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PubMed2006

The placebo effect in the pharmacologic treatment of patients with lower urinary tract symptoms.

OBJECTIVES: We reviewed placebo responses in randomised controlled trials (RCTs) for pharmacologic treatment of lower urinary tract symptoms (LUTS), including urinary incontinence (UI), overactive bladder, and benign prostatic hyperplasia. Review papers on placebo effects in non-urologic disorders were assessed to compare the magnitude of placebo responses in drugs for LUTS with those reported for other diseases. METHODS: Data were retrieved from registration trials for LUTS drugs on the Web sites of the Food and Drugs Administration and the European Medicines Agency. Reviews were retrieved from Medline using the MeSH term "placebo effect" (English language; published between 1990 and 2005). RESULTS: Placebo treatment of LUTS yields reductions in incontinence episodes (IEs) ranging from 32% to 65%, whereas prostate or UI symptom scores are reduced by 9-34%. Genuine drugs decrease IEs by 45-77% and symptom scores by 22-45%. Placebo responses are much lower when objective changes in voided volume or peak flow rate are assessed. CONCLUSIONS: The placebo effect in LUTS has a strong behavioural component as patients become aware of their voiding habits and potential risk factors. Symptom severity, treatment naivety, study duration, and interaction with health care providers may also influence it. Proper patient selection, study duration, and objective and subjective outcome measures may better separate genuine treatment effects from artefacts. Observational studies with patients representative for real-life situations and covering a sufficient period of time could allow for better understanding of RCT results and their applicability in clinical practice.

Adrenergic Antagonists↗

PubMed2006

Darifenacin: Pharmacology and clinical usage.

Darifenacin is one of several recently approved antimuscarinics for the treatment of overactive bladder (OAB) and urge urinary incontinence. Darifenacin is an effective drug for the treatment of OAB and is tolerated by patients. Darifenacin's M3 selectivity is unique among antimuscarinics. This M3 selectivity could confer advantages in patients who have cardiovascular side effects (tachycardia), impaired cognition, complaints of dizziness, or sleep disturbances. In some studies, darifenacin caused less dry mouth than oxybutynin. Rates of constipation, although significant, are tolerated and rarely a cause for discontinuation in clinical trials. This review describes the role of M3 receptors and covers the mechanism of action, pharmacokinetic properties, clinical efficacy safety and tolerability, drug interactions, and dosing guidelines for darifenacin.

Benzofurans↗

PubMedDate not supplied

[Lower urinary tract symptoms in women and impact on quality of life. Results of the application of the King's Health Questionnaire].

BACKGROUND: The self-assessment of quality of life (QoL) of women with urinary symptoms may help in selecting the best treatment in each case. METHOD: Epidemiologic, observational, cross-sectional and multicentric study of 674 women who underwent to a gynecology unit with symptoms suggesting Overactive Bladder, with or without urinary incontinence (UI). All women fill out the King's Health Questionnaire. Sociodemographic data and a complete register of urinary symptoms and the degree of afectation which caused, were also collected. RESULTS: Most frequent symptoms were "frequency" (612 women-90.8%), followed by "urgency" (562-83.4%), "nocturia" (543-80.6%) and "stres UI" (535-79.4%). Symptoms of "frecuency", "nocturia", "urgency" and "urgency UI" were more frequent in women aged 65 or under 65 years and that of "stress UI", in women over 65 years (79.8% vs 77.9%). 210 women did not fill out all the KHQ dimensions, mainly "Personal Limitations", "Personal Relationship", "Social limitations" and "Incontinence Impact". Global KHQ score was38.3 (SD=19.2). Higher scores (worse QoL) corresponded to "Incontinence Impact", "Severity Measures", "Personal Limitations" and "Role Limitations". Variables associated to global KHQ score were (multiple linear regression): age, BMI, urgency UI, UI in sexual intercourse, frequent urinary infections. CONCLUSIONS: QoL impact in women with urinary symptoms is important. The symptoms with higher association with QoL are: UI in sexual intercourse, urgency UI and frequent urinary infections.

Adult↗

PubMed2006

Patients' experience with ambulatory urodynamics. A prospective study.

OBJECTIVE: To assess emotional variables in patients who underwent ambulatory urodynamic monitoring (AUM). MATERIAL AND METHODS: A total of 33 females and 7 males aged 23-72 years with an overactive bladder who had undergone three consecutive AUM sessions were included in the study on a prospective basis. Patients completed a self-administered questionnaire before and immediately after each procedure. Answers were given using a visual analog scale. RESULTS: The pre-procedural level of anxiety did not differ significantly with respect to sex, age, education level or income. The degree of bother experienced by patients aged > or = 50 years was higher than for those aged < 50 years: 5 vs 2.5 (p = 0.030). As income increased, the degrees of pain (p = 0.016), bother (p = 0.013) and boredom (p = 0.010) decreased. Other emotional aspects did not differ significantly according to age or income (p > 0.05). Only the subjective bother score influenced the examiner-rated degree of intolerance during AUM (p = 0.007). A total of 34 patients (85.0%) indicated that they would be willing to return for a further session of AUM. The degree of intolerance decreased at the second (p = 0.006) and third (p = 0.049) AUM sessions, whereas other parameters were not significantly different. CONCLUSION: Our results demonstrate that AUM is acceptable and well tolerated by patients with bladder dysfunction.

Adult↗

PubMed2006

Medium-term experience of sacral neuromodulation by tined lead implantation.

OBJECTIVE: To describe patient selection for sacral neuromodulation, also known as Interstim therapy, and the results of tined-lead implantation in the medium term. PATIENTS AND METHODS: In all, 49 patients, 39 with refractory overactive bladder symptoms and 10 with urinary retention, were implanted with the tined lead under local anaesthesia. The mean (sd) test period was 12.4 (5.8) days. Patients were implanted when they had a > or = 50% improvement in voiding diary variables during the test period. The mean follow-up for implanted patients was 15.5 (7.9) months. Changes in voiding variables were compared using a t-test. RESULTS: Ten patients had a one-stage and 39 a two-stage implant; of the latter group, 31 (80%) had a positive response and eight (21%) did not. In all, 31 patients were included in the follow-up. At the last follow-up, 28 (90%) patients had a >50% improvement in diary variables and three (10%) did not. In 21 patients with urgency symptoms the mean (sd) number of voids decreased from 11.7 (8.9)/day at baseline to 7.3 (3.4)/day (P = 0.1); the voided volume increased from 160.2 (70.7) mL to 231.1 (119.5) mL (P = 0.001); and the number of leakages decreased from 9.5 (8.7) to 3.3 (2.2)/day (P = 0.17). In the 10 patients with retention, the number of catheterizations decreased from 5.44 (1.6)/day with a volume of 297.6 (76.8) mL, to 1.2 (1.7)/day and 111.6 (158.1) mL; the mean number of voids increased from 3.7 (3.8)/day with a volume of 123.3 (141.7) mL, to 4.2 (2.4)/day and 248.3 (146.0)mL. There were no significant differences in the variables in the patients with retention. Seven patients had an adverse event. There was one incomplete electrode migration that was treated conservatively. CONCLUSION: This new minimally invasive approach gives positive results in the medium term. Two-stage testing with the tined lead seems more reliable than the classic percutaneous nerve evaluation. The lead anchoring method seems sufficient for fixing the electrode in the medium term.

Adolescent↗

PubMed2006

The emerging role of intravesical botulinum toxin therapy in idiopathic detrusor overactivity.

Recently there has been considerable original research into the use of the botulinum neurotoxins in idiopathic detrusor overactivity (DO). This common condition underlies the overactive bladder syndrome in a significant proportion of cases and was previously known as idiopathic detrusor instability. Failure of initial pharmacotherapy in this condition leaves few effective conservative/medical treatment options. Early reports of botulinum toxin (BoNT) therapy have been extremely promising, and the therapy appears to bridge the gap in such patients, before resorting to invasive surgical procedures. Approximately 30 studies have been reported often with widely differing techniques and some clinicians are beginning to administer BoNT for this unlicensed indication. This has led to the urgent need to critically review all available evidence to assess efficacy, safety and technique. In addition to performing a systematic Medline review, all abstracts presented to urological, urogynaecological and incontinence meetings that reported BoNT usage in idiopathic DO were analysed. Remarkable efficacy has been demonstrated in the vast majority of reported series and the treatment has also been used safely in paediatric and elderly populations. Side effects in all populations appear to be minimal and short lived. However, all the series are small and there remains a considerable number of fundamental questions to be answered. Hopefully large-scale robust randomised controlled trials will provide the necessary answers to facilitate the widespread adoption of this technique. Until then caution must be exercised in this unlicensed indication.

Aged↗

PubMed2003

[Initial results of Stoller peripheral neuromodulation in disorders of bladder function].

PURPOSE: The Stoller peripheral neurostimulation (SANS) is a new therapeutic procedure for bladder dysfunction. MATERIAL AND METHODS: Each of 11 patients (8 women, 3 men) underwent 12 SANS treatment sessions. INDICATIONS: overactive bladder (5 patients), chronic nonobstructive urinary retention (3 patients) and pelvic pain (3 patients). Median follow-up was 3 months. RESULTS: In 2 overactive bladder patients, the number of voids was reduced by at least 50%. In one patient with chronic retention, residual urine was temporarily decreased to <100 cc. 2 pelvic pain patients reported a slight improvement. In summary, 50% of the patients demonstrated a temporary response. Only 2 overactive bladder patients reported a permanent objective and subjective improvement. No complications were observed. CONCLUSION: As the success rate was low and the procedure is time-consuming, we recommend the SANS procedure only in selected cases. We perform SANS treatment only in patients with overactive bladder refractory to conservative treatment. Prerequisites for a successful treatment is a high patient motivation.

Adult↗

PubMed2005

Do women with urinary incontinence really know where all the toilets are? The toilet paper.

AIMS OF STUDY: Aim of this study was to determine if women with overactive bladder really do have a more detailed knowledge about toilets and their conditions in their vicinity in comparison to women with urinary stress incontinence and those without any urinary symptoms. PATIENTS AND METHODS: A questionnaire survey of 270 women from three symptom groups, those with stress incontinence, overactive bladder and controls without any bladder symptoms from an inner city area and two local towns. The knowledge of the three groups was compared and measured by a score assessed by the authors who had visited the toilets themselves. RESULTS: Women with overactive bladder are more likely to exhibit precautionary voiding prior to leaving home and have significantly more detailed knowledge about toilets in their neighbourhood. DISCUSSION: The overactive bladder seems to have a greater influence on behaviour and on quality of life than stress incontinence which could mean that they are more tortured by their symptoms.

Adult↗

PubMed2026

Efficacy of a multimodal conservative rehabilitation program for bladder control in individuals with incomplete spinal cord injury: A randomized controlled trial.

ObjectiveThe study aimed to evaluate the efficacy of a multimodal intervention on urodynamic outcomes, urinary incontinence severity, and pelvic floor muscle strength in individuals with overactive bladder after incomplete spinal cord injury.MethodsA single-blind randomized controlled trial was conducted on 74 male participants diagnosed with overactive bladder and incomplete spinal cord injury. Participants were randomly assigned to an experimental group or a control group. Treatment was conducted for 8 weeks, three sessions per week. Outcomes were assessed at baseline, post-intervention, and the 8-week follow-up.ResultsThe experimental group showed significantly greater improvements in the measured outcomes compared with the control group (P < 0.001).ConclusionIncorporating a multimodal regimen demonstrated significant efficacy in enhancing bladder capacity, continence, and muscle function in individuals with overactive bladder due to incomplete spinal cord injury.Clinical trial registry (ID: NCT07008157).https://clinicaltrials.gov/study/NCT07008157?cond=Spinal%20Cord%20Injuries&intr=Multimodal%20Rehabilitation%20Program&viewType=Card&rank=1.

Humans↗

PubMed2000

Bladder cooling reflex in patients with multiple sclerosis.

PURPOSE: We describe the effect of intravesical ice water instillation in patients with multiple sclerosis and without an overactive bladder. MATERIALS AND METHODS: Of 131 consecutive patients with multiple sclerosis who presented with a urinary disorder we selected for study 10 men and 29 women with a mean age plus or minus standard deviation of 50 +/- 9 years who had multiple sclerosis without an overactive bladder. Nonoveractive bladder was defined as no involuntary detrusor contraction up to 400 ml. of maximum fill on routine cystometry. We performed cystometry with saline at 25 to 30C at an infusion rate of 50 and 100 ml. per minute, and with ice water at 0 to 4C at a rate of 100 ml. per minute. Ice water cystometry was considered positive when an involuntary detrusor contraction occurred before 200, and between 200 and 400 ml. of filling. Ice water cystometry was considered negative when there was no involuntary detrusor contraction during ice water filling up to 400 ml. RESULTS: Ice water cystometry enabled us to elicit involuntary detrusor contractions in 21 patients, which remained undetected by warm water cystometry at rates of 50 and 100 ml. per minute. The test was positive before 200, and between 200 and 400 ml. in 10 and 11 cases, respectively. Positive ice water cystometry was significantly associated with irritative signs or significant post-void residual urine volume. CONCLUSIONS: An involuntary detrusor contraction was not elicited by cystometry at 50 or 100 ml. per minute, implying that the afferent mechanoreceptor reflex limb via ADelta fibers is not involved. In contrast, ice water cystometry at 100 ml. per minute elicited an involuntary detrusor contraction, suggesting involvement of an afferent reflex limb via capsaicin sensitive C fibers. These involuntary detrusor contractions revealed by ice water cystometry are probably relevant to an overactive bladder. In urinary disorders such a positive test indicates a spinal lesion. In multiple sclerosis it may have pathophysiological value, indicating a spinal rather than cerebral mechanism of overactive bladder, and diagnostic value, indicating multifocal demyelination.

Cold Temperature↗

PubMed2006

Participation of endogenous endothelin and ETA receptor in premicturition contractions in rats with bladder outlet obstruction.

A relationship between endogenous endothelins and bladder overactivity has recently been suggested, but the related endothelin receptor subtype has not been identified. Here, to evaluate the involvement of endothelin-1 and its receptors in bladder overactivity, we investigated endothelin-1 levels and the expression of its receptors in the bladder of rats with bladder outlet obstruction (BOO), a model for bladder overactivity. We also investigated the effects of a selective endothelin ET(A) receptor antagonist, (E)-N-[6-methoxy-5-(2-methoxyphenoxy)[2,2'-bipyrimidin]-4-yl]-2-phenylethenesulfonamide monopotassium salt (YM598), on bladder functions in conscious BOO rats. Partial obstruction of the urethra led to a progressive increase in bladder weight from weeks 1 to 6. Binding assays performed using plasma membranes prepared from these bladders to estimate endothelin receptor density from the maximum [(125)I]endothelin-1 binding showed increased endothelin receptor density (about double) at 1, 2, and 6 weeks after the operation in the BOO bladder. The densities of endothelin ET(A) receptors in the bladder of sham-operated and BOO rats at 2 weeks after operation were about 3.5 and 5 times those of endothelin ET(B) receptors respectively. Furthermore, the endothelin-1 level was also increased in the BOO bladder. Two weeks after operation, BOO rats showed an increase in maximum bladder capacity and micturition volume and the generation of premicturition contractions. The frequency of premicturition contractions was dose-dependently reduced by YM598 (0.1-3 mg/kg, i.v.) without any effect on other voiding parameters in BOO rats. These data suggest that endothelin-1 and endothelin ET(A) receptors might be involved in the generation of premicturition contractions in BOO rats, and that endothelin ET(A) receptor antagonists such as YM598 may have ameliorating effects in patients with bladder overactivity associated with BOO.

Animals↗

PubMed2006

Effects of goshajinkigan (niu-che-sen-qi-wan) for resiniferatoxin-sensitive afferents on detrusor overactivity induced by acetic acid in conscious rats.

This study was performed to investigate the effects of goshajinkigan, a traditional Chinese herbal mixture, in conscious rats undergoing continuous cystometry. Systemic resiniferatoxin (RTX) pretreatment can block resiniferatoxin-sensitive (C-fiber) nerve-mediated bladder overactivity, such as that induced by intravesical administration of acetic acid. The effects of pretreatment with goshajinkigan and RTX alone or in combination on acetic acid-induced bladder overactivity in conscious rats were also compared. Female SD rats were divided into four groups. Groups 1 and 3 received normal food for 4 weeks, while groups 2 and 4 received goshajinkigan (0.09 g/kg/day) during the same period. Two days after bladder catheterization, groups 3 and 4 received RTX (0.3 mg/kg) injection, while groups 1 and 2 received vehicle alone. Cystometric investigations were performed on all animals 24 hours after RTX or vehicle injection. The effects of intravesical instillation of acetic acid (pH = 4.0) were compared with those of intravesical saline. Goshajinkigan significantly increased threshold pressure, voiding interval, micturition volume, and bladder capacity. Intravesical instillation of acetic acid induced bladder overactivity in both normal rats and in those pretreated with goshajinkigan. However, the effects of acetic acid on voiding interval and micturition volume were significantly different between rats given normal diet and those pretreated with goshajinkigan. The effect of acetic acid was not different between goshajinkigan- and RTX-pretreated rats. The results of the present study indicated that goshajinkigan increases voiding interval, micturition volume, and bladder capacity, and pretreatment with goshajinkigan partially blocks the bladder overactivity induced by intravesical administration of acetic acid in rats.

Acetic Acid↗

PubMed2006

Mechanisms of Disease: the role of nerve growth factor in the pathophysiology of bladder disorders.

The case is compelling for the involvement of nerve growth factor (NGF) in the pathogenesis of lower urinary tract disease, especially in conditions with altered neural function. Remodeling of the micturition pathways occurs following experimental bladder-outlet obstruction, denervation, spinal cord injury, cystitis, and diabetes mellitus. Clinically, NGF levels are elevated in the bladders of men with benign prostatic hyperplasia, women with interstitial cystitis and in patients with idiopathic overactive bladder. Blockade of NGF, using either an endogenous antibody or an antibody against the NGF receptor, prevents neural plasticity and bladder overactivity in experimental models of these conditions. The ability of NGF to trigger bladder overactivity might rely on altering the properties of sodium or potassium channels (or their expression) in bladder afferent fibers. Therapies based on altered NGF levels, or changes in channel properties in afferent nerves, represent an intriguing avenue of investigation for the management of detrusor overactivity or diabetic cystopathy.

Humans↗

PubMed2005

Stoller afferent nerve stimulation in woman with therapy resistant over active bladder; a 1-year follow up.

AIM: In this prospective observational study, we investigated the efficacy of Stoller afferent nerve stimulation (SANS) in subjects with overactive bladder who failed anticholinergic treatment. METHODS: Thirty-five subjects with overactive bladder who failed therapy with oxybutynin participated in this study. Treatment (n = 35) was given once a week for 30 minutes for overall 10 weeks. In treatment, SANS device (Urosurge) was used. Subjects were assessed with 3-day voiding diary, SEAPI quality of life questionnaires and cystometry before therapy after completion of therapy and at one-year follow-up. RESULTS: In 54% (n = 19) of subjects complete recovery was obtained after treatment. Urgency and SEAPI were reduced significantly whereas urine volume increased significantly (p < 0.01). Complete recovery was maintained in eight of the 19 subjects at one year. CONCLUSIONS: SANS treatment has a short-term positive effect in patients with resistant overactive bladder. However, it was also established that efficacy was maintained at 1 year in only 23% of subjects.

Adult↗

PubMed2006

Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior?

The purpose of this study was to assess the prevalence of female urinary incontinence (UI) and risk factors of bothersomeness and help-seeking behavior of hidden female UI in urology and obstetrics and gynecology outpatient clinics. This multicentric and cross-sectional study was conducted as a part of the Turkish Overactive Bladder Study. Female patients (n = 5,565) who were referred with complaints other than UI and overactive bladder symptoms were surveyed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with supplementation of five more questions. The crude prevalence of UI was found to be 35.7%. The prevalence of frequent and severe incontinence was 8.2 and 6.8%, respectively. The mean age of incontinent patients was significantly higher (p < 0.001). The prevalence of stress, urge, and mixed UI was 39.8, 24.8, and 28.9%, respectively. More than half (53%) of incontinent patients were not bothered by UI, and only 12% of incontinent patients had previously sought medical help for their problem. Frequency, severity, and type of UI were independent factors for predicting bothersome UI, while only bothersomeness increased help-seeking behavior. The ICIQ-SF score of 8 has been found to be the best cutoff value to delineate the bothersome UI. Although the crude prevalence of female UI was found to be high, bothersome UI was not so common. The majority of incontinent female patients did not seek medical help. Frequency, severity, and mixed type of UI were found to be the determinants of bothersome UI for which the ICIQ-SF cutoff score of 8 was obtained.

Adult↗

PubMed2000

[Clinical trial to evaluate trospium chloride (Uraplex) effectiveness and tolerance in patients with detrusor instability incontinence and its impact on quality of life].

OBJECTIVE: To determine the efficacy, tolerance and quality-of-life effects of trospium chloride in women with overactive bladder. METHODS: An open, prospective multicenter trial was conducted on 75 women with urinary incontinence from overactive bladder (ICS criteria, urodynamic evaluation). Trospium chloride was administered at a dose of 20 mg twice daily for 8 weeks. Neurological examination and cystometry were performed at the start of the trial. Quality of life was evaluated by analogue visual scales (faces scale) and EUROQOL (health status scale). At the 4th week, urodynamic, clinical, quality-of-life and tolerance evaluations were performed. Clinical and tolerance data and quality of life index were assessed at the 8th week. RESULTS: 8 of the 75 patients did not complete the study. Thus, analysis of the therapeutic efficacy was performed in 67 patients, while description and tolerance analyses were performed for the overall group of patients. Urodynamic parameters significantly improved at 4 weeks: maximum bladder capacity (232.09 ml pre-treatment vs 315.83 ml post-treatment) and first desire to void (100.9 ml pre-treatment vs 156.7 ml post-treatment). Incontinence clinical items also improved. All quality-of-life indixes significantly increased at the 4 and 8 weeks control evaluation. Excellent or very good tolerance was observed in 89.5% of the patients. CONCLUSIONS: The results of the study corroborate the efficacy and tolerance of trospium chloride in the management of overactive bladder in women. Improvement in patient quality of life was also observed.

Benzilates↗

PubMed2007

The responsiveness of the OAB-q among OAB patient subgroups.

AIMS: Although the majority of patients with overactive bladder (OAB) are continent, most patient-reported outcome measures for OAB were designed for patients with urinary incontinence. The overactive bladder questionnaire (OAB-q) was developed to assess symptom bother and HRQL among both continent and incontinent OAB patients; however, the responsiveness of the OAB-q among continent patients has not been evaluated. The purpose of this analysis was to assess the responsiveness of the OAB-q among OAB patient subgroups with a focus on continent patients. METHODS: Post-hoc analyses were conducted from two 12-week trials of tolterodine for the treatment of OAB. Patients completed the OAB-q and daily bladder diaries (assessing frequency, urgency, and incontinence episodes) at baseline, 4 weeks, and 12 weeks. Three patient subgroups were identified on the basis of continence status at all three timepoints: (1) continent; (2) incontinent; and (3) incontinent at baseline and continent by Week 12 (ITC). General linear models were used to compare changes from baseline, and Spearman correlations assessed the association between OAB-q changes and bladder diary changes. Effect sizes were computed separately for each group. RESULTS: A total of 262 continent, 552 incontinent, and 397 ITC patients were included in this analysis. Continent patients tended to be younger than incontinent patients, and patients were predominantly female, although continent patients had the highest percentage of male patients in both studies. Compared with continent patients, patients who were incontinent at baseline tended to have greater symptom bother and lower HRQL at baseline. All OAB-q change scores were consistently greatest for the ITC group (12.1-33.9), and greater for continent patients (10.8-28.6) than for incontinent patients (7.6-20.1). All three groups of patients experienced reductions in frequency and urgency episodes, and these changes were significantly correlated with changes in the OAB-q scales. Among all three groups, effect sizes were in the moderate-to-large range for all OAB-q subscales except Social Interaction. CONCLUSIONS: The OAB-q is highly responsive to change between continent and incontinent patients with OAB, and is a valid tool for measuring treatment outcomes among continent OAB patients.

Adaptation, Psychological↗

PubMed2001

Clinical experiences with tolterodine.

Tolterodine is the first muscarinic receptor antagonist that has been specifically developed for the treatment of overactive bladder. The objectives in the discovery program were to design a potent muscarinic receptor antagonist that is equipotent to oxybutynin in the bladder, but less potent in salivary glands, with the aim of improving tolerability (less dry mouth) in patients with overactive bladder. Tolterodine is non-selective with respect to the muscarinic M1-M5 receptor subtypes, but has a greater effect on the bladder than on salivary glands in vivo, in both animals and humans. Clinical results show that the efficacy and safety of tolterodine in overactive bladder is equal to that of oxybutynin, but that tolterodine is significantly better tolerated by the patients.

Animals↗