Gajewski J B, Awad S A
J Urol. 1986 May;135(5):966-8. doi: 10.1016/s0022-5347(17)45940-4.
Hyperreflexia is the most common urological finding in patients with multiple sclerosis. A prospective randomized study was done to compare the effectiveness of 2 commonly used drugs, oxybutynin and propantheline. Of the 34 patients entered into the trial 19 were treated with oxybutynin and 15 with propantheline. The urological symptoms (frequency, nocturia, hesitancy, urgency and urge incontinence) were graded according to severity from 0 to 3. Patients with urinary infection were excluded. Urodynamic examination, consisting of cystometrography and electromyography, was performed in all patients before treatment. Both groups of patients had comparable neurological, urological and urodynamic status before treatment. In 4 patients (21 per cent) treated with oxybutynin and in 4 (27 per cent) treated with propantheline side effects were so severe that the treatment had to be discontinued. Symptomatic response to oxybutynin was good in 10 patients (67 per cent), fair in 2 (13 per cent) and poor in 3 (20 per cent). Propantheline produced good symptomatic results in 4 patients (36 per cent), fair in 1 (9 per cent) and poor in 6 (55 per cent). The mean increase in maximum cystometric capacity on cystometrography was significantly larger in the oxybutynin group than in the propantheline group (144 +/- 115 versus 35 +/- 101). Our results indicate that oxybutynin is more effective than propantheline in the treatment of detrusor hyperreflexia in patients with multiple sclerosis.
反射亢进是多发性硬化症患者最常见的泌尿系统表现。一项前瞻性随机研究旨在比较两种常用药物奥昔布宁和丙胺太林的疗效。34名进入试验的患者中，19名接受奥昔布宁治疗，15名接受丙胺太林治疗。泌尿系统症状（尿频、夜尿、排尿犹豫、尿急和急迫性尿失禁）根据严重程度从0到3进行分级。排除有泌尿系统感染的患者。所有患者在治疗前均进行了包括膀胱测压和肌电图检查在内的尿动力学检查。两组患者在治疗前的神经、泌尿和尿动力学状况相当。接受奥昔布宁治疗的4名患者（21%）和接受丙胺太林治疗的4名患者（27%）出现了严重的副作用，以至于不得不停止治疗。奥昔布宁治疗后有10名患者（67%）症状反应良好，2名患者（13%）反应一般，3名患者（20%）反应较差。丙胺太林治疗后有4名患者（36%）症状改善良好，1名患者（9%）反应一般，6名患者（55%）反应较差。膀胱测压时最大膀胱容量的平均增加量在奥昔布宁组显著大于丙胺太林组（144±115对35±101）。我们的结果表明，在治疗多发性硬化症患者的逼尿肌反射亢进方面，奥昔布宁比丙胺太林更有效。
