A randomized, double-blind placebo-controlled trial of the effects of the 5-hydroxytriptamine(4) agonist cisapride on the female urinary bladder

OBJECTIVE: Anecdotal reports have proposed the use of the 5-hydroxytriptami ne(4) agonist cisapride as a treatment for female voiding dysfunction on th e basis of the known prokinetic actions of the medication, The purpose of o ur study is to assess the effects of this agent on the normal bladder in vi vo. STUDY DESIGN: In this randomized, double-blind placebo-controlled trial, pa tients were randomized to receive either 20 mg cisapride or an identical pl acebo. They then underwent urodynamic evaluation that included uroflowmetry , multichannel filling cystometry, pressure-flow studies, and a urethral pr essure profile. After a washout period of at least 7 days, subjects were th en crossed over to the other arm and the tests were repeated. RESULTS: Twenty women without significant urinary incontinence agreed to pa rticipate. There was a decrease in the maximum cystometric capacity from 55 6 mL for placebo to 496 mL for cisapride (P < .001). There was no differenc e in the detrusor pressure at maximum flow, the maximum detrusor pressure, the flow rate, or the percentage of maximum cystometric capacity voided. CONCLUSIONS: In healthy women, cisapride caused a significant decrease in t he maximum cystometric capacity, which could account for the higher reporte d rates of urinary frequency and urgency with this medicine. There was no e vidence that this prokinetic agent improved voiding function.