Bethanechol Remains the Preferred Drug in Suspected Underactive Bladder: Findings from Nation-Wide Prescription Analysis

Abstract

<b>Background:</b> Bethanechol chloride, a cholinergic agonist, is often prescribed in suspected underactive bladders to improve detrusor contractility, despite its limited clinical efficacy. We investigated the usage pattern of bethanechol in actual practice with the understanding that it would enable the physicians to make an informed decision on the coherent use of bethanechol. <b>Methods: </b>A<b> </b>nation-wide survey was carried out to obtain the responses of the urologists.<b> </b>Out of the 755 urologists approached, 630 survey responses were considered for analysis. <b>Results: </b>Usage of bethanechol was advocated as very common [318 (50.48%)], common [200 (31.75%)], not so common [107 (16.98%)], and rare [5 (0.79%)] in postoperative urinary retention, where it was preferred either exclusively [255 (40.48%)] or along with alpha blockers [247 (39.21%)]. Predilection to use alpha-blocker [247 (39.21%)], alpha-blocker plus naloxone [4 (0.64%)], naloxone [1 (0.16%)], alpha-blocker plus bethanechol plus naloxone [1 (0.16%)] was also observed. It was also preferred individually in pathologies causing urinary retention such as benign prostatic hyperplasia [125 (19.84%)], diabetic neuropathy [82 (13.02%)], neurological diseases [69 (10.95%)], senile bladder [14 (2.22%)], drugs [13 (2.06%)], and infective/inflammatory conditions [6 (0.95%)]. Other [321 (50.95%)] physicians opted to prescribe bethanechol in two or more of the enumerated indications. Bethanechol was prescribed orally as 25 mg thrice daily [441 (70.00%)], 50 mg thrice daily [86 (13.65%)], 25 mg four times daily [59 (9.37%)], and many &#8220;strongly agree&#8221; and &#8220;agree&#8221; that its sustained release formulation may offer better treatment compliance [565 (89.68%)], safety [548 (86.99%)], and efficacy [544 (86.35%)]. <b>Conclusion: </b>Bethanechol was the most prescribed drug for the management of postoperative urinary retention and other pathologies suspected to cause underactive bladder.