Is There a Synergistic Effect of Topical Oestrogens When Administered with Antimuscarinics in the Treatment of Symptomatic Detrusor Overactivity?

Maurizio Serati, Stefano Salvatore, Stefano Uccella, Linda Cardozo, Pierfrancesco Bolis

Research output: Contribution to journalArticlepeer-review

Abstract

Background: No authors have investigated whether the administration of local oestrogens in addition to antimuscarinics could have a synergistic effect in the therapy of overactive bladder (OAB). Objectives: To compare the efficacy of antimuscarinics alone versus antimuscarinics in combination with local oestrogens for OAB; to verify whether risk factors for lower antimuscarinic efficacy can be overcome by the concomitant use of local oestrogens. Design, setting, and participants: Some 229 postmenopausal women with symptomatic urodynamically proven detrusor overactivity were prospectively enrolled at a tertiary level urogynaecology centre and divided into two groups. Intervention: Women in group 1 (n = 129) were prescribed tolterodine extended release (ER) 4 mg once daily; women in group 2 (n = 100) were prescribed both tolterodine ER 4 mg and concomitant oestriol cream application once daily. Measurements: All women underwent clinical evaluation and urodynamics in accordance with the Good Urodynamic Practices Guidelines. After 12 wk of treatment the two groups were compared in terms of subjective efficacy for OAB symptom improvement using a three-point scale. Nonresponders were compared to the patients who improved or were cured in order to identify risk factors for resistance to therapy. Results and limitations: There was no significant difference between the two groups in terms of efficacy of therapy: 80.6% in group 1 versus 82% in group 2 (p = 0.86). Patients with urodynamically proven detrusor overactivity (DO) occurring during provocative manoeuvres and patients with coital incontinence during orgasm reported a higher failure rate both in the overall study population and in group 2. A possible limitation of the study is the nonrandomised design. Conclusions: No synergistic effect of local oestrogens and antimuscarinics in the treatment of OAB was found. Antimuscarinic treatment has lower cure rates in women with symptomatic DO complaining of incontinence at orgasm or in patients with DO following provocative manoeuvres. The association of local oestrogens does not influence the role of the two mentioned risk factors.

Original languageEnglish
Pages (from-to)713-720
Number of pages8
JournalEuropean Urology
Volume55
Issue number3
DOIs
Publication statusPublished - Mar 2009

Keywords

  • Antimuscarinics
  • Detrusor overactivity
  • Oestrogens
  • Overactive bladder
  • Tolterodine
  • Urinary incontinence

ASJC Scopus subject areas

  • Urology

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