Incontinence

REVIEWING THE LITERATURE News and Views from the Literature Incontinence Treatment of Mixed Incontinence Reviewed by Izumi Kamo, MD, Michael B. Chancellor, MD Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA [Rev Urol. 2004;6(3):166] © 2004 MedReviews, LLC Tolterodine is Equally Effective in Patients With Mixed Incontinence and Those With Urge Incontinence Alone Kreder KJ Jr, Brubaker L, Mainprize T. BJU Int. 2003;92:418-421. It is well known that antimuscarinic agents are effective for the treatment of overactive bladder (OAB) and urge incontinence (UI). However, in women with mixed urge and stress incontinence (MI), the issues of which component of incontinence is more important and which should be treated first remain unresolved. Kreder and colleagues studied the efficacy of tolterodine in patients with MI compared with UI alone. The study included 239 patients with MI (urge predominating) and 755 patients with UI alone from a single-blind, multicenter trial of 1380 166 VOL. 6 NO. 3 2004 REVIEWS IN UROLOGY patients (80% female) with OAB. After a 7-day washout and a 3-day run-in to collect baseline information, patients received tolterodine, 2 mg twice daily, for 16 weeks. The 2 groups were compared with respect to incontinence episodes per 24 hours, voiding frequency, nocturia episodes, and pad usage after 16 weeks of treatment. After 16 weeks, median changes from baseline for all voiding variables were significant for the MI and UI groups (P = .001), with no apparent significant differences between groups. The median reduction in incontinence episodes from baseline was 67% for the MI group and 75% for the UI group (P = .39). Thirty-nine percent of MI patients and 44% of UI patients achieved total continence by the end Thirty-nine percent of MI patients and 44% of UI patients achieved total continence by the end of the study. of the study. This is quite remarkable, given that one would not initially expect any patient with MI to gain complete continence with oral antimuscarinic therapy. Cure rates for nocturia and the reduction in the number of patients using pads were also similar between the groups. The authors concluded that tolterodine can be effective in reducing leakage and other OAB symptoms not only in patients with UI but also in patients with MI.