Pressure-flow variables in patients treated with tolterodine for detrusor overactivity

OBJECTIVE: To test the hypothesis that drug treatment which modifies detrusor function (tolterodine) may influence the higher detrusor pressure at urethral opening and closure recorded in patients with detrusor overactivity than in those with stable bladders. PATIENTS AND METHODS: All patients treated with tolterodine in the treatment arm of a phase III, randomized, placebo-controlled trial of tolterodine were eligible for the study. Patients underwent urodynamics before and immediately after 4 weeks of therapy. The detrusor pressure at urethral opening, at maximum flow and at urethral closure, and the maximum bladder capacity and postvoid residual urine volume were recorded from matched urodynamic studies in the trial. Patients with a reduction in urinary frequency of more than two voids per 24 h were defined as responders to treatment and urodynamic data were dichotomised accordingly to allow comparison. RESULTS: There were no between-group differences in either the detrusor pressure at opening or closure when responders were compared with non-responders. Successful treatment was associated with a statistically significant change in bladder capacity and postvoid residual volume, although the change in residual volume was not clinically significant. Values of detrusor pressure at opening before treatment were greater in non-responders. CONCLUSION: The absence of changes in the pressure-flow plot variables is in keeping with previous studies reporting the search for a urodynamic variable which might be used to predict a favourable outcome after drug treatment.     

Choosing oral drug therapy for overactive bladder in older people

Introduction: Overactive bladder (OAB) and urgency incontinence are common in older people. Nevertheless, there remains a paucity of prospectively collected data on the efficacy of commonly used drug treatments for the condition. Many trials have included older people, but have seldom reported results stratified by age or reported adverse events of particular relevance to older people in clinical practice. This has partially been rectified with the introduction of more recently introduced antimuscarinic agents, particularly fesoterodine, and the beta-3-agonist, mirabegron.

Areas covered: This article discusses evidence from recent trials relevant to robust and medically complex older people including synthesis of evidence on the association of anticholinergic medications and impaired cognition with relevance to OAB medications

Expert opinion: There are increasing data concerning pharmacological therapy in both robust and medically complex older adults. There is a need to explore the efficacy and tolerability of pharmacological treatment of OAB and UUI (urgency urinary incontinence) in specific subgroups and to produce confirmatory real-world data on efficacy and tolerability. Guidelines which address treatment of older people is currently sparse but, as time progresses and data improve, more specific guidance should become available.