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PubMed2003

Overactive bladder: improving the efficacy of anticholinergics by dose escalation.

Overactive bladder (OAB) affects millions of people in the United States and significantly impacts their quality of life. New antimuscarinic anticholinergic medications have improved the treatment of OAB, offering patients efficacy equal to that of immediate-release oxybutynin with fewer side effects and an improved dosing schedule. The commonly reported range of reduction of urge incontinence episodes is between 46% and 92%. Although patients are improving, continence rates are lower and many responders continue to leak significantly. The literature supports that the efficacy of anticholinergics is enhanced by dose escalation, but using higher dosages has not become routine in clinical practice. Although dose escalation can be implemented with all of the anticholinergics, it is done most easily and approved by the US Food and Drug Administration with extended-release oxybutynin. This paper critically evaluates the pros and cons of dose escalation in the hope to improve efficacy in patients with OAB.

Benzhydryl Compounds↗

PubMed2002

Geriatric considerations in the diagnosis and management of overactive bladder.

Numerous considerations affect the diagnosis and management of overactive bladder (OAB) in older patients, including neurologic and cardiovascular disorders, musculoskeletal conditions, diabetes, and psychiatric disorders. Older patients are commonly prescribed multiple medications, and many medications can contribute to OAB symptoms and/or interact with drug treatment for OAB. In addition to chronic illnesses and related medications, several factors outside the lower urinary tract can play an important part in managing OAB in older patients. These factors include mobility disorders, cognitive impairment, bowel habits, and fluid intake. Moreover, OAB often does not occur in isolation in the geriatric population. Estrogen deficiency and sphincter weakness in women, prostatic enlargement and obstruction in men, and impaired bladder contractility in both sexes are common and can have prominent effects on management. The diagnostic evaluation of geriatric patients with OAB can usually be accomplished with a basic assessment, without more invasive and expensive procedures. Treatment depends on numerous factors, ranging from comorbidities and functional status to transportation, finances, and patient and caregiver preferences. Adverse effects of bladder-relaxant medications can be bothersome and exacerbate existing conditions common in older patients (eg, constipation, glaucoma, gastroesophageal reflux, and dementia). Setting realistic goals for treatment and communicating them clearly to older patients and their caregivers are crucial for patient satisfaction. There are myriad opportunities for research designed to improve the management of OAB in the geriatric population.

Aged↗

PubMed2005

Overactive bladder in the elderly: a guide to pharmacological management.

Overactive bladder (OAB) is a common condition characterised by the symptoms of urinary frequency and urgency, with or without urge incontinence and nocturia. The prevalence of OAB increases markedly with age in both men and women. OAB can have a detrimental effect on physical functioning and psychological well-being, as well as significantly reducing quality of life. Antimuscarinic therapy -- with or without behavioural therapy -- represents the most common treatment for patients with OAB. Several antimuscarinic agents are currently available for the treatment of OAB in adults, including oxybutynin, tolterodine, trospium chloride, darifenacin and solifenacin. The antimuscarinics all appear to exert their clinical effect through inhibition of the bladder muscarinic receptors, but they vary both in structure and in their functional profile. While efficacy has been demonstrated in adult populations (including patients >65 years of age), few studies have been reported specifically in a geriatric population, and antimuscarinics are often underutilised in the elderly despite the marked increase in the prevalence of OAB in this age group. One explanation for this apparent underuse of an effective treatment option may be concerns about the frequency of anticholinergic adverse events, such as dry mouth; the likelihood of detrimental CNS effects, including cognitive impairment and sleep disturbances; and the potential for harmful interactions with existing pharmacotherapy. When selecting an antimuscarinic agent for the management of an elderly patient presenting with OAB, in addition to considering evidence of clinical efficacy and tolerability, issues of safety specific to an older population should be borne in mind. In particular, the likelihood of detrimental CNS effects should be considered, including cognitive impairment and sleep disturbances, secondary to anticholinergic load. Oxybutynin and tolterodine have both been associated with cognitive adverse events and effects on sleep architecture and quality. In contrast, trospium chloride and darifenacin do not appear to be associated with cognitive adverse events and trospium chloride does not negatively affect sleep architecture or quality. Biotransformation by the cytochrome P450 (CYP450) system is an important step in the activation or elimination of a large number of drugs, including oxybutynin, tolterodine, darifenacin and solifenacin, raising the possibility of clinically relevant and potentially serious drug interactions. In elderly patients, such interactions are of particular relevance given the potential for declining activity of certain members of the CYP450 family combined with decreased hepatic blood flow, which can reduce first-pass metabolism and thus the bioavailability of drugs metabolised via this route. Of the antimuscarinic agents used to treat OAB, only trospium chloride is not extensively metabolised in the liver by the CYP450 system and is excreted largely as the active parent compound in the urine. This paper provides an overview of the pathophysiology of OAB and reviews current approaches to achieving a differential diagnosis and selecting appropriate treatment for the older patient. The pharmacology and clinical effects of current medication for the treatment of OAB symptoms in patients defined by the OAB pharmacology literature as 'elderly' are also reviewed.

Aged↗

PubMed2004

Drug treatment of overactive bladder: efficacy, cost and quality-of-life considerations.

Overactive bladder (OAB) syndrome has been recognised by the International Continence Society as an important symptom syndrome that affects millions of people worldwide. Quality of life is affected in most people with OAB; however, the aetiology is unknown. Some researchers suggest that it is because of a damage to central inhibitory pathways or sensitisation of peripheral afferent terminals in the bladder, others suggest that it is a bladder muscle problem; the reality is probably a spectrum encompassing these two main explanations. Therefore, treatment is difficult and is aimed at alleviating symptoms (being those of urgency, with or without urge incontinence, usually with frequency and nocturia) rather than treating the cause. A thorough patient history and physical examination are required to establish a possible diagnosis. Frequency/volume charts form an important aid to the diagnosis. Once a presumptive diagnosis is made, conservative management forms the first line of treatment and includes lifestyle modifications, bladder training and pelvic floor exercises. If this fails, pharmacotherapy, in the form of anticholinergic drugs, is initiated. There are many antimuscarinic drugs, for example oxybutynin, tolterodine and trospium chloride. Each has a different specificity to bladder muscarinic receptors, thus producing different adverse effect profiles (e.g. dry mouth, blurred vision and constipation). Different individuals experience these adverse effects to different extents. New anticholinergic drugs, that have undergone phase III trials and are more specific to the muscarinic M3 human bladder receptor, are being introduced to the market in 2004 (e.g. solifenacin succinate and darifenacin). In addition to adverse effect profile, cost and improvement in quality of life are important factors in choosing treatment. Further research is being conducted on other types of drugs and different administration modalities, for example intravesical botulinum toxin A. Sacral nerve neuromodulation is emerging as a potential treatment, but if all treatments fail then surgery is the last resort.

Cost-Benefit Analysis↗

PubMed2002

Contribution of cerebral nitric oxide to bladder overactivity after cerebral infarction in rats.

PURPOSE: We investigated the contribution of cerebral nitric oxide to neurogenic voiding dysfunction after cerebral infarction. MATERIALS AND METHODS: The left mid cerebral artery in female Sprague-Dawley rats was occluded with 4-zero monofilament nylon thread. Bladder activity was monitored during infusion cystometrography. Time or dose dependent effects of intracerebral ventricular administration of the nonselective nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME), were investigated in conscious, sham operated and cerebral infarcted rats. The selective neuronal nitric oxide synthase inhibitor 1-(2-trifluoromethylphenyl) imidazole was also administered to determine the participation of nitric oxide synthase subtypes. Cross-sectional infarct area was measured and infarct volume was calculated 12 hours after mid cerebral artery occlusion. RESULTS: Bladder capacity was reduced by 54% 30 minutes after mid cerebral artery occlusion. L-NAME significantly increased bladder capacity in a dose and time dependent manner in cerebral infarcted rats but had no effect on sham operated rats. L-NAME (50 microg./kg.) administered 3 or 5 hours after occlusion significantly increased bladder capacity. This effect of L-NAME was reversed by injecting 250 microg. L-arginine per rat, which alone did not produce any significant change in bladder capacity in cerebral infarcted rats. Administration of 1-(2-trifluoromethylphenyl) imidazole also significantly increased bladder capacity in these rats. On the other hand, 5 microg. of the nitric oxide donor FK-409 per rat reduced bladder capacity for 10 to 15 minutes. None of the drugs affected infarct volume. CONCLUSIONS: These results indicate that supraspinal nitric oxide has an important role in bladder overactivity after cerebral infarction but it does not affect normal micturition in rats. This finding suggests a central mechanism sensitive to nitric oxide for bladder overactivity after cerebral infarction.

Animals↗

PubMed2006

[The overactive bladder during childhood: when and how should it be treated?].

Enuresis is one of the most frequent urinary symptoms in children. 80% suffer from primary enuresis nocturna. 20% have urinary incontinence with additional symptoms of frequency, urgency and daytime incontinence, which is also defined in children as overactive bladder in absence of urinary tract infections, neurological, anatomical or further local pathology (OAB in childhood). The underlying pathophysiology is a maturation arrest of the bladder control resulting in detrusor hyperactivity. In most of the cases the differentiation between enuresis and OAB is easily possible with non-invasive primary diagnostic procedures. Invasive diagnostic tools like video urodynamic studies may become necessary when first-line therapy fails. The treatment options comprise bladder training with timed voiding and drink protocols (urotherapy) as well as pharmacologic relaxation of detrusor instability by anticholinergic drugs.

Child↗

PubMed2003

Treatment of overactive bladder with botulinum toxin type B: a pilot study.

The purpose of this study was to determine the efficacy and safety of botulinum toxin type B (BTX-B/Myobloc) in the treatment of patients with overactive bladder. This open-label dose-escalation study enrolled 15 female patients with urinary frequency with or without incontinence. The BTX-B doses used in this study were 2500, 3750, 5000, 10 000 and 15 000 units. Response was defined as a subjective improvement in frequency, urgency and incontinence symptoms. A paired t-test of the pre/post frequency difference indicates that these 15 patients experienced an average of 5.27 fewer frequency episodes per day after treatment with BTX-B. The p value for the paired t-test was <0.001. The longest duration effect was 3 months using 10 000-15 000 units of BTX-B. The correlation between dose and duration was very significant, with a correlation coefficient = 0.96, p<0.001. Based on these findings, we feel the use of botulinum toxin to treat patients with overactive bladder warrants further study.

Aged↗

PubMed2002

Prevalence of overactive bladder and urinary incontinence.

We conducted a cross-sectional study in Italy among men at least 50 years old and women at least 40 years old who consecutively visited their general practitioners. Patients were asked about the frequency of symptoms of overactive bladder and urinary incontinence. A total of 9613 men (mean age, 64.8 years; range, 50-98 years) and 13,365 women (mean age, 60.3 years; range, 40-98 years) were identified by 774 general practitioners. The frequencies of overactive bladder were 3.0% (95% confidence interval, 2.7-3.5) in men and 1.1% (95% confidence interval, 0.9-1.3) in women. The corresponding frequencies for urinary incontinence were 8.3% (95% confidence interval, 7.7-8.9) in men and 10.2% (95% confidence interval, 9.6-10.8) in women.

Adult↗

PubMed2000

Effects of aniracetam on bladder overactivity in rats with cerebral infarction.

Aniracetam has been used to improve the mental condition of patients with cerebrovascular disease. Previous studies have demonstrated that aniracetam activates the residual functions of cholinergic neurons in damaged brain areas. In this study, the effects of aniracetam on bladder overactivity after left middle cerebral artery occlusion were assessed through oral or i.c.v. administration in sham-operated and cerebral infarcted rats. Oral administration of aniracetam (100 and 300 mg/kg) resulted in a significant and dose-dependent increase in bladder capacity in cerebral infarcted rats but had no effect on bladder capacity in sham-operated rats. Intracerebroventricular administration of aniracetam (0.25 and 2.5 microg/rat) resulted in a significant and dose-dependent increase in bladder capacity in cerebral infarcted rats but not in sham-operated rats. Aniracetam had no significant effect on bladder contraction pressure or micturition threshold pressure in either sham-operated or cerebral infarcted rats. Furthermore, i.c.v. administration of atropine (1 microg/rat), a muscarinic acetylcholine receptor antagonist, completely inhibited the enhancing effects of aniracetam on bladder capacity in cerebral infarcted rats. The effects of aniracetam on bladder overactivity are thought to be mediated in part by activation of cholinergic inhibitory mechanisms in the brain. These results indicate that aniracetam may improve the neurogenic voiding dysfunction observed in patients with cerebrovascular disease.

Animals↗

PubMed2003

The efficacy of Thai capsaicin in management of overactive bladder and hypersensitive bladder.

This paper has been generated to provide information on the effectiveness of capsaicin treatment among patients with overactive or hypersensitive bladder. The evaluation process required approximately 14 (overactive bladder) and 11 (hypersensitive bladder and primary detrusor instability) participants who received capsaicin intravesically. The solution consisted of capsaicin (concentration = 1 mM/L) diluted in 30 per cent ethanol solution 100 ml. All participants went through at least 1 urodynamic test 1 month before and after receiving capsaicin intravesical instillation. The capsaicin treatment for overactive and hypersensitive bladders was very effective. On the average, (overactive bladder) participants' voiding needs decreased from 16.5 +/- 4.8 times/day to 8.6 +/- 2.5 times/day, leakage from 9.7 +/- 8.1 times/day to 2.4 +/- 4.3 times/day, bladder capacity from 160.1 +/- 123.3 ml to 236.9 +/- 146.1 ml, and detrusor contraction from 71.1 +/- 29.2 cm/H2O to 57.3 +/- 27.2 cm/H2O. On average, (hypersensitive bladder and primary detrusor instability) participants' voiding needs decreased from (Day time) 19.45 +/- 17.99 times to 12.00 +/- 8.91 times/day, (Night time) 7.09 +/- 6.03 times to 4.09 +/- 3.8 times, bladder capacity from 197.40 +/- 156.06 ml to 323.45 +/- 129.46 ml, and detrusor contraction from 32.64 +/- 22.77 cm/H2O to 36.64 +/- 19.22 cm/H2O. Capsaicin efficiency was rated very high for both overactive and hypersensitive bladder and primary detrusor instability. In Thailand, it has been possible to produce capsaicin using local chili supplies, thus the price of the drug itself is very economical. When considering the efficiency and the inexpensive cost of capsaicin, this treatment would be another great alternative for overactive and hypersensitive bladder cure.

Administration, Intravesical↗

PubMed2001

Tolterodine once-daily: superior efficacy and tolerability in the treatment of the overactive bladder.

OBJECTIVES: To evaluate the efficacy and tolerability of a new extended-release (ER), once-daily, capsule formulation of tolterodine, relative to placebo and the existing immediate-release (IR), twice-daily, tablet formulation, for treatment of the overactive bladder. METHODS: This was a double-blind, multicenter, randomized, placebo-controlled trial. One thousand five hundred twenty-nine patients (81% women) with urinary frequency (eight or more micturitions every 24 hours) and urge incontinence (five or more episodes per week) were randomized to oral therapy with tolterodine ER 4 mg once daily (n = 507), tolterodine IR 2 mg twice daily (n = 514), or placebo (n = 508) for 12 weeks. Efficacy was assessed at the end of the treatment period on the basis of the micturition diary variables. Tolerability and safety were assessed by evaluating the adverse events, electrocardiogram parameters, laboratory values, and treatment withdrawals. RESULTS: Tolterodine ER 4 mg once daily (P = 0.0001) and tolterodine IR 2 mg twice daily (P = 0.0005) both significantly reduced the mean number of urge incontinence episodes per week compared with placebo. The median reduction in these episodes as a percentage of the baseline values was 71% for tolterodine ER, 60% for tolterodine IR, and 33% for placebo. The ER formulation was 18% more effective than the IR formulation (P <0.05). Treatment with both formulations of tolterodine was also associated with statistically significant improvements in all other micturition diary variables compared with placebo. For both formulations, the mean decreases in micturition frequency (P <0.0079) and pad usage (P <0.0145) were significant, and the mean volume voided per micturition increased (P = 0.0001). The rate of dry mouth (of any severity) was 23% for tolterodine ER, 30% for tolterodine IR, and 8% for placebo. The overall dry mouth rate for patients taking tolterodine ER was 23% lower than for tolterodine IR (P <0.02), and the rate of severe dry mouth in the ER group was only 1.8%. The rates of withdrawal were comparable for the two active groups and the placebo group. No safety concerns were noted. CONCLUSIONS: Tolterodine ER 4 mg once daily is effective and well tolerated in the treatment of overactive bladder with no safety concerns. Tolterodine ER demonstrated an improved efficacy for reducing urge incontinence episodes and a lower frequency of dry mouth compared with the existing IR twice-daily formulation.

Administration, Oral↗

PubMed2003

Bladder overactivity in mice after 1 week of outlet obstruction. Mainly afferent dysfunction?

PURPOSE: Partial bladder outlet obstruction (BOO) is an established way to create bladder overactivity in animals. However, the micturition pattern achieved can vary considerably. We investigated the correlation between different micturition patterns, post-void residual urine, bladder capacity, bladder weight and in vitro contractility in a conscious mouse model of BOO. MATERIALS AND METHODS: Female MNRI mice with moderate (urethral) outlet obstruction were used. After 7 days of BOO cystometry without anesthesia was performed with the animal in a metabolic cage. Results were compared with those in unoperated controls and sham operated animals. In vitro contractility studies were performed. RESULTS: The majority of obstructed animals had an overactive voiding pattern with increased nonvoiding detrusor activity and without increased bladder weight. The remaining obstructed animals had significantly increased bladder weight and normal micturition volume but increased threshold pressure, bladder capacity and post-void residual urine. Subtle in vitro differences were found among the groups. CONCLUSIONS: The urodynamic characteristics of BOO mice correlate with bladder weight. However, detrusor overactivity in obstructed mice may develop without an increase in bladder weight and with only subtle changes in smooth muscle function, as investigated in vitro. This observation suggests that major disturbances caused by BOO may lie in the afferent arm of the signaling pathway.

Animals↗

PubMed2005

Long-term safety, tolerability and efficacy of extended-release tolterodine in the treatment of overactive bladder in Japanese patients.

AIM: To evaluate the long-term safety, tolerability and efficacy of extended-release (ER) tolterodine in Japanese patients completing 12-week treatment in a randomized, double-blind trial comparing tolterodine ER 4 mg once daily, oxybutynin 3 mg three times daily or placebo in patients with overactive bladder. METHODS: Of 293 Japanese patients completing the 12-week study, 188 continued in the open-label trial and received tolterodine ER 4 mg once daily for 12 months, irrespective of previous treatment. The primary objective was to assess the safety of tolterodine ER for up to 52 weeks of treatment and at post-treatment follow-up. Secondary endpoints included changes in micturition diary variables, patient perception of bladder condition and urgency and treatment benefit. RESULTS: Overall, 77% of patients completed 12 months of open-label treatment. Tolterodine ER was well tolerated and the most common adverse event was dry mouth (33.5%). In general, there was no increase in adverse event frequency with long-term treatment compared with short-term treatment. The efficacy of tolterodine ER was maintained over the 12-month period. The complete analysis showed a median reduction in incontinence episodes/week (-92.9%; mean reduction, -77.2%), a mean reduction in micturitions/24 h (-21.3%) and a mean increase in volume voided per micturition (19.6%). Of patients completing the 12-month study, 78.6% reported improvement in patient perception of bladder condition, 52.4% reported improvement in perception of urgency and 89.7% reported treatment benefit. CONCLUSIONS: Favorable safety, tolerability and efficacy of once-daily tolterodine ER was maintained over 12 months in a Japanese overactive bladder patient population.

Adult↗

PubMed2004

Increased nerve growth factor expression triggers bladder overactivity.

UNLABELLED: Prior studies have demonstrated an association between visceral inflammation, an increase in nerve growth factor (NGF) expression, and development of hyperalgesia. Because multiple mediators are released during inflammatory processes, we examined the effect of NGF alone using viral gene transfer in vivo. Replication-deficient adenoviral vectors encoding for NGF or beta-galactosidase were injected into the bladder wall. NGF levels were determined with an enzyme-linked immunoabsorbance assay. Cystometrograms were obtained 3 and 5 days after gene transfer by using a surgically implanted bladder catheter in awake male rats. Although the treatment with a control virus did not change NGF levels compared with those of naive animals, the vector encoding for NGF increased NGF protein levels in the bladder 4-fold. Histologically, no evidence of inflammation was noted. Expression of NGF led to bladder overactivity, whereas beta-galactosidase expression was without effect. These data demonstrate that a transient increase in NGF expression without associated inflammation sensitizes visceral reflex pathways, leading to bladder overactivity. Treatment strategies targeting NGF signaling might be useful in disorders involving sensitization of peripheral nerves. PERSPECTIVE: Growth factors have been implicated in the pathogenesis of inflammatory pain. This study uses gene transfer to demonstrate that NGF sensitizes afferent pathways in the absence of inflammation, making it a potentially relevant treatment target.

Animals↗

PubMed2003

CNS involvement in overactive bladder: pathophysiology and opportunities for pharmacological intervention.

The pathophysiology of overactive bladder (OAB) syndrome is complex, and involves both peripheral and CNS factors. Several CNS disorders are associated with OAB, e.g. stroke, spinal cord injury, Parkinson's disease and multiple sclerosis, and in each disorder the pathophysiology of OAB can be multifactorial. Irrespective of cause or pathophysiology of OAB, antimuscarinic drugs are the first line of pharmacological treatment. However, adverse effects and limited efficacy makes alternative therapeutic principles desirable. Most alternative drugs used for the treatment of OAB have a peripheral site of action, mainly affecting efferent or afferent neurotransmission or the detrusor muscle itself. New targets for pharmacological intervention may be found in the CNS. Several CNS transmitters/transmitter systems are known to be involved in micturition control, but few drugs with a defined CNS site of action (e.g. baclofen, imipramine and duloxetine) have been used for the treatment of voiding disorders. GABA, glutamate, opioid, serotonin, noradrenaline (norepinephrine), and dopamine receptors and mechanisms are known to influence micturition, and drugs influencing these systems could potentially be developed for the treatment of OAB. Preclinical studies in different animal models have shown that modulation of normal micturition and detrusor overactivity by drugs acting within the spinal cord or supraspinally is possible. Promising results have been obtained in such models, e.g. with drugs interfering with GABA mechanisms, serotonin 5-HT1A receptors, mu-opioid receptors and alpha-adrenoreceptors. However, considering the limited predictability of existing animal models for efficacy in humans, positive proof of concept studies in humans are mandatory. Such studies are scarce and further investigations are needed.

Animals↗

PubMed2005

Analysis of heart rate variability in female patients with overactive bladder.

OBJECTIVES: To characterize autonomic dysfunctions in patients with an overactive bladder (OAB), we compared their heart rate variability (HRV) with the HRV of a normal population. METHODS: Electrocardiographic signals were obtained from 40 female patients (mean age 46.4 +/- 12.1 years) and 131 healthy female controls (mean age 45.6 +/- 7.24 years) in a resting state. RESULTS: The time domain analysis of the electrocardiographic signals for patients with OAB, including the standard deviation of the N-N interval and the square root of the mean squared differences of successive N-N intervals, revealed significantly lower values than those of the controls (P <0.05). Evidence was found of decreased total power, very low frequency, and high frequency signals in patients with OAB (P <0.05), but no significant differences were found in other parameters such as low frequency or the low frequency/high frequency ratio. CONCLUSIONS: Patients with OAB exhibited different HRV parameters compared with normal controls. With the exception of low frequency and the low frequency/high frequency ratio, all HRV parameters in patients with OAB were lower than those in normal controls. These decreased values indicate that they may have some kind of disease or imbalance in the autonomic nervous system. Thus, a study of HRV may serve as a tool to evaluate altered autonomic nervous system activity in such patients.

Electrocardiography↗

PubMed2001

Coping strategies and health care-seeking behavior in a US national sample of adults with symptoms suggestive of overactive bladder.

BACKGROUND: Although millions of individuals have symptoms suggestive of overactive bladder (OAB), few ever seek or receive medical treatment for their condition. OBJECTIVE: The purpose of this study was to describe coping strategies and health care-seeking behavior in a community-based sample of adults with symptoms suggestive of OAB. METHODS: A cross-sectional household telephone survey of an age- and sex-stratified sample of adults was conducted. The survey consisted of general health-related questions as well as questions related to OAB symptoms. A total of 4896 adults completed the interview Respondents were considered to have OAB if they reported > or = 1 symptom of urinary urgency, frequency, or urge incontinence. A follow-up questionnaire was then mailed to a subsample of the telephone interview respondents. The mailed questionnaire contained questions related to type and severity of OAB symptoms, coping strategies, medical care/treatment, feelings/beliefs about OAB, and quality of life. Half of the phone respondents with urinary incontinence (n = 638) and a random sample of all other phone respondents received the mailed questionnaire (n = 873); 1,034 questionnaires were returned. RESULTS: Of the respondents with OAB, 69.6% tried > or = 1 nonmedical coping strategy. Respondents with incontinent OAB were significantly more likely than those with continent OAB or those with no OAB (controls) to use nonmedical coping strategies (incontinent OAB, 76.1%; continent OAB, 59.0%; controls, 31.9%; P < 0.001). Fewer than half of the respondents with OAB (43.5%) had spoken with a provider about OAB in the previous 12 months. Medical consultation was associated with sex, type and severity of OAB, number of nonmedical coping strategies tried, number of OAB information sources consulted, inclination to try new OAB medications, and feelings/beliefs about OAB. In 90% of patient-provider discussions about OAB, the patient initiated the topic. CONCLUSIONS: Individuals manage symptoms suggestive of OAB primarily by using nonmedical coping strategies rather than consulting health care providers. Results of this study support the need for improved clinical recognition of OAB and increased patient-provider communication about this condition.

Adaptation, Psychological↗

PubMed2005

Is it possible to make cross-study comparisons of urinary continence rates in patients with overactive bladder?

Several antimuscarinic agents are available for the treatment of overactive bladder but there are few head-to-head studies to guide physicians in choosing one over another. Here we propose ways in which logical adjustments can be made to account for differences in disease severity and placebo effects when considering continence data to allow estimation of relative effectiveness across studies.

Cholinergic Agents↗