Persistence with antimuscarinic therapy in patients with overactive bladder

Abstract

Overactive bladder (OAB) is a chronic condition, which impacts patients' health and quality of life. The primary symptoms of OAB are distressing and may interfere with work, psychosocial and sexual functioning. OAB also is associated with increased risk of urinary tract infections, fractures from falls, skin infections and depression. Patient's concerns about the effects of incontinence on lifestyle highlight the need to restore continence. The mainstay of treatment is antimuscarinic drug therapy, which may often produce only modest reductions in OAB symptoms and may be accompanied by bothersome adverse effects, leading to poor adherence to prescribed medications. Successful treatment of OAB depends on persistence with the prescribed medication, and efficacy and tolerability are key influencers of persistence. New antimuscarinic agents are now available for treating OAB that significantly improve symptoms of incontinence, urgency and frequency with few adverse effects. An improved efficacy and tolerability profile should result in greater patient satisfaction and persistence with therapy during long-term therapy.

A review of adherence to drug therapy in patients with overactive bladder

“…This is influenced by factors including symptom severity, the ability to obtain the medication, perceived efficacy and the presence of side-effects [5]. Poor adherence to medication represents a major challenge in the management of OAB.…”

Botulinum toxin therapy for nonneurogenic overactive bladder: first experience

“…According to the literature, however, this treatment results in only a 50% improvement of the continence. Furthermore, anticholinergic drugs have side effects such as mouth dryness, constipation, vision and sleep disorders, and the patients experiencing such side effects discontinue the treatment (2,12,15). The other methods of treatment, such as neuromodulation and surgery, are invasive and more traumatic.…”

“…The disorder of the vesicosphincter coordination results in a functional obstruction to the flow of urine, preventing a full voiding of the bladder (dysuria, residual urine, vesicorenal refluxes) and causing urinary infections and damage to the kidney (2,(5)(6)(7)(8)(9)(10)(11). The neurogenic overactive bladder is treated with anticholinergic drugs or, in the case of ineffectiveness of the latter, with botulin toxin injections (12). In case of urinary retention, autocatheterisation, neuromodulation, or bladder augmentation surgery are applied (2,13).…”

“…Anticholinergic drugs improve the continence of urine but often have side effects (12,13). Thus, in cases the treatment with drugs is not effective or there is intolerance to the drugs, a minimally invasive method -injections of botulinum toxin into the detrusor -is applied as an intermediate option between conservative and operative treatment (14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Résultats et intérêt de l’utilisation de la toxine botulique dans l’hyperactivité détrusorienne idiopathique

“…On associe à leur prescription la rééducation périnéosphinctérienne [6] et la correction de facteurs aggravants, tels que la carence hormonale ou le prolapsus des organes pelviens chez la femme, ou déclenchants, tels que l'obstruction dans les deux sexes. Cependant, l'efficacité modérée et la tolérance médiocre à moyen terme (hyposialorrhée, constipation) des anticholinergiques oraux conduisent jusqu'à 80 % des patients à l'abandon du traitement avant un an [7]. La neuromodulation est efficace dans la prise en charge de l'HD idiopathique réfractaire aux anticholinergiques [8].…”