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Incontinence Episodes (incontinence + episode)

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Selected Abstracts

Sacral nerve modulation and other treatments in patients with faecal incontinence after unsuccessful pelvic floor rehabilitation: a prospective study

COLORECTAL DISEASE, Issue 4 2010
S. M. Koch
Abstract Objectives Sacral nerve modulation (SNM) is a minimally invasive technique for the treatment of faecal incontinence. This study investigates the results of SNM after negative outcome of a standardized pelvic floor rehabilitation (PFR) programme for the treatment of faecal incontinence. Method, A prospective cohort study was performed between December 2001 and August 2007. Consecutive patients who visited the outpatient department for faecal incontinence were included in a multicentre study and treated with standardized PFR. Those with an unsuccessful result who were eligible for SNM were included in the present study. Failures at test stimulation or SNM received another treatment. Clinical outcome, Vaizey scores and Hirschsprung's disease/anorectal malformation quality-of-life (EQ-5D and HAQL) were assessed during follow-up in patients with SNM and in patients with other treatments (OT). Adverse events (AE) were documented. Results, Thirty-five patients (mean age 59.7 years; 31 females) were included. Twenty-one had a successful test stimulation and 19 patients proceeded to a SNM implant. Incontinence episodes per week decreased significantly from 11.1 ± 11.7 to 1.9 ± 2.6 during test stimulation (P < 0.0001) and SNM over 24.1 months follow-up. The overall success rate was 49% (17/35). The patients with unsuccessful test stimulation or SNM received OT. The Vaizey score improved in both SNM (18.2 ± 3.5 vs 13.7 ± 4.8; P = 0.004) and other treatment (18.2 ± 3.5 vs 13.9 ± 6.9; P = 0.019). The HAQL scale improved significantly during SNM in all subscales (P < 0.005), but not in the other treatment group. Eight AE occurred during test stimulation (23%) and six AE after permanent implantation (26%). Conclusion, Sacral nerve modulation improves disease specific quality of life significantly compared with other treatment. [source]

Tolterodine causes measurable restoration of urethral sensation in women with urge urinary incontinence,,

NEUROUROLOGY AND URODYNAMICS, Issue 4 2010
Kimberly Kenton
Abstract Introduction & Hypothesis Determine if treatment of urge incontinence with tolterodine results in changes in bladder and/or urethral sensation using Current Perception Threshold (CPT) testing. Methods Women with ,1 incontinence episode on 7-day diary were treated with 4 mg of long-acting tolterodine for 2-months. At baseline and 2-months, participants had CPT testing of the urethral and bladder at 3 frequencies 2000, 250, and 5 Hz. Baseline and post-treatment measures were compared using Wilcoxon Signed Rank Test. Results Seventeen women underwent baseline CPT testing. Four discontinued medication due to side effects and did not have repeated testing. Urethral CPT at 250 Hz was lower after treatment (median 1.3 [Interquartile range .69--2.1] and .75 [.45--1.2], p,=,.003) and at 5 Hz trended toward a significant decrease (1.1 [1--1.9] and .84 [.32--1.1], p,=,.06). Conclusions Urethral sensitivity improves after 2-months of tolterodine, suggesting it may restore urethral sensory nerves in addition to known motor effects. Neurourol. Urodynam. 29:555,557, 2010. © 2009 Wiley-Liss, Inc. [source]

A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: Description of the method and preliminary data

NEUROUROLOGY AND URODYNAMICS, Issue 4 2005
Michele Spinelli
Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach. We have named this approach chronic pudendal nerve stimulation (CPNS). Methods Fifteen neurogenic patients (eight male, seven female) with symptoms of urge incontinence due to neurogenic overactive bladder underwent CPNS. All patients had complete neurophysiological and urodynamic evaluation at baseline and follow-up and were asked to complete voiding and bowel diary for 7 days. Results During screening, average number of incontinent episodes per day decreased from 7,±,3.3 to 2.6,±,3.3 (P,<,0.02, paired t -test). Eight patients became continent, two improved by more than 88% (from 9 to 1 daily incontinence episode) and two patients reduced the number of incontinence episodes by 50%. The implantable pulse generator (IPG) was subsequently implanted in those 12 patients. Three patients without improvement did not continue to second stage. In implanted patients with 6 months follow-up, urodynamic evaluation showed an objective improvement in the maximum cystometric capacity which increased from 153.3,±,49.9 to 331.4,±,110.7 ml (P,<,0.01, paired t -test). The maximum pressure decreased from 66,±,24.3 to 36.8,±,35.9 cmH2O (P,=,0.059, paired t -test). Eight patients reported significant improvement in bowel function. Conclusion Chronic pundedal nerve stimulation is feasible. Neurophysiological guidance is mandatory to place the lead near the pudendal nerve either using perineal or posterior approach. Further studies must be carried out to identify the best stimulation parameters and to verify the long term results. Neurourol. Urodynam. 24:305,309, 2005. © 2005 Wiley-Liss, Inc. [source]

Effects of flexible-dose fesoterodine on overactive bladder symptoms and treatment satisfaction: an open-label study

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2009
J.-J. Wyndaele
Summary Aims:, To evaluate the efficacy and tolerability of flexible-dose fesoterodine in subjects with overactive bladder (OAB) who were dissatisfied with previous tolterodine treatment. Methods:, This was a 12-week, open-label, flexible-dose study of adults with OAB (, 8 micturitions and , 3 urgency episodes per 24 h) who had been treated with tolterodine (immediate- or extended-release) for OAB within 2 years of screening and reported dissatisfaction with tolterodine treatment. Subjects received fesoterodine 4 mg once daily for 4 weeks; thereafter, daily dosage was maintained at 4 mg or increased to 8 mg based on the subject's and physician's subjective assessment of efficacy and tolerability. Subjects completed 5-day diaries, the Patient Perception of Bladder Condition (PPBC) and the Overactive Bladder Questionnaire (OAB-q) at baseline and week 12 and rated treatment satisfaction at week 12 using the Treatment Satisfaction Question (TSQ). Safety and tolerability were assessed. Results:, Among 516 subjects treated, approximately 50% opted for dose escalation to 8 mg at week 4. Significant improvements from baseline to week 12 were observed in micturitions, urgency urinary incontinence episodes, micturition-related urgency episodes and severe micturition-related urgency episodes per 24 h (all p < 0.0001). Approximately 80% of subjects who responded to the TSQ at week 12 reported satisfaction with treatment; 38% reported being very satisfied. Using the PPBC, 83% of subjects reported improvement at week 12 with 59% reporting improvement , 2 points. Significant improvements from baseline (p < 0.0001) exceeding the minimally important difference (10 points) were observed in OAB-q Symptom Bother and Health-Related Quality of Life (HRQL) scales and all four HRQL domains. Dry mouth (23%) and constipation (5%) were the most common adverse events; no safety issues were identified. Conclusion:, Flexible-dose fesoterodine significantly improved OAB symptoms, HRQL, and rates of treatment satisfaction and was well tolerated in subjects with OAB who were dissatisfied with prior tolterodine therapy. [source]

Comparison of the effectiveness and side-effects of tolterodine and oxybutynin in children with detrusor instability

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2006
NIZAMETTIN KILIC
Background:, Treatment with anticholinergic agents is the mainstay of therapy for detrusor instability (DI), a chronic and morbid condition characterized by urge urinary incontinence. The aim of this study is to assess the effectiveness and tolerability of tolterodine and oxybutynin in children with DI. Methods:, A total of 60 children with DI were enrolled, 30 (14 male, 16 female, mean age 7.97 ± 2.71 years) in the tolterodine group and 30 (12 male, 18 female, mean age 7.33 ± 2.23 years) in the oxybutynin group. In this prospective study we reviewed data from 60 children followed for at least 6 months. All of the patients in the study population had a history of dysfunctional voiding. Urodynamic investigations were conducted in all of the patients before and after anticholinergic treatment. Episodes of urge urinary incontinence and adverse events were also evaluated. Results:, Improvements in urge incontinence episodes were similar for the children who received tolterodine or oxybutynin. Improvements in the urodynamic parameters were also the same in the two groups. Adverse events were significantly lower in the tolterodine group (13 events in 13 patients) compared to the oxybutynin group (27 events in 20 patients; P = 0.027). Conclusion:, Reductions in urge urinary incontinence episodes were similar with tolterodine and oxybutynin in children with DI. Side-effects were more common with oxybutynin. Treatment of children with DI with tolterodine shows significantly better tolerability and this may enhance children's compliance during long-term treatment. [source]

Device to promote pelvic floor muscle training for stress incontinence

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2003
KIMIO SUGAYA
Abstract Aim:, Many patients with stress urinary incontinence do not have enough motivation to continue pelvic floor muscle training (PFMT) by themselves. Therefore, a device was created to support PFMT, and its effect was examined. Methods:, Forty-six women with stress urinary incontinence were assigned to a control group or a device group in order of presentation. A pamphlet on PFMT was given to control patients, while the same pamphlet plus the device and instructions on its use were given to patients in the device group. The device had a chime that was set to sound three times a day when exercise sessions were scheduled. PFMT consisted of fast and slow pelvic floor muscle contraction exercises that were performed for 2 min and followed a rhythm set by the device. Results:, After 8 weeks, 20 patients from the control group and 21 patients from the device group could be evaluated. In the control group, only the quality of life (QOL) index improved significantly. In the device group, however, the daily number of incontinence episodes, the number of pads used daily, the QOL index, and the pad weight in the pad test improved significantly. Patients in the device group said that they felt obligated to perform PFMT when the chime sounded. Forty-eight percent of patients from the device group were satisfied with the outcome of PFMT, while only 15% were satisfied in the control group. Conclusion:, This device may be useful to support the management of stress urinary incontinence. [source]

The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trial

JOURNAL OF CLINICAL NURSING, Issue 19-20 2010
Linda Mason
Aim., This article reports a randomised controlled trial to determine the efficacy of antenatal pelvic floor muscle exercises in the primary prevention of postpartum stress incontinence in primiparous women. Background., Pelvic floor muscle exercises are effective in treating stress incontinence, yet prevention studies demonstrate equivocal findings. Design., Randomised controlled trial. Method., Pregnant women recruited from two hospitals in North-west England were randomised to an intervention (n = 141) or control group (n = 145). Data were collected from 2005,2006. The intervention comprised four sessions of taught pelvic floor muscle exercise training during pregnancy and 8,12 maximal contractions repeated twice daily at home. A modified Bristol Female Lower Urinary Tract Symptom questionnaire, Leicester Impact Scale and Three Day Diary were administered at 20 and 36 weeks of pregnancy and three months postpartum. Results., The intervention group was more likely to exercise their pelvic floor muscles compared to controls at 36 weeks (p = 0·019) and three months (0·022), reporting fewer episodes of incontinence and a lower score on the Leicester Impact Scale. However, these differences were not statistically significant. Conclusion., Significant differences were not demonstrated between the groups in relation to incontinence episodes and degree of bother of symptoms postpartum, although trends indicate a positive effect. Further research is necessary to address issues of adherence and the effect of pelvic floor muscle exercise undertaken during pregnancy on postpartum stress urinary incontinence. Relevance to clinical practice., A proportion of women did not meet the required attendance at antenatal class, furthermore, few exercised their pelvic floor muscles during pregnancy according to instructions. Health professionals need to find ways to instruct and motivate women to perform pelvic floor muscles exercises regularly during pregnancy and the postpartum. [source]

The effects of clonidine on symptoms and anorectal sensorimotor function in women with faecal incontinence

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010
A. E. Bharucha
Aliment Pharmacol Ther 2010; 32: 681,688 Summary Background, Women with faecal incontinence and rectal urgency have increased rectal stiffness and sensation. Aim, To evaluate the effects of clonidine, an ,2 -adrenergic agonist, in faecal incontinence. Methods, In this open-label uncontrolled study, bowel symptoms and anorectal functions (anal pressures, rectal compliance, and sensation) were assessed before and during treatment with transdermal clonidine (0.2 mg daily, 4 weeks) in 12 women with urge-predominant faecal incontinence. Results, Clonidine reduced the frequency (17.8 ± 3.1 before vs. 8.8 ± 3.9 after, P = 0.03) and number of days with faecal incontinence (11.8 ± 1.6 before vs. 6.1 ± 1.8 after, P = 0.02), faecal incontinence symptom severity score (max = 13, 8.3 ± 0.7 vs. 5.6 ± 0.9, P < 0.01), and allowed patients to defer defecation for a longer duration (P = 0.03). Although overall effects on anorectal functions were not significant, the treatment-associated reduction in faecal incontinence episodes was associated with increased rectal compliance (r = ,0.58, P < 0.05) and reduced rectal sensation. (r = ,0.73, P = 0.007 vs. desire to defecate pressure threshold). Conclusions, Clonidine improves symptoms in women with faecal incontinence; this improvement is associated with increased rectal compliance and reduced rectal sensitivity. A controlled study is necessary to confirm these observations. [source]

Mixed incontinence: Comparing definitions in women having stress incontinence surgery,,§¶

NEUROUROLOGY AND URODYNAMICS, Issue 4 2009
Linda Brubaker
Abstract Objective To develop an empirically derived definition of mixed urinary incontinence (MUI) for use in incontinence outcomes research. Methods Participants in a randomized trial comparing the fascial sling and. Burch colposuspension were assessed using standardized measures including the Medical, Epidemiologic and Social Aspects of Aging (MESA), UI questionnaire, the Urogenital Distress Inventory (UDI), 3-day urinary diary and urodynamic studies (UDS). Participants were required to have stress incontinence with a MESA stress subscale score,>,MESA urge subscale score. Several definitions of MUI were considered. Logistic and linear regression analysis methods were used to predict clinical outcomes based on the different MUI definitions. Analyses were carried out using SAS (SAS Institute, Inc., Cary, NC, Version 9.1). Statistical significance was defined at P -value <0.05. Results In 655 participants, the proportion of women with MUI varied from 8.3% to 93.3% depending on the MUI definition All definitions were associated with severity as measured by the frequency of incontinence episodes at baseline; however little of the variability was explained by any single definition. No strict cut-off value for these baseline measures was identified to predict clinical outcomes. Conclusions These MUI definitions do not adequately categorize clinically relevant UI subgroups. For research reporting, MUI subcomponents of stress and urge UI should be described separately rather than as a single dimension. Neurourol. Urodynam. 28:268,273, 2009. © 2009 Wiley-Liss, Inc. [source]

Bladder control, urgency, and urge incontinence: Evidence from functional brain imaging,

NEUROUROLOGY AND URODYNAMICS, Issue 6 2008
Derek Griffiths
Abstract Aim To review brain imaging studies of bladder control in subjects with normal control and urge incontinence; to define a simple model of supraspinal bladder control; and to propose a neural correlate of urgency and possible origins of urge incontinence. Methods Review of published reports of brain imaging relevant to urine storage, and secondary analyses of our own recent observations. Results In a simple model of normal urine storage, bladder and urethral afferents received in the periaqueductal gray (PAG) are mapped in the insula, forming the basis of sensation; the anterior cingulate gyrus (ACG) provides monitoring and control; the prefrontal cortex makes voiding decisions. The net result, as the bladder fills, is inhibition of the pontine micturition center (PMC) and of voiding, together with gradual increase in insular response, corresponding to increasing desire to void. In urge-incontinent subjects, brain responses differ. At large bladder volumes and strong sensation, but without detrusor overactivity (DO), most cortical responses become exaggerated, especially in ACG. This may be both a learned reaction to previous incontinence episodes and the neural correlate of urgency. The neural signature of DO itself seems to be prefrontal deactivation. Possible causes of urge incontinence include dysfunction of prefrontal cortex or limbic system, suggested by weak responses and/or deactivation, as well as abnormal afferent signals or re-emergence of infantile reflexes. Conclusions Bladder control depends on an extensive network of brain regions. Dysfunction in various parts may contribute to urge incontinence, suggesting that there are different phenotypes requiring different treatments. Neurourol. Urodynam. 27:466,474, 2008. © 2007 Wiley-Liss, Inc. [source]

Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis, A double blind, placebo controlled, randomised clinical trial,,

NEUROUROLOGY AND URODYNAMICS, Issue 3 2008
D. McClurg
Abstract Aims Lower urinary tract dysfunction affects up to 75% of the multiple sclerosis population. Results from our recent Pilot Study (McClurg et al., 2006) indicated that a combined programme of pelvic floor muscle training, electromyography biofeedback and neuromuscular electrical stimulation modalities may alleviate some of the distressing symptoms within this population. This clinical trial aimed to evaluate further the efficacy of these interventions and to establish the benefit of neuromuscular electrical stimulation above and beyond that of EMG biofeedback and pelvic floor muscle training. Methods 74 multiple sclerosis patients who presented with lower urinary tract dysfunction were randomly allocated to one of two groups - Group 1 received Pelvic Floor Muscle Training, Electromyography Biofeedback and Placebo Neuromuscular Electrical Stimulation (n=37), and Group 2 which received Pelvic Floor Muscle Training, Electromyography Biofeedback, and Active Neuromuscular Electrical Stimulation (n=37). Treatment was for nine weeks with outcome measures recorded at weeks 0, 9, 16 and 24. The Primary Outcome Measure was the number of leakage episodes. Within group analysis was by Paired Samples t-test. Group differences were analysed using Repeated Measures Analysis of Variance and Post-hoc tests were used to determine the significance of differences between Groups at each time point. Results The mean number of incontinence episodes were reduced in Group 2 by 85% (p=0.001) whereas in Group 1 a lesser reduction of 47% (p=0.001) was observed. However, there was a statistically superior benefit in Group 2 when compared to Group 1 (p=0.0028). This superior benefit was evident in all other outcome measures. Conclusions The addition of Active Neuromuscular Electrical Stimulation to a programme of Pelvic Floor Muscle Training and Electromyography Biofeedback should be considered as a first-line option in alleviating some of the symptoms of lower urinary tract dysfunction associated with multiple sclerosis. Neurourol. Urodynam. 27:231,237, 2008. © 2007 Wiley-Liss, Inc. [source]

Bladder diary patterns in detrusor overactivity and urodynamic stress incontinence,

NEUROUROLOGY AND URODYNAMICS, Issue 6 2007
Matthew Parsons
Abstract Aims Our aims were: (1) to describe and compare frequency-volume and incontinence episode patterns in patients with urodynamic stress incontinence (USI) and detrusor overactivity (DO) as measured by a hand-written and computer-analyzed bladder diary and (2) to compare degree of separation between these clinical groups produced by raw diary measurements and after age- and total-volume-adjustment against a reference population. Materials and Methods We studied 58 patients with USI, 29 with DO, and 22 with both USI and DO. From 3-day hand-written and computer-analyzed bladder diaries, we calculated average and maximum volume voided (Vol/Void), voiding frequency and volume voided over 24 hr, and number, size and type (whether accompanied by activity or urge) of incontinence episodes. Results Compared to the USI patients, the DO patients tended to have (1) higher voiding frequency, (2) lower Vol/Void, (3) more urge-related, than activity-related leaks, (4) smaller volume, and equally frequent leaks and (5) more severe incontinence symptoms. The age- and volume-adjusted percentiles better separated the USI and DO groups' frequency and volume measurements than did the raw measurements. Unexpectedly high percentages of our USI patients had low Vol/Void measurements, high voiding frequency, and predominantly urge-related leaks. A subgroup of 29 USI patients with "low" (average volume <30th reference population percentile) Vol/Void measurements had high incidences of urgency and urge-related leaks. Conclusions Reference population percentiles better separate the frequency/volume patterns of USI and DO than do the raw measurements. We found a subgroup of USI patients that had an OAB-like clinical picture. Neurourol. Urodynam. 26:800,806, 2007. © 2007 Wiley-Liss, Inc. [source]

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

NEUROUROLOGY AND URODYNAMICS, Issue 2 2007
Karin S. Coyne
Abstract 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. Neurourol. Urodynam. 26:196,203, 2007. © 2006 Wiley-Liss, Inc. [source]

A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: Description of the method and preliminary data

Botulinum injections for the treatment of bladder symptoms of multiple sclerosis

ANNALS OF NEUROLOGY, Issue 5 2007
MRCS, Vinay Kalsi MBBS
Objective Our objective was to demonstrate the efficacy and impact on quality of life of detrusor injections of botulinum neurotoxin type A in the treatment of bladder dysfunction in patients with multiple sclerosis. Methods Forty-three patients with multiple sclerosis suffering from severe urgency incontinence were treated with detrusor injections of botulinum neurotoxin type A. Data from cystometric assessment of the bladder, voiding diaries, quality-of-life questionnaires, and procontinence medication usage were collected before treatment and 4 and 16 weeks after injection. The same data were also collected after repeat treatments. Results Highly significant improvements (p < 0.0001) in incontinence episodes and urinary urgency, daytime frequency and nocturia, were the symptomatic reflection of the significant improvements in urodynamically demonstrated bladder function. Although 98% of patients had to perform self-catheterization after treatment, there were sustained improvements in all quality-of-life scores. The mean duration of effect was 9.7 months. Similar results were seen with repeat treatments. Interpretation Minimally invasive injections of botulinum neurotoxin type A have been shown to be exceptionally effective in producing a prolonged improvement in urinary continence in patients with multiple sclerosis. This treatment is likely to have a major impact on future management. Ann Neurol 2007 [source]

Antimuscarinic drugs in detrusor overactivity and the overactive bladder syndrome: motor or sensory actions?

BJU INTERNATIONAL, Issue 3 2006
STEVEN M. FINNEY
Antimuscarinic drugs are generally thought to exert their therapeutic action on detrusor overactivity by reducing the ability of the detrusor muscle to contract. We review currently available published data to establish whether there is any evidence to support this contention. Using a PubMed data search, only 14 original articles (including two abstracts) were found that contained cystometric data for both filling and voiding phases and where the actions of antimuscarinic drugs have been reported in detail. These articles were separated into three groups dealing with neuropathic patients (three papers), patients with idiopathic overactive bladder (four papers) and a group whose aetiology was unclear (seven papers). Variables relating to bladder function during the filling phase (time of first desire to void, time to first unstable contraction, and bladder capacity) were identified. Similarly, variables relating to voiding were identified and compared (e.g. maximum detrusor pressure and detrusor pressure at maximum flow rate). The antimuscarinic drugs have a clearly significant effect on sensations of urge, time to first sensation to void, maximum bladder capacity, decrease in voiding frequency and reduction in incontinence episodes. However, only one article (studying neuropaths) reported a significant reduction of the variables associated with detrusor contraction. The remaining four studies (idiopaths/not stated), reported no change in bladder contractility with antimuscarinic drugs. Thus the available data do not support the conclusion that antimuscarinic drugs at doses used in current clinical practice exert their therapeutic action by inhibiting detrusor contractility, but they suggest effects on variables associated with sensation. [source]

An investigation of dose titration with darifenacin, an M3 -selective receptor antagonist

BJU INTERNATIONAL, Issue 4 2005
William Steers
OBJECTIVES To evaluate the efficacy, tolerability and safety of a flexible-dosing strategy with darifenacin, an M3 -selective receptor antagonist, in patients with symptoms of overactive bladder (OAB). PATIENTS AND METHODS In this multicentre double-blind 12-week study, 395 patients (aged 22,89 years; 84% female) with OAB symptoms for >6 months were randomized (2 : 1) and received once-daily treatment with darifenacin controlled-release tablets 7.5 mg (268 patients) or matching placebo (127). After 2 weeks of treatment, the efficacy, safety and tolerability were assessed and the dose increased to 15 mg once daily (pseudo-increase for placebo recipients) if additional efficacy was required by both the patient and physician. In the week before clinic visits (at 2 and 12 weeks), patients recorded incontinence episodes (primary efficacy endpoint) and several secondary efficacy variables in an electronic daily diary. Safety and tolerability were evaluated from withdrawal rates and adverse-event reports. RESULTS The treatment groups had comparable baseline characteristics. Similar proportions of darifenacin (59%) and placebo (68%) recipients increased the dose at 2 weeks; at 12 weeks patients on darifenacin (overall group) had a significantly greater reduction in the median number of incontinence episodes per week than had those on placebo, at ,,8.2 (,62.9%) and ,,6.0 (,48.1%), respectively (P = 0.035). There were also significant improvements in voiding frequency (P = 0.001), bladder capacity (volume voided; P=,0.036), frequency of urgency (P < 0.001), severity of urgency (P = 0.013) and number of significant leaks/week (i.e. incontinence episodes needing a change of clothing or pads, per week; P = 0.010) for darifenacin over placebo. Subset analysis suggested that some patients (those remaining on darifenacin 7.5 mg) were more sensitive to darifenacin than those who increased the dose, based on both efficacy and adverse events. Continued treatment with 7.5 mg for ,sensitive' patients, and an increased dose (to 15 mg) for remaining patients, resulted in comparable outcomes by 12 weeks. The most common treatment-related adverse events were mild-to-moderate dry mouth and constipation, which led to discontinuation in <,3.0% of darifenacin-treated patients and <1.0% of the placebo group. Central nervous system and cardiovascular adverse events were comparable to those with placebo. CONCLUSIONS Darifenacin appears to be an effective, well-tolerated and flexible treatment for patients with OAB, allowing individualized dosing according to patient needs. [source]

Safety and efficacy of tramadol in the treatment of idiopathic detrusor overactivity: a double-blind, placebo-controlled, randomized study

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2006
M. R. Safarinejad
Aim To evaluate the efficacy and safety of tramadol in patients with idiopathic detrusor overactivity (IDO). Methods A total of 76 patients 18 years or older with IDO were randomly assigned to receive 100 mg tramadol sustained release (group 1, n = 38) or placebo (group 2, n = 38) every 12 h for 12 weeks. Clinical evaluation was performed at baseline and every 2 weeks during treatment. All patients underwent urodynamics and ice water test at baseline and 12-week treatment. Main outcome measures were number of voids per 24 h, urine volume per void and episodes of urge incontinence per 24 h on a frequency volume chart and detailed recording of adverse effect. Results After 12 weeks of treatment mean number of voids per 24 h ± SD decreased from 9.3 ± 3.2 to 5.1 ± 2.1 (P < 0.001 vs. placebo) [95% confidence interval (CI) ,5.1-,0.4]. At that time mean urine volume per void increased from 158 ± 32 to 198 ± 76 ml (P < 0.001 vs. placebo) (95% CI 8-22), while mean number of incontinence episodes per 24 h decreased from 3.2 ± 3.3 to 1.6 ± 2.8 (P < 0.001 vs. placebo) (95% CI ,2-0.3). Tramadol induced significant improvements in urodynamic parameters. More adverse effects were associated with tramadol treatment than with placebo (P < 0.05). The main adverse event with tramadol was nausea. Conclusions In patients with non-neurogenic IDO tramadol provided beneficial clinical and urodynamic results. Further studies are required to draw final conclusions on the efficacy of this drug in IDO. [source]

Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations

COLORECTAL DISEASE, Issue 8 2007
J. Melenhorst
Abstract Objective, Faecal incontinence (FI) is a socially devastating problem. Sacral nerve modulation (SNM) has proven its place in the treatment of patients with FI. In this study, the first 100 definitive SNM implants in a single centre have been evaluated prospectively. Method, Patients treated between March 2000 and May 2005 were included. Faecal incontinence was defined as at least one episode of involuntary faecal loss per week confirmed by a 3-week bowel habit diary. Patients were eligible for implantation of a permanent SNM when showing at least a 50% reduction in incontinence episodes or days during ambulatory test stimulation. Preoperative workup consisted of an X-defaecography, pudendal nerve terminal motor latency measurement, endo-anal ultrasound and anal manometry. The follow-up visits for the permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter. The bowel habit diary and anal manometry were repeated postoperatively during the follow-up visits. Results, A total of 134 patients were included and received a subchronic test stimulation. One hundred patients (74.6%) had a positive test stimulation and received a definitive SNM implantation. The permanent implantation group consisted of 89 women and 11 men. The mean age was 55 years (range 26,75). The mean follow-up was 25.5 months (range 2.5,63.2). The mean number of incontinence episodes decreased significantly during the test stimulation (baseline, 31.3; test, 4.4; P < 0.0001) and at follow-up (36 months postoperatively, 4.8; P < 0.0001). There was no significant change in the mean anal resting pressure. The squeeze pressures were significantly higher at 6 months (109.8 mmHg; P = 0.03), 12 months (114.1 mmHg; P = 0.02) and 24 months postoperatively (113.5 mmHg; P = 0.007). The first sensation, urge and maximum tolerable volume did not change significantly. Twenty-one patients were considered late failures and received further treatment. Conclusion, Sacral neuromodulation is an effective treatment for FI. The medium-term results were satisfying. [source]