Solifenacin Versus Tolterodine in Catheter-Related Bladder Spasms Following Prostatectomy; A Randomised Triple-Blind Study

Abstract

Abstract Background: Bladder spasms are common during the immediate postoperative period while the urethral catheter is insitu following prostatectomy. This often presents in the form of urgency, intense suprapubic pain, increased bleeding, and pericatheter leakage of urine. This is due to involuntary contractions of the detrusor muscle stimulated by the bladder mucosa’s irritation by the urethral catheter’s balloon in situ . These bladder spasms post-prostatectomy can be inhibited using selective antimuscarinics such as Solifenacin and tolterodine. Both have been found effective in relieving patients with overactive bladder syndrome and urinary incontinence. The efficacy and tolerability of these agents in post-prostatectomy patients with bladder spasms were reviewed to guide treatment decisions. Materials and Methods: Patients scheduled for prostatectomy for benign prostatic hyperplasia from March 2022 to February 2023 were studied. Patients who had bladder spasms post-prostatectomy were allocated using simple randomisation into two different groups; Group A received 10mg of Solifenacin daily and Group B 4mg of Tolterodine daily. Treatment was for a week from the onset of symptoms. The primary outcome measure was the resolution of spasms within the treatment period. Changes in pain scores were assessed using the visual analogue scale, and the frequency of side effects of the therapy was a secondary outcome. Results: A total of 126 patients had prostatectomy during the study period, and 72 (60%) of the patients had bladder spasms following the procedure and were randomised into both treatment arms. The age of the patients, approach to surgery, and clinical characteristics of the patients were similar in both groups, and no statistically significant difference was seen. Complete resolution of symptoms was seen in 64% of patients in the Solifenacin group, while in 58% of patients in the Tolterodine group. This was significant with P value = 0.001. The changes in mean pain scores were statistically significant in the two groups. 66.67% of patients in the Solifenacin group and 44.45% in the Tolterodine group had side effects. Conclusion: Six out of 10 patients are likely to have bladder spasms post-prostatectomy. Although both Solifenacin 10 mg and tolterodine 4 mg are efficacious in relieving symptoms, Solifenacin 10 mg is superior and associated with more side effects.