Therapeutic Effect Consolidation in Overactive Bladder Treatment in Elderly Women by the Use of Increased Antimuscarinic Dosages

Previously, the authors had carried out the study, in which the patients after trospium hydrochloride course with minimal or unstable therapeutic effect were administered the combination of trospium and an increased dosage of one of three antimuscarinics — oxybutinin, solifenacin and tolterodine for 6 weeks. This combination of drug therapy of elderly women with overactive bladder (OAB) was found to result in stable clinical and urodynamic result causing no additional side effects.

The present study was aimed at searching an optimal supporting course, which would enable to consolidate an initial effect and reduce the risk of OAB recurrence.

The aim of the investigation was to assess the possibilities of improving the supporting therapy efficiency in elderly women with overactive bladder using double doses of trospium hydrochloride and solifenacin.

Materials and Methods. The study included 229 women (mean age — 66.3 years: from 65 to 77) with clinically confirmed overactive bladder, who received daily trospium — 60 mg and solifenacin — 40 mg for 6 weeks (such treatment regimen had been justified in the previous study). In order to study the possibilities of each type of supporting therapy, the patients were divided into four groups: group 1 (n=59) was given trospium (60 mg o.d.) + solifenacin (40 mg o.d.) for a month; group 2 (n=51) — detrusor electrical stimulation for a month; group 3 (n=63) — laseropuncture for a month; and group 4 (n=56) patients were given placebo. A supporting therapy course followed the main course 2.5 months later. The patients’ condition was monitored using OAB-q questionnaires (for a year) and urodynamic examination (before a treatment course, 6 and 12 months after the study initiation).

Results. A group of elderly women with OAB underwent a short course of treatment by high (double) doses of two antimuscarinics of different generations (trospium and solifenacin) 2.5 months after the main therapy, which had been similar, and enabled to maintain the initial clinical and urodynamic result for a long period of time (minimum 7 months), with the level of side effects being acceptable. The patients were found to have a high correlation of urodynamic and clinical indices on 6 and 12 month of the study. The use of detrusor electrical stimulation and laseropuncture as a supporting therapy does not enable to maintain a positive effect of drug therapy for a long time.

Conclusion. The supporting course of OAB treatment in elderly women by a combination of high doses of antimuscarinics two months after the main therapy course is the most effective method to reduce the symptomatic relapse risk of the disease.

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Kosilov К.V., Loparev S.А., Ivanovskaya М.А., Kosilova L.V. Therapeutic Effect Consolidation in Overactive Bladder Treatment in Elderly Women by the Use of Increased Antimuscarinic Dosages. Sovremennye tehnologii v medicine 2013; 5(4): 78