Approximately individual in six ad...

Approximately individual in six adults reports having "overactive bladder" symptoms similar as urgency, urge incontinence, frequent occurrence or nocturia. The prevalence of these symptoms increases with age. Pharmacologic treatment of overactive bladder symptoms is based forward the use of anticholinergic physics that block the parasympathetic pathways and lessen detrusor muscle contraction. The effectiveness of these medicines remains uncertain and they have significant side weights (e.g., dry mouth, constipation, headache). Herbison and colleagues course of lifeed a systematic review of anticholinergic therapy for overactive bladder symptoms.

The authors used the Cochrane Incontinence Group's register of controll trials plus a search of citations to identify all randomized controll trials of overactive bladder or detrusor overactivity that compared an anticholinergic physic with placebo. Of the 64 potential trials, 32 trials with 6800 participants met inclusion criteria for the analysis. The sample sizes ranged from 20 to 1529 (median, 155) and involved more than twice as many women as men although a certain number of trials did not report sex Six put drugs intos were studied, and the trials differed in inclusion criteria, methodology, duration of follow-up and issue measures.

Patients taking an anticholinergic agent were more likely to report subjective improvement than patients taking placebo--equivalent to about single less leakage episode or single micturition fewer per 48-hour period. Anticholinergic agents also were consistently associated with improvements in measures of bladder capacity. Maximum cystometric capacity increased on an average 49 mL and average turn at first contraction increased at 52 mL. Average residual tome was 4 mL greater in the drug-treated patients, however significant heterogeneity was observed. medicine and placebo groups did not differ significantly in withdrawals because of adverse consequences but dry mouth was sum of two units and one half times as frequent in patients treated with an anticholinergic agent in the 20 trials reporting side effects

The authors decide that therapy with an anticholinergic agent be the effects in small improvements in symptoms and urodynamic measures when compared with placebo nevertheless is associated with significant side general intents especially dry mouth. They note that improvements were reported in the two treatment and placebo groups, still few studies used recognized quality-of-life measures. They question the clinical significance of the improvements reported with anticholinergic agents and call for direct comparisons of these medications with bladder retraining and other nonpharmacologic treatments for overactive bladder symptoms.

Anne D Walling, MD

Herbison P et al. Effectiveness of anticholinergic mix with drugss compared with placebo in the treatment of overactive bladder: systematic review. BMJ April 19 2003;326:841-7

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