A longitudinal study over 5 to 10 years of clinical outcomes in women with idiopathic detrusor overactivity

Abstract

Objective To evaluate the long-term clinical outcome in women with idiopathic detrusor overactivity (IDO) and to identify significant prognostic factors.Design Longitudinal study incorporating retrospective case note review and a postal questionnaire.Setting Tertiary referral urogynaecology clinic in Australia.Population Women with a sole urodynamic diagnosis of IDO.Methods Audit of urodynamic records and case notes. Postal questionnaire incorporating validated disease-specific qualityof-life (QoL) instruments.Main outcome measure Subjective assessment of overall improvement on a 4-point scale followed by scoring of short forms of the urogenital distress inventory and incontinence impact questionnaire.Results One hundred and thirty two women were identified following examination of 1975 consecutive records with 76 (67%) returning questionnaires. Median follow up was 8 years (6-9), and the duration of symptoms was 13 years (9-18). Improvement was achieved in 25 (35%) women. Disease symptoms fluctuated in severity and QoL were worse in nonresponders to therapy (P < 0.0001). Urge incontinence at presentation was associated with treatment failure (P = 0.001) as was nocturia (P = 0.04), but urodynamic variables were not associated with outcome. Only 3 of 46 (6.5%) women not responding to therapy thought that their symptoms would improve with time.Conclusions IDO seldom resolves and fluctuates in severity. Individual response is unpredictable, although the presence of urge incontinence is associated with a significantly worse prognosis.Keywords Female, idiopathic detrusor overactivity, longitudinal.Please cite this paper as: Morris A, Westbrook J, Moore K. A longitudinal study over 5 to 10 years of clinical outcomes in women with idiopathic detrusor overactivity. BJOG 2008;115:239-246.

The gynaecological subspecialties: advances in women’s health

“…A significant proportion of women have a suboptimal response to treatment; an Australian study showed that after 10 years of attending a specialist incontinence clinic, only 30% of women showed improvement. 19 A small retrospective study of 100 patients attending our clinic over the past 12 years showed similar results; 62% of the women claimed that their condition was unimproved or worse. This has prompted research into novel treatment strategies in women with OAB in our department over the past 15 years.…”

The long‐term natural history of overactive bladder symptoms due to idiopathic detrusor overactivity in women

“…However, symptoms due to IDO were not addressed in that study. A more recent study [11] considered the medium‐term symptomatic follow‐up of women with IDO but did not consider repeat UDS, and involved fewer participants than the present study. There have been longitudinal community‐based questionnaire studies that considered LUTS and incontinence in women over time [12,13].…”

Role of fesoterodine in the treatment of overactive bladder

“…Treatment with 8 mg fesoterodine showed significant improvements (compared with placebo) in 8 of the 9 domains assessed by the King’s Health Questionnaire. While 4 mg fesoterodine (and tolterodine 4 mg), showed significant improvements (compared with placebo) in 7 of the 9 domains 59. The domains where fesoterodine was associated with improvement include: severity/coping, emotions, role limitations, physical limitations, social limitations, sleep/energy, personal relationship and incontinence impact 56,57.…”

“…While muscarinic antagonists can be used to effectively treat OAB in approximately 65% of patients, numerous patients discontinue therapy long term due to adverse events including dry mouth and constipation 59. These adverse events occur due to a lack of organ selectivity of antimuscarinic agents60 as muscarinic receptors are not only located on the detrusor muscle but also in the salivary glands61 and smooth muscle of the gastrointestinal tract 13,62.…”