Presentation Authors: Sidney Goldfarb*, Princeton, NJ
Introduction: Donepezil, a cholinesterase inhibitor, was given to 23 patients (19 males and 4 females) to potentiate the bladder emptying effects of Bethanechol. All patients were seen in urinary retention, most with upper tract changes of hydronephrosis, some without. Males had bladder outlet obstruction due to BPH and had Trans Urethral Resection of the Prostate (TURP). Continued retention in male patients was treated with maximal alpha blockade therapy and high-dose Bethanechol. Patients continued to be unable to void until the addition of Donepezil.
Methods: All 19 males had very high post-void residuals (PVRs) when seen initially, one patient up to 4800 mL. They opted for immediate TURP and pharmacological therapy with alpha blocker, Bethanechol, and Donepezil if needed. The 4 females were given medications only; they presented in urinary retention with high PVRs and hydronephrosis.
Results: Pre-TURP residuals (PVR) were over 1000 mL, and average post-therapy PVRs were under 100 mL; some PVRs were 0 mL. Eventually, all patients were tapered off of high-dose therapy and could be maintained on very low-dose alpha blockade or off drugs. Some long-term results show a further deterioration of bladder function and failure to maintain emptying as the patients aged further. Only one male patient failed and was treated with suprapubic cystostomy.
Conclusions: Donepezil potentiates Bethanechol to facilitate bladder emptying in 18 of 19 sequentially seen male patients, who otherwise would be on catheter drainage or self-catheterization for prolonged periods of time. Use of Donepezil will help treatment of patients with underactive bladder function. Most males did better than females. 18 out of 19 male patients had complete successes; only one of four female patients was a success. Major new finding: Bethanechol is underused for bladder emptying because of severe under-dosing. The high-dose combination of Bethanechol and Donepezil gets the bladder to function.