Safety and Efficacy of Intermittent versus Continuous Anticholinergic Medication in Management of Overactive Bladder in Adult

Abstract

Background: overactive bladder (OAB) also referred to as the urgency-frequency syndrome, with or without urge urinary incontinence can considerably impair the patient's quality of life. It is widely accepted that diet and life style modifications, behavioral therapy and medication belong to the standard conservative therapeutic options and considered as the first-line measures. The International Consultation on Incontinence (ICI) guidelines reported that when the first line approach is not fully satisfactory or fails after 8-12 weeks, alternative therapies should be sought out. It is worthwhile and justified to proceed to second-line therapy if patients are refractory to antimuscarinic therapy or if the treatment is contraindicated. Second-line of therapies include less-invasive measures such as percutaneous posterior tibial neve stimulation, sacral neuromodulation, detrusor injections with botulinum toxin (BTX) and whereas more-invasive measures constitute surgical techniques e.g. bladder augmentation or substitution. Pelvic neuromodulation has been proven effective and is today an established treatment option for patients refractory to or intolerant of conservative treatments. Objective: this study aimed to compare between the efficacy of continuous anticholinergic therapy and intermitted anticholinergic therapy for treatment of the overactive bladder. Patients and Methods: our study included 60 patients categorized into two groups: continuous anticholinergic therapy group and intermitted anticholinergic therapy. By using 12 weekly intermitted anticholinergic therapies, remarkable clinical results were obtained. Percent of the patients who complained OAB in the intermitted anticholinergic group reported a statistically significant subjective success. These patients chose to continue treatment to maintain the response. Results: patients in the intermitted anticholinergic therapy group showed significant improvement of frequency (31%) urgency (50%) urge incontinence (50%) and nocturia (53%) compared to propiverine group frequency (50%) urgency (60%) urge incontinence (67%) and nocturia (67%). No serious side effects were reported, in group A 8 patients had horm of dry mouth in 5 cases (16.7%), constipation in 2 cases (67%) 8 blurred vision in one case (33%). In group B, there were 5 patients (16.7%) in the horm of dry mouth in 3 cases (10% constipation in one case (3.3) and blurred vision in one case (3.3%). Conclusion: our study concluded that intermittent anticholinergic therapy induced improvement of bladder over activity symptoms and less side effects than continuous anticholinergic group.