COMMENTARY

December 2004: The Year in Review -- Ob/Gyn & Women's Health

Ursula Snyder, PhD

Disclosures

January 24, 2005

Urogynecology - Pharmacologic Treatment for Overactive Bladder

By Medscape Ob/Gyn & Women's Health board member,
Victoria L. Handa, MD

In the realm of pharmacology, trospium chloride (Sanctura) became available for treatment of overactive bladder (OAB) in 2004. Other drugs currently available for overactive bladder include tolterodine (Detrol), generic oxybutynin, transdermal oxybutynin, and extended-release oxybutynin. Trospium chloride is administered twice daily. Research shows that this drug improves functional bladder capacity, significantly decreasing symptoms of frequency and nocturia. Unfortunately, as for many of the other pharmacologic treatments for OAB, trospium does not typically "cure" urge incontinence. A minority of women treated with trospium will experience complete control of incontinence. For example, in the phase 3 clinical trial published this year, only 21% of trospium-treated patients became "dry" (vs 11% of placebo-treated patients).[57] Trospium chloride seems to have a favorable side effect profile and causes less dry mouth than generic oxybutynin,[58] but there are no published comparisons to tolterodine, transdermal oxybutynin, or extended-release oxybutynin.

With respect to surgical treatment for stress incontinence, there are a growing number of surgical "kits" available. Some of the commercially available products involve materials or techniques that are unproven. Clinicians interested in issues pertaining to the marketing of new surgical therapies should read the 2004 Green Journal review by Nygaard and Heit.[59] There are a growing number of products designed to facilitate a minimally invasive approach to stress incontinence. This trend will continue, because powerful social and economic forces drive the development, marketing, and implementation of new surgical products. The cautious surgeon should critically evaluate new products for safety and efficacy before implementation. (See also Appraisal of Surgical Techniques for Stress Urinary Incontinence)

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