A prospective, blinded study was done to examine the effects of acute bolus and chronic continuous intrathecal
baclofen on genitourinary function in 10 patients with severe spasticity due to spinal cord pathology. Genitourinary function was assessed by symptom questionnaires and urodynamic studies performed after a bolus dose of
baclofen and 6 to 12 months after continuous intrathecal
baclofen. Results were compared to placebo for acute bolus testing or to pre-continuous intrathecal
baclofen values. In all patients with irritative voiding and
urge incontinence uninhibited bladder contractions were eliminated. Of 3 patients with an indwelling
urethral catheter for incontinence due to detrusor
hyperreflexia 1 was converted to intermittent self-catheterization. Whereas bladder capacity, compliance, sensation and voiding pressures were not different after continuous intrathecal
baclofen, when a mean of all patients was compiled, a 72% increase in capacity and 16% improvement in compliance were observed in subjects without cervical spinal cord pathology. Detrusor-sphincter
dyssynergia was abolished in 40% of the patients. Continuous intrathecal
baclofen may represent a novel approach to the management of patients with a
neurogenic bladder who have decreased bladder compliance and detrusor
hyperreflexia not controlled by oral medications.