The combination of solifenacin in a double dosage along with tamsulosin can be recommended for elderly benign prostatic hyperplasia patients with overactive bladder symptoms.

Objective: To increase the safety and effectiveness of treatments for overactive bladder (OAB) with moderate symptoms in elderly patients. Patients and Methods: Patients were examined at the Urodynamic Department of the Regional Diagnostic Center (Vladivostok, Russian Federation) from September 1, 2012 to December 31, 2012. The assignment of patients [n = 177, average age 69. 4 years, 98 women (55.4%) and 79 men (44.6%)] was random and blind in this placebo-controlled study. Patients were distributed into subgroups according to the method of treatment as follows: group А1: n = 57, trospium 30 mg/day + solifenacin 10 mg/day; group А2: n = 61, trospium 15 mg/day + solifenacin 5 mg/day; group А3: n = 59, placebo. All patients underwent a urodynamic examination in accordance with international standards before and 2 months after treatment. ICIQ-SF questionnaires recommended by the International Continence Society (ICS) and bladder diaries were used to evaluate the clinical results. The clinical severity of the OAB symptoms and the effectiveness of the treatment were evaluated based on the frequency of episodes of incontinence (EI) per day. Three or fewer EI per day were considered moderate dysfunction of the lower urinary tract. Results: Groups of elderly patients with moderate symptoms of OAB who were treated with standard- and low-dose trospium and solifenacin demonstrated a significant increase in the median values of reflex volume, bladder capacity, and detrusor compliance and a decrease in the frequency of urination and urinary urgencies. The frequency of EI in both of the main groups decreased by almost 2-fold in comparison to the initial data and reached the following values: group А1: 1.27 (-1.08), p ≤ 0.05; group A2: 1.49 (-1.18), p ≤ 0.05. The correlation with the decrease in the frequency of EI in these groups was r = 0.85 (p ≤ 0.01). The percentage of patients with a significant decrease (EI ≥1.0) among those treated with standard- and low-dose trospium and solifenacin increased synchronously, prompting us to suppose the absence of a direct correlation between medicine dose and therapeutic effect for moderate OAB symptoms. Conclusion: The combination of low-dose trospium and solifenacin provides good clinical and urodynamic effects in elderly patients with moderate symptoms of OAB. Combination of these drugs in standard doses for such patients is excessive.

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PurposeTo improve the long-term efficiency of the pharmacologic management of overactive bladder (OAB) in elderly women.MethodsThe study comprised 229 women (mean age, 66.3 years; range, 65-77 years) with urodynamically and clinically confirmed OAB. All patients received the most effective treatment regimen based on the data obtained in the initial part of the study (trospium 60 mg/day + solifenacin 40 mg/day, for 6 weeks), and positive results similar to those in the first phase were obtained. They were then divided into four groups, based on the maintenance therapy: group A (59 women), trospium (60 mg/day) + solifenacin (40 mg/day) for 1 month; group B (51 women), electrical stimulation of the detrusor muscle for 1 month; group C (63 women), laser puncture for 1 month; group D (56 women), placebo. Maintenance therapy was administered 2.5 months after completion of primary treatment. The patients' condition was monitored through the OAB questionnaire for 1 year and by urodynamic examination at months 6 and 7 from the start of the study.ResultsIn group A, the clinical and urodynamic results achieved after the initial + main treatment phase (two high-dosage antimuscarinics of different generations, trospium and solifenacin, for a total of 2.5 months) were maintained for at least 7 months. Electrical stimulation of the urinary bladder as a method of maintenance therapy proved to be less effective. In groups C and D, deterioration in results was observed at 6-8 months, which led us to conclude that laser puncture was an inefficient method of maintenance therapy in elderly women with OAB.ConclusionsMaintenance treatment of OAB in elderly women with a combination of high-dosage antimuscarinics is an effective method for reducing the risk of recurrence of the disease.

Increase of effectiveness of treatment for severe overactive bladder (OAB) symptoms in patients 40–65 and 66–80 years of aged with combined antimuscarinic drugs. This placebo‐controlled longitudinal study was performed on the basis of Regional Diagnostic Centre (Vladivostok city, Russian Federation) from 1 June 2011 to 30 December 2012. Assignment of patients (n = 299, average age: 67·1; women: 174 or 58·2%, men: 125 or 41·8%) was random blind. All patients were distributed into two age groups 40–65 and 66–80 years, and then into groups in accordance with treatment algorithm. Group A1 – patients below 65 years old treated with Trospium 60 mg/day + Soilfenacin 20 mg/day, Group A2 (n = 51; also below 65 years old): Trospium 30 mg/day + Soilfenacin 10 mg/day, Group A3 (n = 45, below 65 years old): Placebo. Group B1(n = 52; over 65 years old): Trospium 60 mg/day + Soilfenacin 20 mg/day, Group B2 (n = 54; over 65 years old): Trospium 30 mg/day + Soilfenacin 10 mg/day, Group B3 (n = 49, over 65 years old): Placebo. Period of treatment in all groups was 2 months. All patients underwent urodynamic examination at the beginning and at the end of the study. International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) questionnaires and bladder diaries were used for evaluating clinical effectiveness of treatment and patients' satisfaction. Frequency of episodes of incontinence (EI) per day was taken as basis for clinical evaluation of treatment effectiveness. Value EI >3/day was considered as severe dysfunction of lower urinary tract (LUT). Patients below 65 years of age treated with double‐dosed antimuscarinics showed the best results both for improvement of main urodynamic and clinical parameters and for number of persons completely or partially satisfied with effect of the treatment (81·2/12·5%). In the group of patients over 65 years of age treated with standard‐dosed Trospium and Solifenacin 74·5/17·6% of patients were completely or partially satisfied with effect of the treatment and experienced significant improvement of main clinical and urodynamic indexes. Comparison of pattern of urodynamic indices, decrease of frequency of EI, correlation of Bladder capacity let us suppose that effectiveness of treatment algorithms is similar in all groups. All urodynamic and clinical indices in the group of patients over 65 years of age, who were treated with double‐dosed antimuscarinics, were significantly different from initial data, and majority of patients were completely or partially satisfied (76·9/5·8%) with results of the treatment. Clinical observation indexes, including EI, and urodynamic examination of the group of elderly patients, who were treated with standard‐dosed Trospium and Solifenacin, showed absence of significant result, and number of patients satisfied with the treatment was minimal. For effective management of overactive bladder with severe symptoms in 40 to 65‐year‐old patients prescription of two standard‐dosed antimuscarinic drugs, preferentially with different spectrum, is suf...

Combination of Trospium and Solifenacin is an effective way to manage residual symptoms of hyperactive bladder during treatment of early obstruction of urinary bladder.

As a result of this study, under the control of the objective functional state of LUT, the influence of various factors on the patients' stability in the treatment with AM drugs was revealed.

The MASRI is a valid tool for rapid assessment of adherence to treatment of patients with BPO and OAB receiving Tamsulosin and antimuscarinic drugs and may be recommended for use in clinical practice.