Bladder-sphincter biofeedback as treatment of detrusor instability in women who failed to respond to oxybutynin.
BACKGROUND
This study was designed to determine the efficacy of bladder-sphincter-biofeedback as a secondary treatment for those women with detrusor instability who failed to respond to oxybutynin chloride.


METHODS
In a prospective non-randomized trial, 31 of 70 women with detrusor instability were assigned to either the study bladder-sphincter-biofeedback training group (n = 16) or to the control pelvic floor exercise group (n = 15) after they had failed to respond to oxybutynin chloride.


RESULTS
Thirty (43%) of the 70 women were cured by oxybutynin chloride, and 9 (13%) withdrew due to various side effects. A comparison of cure rates between biofeedback training and pelvic floor exercise groups demonstrated that there were significant differences in objective changes: detrusor pressure (68.75% vs. 0%, p < 0.001), compliance (75.0% vs. 6.67%, p < 0.001), and resting maximal urethral closure pressure (43.75% vs. 6.67%, p < 0.037). Neither the cure rate nor improvement rate of subjective changes (urgency, and frequency and episodes of urge incontinence), significantly differed.


CONCLUSIONS
Oxybutynin chloride was not well tolerated while bladder-sphincter-biofeedback was well accepted. As a secondary treatment, it appears better than pelvic floor exercise alone and may be the choice of non-surgical treatment in those women who failed to respond to oxybutynin chloride for detrusor instability.
Wang
A C
AC
Section of Urogynecology/Reconstructive Pelvic Surgery, Department of Obstetrics/Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C. alexwang@adm.cgmh.com.tw
D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008333:Mandelic Acids / Q000627:therapeutic use; D008875:Middle Aged; D017773:Pelvic Floor; D011446:Prospective Studies; D017211:Treatment Failure; D001743:Urinary Bladder; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000628:therapy*; D014563:Urodynamics
D018680:Cholinergic Antagonists; D008333:Mandelic Acids; C005419:oxybutynin