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abstract

420 - BACLOFEN: A FORGOTTEN DRUG FOR VOIDING DYSFUNCTION

420

BACLOFEN: A FORGOTTEN DRUG FORVOIDING DYSFUNCTION

L. MARTIN, N. CHANDRASEKARAN, H.DEVAKUMAR, J. S. SCHACHAR, E. A. HURTADO, G. DAVILA;
ClevelandClinic Florida, Weston, FL.

Introduction: Dysfunctional andobstructed voiding are etiologies of urinary retention, a conditionthat can lead to recurrent infections, elevated intra-vesicalpressures, reflux and potentially renal damage. (1) In order toremedy this problem, both non-invasive approaches, such as medicalmanagement, and invasive approaches, such as catheterization andsphincterotomy, have been implemented. (2) Baclofen, a musclerelaxant, has been used with some efficacy in patients withobstructed voiding due to detrusor sphincter dyssynergia; theparadoxical contraction of the urethral sphincter during a detrusorcontraction. (2) The medication has been used to decrease externalurethral sphincter resistance and in turn, improve bladder emptying.(3) Therefore, we hypothesize that baclofen can significantly improvethe post-void residual (PVR) in patients with dysfunctional orobstructive voiding.
Objective: To report on whetherBaclofen can be used to improve the post-void residual in patientswith dysfunctional voiding , or with obstructive voiding aftersub-urethral sling.
Methods: This is aretrospective review of patients who received baclofen in oururogynecologic clinic from 2004-2016. Patients were selected who hada diagnosis of dysfunctional voiding found on urodynamics (UDS) orurinary retention, defined as a post-void residual (PVR) greater than100 ml. Demographic data on patients was collected. The patients werestarted on a dose of baclofen 10 mg BID. The dosages were titratedbased on efficacy. A repeat PVR was performed while on baclofen todetermine the effect of the medication. The difference in thepre-baclofen and post-baclofen PVR was calculated for each patientand a paired t-test was performed. Subjective data was also collectedand noted as cured, greatly improved, somewhat improved, notimproved, and worse. Our primary outcome was a significant decreasein the post-void residual. Our secondary outcome was symptomaticimprovement of cured, greatly improved, or somewhat improved. Asignificance criterion of 0.05 will be assumed for allanalyses.
Results: A total of 57 patients were reviewed inthis study. The average age was 62 years old upon starting baclofen.Patients took baclofen for a minimum of 3 weeks and a median of 13weeks. The average PVR prior to treatment was 130 ml (min 5 ml, max640 ml). After treatment the average decrease in PVR was 60.3 ml(P<0.001). A total of 74% of patients were found to have adecrease in their PVR which resulted in a residual of less than 100ml and allowed most patients in the study to normalize theirresidual. When stratified by patients who had a sling with obstructedvoiding (N=25) versus a diagnosis of dysfunctional voiding (N=32),there was a small difference in the average change in PVR’s, 71.6ml vs 55.9 ml respectively. The median subjective score was found tobe somewhat improved. A total of 47.3% of patients consideredthemselves to be somewhat improved and 29.8 % considered themselvesto be greatly improved after taking baclofen.
Conclusions:Baclofen should be considered as a treatment for dysfunctional andobstructed voiders. Further prospective studies are needed toevaluate the efficacy of this older medication in urogynecologicpatients.
References:

  1. Curr UrolRep.200; 2(5):379-387.

  2. Int UrolNephrol. 2007;38 (3-4):537-41.

  3. J. Urology1980; 124 (1): 82-84.