title: Urodynamic approach to female urinary incontinence refractory to treatment with anticholinergics.
abstract: OBJECTIVE
  The administration of empirical anticholinergic treatment is widespread in women with urinary incontinence and has produced varied results. The objective of our paper is to determine the effectiveness of anticholinergics for the treatment of female urinary incontinence and to determine by urodynamics the possible causes that may explain the resistance to anticholinergics to obtain urodynamic predictors of success or failure.
  
  
  METHODS
  We evaluated 182 women over 14 years of age with urinary incontinence that had previously been treated with anticholinergics for at least three months. The patients underwent a complete medical history including clinical history, physical examination, and urodynamic and lower urinary tract video-radiologic studies. Statistical analysis was performed using SPSS 17.0 for Windows.
  
  
  RESULTS
  Clinical therapeutic efficacy was demonstrated in 39.6% of cases. Cystometric bladder capacity was decreased in 89.2%of patients that did not improve clinically with anticholinergics (p=0.01). Detrusor overactivity was urodynamically demonstrated in 51% of cases (p=0.05) among patients without clinical improvement with anticholinergic treatment. This hyperactivity was demonstrated during early bladder filling (<100ml). Urodynamic stress urinary incontinence (SUI) was demonstrated in 26.5% of patients without clinical improvement after treatment (p=0.04). Lower urinary tract obstruction was urodynamically demonstrated in 20.6% of patients with no clinical improvement (p=0.05). Urodynamic data did not demonstrate a relationship between detrusor overactivity, a high-grade cystocele ( 37.4% of total), and irregular bladder morphology (11.5% of total).
  
  
  CONCLUSIONS
  It is important to conduct urodynamic study before starting anticholinergic treatment of females with urinary incontinence to identify therapeutic data of poor prognosis, such as SUI and lower urinary tract obstruction, thus optimizing the therapeutic efficacy of anticholinergics.
authors.affiliation: Urology Unit, Sanatorio Virgen del Mar, Madrid, Spain. cnaranjoortiz@gmail.com
authors.forename: Cristina
authors.initials: C
authors.lastname: Naranjo-Ortiz
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Clemente-Ramos
authors.forename: Jesús
authors.initials: J
authors.lastname: Salinas-Casado
authors.forename: Santigo
authors.initials: S
authors.lastname: Méndez-Rubio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000175:diagnosis; D053201:Urinary Bladder, Overactive / Q000188:drug therapy; D014549:Urinary Incontinence / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D014563:Urodynamics
chemical_list: D018680:Cholinergic Antagonists