UP-2.41: A comprehensive patient support programme improves persistence with solifenacin in overactive bladder (OAB)

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Table 1, UP-2.39. Change in overactive bladder symptoms Completion of Baseline treatment Voiding diary Urgency episode/24hrs 8.0 ⫾ 5.6 2.2 ⫾ 3.1* Micturition frequency/24hrs 11.7 ⫾ 4.6 8.3 ⫾ 2.2* Urgency severity/voiding 2.9 ⫾ 0.7 2.1 ⫾ 0.6* OAB questionnaire Bother score 47.9 ⫾ 20.5 20.9 ⫾ 17.4* HRQL score 62.0 ⫾ 22.6 82.8 ⫾ 17.2* PPBC 4.6 ⫾ 0.9 2.8 ⫾ 0.9* PPU 1.7 ⫾ 0.5 2.3 ⫾ 0.6*

1-month posttreatment visit

3-month posttreatment visit

4.0 ⫾ 4.6* 9.0 ⫾ 3.0* 2.4 ⫾ 0.9*

4.4 ⫾ 4.5* 9.1 ⫾ 2.9 2.5 ⫾ 0.9

29.0 ⫾ 22.7* 75.8 ⫾ 21.5* 3.3 ⫾ 1.3* 2.1 ⫾ 0.6*

31.3 ⫾ 23.5 75.4 ⫾ 21.6 3.2 ⫾ 1.3 2.1 ⫾ 0.6

Result: There was a significant association between fall and overactive bladder (odds Ratio, OR⫽1.80, 95% confidence interval, 95% CI 1.05 to 3.11). However, there was no association between fracture and overactive bladder (OR⫽1.06, 95% CI 0.60 to 1.88). Conclusion: Urgency or urge incontinence symptom was associated with falls among OAB patients. Early diagnosis and proper treatment can prevent falls and it can improve quality of life in OAB patients.

*p ⬍ 0.05 compared with each preceding visit

additional treatment (group B), 3) 5-month additional treatment (group C). After completion of the 1, 3, 6-month treatment, patients discontinued the medication and followed-up at 1 and 3 months. Criteria for the successful treatment and discontinuation were 1) decrease in micturition frequency ⱖ 2/24hrs, 2) decrease in urgency episode ⱖ 50%, 3) patients’ answer of “benefit” to the patient perception of treatment benefit (PPTB) questionnaire, and 4) patients’ consent to discontinue the treatment. Subjects were assayed by a 3-day bladder diary, OAB questionnaire (OAB-q), patient’s perception of bladder condition (PPBC), patients’ perception of urgency (PPU), PPTB and patient’s need of re-treatment. Results: Of a total of 542 patients who took the study medication, 168 were randomized (A; 57, B; 60, C; 51) and 108 were analyzed (A; 40, B; 40, C; 28). Their mean age was 56.2 years, a mean micturition frequency was 11.7/24hrs, and a mean urgency episode was 8.0/24hrs. The mean urgency episode was decreased by 5.8 times/24hrs after treatment. After completion of successful treatment, the urgency episode was increased by 1.8 times at 1 month post-treatment visit and 0.4 times at 3-month post-treatment visit compared with each preceding visits. The changes in the voiding diary and questionnaires were summarized in the table. Overall, 64.8% needed re-treatment (A; 60%, B; 60%, C; 79%, p⫽0.208) and 66.7% relapsed (A; 57.5%, B; 62.5%, C; 67.9%, p⫽0.685). HRQL of OAB-q (OR; 0.952, 95% CI 0.901-1.007, p⫽0.035) was the only predictive factor for retreatment. Conclusions: This may help to enhance communication between the patient and physician on the durability of the effectiveness of the anticholinergic treatment and to increase persistence of the medication.

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UP-2.40 Influence of overactive bladder on falls: study on females aged 40 and older in urban and rural communities Moon H1, Kim J1, Park S1, Kim Y1, Park H1, Choi H1, Kim S2, Choi B2, Lee T1 1 Dept. of Urology; 2Dept. of Preventive Medicine, Hanyang University, Seoul, South Korea Introduction and Objectives: Unpredictable urgency or urge incontinence affects quality of life. Patients who suffer from overactive bladder (OAB) dash to the toilet to prevent incontinence frequently and their behavior would increase risk of falls and fractures. This study was done to investigate the influence of overactive bladder on falls in females aged over 40 who dwell in urban and rural communities. Materials and Methods: We conducted a poll with King’s health questionnaire (KHQ) and questionnaire regarding fall on female aged over 40 years old from Guri city, a medium-sized urban city and rural Yangpyung county. Definition of fall was whether the respondents experienced a fall in the last year and definition of fracture was whether the respondents experienced a fracture from a fall in her life time. Total number of respondents reached 535 females and among these, 4 who did not complete the questionnaire were excluded. Statistical analysis was performed by chi-square test and t-test. Multivariate logistic regression model was adopted in order to examine the effects of OAB on fall. Age, area, marital status, education, self reported doctor’s diagnosis of disease (diabetes, hypertension, cerebrovascular disease, osteoporosis, osteoarthritis and urinary incontinence) were documented as covariates. 2-tailed test at the level of ␣-error⫽0.05 was performed for every statistical analyses. SAS 9.1(SAS Institute Cary, NC) was used for statistical tool.

UP-2.41 A comprehensive patient support programme improves persistence with solifenacin in overactive bladder (OAB) Siddiqui E1, Wood D2, Compion G1 1 Astellas Pharma Ltd, Staines, UK, 2University College London Hospitals, London, UK Introduction and Objective: Persistence with antimuscarinics is often suboptimal. Analysis of UK prescription data for antimuscarinic agents in OAB patients previously showed that persistence with solifenacin was higher than with tolterodine, oxybutynin, trospium and darifenacin. Nevertheless, only about a third of patients remained on solifenacin after 12 months. In the UK, a Patient Support Programme (PSP) is available to solifenacin-treated patients, for a duration of 12 weeks. We investigated if enrolment in the PSP improved persistence with solifenacin. Materials and Methods: OAB patients who were prescribed solifenacin were offered the opportunity to enrol in the PSP, after which they received various support items, e.g. helpful hints leaflet, educational DVD, progress monitor, alert card, dedicated website and care line, reminder e-mails/texts and similar reminder items; they also received telephone calls from a PSP nurse at weeks 3, 7 and 11. To evaluate persistence, a questionnaire survey was used to obtain feedback from 50 different patients each month for 12 months, with their prior consent, i.e. the first group of 50 had enrolled 12 months ago, the second group had enrolled 11 months ago, etc. Data from patients who enrolled in the PSP within 4 weeks of starting solifenacin were used in the current analysis. Results: Overall, 445/600 patients enrolled in the PSP within the first 4 weeks of being prescribed solifenacin. For this subgroup, cumulative persistence data were available from 319 patients who had

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enrolled in the PSP 3 months prior to the questionnaire, 218 at 6 months, 110 at 9 months, and 36 at 12 months. Persistence with solifenacin was 83%, 80%, 76% and 78% at 3, 6, 9 and 12 months after PSP enrolment, respectively. Conclusions: Enrolment of OAB patients into a 12-week PSP gave a high level of persistence with solifenacin at the end of the PSP. Persistence remained high in the following 9 months in this sample group (ⱖ76% of patients were still taking solifenacin at 3-12 months after PSP enrolment). This represents an improvement for patients taking solifenacin and other antimuscarinic treatments. UP-2.42 Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships Valentini F1, Marti B2, Robain G1, Nelson P,1 Osaghae S3 1 ER6-Universite´ Pierre et Marie Curie (Paris 06); 2Ho ˆ pital Saint Antoine, Paris, France; 3Pilgrim Hospital, Boston, UK Introduction and Objective: Detrusor overactivity (DO) is a frequent urodynamic diagnosis in women with urge syndrome. According with the ICS recommendations, it is usual to distinguish phasic (P) (wave(s) with or without leakage) from terminal (T) DO (single contraction resulting in leakage and micturition) [1]. Our purpose was to search for correlation between P or T DO and age, urodynamic findings or sphincter behavior. Materials and Methods: DO was the urodynamic diagnosis for 172 women (77 had a history of neurological disease) among 493 successive female patients. Four sub-groups: pre- (18-44y), peri- (4554y), post-menopause (55-74y) and oldest old (ⱖ75y). Cystometries: triple lumen catheter 7F, filling rate of 50 mL/min in seated position. Urethral sensor positioned at the level of the maximum urethral closure pressure for sphincter behavior analysis; a displacement during filling led to exclusion. DO or sphincter response needed a variation of 5 cmH2O in pressure (detrusor or urethra). Recordings were reviewed independently by three investigators. Results: Occurrence of P and T DO was similar in the whole population: 90 (52.3%) P and 82 (47.4%) T. Incidence of age on P DO was weak while it was significant on T DO (table) (p ⫽ .0005). The percentage of P DO remained constant (12%) in each age-group while that of T DO increased with age, from 5% to 45%.

Occurrence of P or T DO was not associated with a history of neurological disease. Uninhibited contraction occurred at a smaller bladder volume in the P group: 149⫾95 vs 221⫾113 mL (p⬍.0001). Steady sphincter was predominant for T DO: 46.9% vs 38.0%. It increased significantly in the ⱖ 75y sub-group (P: 53.0% vs 34-29-38%; T: 64% vs 44-38-37%). Conclusions: Steady sphincter during uninhibited detrusor contraction for both P and T DO, and occurrence of T DO appear as specific of aging. In elderly, occurrence of steady sphincter may be associated with loss of sensory nerve function in the urethra, and occurrence of T DO could be related to the change in muscarinic receptors subtypes and the increase in non-neuronal acetylcholine release from urothelium with aging. 1- NAU 2002; 21: 167-178. UP-2.43 Nervous control of lower urinary tract (LUT) during detrusor overactivity (DO): an approach using modeled analysis of filling cystometries and pressure-flow studies Valentini F1, Nelson P1, Osaghae S2 1 ER6-Universite´ Pierre et Marie Curie (Paris 06), Paris, France; 2Pilgrim Hospital, Boston, UK Introduction and Objective: DO is a frequent urodynamic diagnosis in patients with urge syndrome. DO is characterized by non inhibited detrusor contractions (NIDCs). The precise mechanism underlying DO remains discussed but evaluation of the detrusor excitation during NIDC and subsequent voiding could allow determining some ways of research. In the VBN model [1], the detrusor contraction depends on the excitation of the efferent neurons, quantified by their firing rate F or by F/Fmax [0-1]. Without DO, F/Fmax⫽0 during continence and in the range 0-1 during voiding, our objective was to apply the model to cystometries in order to analyze the efferent excitation. Materials and Methods: Cystometries (filling rate 50 mL/min, catheter size 6 or 7F) of 13 men (suspected of benign prostatic enlargement) and 11 women (incontinence or frequency) with phasic (5M7W) or terminal (8M-4W) DO were analyzed. The VBN model [1] was applied to the recordings to deduce F/Fmax from the recorded pressures. Due to the calcium turnover, the detrusor pressure is a sigmoid function of an “intermediate excitation” E proportional to the free Ca2⫹ concentration and given by dE/dt ⫽(F/ Fmax - E)/T with T⫽6s.

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Results: Phasic DO: In men and women, each NIDC resulted from an efferent excitation of constant amplitude F/Fmax and of 7-10s duration (then F/Fmax returned to 0). F/Fmax was ⫽1 during all NIDCs and voiding for 4/12 patients. F/Fmax was in the range 0.3-0.8 during NIDCs for the other 8 patients, but was ⫽1 for 6 of them during voiding. When F/Fmax⬍1 (2/8 patients) the value was the same during NIDCs and voiding. Terminal DO: During NIDC: for all women F/Fmax⫽1, for men F/Fmax⫽1 in 4/8 patients. For the other 4 men, there was a 2 steps mechanism with F/Fmax initially in the range 0.20.5 and then ⫽1 without intermediate decrease. Conclusions: Several authors ascribe DO to abnormal afferent signalling. That first study of the efferent signal suggests that the afferent signal would trigger a normal contraction of the detrusor. In phasic DO, an inhibitory reflex stops the contraction after a 5s delay while that reflex is inadequate in terminal DO. 1- NAU 2000; 19:153-176 UP-2.44 An electronic tool to support the selection of patients with overactive bladder syndrome for sacral neuromodulation Van Kerrebroeck P1, Chartier-Kastler E2, Castro-Diaz D3, De Ridder D4, Elneil S5, Kaufmann A6, Kessler T7, Spinelli M8, Wachter J9, Stoevelaar H10 1 Dept. of Urology, University Hospital Maastricht, Maastricht, The Netherlands; 2 Dept. of Urology, Pitie´-Salpeˆtrie`re Hospital, Paris, France; 3Dept. of Urology, University of La Laguna, Santa Cruz de Tenerife, Spain; 4Dept. of Urology, University Hospital KU Leuven, Leuven, Belgium; 5Dept. Uro-neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom; 6Kontinenz-Zentrum Maria Hilf, Centre for Continence and Neurourology, Mönchengladbach, Germany; 7Dept. of Urology, University of Bern, Bern, Switzerland; 8 Dept. of Urology, Alberto Zanollo Center Niguarda Hospital, Milan, Italy; 9 Donauspital, Dept. of Urology, Vienna, Austria; 10Ismar Healthcare, Centre For Decision Analysis and Support, Lier, Belgium Introduction and Objective: Sacral neuromodulation (SNM) is an established treatment for patients with idiopathic overactive bladder (i-OAB) syndrome, insufficiently responding to conservative treatment. However, identifying the appropriate candidates for a test procedure may be challenging to non-specialised

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