Comparative Effectiveness of Anticholinergic Therapy for Overactive Bladder in Women

Reynolds, W. Stuart; McPheeters, Melissa L; Blume, Jeffery; Surawicz, Tanya; Worley, Katherine; Wang, Li; Hartmann, Katherine E.

doi:10.1097/aog.0000000000000851

“…All newer anticholinergic medications for overactive bladder syndrome have been compared in RCTs against both placebo and oxybutynin as a condition of licensing. The overall effect of this class of drugs is very modest, with few long-term treatment responders 133 . Very few head-to-head studies of contemporary anticholinergic medications have been conducted, and when direct comparisons have been made, the evidence of differential efficacy is limited 134 .…”

Section: Managementmentioning

confidence: 99%

Urinary incontinence in women

Aoki

¹

,

Brown

²

,

Brubaker

³

et al. 2017

Nat Rev Dis Primers

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Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.

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“…Pharmacotherapy is generally efficacious based on individual clinical trials; however, in aggregate, the mainstay of pharmacotherapy, anticholinergic medications, is only modestly superior to placebo [20]. In a recent comparative effectiveness review of anticholinergic agents for OAB, meta-analyses of data from 50 randomized controlled trials estimated that daily agents reduced urge incontinence by 1.73 episodes per day (95 % CI 1.37–2.09) and voids by 2.06 per day (95 % CI 1.66–2.46).…”

Section: Management and Treatment Considerations On Oab Health Burdenmentioning

confidence: 99%

The Burden of Overactive Bladder on US Public Health

Reynolds

¹

,

Fowke

²

,

Dmochowski

³

2016

Curr Bladder Dysfunct Rep

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Overactive bladder (OAB) is a highly prevalent symptom condition that affects millions of US men and women. Not only can the symptoms of OAB be very bothersome, but OAB can have significant detrimental effects on many aspects of individuals’ lives, representing a particularly impactful health burden to quality of life and productivity. Estimates of the individual and societal costs for the management of OAB continue to rise, particularly as effective treatments remain elusive. As such, OAB represents a significant public health burden to the USA.

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“…All newer anticholinergic medications for overactive bladder syndrome have been compared in RCTs against both placebo and oxybutynin as a condition of licensing. The overall effect of this class of drugs is very modest, with few long-term treatment responders 133 . Very few headto-head studies of contemporary anticholinergic medications have been conducted, and when direct comparisons have been made, the evidence of differential efficacy is limited 134 .…”

Section: Medical Interventionsmentioning

confidence: 99%

Urinary incontinence in women

Ss

¹

,

Rm²

2017

Nat Rev Dis Primers

15

0

1

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Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.Correspondence to R.C. Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK. r.cartwright@imperial.ac.uk. Author contributions Competing interestsThe authors declare no competing interests. Publisher's noteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. HHS Public AccessAuthor manuscript Nat Rev Dis Primers. Author manuscript; available in PMC 2018 April 01. Published in final edited form as:Nat Rev Dis Primers. ; 3: 17042. doi:10.1038/nrdp.2017.42. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptUrinary incontinence is the complaint of involuntary loss (leakage) of urine 1 . The condition occurs in both sexes, but is much more frequent in women. Although some overlap in pathophysiology is evident between sexes, incontinence in men is often a consequence of prostatic enlargement or from damage to continence mechanisms during surgery or radiotherapy for prostate cancer. By contrast, incontinence in women is typically related to dysfunction of the bladder or pelvic floor muscles, with such dysfunction often arising during pregnancy or childbirth, or at the time of menopause. This Primer focuses on female urinary incontinence because of its higher prevalence and unique pathophysiology.There are two main subtypes of urinary incontinence: stress incontinence and urgency incontinence. According to the International Urogynecological Association (IUGA) and the International Continence Society (ICS) standard definition, stress incontinence is the complaint of urine leakage in association with coughing, sneezing or physical exertion, whereas urgency incontinence is the comp...

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Comparative Effectiveness of Anticholinergic Therapy for Overactive Bladder in Women

Abstract: Evidence from more than 27,000 women participating in randomized controlled trials suggests that improvement in symptoms with anticholinergic management of overactive bladder is modest and rarely fully resolves symptoms.

Cited by 63 publications

References 90 publications

Urinary incontinence in women

Urinary incontinence in women

The Burden of Overactive Bladder on US Public Health

Urinary incontinence in women

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