Combined effects of behavioral intervention and tolterodine in patients dissatisfied with overactive bladder medication.
OBJECTIVE
We assessed the effect of tolterodine extended release plus behavioral intervention on treatment satisfaction and bladder diary variables in patients with overactive bladder who had been previously treated and were dissatisfied with tolterodine or other antimuscarinics.


METHODS
This 16-week, multicenter, open label study included eligible patients 18 years old or older who reported overactive bladder symptoms 3 months or greater in duration, 8 or greater micturitions and 2 or greater urgency related micturitions per 24 hours, and 1 or greater urgency urinary incontinence episodes in a 5-day bladder diary at baseline as well as dissatisfaction with prior antimuscarinic medication. Patients received tolterodine extended release plus self-administered behavioral intervention, consisting of an educational pamphlet with verbal reinforcement, for 8 weeks. Satisfied patients continued with this therapy and dissatisfied patients received tolterodine extended release plus individualized behavioral intervention, consisting of in-depth interaction with a clinician to refine behavioral techniques, for 8 weeks thereafter. Patients rated treatment satisfaction at weeks 8 and 16, and completed a 5-day bladder diary at weeks 4, 8, 12 and 16, respectively.


RESULTS
At weeks 8 and 16, 346 and 357 patients or 91% of the total cohort reported being at least a little satisfied with tolterodine extended release plus behavioral intervention, including 201 (53%) and 252 (64%), respectively, who were very satisfied. Of the 33 patients who were dissatisfied at week 8, 25 (76%) reported treatment satisfaction at week 16 after individualized behavioral intervention. Compared with baseline all bladder diary variables were significantly improved by week 4 (p <0.0001). Patients who were dissatisfied with prior tolterodine or other antimuscarinic treatment reported similar results.


CONCLUSIONS
Tolterodine extended release plus behavioral intervention resulted in high treatment satisfaction and improved bladder diary variables in patients who had previously been treated and were dissatisfied with tolterodine or other antimuscarinics.
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63141, USA. klutkec@wudosis.wustl.edu
Carl G
CG
Klutke
Kathryn L
KL
Burgio
Jean F
JF
Wyman
Zhonghong
Z
Guan
Franklin
F
Sun
Sandra
S
Berriman
Tamara
T
Bavendam
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003408:Cresols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D017060:Patient Satisfaction; D010665:Phenylpropanolamine / Q000627:therapeutic use*; D000068737:Tolterodine Tartrate; D053201:Urinary Bladder, Overactive / Q000628:therapy*; D055815:Young Adult
D001559:Benzhydryl Compounds; D003408:Cresols; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate