Is there a synergistic effect of topical oestrogens when administered with antimuscarinics in the treatment of symptomatic detrusor overactivity?
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).


OBJECTIVE
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.


METHODS
Some 229 postmenopausal women with symptomatic urodynamically proven detrusor overactivity were prospectively enrolled at a tertiary level urogynaecology centre and divided into two groups.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Serati
Maurizio
M
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. mauserati@hotmail.com
Salvatore
Stefano
S
Uccella
Stefano
S
Cardozo
Linda
L
Bolis
Pierfrancesco
P
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001559:Benzhydryl Compounds / Q000008:administration & dosage* / Q000494:pharmacology; D003408:Cresols / Q000008:administration & dosage* / Q000494:pharmacology; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004964:Estriol / Q000008:administration & dosage* / Q000494:pharmacology; D004967:Estrogens / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006801:Humans; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000494:pharmacology; D010665:Phenylpropanolamine / Q000008:administration & dosage* / Q000494:pharmacology; D011446:Prospective Studies; D000068737:Tolterodine Tartrate; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
D001559:Benzhydryl Compounds; D003408:Cresols; D004967:Estrogens; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D004964:Estriol