1002 PERSISTENCE AND COMPLIANCE WITH ANTICHOLINERGIC TREATMENT GIVEN FOR OVERACTIVE BLADDER IN DAILY CLINICAL PRACTICE

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Overactive Bladder Is Less Common Than Previously Reported - A Population-Based Study Tikkinen K.A.O.1, Tammela T.L.J.1, Rissanen A.M.2, Valpas A.3, Huhtala H.4, Auvinen A.4



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Persistence and compliance with anticholinergic treatment given for overactive bladder in daily clinical practice

Tampere University Hospital and University of Tampere, Department of Urology and Medical School, Tampere, Finland, 2Helsinki University Central Hospital, Obesity Research Unit, Helsinki, Finland, 3South Karelian Central Hospital, Department of Obstetrics and Gynecology, Lappeenranta, Finland, 4University of Tampere, Tampere School of Public Health, Tampere, Finland

Corcos J., Tamarkina E., Blok B.

Introduction & Objectives: Most earlier studies on overactive bladder (OAB) have reported a prevalence of 10%-20%, the most widely cited studies estimating prevalence of OAB as one in six. However, earlier studies have either not been populationbased or have suffered from methodological limitations. Our aim was to assess the prevalence of OAB symptoms, based on a representative study population and using consistent definitions and exclusions.

Introduction & Objectives: Most clinical studies of patient compliance with anticholinergics (AC) are part of investigations conducted to examine the efficacy and safety of these drugs. Real-life clinical compliance of treatment for overactive bladder (OAB) may be different since patients have more freedom to use these drugs according to their feelings, symptoms and side effects. We have designed a prospective study to assess their persistence and compliance in urological practice.

1

Material & Methods: We assessed the age-standardised prevalence of OAB defined as urinary urgency, with or without urgency incontinence, usually with frequency and nocturia in the absence of urinary tract infection or other obvious pathology. In 2003– 2004, a questionnaire was mailed to 6,000 randomly selected Finns aged 18–79 years identified from the Finnish Population Register Centre. Information on voiding symptoms was collected using the validated Danish Prostatic Symptom Score, with additional frequency and nocturia questions. Urgency and urgency incontinence were defined as abnormal if reported often or always (in scale never-seldom-often-always, applied for the past 2 weeks). Frequency was defined as >8 voids/day and nocturia as >1 void/night. Corrected prevalence was calculated with adjustment for selection bias due to non-response. Results: Of the 6,000 subjects, 62.4% participated. We excluded 54 men and 156 women due to pregnancy, puerperium (6 weeks), genitourinary excluding kidney cancer, contracted bladder, or use of loop-diuretics. Age-standardised (to the European standard population) prevalence of OAB was 6.3% (95% confidence interval, 5.2%-7.3%) for men and 8.6% (7.4%-9.8%) for women (Table 1). Exclusion of men with benign prostatic hyperplasia reduced prevalence among men by one percentage point (to 5.3% [4.3%-6.3%]). Among subjects with OAB, urgency incontinence, frequency, and nocturia were reported by 10%, 22%, and 54% of men and 24%, 37%, and 37% of women, respectively. However, only 30% of men and 33% of women with frequency, and 31% of subjects of both sexes with nocturia reported OAB (Table 2). Table 1. Prevalence (%) of overactive bladder by age and sex. Age (years) 18-29 30-39 40-49 50-59 60-69 70-79 Age-standardised

Men 2.1 1.8 4.5 6.1 17.5 17.6 6.3

Women 5.9 4.2 8.5 11.8 12.3 15.6 8.6

Total 4.0 3.0 6.5 8.9 14.9 16.6 7.5

McGill University, Urology, Montreal, Canada

Material & Methods: From 03/2005 to 08/2005 all naive patients treated for OAB with AC were recruited in our study. A series of telephone interviews were conducted at 1, 3, 6 and 12 months following initiation of the treatment. Only routine drug information was given by the prescribing physician. A validated standardized questionnaire conducted by a nurse was used in the study. Results: Of 108 patients started on a different AC, 13 stopped medication as per M.D. order (various reasons), and 9 never started taking the medication. Those patients were excluded from calculations. Of the remaining 86 patients, 32 (37.2%) were still taking the drug at 12 months. Drug Ditropan Dirtopan XL Oxytrol Detrol/Detrol LA Total No of patients

Men 2.2 0.0 0.6 0.1 2.3 0.4 0.6 0.1 2.2 6.6 1.0

Drug

Women 3.3 0.4 1.4 0.3 0.9 0.8 0.9 0.6 5.1 5.7 1.3

No. patients d/c a Study population drug as per M.D. 7 2 2 2 13

49 11 15 11 86

No. patients still taking drug at 12 m of treatment 16(32.6%) 5(45.4%) 6(40%) 5(45.4%) 32

Ditropan

Patients having stopped medication during study period 33

No. of patients stopped because of side effects 19 (57.5%)

No. of patients stopped because of other reasons 14(42.4%)

Ditropan XL Oxytrol

6 9

1 (16.6%) 4 (44.4%)

5(83.3%) 5 (55.5%)

Detrol/ Detrol LA Total number of patients

6

1 (16.6%)

5 (83.3%)

54

25 (46.3%)

29 (53.7%)

Most common side effect Dry mouth (12 patients) Dry mouth Migraine, headache (2 patients) Blurred vision

Table 2: Causes for stopping medication

where OAB = overactive bladder; UUI = urinary urgency incontinence; F = frequency; N = nocturia; + = symptomatic; and - = asymptomatic. Conclusions: Our results indicate a prevalence of OAB as low as 7.5%. In previous studies, occurrence has been substantially overestimated due to vague criteria and selected study populations regarding age distribution and low participation.



No. patients that never started drug 6 1 2 0 9

Table 1: Distribution of patients and persistence at 12 months

Table 2. Age-standardised prevalence (%) of overactive bladder symptoms by sex. Symptoms OAB+/UUI-/F-/NOAB+/UUI+/F-/NOAB+/UUI-/F+/NOAB+/UUI+/F+/NOAB+/UUI-/F-/N+ OAB+/UUI+/F-/N+ OAB+/UUI-/F+/N+ OAB+/UUI+/F+/N+ OAB-/UUI-/F+/NOAB-/UUI-/F-/N+ OAB-/UUI-/F+/N+

No. patients to whom a drug was initially prescribed 62 14 19 13 108

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Conclusions: Among patients who stopped the medication, only half of them indicated drug side effects as the reason for discontinuing the treatment. Ditropan had the highest rate of side effects, most commonly dry mouth. Ditropan XL and Detrol/Detrol LA had the lowest percentage of side effects. We found that, even though time consuming, the applied methodology is satisfactory and could be used to evaluate new ACs recently launched on the market. Financial support: Quebec Health research fund.



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Correlation between the overactive bladder questionnaire (oab-q) and urodynamic data of parkinson’s disease patients affected by neurogenic detrusor overactivity during antimuscarinic treatment

Solifenacin in neurogenic overactive bladder

Palleschi G.1, Pastore A.1, Stocchi F.2, Inghilleri M.2, Bova G.1, Carbone A.1

Introduction & Objectives: In spinal cord injured patients with upper motoneuron lesion (UMNL), after the spinal shock phase, the development of neurogenic detrusor overactivity is observed. The search of voiding reflex induced by triggers like suprapubic percussion, genital friction or anal stretching represented, for a long time, a method to obtain the so called balanced-bladder function. However, in the light of past experiences and recent acquisitions, this kind of rehabilitation is no longer very used: in the long-term it is at risk for the detrusor myogen component. It is preferable to inhibit involuntary detrusor contractions by introducing, taking into account the patient’s own autonomy, an artificial voiding through intermittent catheterization (IC) with pharmacological or “electrical” treatment to inhibit bladder activity. The antimuscarinic therapy, first with oxybutynin and, later, with propiverine, tolterodine and trospium chloride, all with pronounced muscle relaxant activity, helped this choice. Inducing a drug-related detrusor areflexia, in many cases these molecules succeeded to obtain continence between catheterisations and lower vesical pressure. Today, even though it is not always possible to obtain the desired effect, this is the first line treatment for hyperreflexia. The introduction of a new potent selective antimuscarinic drug, solifenacin, represents a new tool for the first line treatment in neurogenic overactive bladder before more invasive approach. Previous studies demonstrated efficacy of solifenacin at 5mg or 10 mg daily dosage in idiopathic overactive bladder.

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University of Rome La Sapienza, Polo Pontino, Neuro-Urology, Latina, Italy, University of Rome La Sapienza, Neurosciences, Roma, Italy

Introduction & Objectives: Parkinson’s disease patients present urinary symptoms during the course of the disease, very often suggestive of overactive bladder sustained by neurogenic detrusor overactivity. Today overactive bladder diagnosis is easier, thanks to the availability of new investigative tools, particularly voiding questionnaires. The aim of the present study was to evaluate the reliability of the OAB screener (Overactive Bladder screener / OAB-q), a new voiding questionnaire specifically developed for the overactive bladder diagnosis, in PD subjects suffering from overactive bladder symptoms. Clinical data obtained by the questionnaire were compared with urodynamic outcomes, at basal conditions and after antimuscarinic treatment, to better explorate the questionnaire reliability. Material & Methods: 40 Parkinson’s disease patients have been enrolled in the protocol, and submitted to the OAB screener, voiding diary and urodynamic investigation before and after antimuscarinic treatment. OAB-score and urodynamic parameters were statistically analyzed and compared. Results: The OAB-q subscales showed significant changes (p < 0.05) of urgency episodes (≥ 3), micturitions (≥ 3) and daily incontinence episodes (≥ 1). Improvements in OAB-q scales were associated and well correlated with voiding diaries and urodynamic changes observed during the therapy. Conclusions: The OAB-q, a voiding questionnaire specifically developed for OAB diagnosis, appeared to be reliable in reporting voiding symptoms of PD pts and their changes during treatment protocol. Basing on these data, this study suggests that OAB-q may be used for the OAB secondary to PD and that its use may be extended to other neurogenic conditions. Therefore, the OAB-q seems to be a useful outcome measure for treatments of OAB also in neurogenic pts.

Spinelli M., Citeri M., Zanollo L., Redaelli T. Niguarda Hospital, Neurourology, Milan, Italy

Material & Methods: Starting from July 2005 we enrolled in a six weeks observational study 41 patients with neurogenic overactive bladder after UMNL; 18 patients coming out from spinal shock period in which solifenacin has been the first line treatment. The other 23 patients were treated with solifenacin after failure of treatment with oxybutynin 15 mg per day, in order to obtain complete retention. All patients gave the consent to treatment and began to use 10 mg of solifenacin monitoring results with bladder diary. Results: In the first group we obtained bladder areflexia induced by solifenacin in 13 patients, that achieved a bladder capacity at IC from 450 to 500 ml; in 7 cases the dosage was increased to 15 mg. No loss of urine was registered between IC. In chronic patients we obtained the same effect of oxybutynin in 12 patients; moreover 11 patients increased their medium capacity from 275 to 410 ml. We didn’t register drop out for dry mouth using solifenacin and no differences were registered with 10 mg or 15 mg. Conclusions: Solifenacin 10mg -15 mg can be considered as first line therapy in neurogenic overactive bladder in order to obtain continence and to manage voiding with IC.

Eur Urol Suppl 2007;6(2):273