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Tolterodine effective for OAB in vaginal wall prolapse

Obstetrics and gynaecology

Obstetrics and gynaecology

Overactivity of the bladder detrusor muscle is common and occurs in around 12% of both sexes. Vaginal wall prolapse in women is also common and, unsurprisingly, a proportion of women will have both prolapse and detrusor overactivity.

A study, from Italy, has assessed the effectiveness of antimuscarinic drugs in women with overactive bladder and concomitant mild anterior prolapse and found that they are an effective option.

The study included 235 women with bladder overactivity (urgency with or without urge incontinence) and no obstructive signs (voiding difficulty or high residual urine volume), of whom 184 had no prolapse and 51 had mild anterior vaginal wall prolapse. The two groups were demographically similar.

All patients had a full urodynamic assessment and received twelve weeks of therapy with tolterodine 4mg SR od. At the end of the trial, all patients were asked if there had been no change, improvement or cure of symptoms.

Women with concomitant prolapse were significantly more likely to report no change in symptoms (39% versus 14%, P=0.002). Eight of the 20 non-responders in the prolapse group subsequently elected to have surgery, of whom six reported improvement or cure. The study did not mention the number of dropouts due to side-effects during the trial. The effect of tolterodine in this trial was impressive; the symptoms of overactive bladder were improved or cured in 86% and 61% of the non-prolapse and prolapse groups respectively.

In women with both overactive bladder and mild anterior wall prolapse, a trial of antimuscarinics is worth considering before referral for surgery.

Salvatore S, Serati M, Ghezzi F et al. Efficacy of tolterodine in women with detrusor overactivity and anterior vaginal wall prolapse: is it the same? BJOG 2007 doi: 10.1111/j.1471-0528.2007.01399.x


Dr Chris Barclay
GP, Sheffield

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