Effect of Sodium Nitroprussıde in Patients With Detrussor Overactivity

Research Article





Detrussor Overactivity, Bladder, Sodium Nitroprusside


Introduction: Detrusor instability is a common cause of urgency and urge incontinence in neurologically normal patients. Nitric oxide, relaxes the smooth muscles of the detrusor, prostate, and urethra.

Aim: We aimed to explain the therapeutic effects of sodium nitroprusside on detrusor overactivity in patients with detrusor overactivity.

Methods: A total of 21 patients with detrussor overactivity have been enrolled in this research. The patients were divided into 3 groups according to their sodium nitroprusside dosage, as low-dose, medium-dose, and high-dose. Hydrostatic pressure in the bladder was measured and at the same time, intra-abdominal pressure was measured with a catheter inserted into the rectum. Cystometry results have been evaluated in terms of sensation (first sensation, first desire, strong desire), detrusor compliance, maximal detrusor pressure, maximal cystometric bladder capacity and instability index parameters.

Results:  No statistical significance has been achieved between nitroprusside groups in terms of first sensation, first desire, and strong desire values (p>0.05). When the patients' maximal detrusor pressure, maximal cystometric bladder capacity and compliance values were interpreted, no significant difference was found between the isotonic and SNP groups and their doses. There was no significant difference between the groups in the duration of contractions. Additionally, no difference has been observed between the groups in the blood pressure values of the patients at the end of the study compared to the baseline.

Conclusion: This study indicated that SNP did not exhibit any positive or negative effects in individuals with detrussor overactivity. The reason for this could be stated as: first, the urothelium acts as a barrier to the passage of sodium nitroprusside and prevents it from reaching the detrusor and the latter may be due to the lack of effect of sodium nitroprusside on detrusor function.


Ruffion A, Castro-Diaz D, Patel H, et al. Systematic review of the epidemiology of urinary incontinence and detrusor overactivity among patients with neurogenic overactive bladder. Neuroepidemiology. 2013;41(3-4):146-55. doi: 10.1159/000353274.

Panicker JN. Neurogenic Bladder: Epidemiology, Diagnosis, and Management. Semin Neurol. 2020 Oct;40(5):569-579. doi: 10.1055/s-0040-1713876.

Panicker JN. Neurogenic Bladder: Epidemiology, Diagnosis, and Management. Semin Neurol. 2020 Oct;40(5):569-579. doi: 10.1055/s-0040-1713876.

Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. JAMA. 2018 Dec 18;320(23):2438-2447. doi: 10.1001/jama.2018.18315.

Clark CB, Ragam R, Das AK, Shenot PJ. Management of neurogenic detrusor overactivity. Can J Urol. 2021 Aug;28(S2):33-37.

Tapia CI, Khalaf K, Berenson K, Globe D, Chancellor M, Carr LK. Health-related quality of life and economic impact of urinary incontinence due to detrusor overactivity associated with a neurologic condition: a systematic review. Health Qual Life Outcomes. 2013 Jan 31;11:13. doi: 10.1186/1477-7525-11-13.

Andersson KE, Garcia Pascual A, Persson K, Forman A, Tøttrup A. Electrically-induced, nerve-mediated relaxation of rabbit urethra involves nitric oxide. J Urol. 1992;147:253 9.

Andersson KE, Persson K. Nitric oxide synthase and the lower urinary tract:possible implications for physiology and pathophysiology. Scand J Urol Nephrol. 1995;175:43-53.

Kedia GT, Uckert S, Jonas U, Kuczyk MA, Burchardt M. The nitric oxide pathway in the human prostate: clinical implications in men with lower urinary tract symptoms. World J Urol 2008;26:603-9.

Bloch W, Klotz T, Loch C, Schmidt G, Engelmann U, Addicks K. Distribution of nitric oxide synthase implies a regulation of circulation, smooth muscle tone, and secretory function in the human prostate by nitric oxide. Prostate 1997;15:33:1-8.

Peyronnet B, Mironska E, Chapple C, et al. A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment. Eur Urol. 2019 Jun;75(6):988-1000. doi: 10.1016/j.eururo.2019.02.038.

Drake MJ, Doumouchtsis SK, Hashim H, Gammie A. Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations. Neurourol Urodyn. 2018 Aug;37(S6):S50-S60. doi: 10.1002/nau.23773.

Gajewski JB, Gammie A, Speich J, et al. Are there different patterns of detrusor overactivity which are clinically relevant? ICI-RS 2018. Neurourol Urodyn. 2019 Dec;38 Suppl 5:S40-S45. doi: 10.1002/nau.23964.

Ptashnyk T, Hatzinger M, Zeller FL, Kirschner-Hermanns R. Overactive bladder syndrome - focus onto detrusor overactivity. Scand J Urol. 2021 Feb;55(1):56-60. doi: 10.1080/21681805.2020.1839130.

Sellers D, Chess-Williams R, Michel MC. Modulation of lower urinary tract smooth muscle contraction and relaxation by the urothelium. Naunyn Schmiedebergs Arch Pharmacol 2018;391:675-94.

Kim HS, Kim JC, Choo MS. Effects of nitric oxide synthases on detrusor overactivity after removal of bladder outlet obstruction in rats. Urol Int 2008;81:107-12.

Yuan X, Wu S, Lin T, He D, Li X, Liu S, et al. Role of nitric oxide synthase in bladder pathologic remodeling and dysfunction resulting from partial outlet obstruction. Urology 2011;77:1008.e1-8.

Pereira ML, D’ancona CA, Rojas-Moscoso JA, Ramos AC Filho, Monica FZ, Antunes E. Effects of nitric oxide inhibitors in mice with bladder outlet obstruction. Int Braz J Urol 2017;43:356-66.

Kim SO, Choi D, Song SH, Ahn KY, Kwon D, Park K. Effect of detrusor overactivity on the expression of aquaporins and nitric oxide synthase in rat urinary bladder following bladder outlet obstruction. Can Urol Assoc J 2013;7:E268-74

Canda A.E, Cross C.R, Chapple C.R. Pharmacology of the Lower Urinary Tract and Management of Overactive Bladder. J Turkish-German Gynecol Assoc, 2006:7;146-57.

Anderson KE, Persson K. Nitricoxide synthase and the lower urinary tract: Possible implications for physiology and pathophysiology. Scand J Urol Nephrol 1995;175: 45-51

Ozawa H, Chancellor MB, Jung SY. Effect of intra vesical nitricoxide therapy on cyclophosphamide induced cytitis. J Urol 1999;162:2211-16.

Hennenberg M, Stief CG, Gratzke C. Pharmacology of the lower urinary tract. Indian J Urol 2014;30:181–188.

Robinson D, Cardozo L. Managing overactive bladder. Climacteric. 2019 Jun;22(3):250-256. doi: 10.1080/13697137.2018.1552254.

Wang HS, Cahill D, Panagides J, Nelson CP, Wu HT, Estrada C. Pattern recognition algorithm to identify detrusor overactivity on urodynamics. Neurourol Urodyn. 2021 Jan;40(1):428-434. doi: 10.1002/nau.24578.

Mancini V, Tarcan T, Serati M, Wyndaele M, Carrieri G, Abrams P. Is coexistent overactive-underactive bladder (with or without detrusor overactivity and underactivity) a real clinical syndrome? ICI-RS 2019. Neurourol Urodyn. 2020 Jul;39 Suppl 3:S50-S59. doi: 10.1002/nau.24311.

Chen LC, Kuo HC. Pathophysiology of refractory overactive bladder. Low Urin Tract Symptoms. 2019 Sep;11(4):177-181. doi: 10.1111/luts.12262.

Karakus S, Musicki B, Navati MS, Friedman JM, Davies KP, Burnett AL. NO-Releasing Nanoparticles Ameliorate Detrusor Overactivity in Transgenic Sickle Cell Mice via Restored NO/ROCK Signaling. J Pharmacol Exp Ther. 2020 May;373(2):214-219. doi: 10.1124/jpet.119.264697.

Loloi J, Babar M, Davies KP, Suadicani SO. Nanotechnology as a tool to advance research and treatment of non-oncologic urogenital diseases. Ther Adv Urol. 2022 Jul 26;14:17562872221109023. doi: 10.1177/17562872221109023.




How to Cite

Erdogan, E. (2024). Effect of Sodium Nitroprussıde in Patients With Detrussor Overactivity: Research Article. Acta Medica Ruha, 2(1), 20–26. https://doi.org/10.5281/zenodo.10800948



Research Articles