***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a multicentre placebo-controlled double-blind study 61 patients with spinal cord injuries and detrusor hyperreflexia were treated : 20 mg trospium chloride was given twice daily over a period of 3 weeks . Pre- and posttreatment urodynamic measurements demonstrated large improvements in maximum cystometric capacity ( mean = 138.1 ml ) , decreased maximum detrusor pressure ( mean = -37.8 cm H2O ) and an increase in compliance ( mean = 12.1 ml/cm H2O ) in the treatment group . Urodynamic parameters in the placebo group remained substantially unchanged . Comparisons between the two groups revealed highly significant differences for these parameters ( all , p less than 0.001 ) . No effect on maximum flow rate and residual urine was detected in either group . The incidence of spontaneously reported side-effects was extremely low and comparable for both groups Aims of the study : The aim of this double-blind , r and omised , prospect i ve , multicentre trial was to evaluate the efficacy of propiverine in patients suffering from detrusor hyperreflexia caused by spinal cord injury in comparison to placebo . Study design : The treatment period of 14 days comprised visits at baseline ( V1 ) and after 14 days treatment ( V2 ) . Fifteen mg propiverine t.i.d . or placebo t.i.d . were administered as medication . The following efficacy parameters were adopted : the urodynamic parameters maximal cystometric bladder capacity , bladder volume on onset of the first as well as duration and amplitude of the maximum detrusor contraction , bladder compliance and residual urine , and subjective assessment of efficacy by physicians . For the evaluation of the safety of propiverine the incidence rate of adverse events by directly question ing as well as laboratory parameters were investigated . For biometrical evaluation t-test for independent groups was applied . Results : One hundred and thirteen patients were investigated .  The maximal cystometric bladder capacity increased significantly in the propiverine group , on average by 104 ml ( V1 : 262±132 ml . V2 : 366±143 ml , P<0.001 ) . The changes in bladder capacity during the first contraction and the maximum detrusor contraction in the verum group were both statistically significant . The bladder compliance documented a more pronounced increase under propiverine in comparison to placebo . Residual urine increased by 37±71 ml in the propiverine group , significantly more than in the placebo group ( P=0.01 ) . Sixty-three per cent of the patients expressed subjectively an improvement under propiverine in comparison with 23 % of the placebo group . Expected anticholinergic adverse events occurred : dryness of the mouth ( 37 % in the verum and 8 % in the placebo group ) , accommodation disorders ( 28 % and 2 % respectively ) . Nausea , constipation , headache , dizziness , tiredness and palpitations were reported in almost comparable incidence rates between 3 and 13 % in both treatment groups . Eight drop-outs were registered in the propiverine group ( five due to adverse events ) and three in the placebo group ( one due to adverse events ) . The laboratory parameters revealed no changes . Conclusion : Propiverine proved its efficacy in detrusor hyperreflexia with regard to the urodynamic parameters of the maximal cystometric bladder capacity and detrusor contractility . Anticholinergic adverse events such as dryness of the mouth and accommodation disorders were considered being tolerable . The increase in residual urine reflects the therapeutically desired effect of detrusor relaxation because the majority of patients normally practise intermittent catheterisation for bladder emptying Abstract Objective : To compare tolterodine with oxybutynin and placebo in people with neuragenie detrusor overactivity . Design : Prospect i ve , r and omized , double-blind , crossover trial plus open-label comparative stage . Participants : Ten participants with neuragenie detrusor overactivity due to spinal cord injury or multiple sclerosis who usedintermittent catheterization . Methods : Bladder capacity on cystometrogram , a 10-day record of catheterization volumes , number of incontinent episodes perday , and perceived dry mouth using a visual analog scale ( VAS ) were measured for the following : ( a ) a blinded comparison : tolterodine , 2 mg twice daily , vs placebo , twice daily ; and ( b ) an unblinded comparison : oxybutynin vs tolterodine , each atself-selected doses ( SSDs ) . Results : Tolterodine , 2 mg twice daily , was superior to placebo in enhancing catheterization volumes ( P<0.0005 ) and reducingincontinence ( P<0.001 ) , but was comparable with placebo in cystometric bladder capacity . Efficacy of tolterodine SSD wascomparable with oxybutynin SSD with regard to catheterization volumes , degree of incontinence , and cystometric bladder capacity . The side effect profile ( dry mouth ) was comparable between tolterodine , 2 mg twice daily , and placebo , but differed significantlywhen comparing tolterodine SSD with oxybutynin SSD ( P<0.05 ) . Conclusion : T olterodine , when used at SSDs , is comparable with oxybutynin at SSDs in enhancing bladder volume and improvingcontinence , but with less dry mouth .  T olterodine at the recommended dosage of 2 mg twice daily improves incontinence and bladdervolumes compared with placebo , and without significant dry mouth . Larger doses of tolterodine may be needed to achieve best effectin this population , but further studies are required Hyperreflexia is the most common urological finding in patients with multiple sclerosis . A prospect i ve r and omized study was done to compare the effectiveness of 2 commonly used drugs , oxybutynin and propantheline . Of the 34 patients entered into the trial 19 were treated with oxybutynin and 15 with propantheline .  The urological symptoms ( frequency , nocturia , hesitancy , urgency and urge incontinence ) were grade d according to severity from 0 to 3 . Patients with urinary infection were excluded .  Urodynamic examination , consisting of cystometrography and electromyography , was performed in all patients before treatment . Both groups of patients had comparable neurological , urological and urodynamic status before treatment . In 4 patients ( 21 per cent ) treated with oxybutynin and in 4 ( 27 per cent ) treated with propantheline  side effects were so severe that the treatment had to be discontinued . Symptomatic response to oxybutynin was good in 10 patients ( 67 per cent ) , fair in 2 ( 13 per cent ) and poor in 3 ( 20 per cent ) . Propantheline produced good symptomatic results in 4 patients ( 36 per cent ) , fair in 1 ( 9 per cent ) and poor in 6 ( 55 per cent ) . The mean increase in maximum cystometric capacity on cystometrography was significantly larger in the oxybutynin group than in the propantheline group ( 144 + /- 115 versus 35 + /- 101 ) . Our results indicate that oxybutynin is more effective than propantheline in the treatment of detrusor hyperreflexia in patients with multiple sclerosis PURPOSE About 15 % to 20 % of patients with detrusor hyperreflexia do not benefit from oral oxybutynin regimens , frequently because of unpleasant side effects . Several reports indicate that intravesical oxybutynin is effective in many of these patients but there are some who still fail to respond . MATERIAL S AND METHODS A select group of 10 adults with detrusor hyperreflexia unresponsive to st and ard oral and intravesical oxybutynin regimens were treated at weekly intervals with 5 mg . oxybutynin orally , or 5 mg . oxybutynin in 100 ml . intravesically for 60 minutes of passive diffusion and for 30 minutes with 5 mA. electrical current . Each treatment ( plus oral placebo and 2 intravesical controls ) was associated with an 8-hour , full urodynamic monitoring session , and periodic blood and bladder content sampling . RESULTS There was no significant objective improvement with oral or intravesical passive diffusion oxybutynin . Conversely there was significant improvement in 5 of 6 objective urodynamic measurements with intravesical electromotive oxybutynin . Plasma profiles were a single peak and decay following oral oxybutynin and 2 distinct peaks with intravesical passive diffusion and electromotive oxybutynin . Area under the curve for intravesical passive diffusion were 709 ng . per 8 hours versus oral 1,485 ( p < 0.05 ) versus intravesical electromotive 2,781 ( p < 0.001 ) . Bladder content sample s confirmed oxybutynin absorption . Oral oxybutynin caused anticholinergic side effects in 7 of 10 patients . There were no side effects with intravesical passive diffusion or electromotive administrations . CONCLUSIONS Accelerated intravesical administration results in greater bioavailability and increased objective benefits without side effects in previously unresponsive patients compared with oral and intravesical passive diffusion oxybutynin administration Study design : Double-blind , r and omised , multicentre study . Objectives : Efficacy and tolerability of propiverine extended-release ( ER ) compared with immediate-release ( IR ) were evaluated in patients with proven neurogenic detrusor overactivity ( NDO ) . Setting : Six Spinal Cord Injury Units located in Austria , Germany and Romania . Methods : Propiverine ER 45 mg s.i.d . or IR 15 mg t.i.d . were administered in patients with proven NDO . Outcomes were assessed at baseline ( V1 ) , and after 21 days of treatment ( V2 ) : Reflex volume served as primary , leak point volume and maximum detrusor pressure as secondary efficacy outcomes , treatment-related adverse events as tolerability outcomes . Results : Sixty-six patients with proven NDO were enrolled .  Reflex volume ( ml ) increased significantly in the IR ( V1 : 100.9 , V2 : 202.9 ) and in the ER ( V1 : 89.8 , V2 : 180.3 ) group , no significant intergroup difference . Leak point volume increased , and maximum detrusor pressure decreased significantly in both groups , no significant intergroup differences . The percentage of patients presenting with incontinence was reduced by 14 % in the IR and by 39 % in the ER group , the difference is significant . Treatment-related adverse events manifested in 42 and 36 % following propiverine IR and ER , respectively . Conclusion : The urodynamic efficacy outcomes demonstrated both galenic formulations to be equieffective . However , following propiverine ER 45 mg s.i.d . higher continence rates compared with propiverine IR 15 mg t.i.d . were achieved , possibly indicative of more balanced plasma-levels . A slight tendency for superior tolerability outcomes of propiverine ER compared with IR was demonstrated . Sponsorship : The study was sponsored by an unrestricted educational grant of APOGEPHA Arzneimittel GmbH , Dresden , Germany Abstract Objective : This study evaluated the effects and tolerability of extended-release oxybutynin chloride on the frequency of voiding and catheterization and urodynamic capacity in spinal cord injury ( SCI ) patients with defined detrusor hyperreflexia . Methods : This was a 1 2-week , prospect i ve , dose-titration study of extended-release oxybutynin ( oxybutynin XL ) .  SCI patients with urodynamically defined detrusor hyperreflexia were recruited for this study . Following a 7 -day washout period , patients were evaluated via video-urodynamic study and then treatment was initiated at a dosage of 1 0 mg per day . Dosage was increased in weekly intervals to a maximum of 30 mg per day . Micturation frequency diaries and urodynamics were completed at baseline and repeated at week 1 2 . Tolerability information was collected at each follow-up visit . Results : Ten patients ( mean age = 49 years ) with complete or incomplete SCI were enrolled . Participants reported clinical improvement ( decreased urinary frequency and fewer incontinence episodes ) with oxybutynin therapy following titration to 30 mg per day . All patients chose a final effective dosage of greater than 1 0 mg , with 4 patients taking the maximum of 3 0 mg per day . Mean cystometric bladder capacity increased from 2 7 4 mL to 3 80 mL ( P = 0.008 ) . No patient experienced serious adverse events during the 12-week study . Conclusion : Oxybutynin XL is safe and effective in patients with detrusor hyperreflexia secondary to SCI . The onset of clinical efficacy occurs within 1 week , and daily dosages up to 30 mg are well tole rated Objective To compare the efficacy of a controlled‐release ( CR ) formulation of oxybutynin with that of conventional oxybutynin in patients with detrusor instability or detrusor hyper‐reflexia whose symptoms were stabilized on conventional oral oxybutynin tablets INTRODUCTION AND OBJECTIVES The dosage of the antimuscarinic drugs : Tolterodine ER or Trospium was increased to a higher-than-recommended dosage in patients where the manufacturer 's recommended dosage had failed . All patients were suffering from neurogenic detrusor overactivity incontinence .  Tolerability and success were evaluated in the present study . MATERIAL S AND METHODS Twenty-one patients with neurogenic 
    Output:
    
The dry-mouth rates were statistically significantly higher with anticholinergics , with no difference in withdrawals because of adverse events .
There was no statistically significant difference in any of the outcomes between oxybutynin and other anticholinergics or among different doses and preparations of anticholinergic drugs .
CONCLUSIONS Compared with placebo , anticholinergic treatment in patients with NDO is associated with better patient-reported cure/improvement and significant reduction of maximum detrusor pressure ; however , there is a higher incidence of adverse events .
None of the anticholinergic drugs or different dosages assessed in this review was superior to another