA: Electromotive drug administration, FDV: First desire to void, SDV: Strong desire to void