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Questions posted in the
The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.
Question Title: Detrol and RefluxForum: The Urology Forum
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I have level II Reflux (and two ureters) in my right Kidney, which has caused me to go through several painful Kidney infections in the past five years. I am a 31-year-old female and my reflux was only discovered two years ago. My doctor recently prescribed Detrol for me saying that it is Could you explain the logic behind using Detrol in this case? I ----------------------------------------------------------------------------------------------------------------------------- Detrol (tolterodine is the generic name) is a new anticholinergic-antimuscarinic medication similar to Ditropan, which apparently has a lesser side-effect profile and taken twice a day. It essentially relaxes the bladder wall, thereby inhibiting bladder spasms which frequently occur in a hyperactive bladder. Detrol is not indicated for all patients with incontinence, but only a subset of patients whose incontinence is secondary to a hyperactive bladder (manifested by bladder spasms, urgency, and urge incontinence). A hyperactive bladder (also called hyperreflexic bladder, or hypersentitive bladder as you called it) is a diagnosis that is made by a urodynamic evaluation in the urology clinic/lab. It entails placement of a catheter into the bladder and another one in the rectum, and measuring volumes and pressure while filling up the bladder and later when the patient is asked to urinate. A duplicated collecting system, on the other hand, is a completely separate problem which may involve reflux of urine from the bladder, through one of the duplicated ureters, into the kidney. Reflux in of itself may not pose a problem, but in association with a bladder infection (which frequently occurs in women) can lead to kidney infections (pyelonephritis). Reflux occurs due to a short muscle wall backing the ureter as it enters the bladder. Therefore, with elevated bladder pressures that occur during urinating and bladder spasms (which may occur in a patient with a hyperreflexic bladder), urine will reflux up backwards into the kidney. By taking a bladder muscle relaxing agent such as Detrol, one may prevent reflux from spasms if the bladder spasms are prevented. You may wonder “What about reflux while I urinate? Even if bladder spasms are under control with Detrol, would I still reflux when I void?” In women, large bladder pressures are not required in order to urinate, and therefore you may not actually have large voiding pressures sufficient to cause reflux of urine while urinating. Although we cannot say this for sure in your case. The only way to know whether you reflux while urinating is to be evaluated by your urologist with a Flourourodynamic test which is similar to test mentioned above, but involving contrast dye and X-ray. In summary, you may benefit from Detrol if you have a hyperactive bladder and reflux, but need to follow-up closely with your urologist if you continue to develop any further episodes of pyelonephritis. This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568). Sincerely,
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