Management Of Urge Incontinence Research Articles

Anticholinergics for urge incontinence

SummaryUrinary incontinence is a common symptom in women, more so in older people, with a significant impact on physical health and wellbeing. About 1 in 5 people have impaired continence. Symptom categorization at initial assessment is the key to guiding further therapy. Non-pharmacological options (bladder training for 6 weeks with guidance from a trained physiotherapist) are preferred and can be supported with biofeedback. If unsuccessful, anticholinergics are added and, rarely, surgical options need consideration.Anticholinergics are the mainstay of pharmacological management of urge incontinence. The National Institute of Health and Clinical Excellence (NICE) recommends immediate release oxybutynin as the first-line agent, with recourse to others if there are adverse effects. The pharmacology, efficacy and adverse effect profile of the various anticholinergic drugs is reviewed, allowing the reader to make an informed choice of appropriate anticholinergics for urge incontinence.

Urinary incontinence in adults

Urinary incontinence is common and distressing and has far-reaching effects on quality of life. This review discusses the classification of incontinence, presentation, investigations, the principles of restoring continence, the management of urge incontinence, management of stress incontinence in women, management of male urinary incontinence, management of incontinence in the elderly and management of transient states of incontinence.

Cost-Effectiveness Analysis of Extended-Release Formulations of Oxybutynin and Tolterodine for the Management of Urge Incontinence

Oxybutynin and tolterodine are two drugs widely used for the management of overactive bladder and urge urinary incontinence. The once-daily, extended-release formulations benefit from being well tolerated and efficacious. However, their costs, compared with generic immediate-release (IR) oxybutynin, are significantly greater. This study compared the cost effectiveness of oxybutynin extended-release (Oxy-XL), tolterodine extended-release (Tol-ER), tolterodine immediate-release (Tol-IR) and oxybutynin immediate-release (Oxy-IR). A cost-effectiveness model. A systematic review that identified appropriate randomised clinical trials provided evidence on efficacy. Empirical models of drug effects (number of incontinent-free weeks) and persistence (proportion of patients still on therapy) were constructed in order to determine clinical effectiveness which was combined with cost data (direct medical costs to the UK NHS, year 2001 values) to calculate the drugs' cost-effectiveness from the perspective of the NHS. Univariate sensitivity analyses were conducted to test the robustness of the results. Hypothetical cohort of patients with urge incontinence associated with overactive bladder. The incremental cost per incontinent-free week for Oxy-IR (versus no treatment) ranged from pound sterling 2.58 to pound sterling 16.59. Oxy-XL and Tol-ER were more effective than Oxy-IR but at additional costs per incontinent-free week. Tol-IR did not appear to be a cost-effective option as it was less effective and more costly than the extended-release formulations. Uncertainty surrounding the health and cost consequences of early discontinuation affected these results, although the model results were robust to parameter uncertainty. Oxy-IR, Oxy-XL and Tol-ER appear to be cost-effective options for the management of urge incontinence from the NHS perspective. A decision among the treatments depends on the acceptable cost per additional incontinent-free week.

A vaginal device (continence guard) in the management of urge incontinence in women.

The aim of the study was to assess the efficacy of a disposable vaginal device in the management of urge incontinence. A total of 38 women with urge incontinence and uninhibited bladder contractions during cystometry were included. They wore the device from morning to night. Before, and again after, using the device for 1 month the women were assessed by pelvic examination, uroflowmetry, postvoid residual urine, two 24-hour pad-tests, a 3-day voiding diary and vaginal and urine cultures. A questionnaire about the subjective effect and adverse events was completed. Thirty women (79%) completed the study. Two (6.7%) were subjectively cured when using the device, 15 (50%) were improved, and 13 (43.3%) experienced unchanged incontinence. The 24-hour pad-test leakage showed a statistically significant decrease (P=0.001) - in 11 women (36.7%) the decrease was more than 50%. The other urodynamic results were unchanged. A significant decrease in the number of daily micturitions was found in the group of responders (P=0.02). No vaginal infections were found; 4 women (13%) had uncomplicated urinary tract infection during the test-period. Subjective complaints were few, and 21 women (70%) wanted to continue the treatment with the device. The vaginal device constitutes a new option in the management of urge incontinence, with a subjective and objective cure/improvement rate of 56.7%. The device is easy to use and well accepted.

Transvesical phenol injection of pelvic nerve plexuses in females with refractory urge incontinence.

A series of 28 female patients with urge incontinence refractory to other forms of treatment underwent a total of 40 transvesical injections of phenol into the pelvic nerve plexuses. Following primary phenol injection only 8 patients (29%) had a significant response to therapy and all relapsed during follow-up. Only 3 of 11 patients undergoing a second injection had a clinical response to this therapy and 1 developed a vesicovaginal fistula. This suggests that phenol injections have little place in the management of urge incontinence and it is unwise to proceed to 2 or more injections because of the risk of fistula.