title: Solifenacin in women with de novo overactive bladder after tension-free obturator vaginal tape--is it effective?
abstract: OBJECTIVE
  To our knowledge no group has evaluated antimuscarinic efficacy in patients with de novo overactive bladder after mid urethral sling placement. We assessed solifenacin efficacy in women with de novo overactive bladder after obturator tension-free vaginal tape placement compared to a control group.
  
  
  METHODS
  We prospectively considered all women with de novo overactive bladder symptoms at a 3-month followup visit after placement of obturator tension-free vaginal tape. Patients with overactive bladder preoperatively and those with obstructive symptoms or signs were excluded from analysis. Women who satisfied inclusion and exclusion criteria (group 1) were compared with a series of consecutive naïve patients with overactive bladder symptoms without a previous surgical procedure for stress urinary incontinence (group 2). We prescribed 12-week antimuscarinic therapy with oral solifenacin 5 mg once daily. Objective outcomes included changes from baseline in 3-day voiding diary data. Subjective efficacy was evaluated using the Overactive Bladder Questionnaire Short Form, Urgency Severity Scale and Patient Global Impression of Improvement questionnaires.
  
  
  RESULTS
  A total of 110 patients with de novo overactive bladder after obturator tension-free vaginal tape placement completed solifenacin treatment and were included in group 1. They were compared with 120 consecutive naïve women with overactive bladder (group 2). Group 1 presented at the 3-month followup visit with significantly less benefit in the mean decrease in urgency and urgency urinary incontinence episodes daily (-1.1 vs -2.3 and -0.2 vs -1.1, respectively, each p <0.0001). In group 1 we also found a lower subjective solifenacin effect. Previous obturator tension-free vaginal tape placement was an independent predictor of failed solifenacin treatment.
  
  
  CONCLUSIONS
  Antimuscarinic treatment with solifenacin had significantly lower efficacy in women with de novo overactive bladder after mid urethral sling placement than in controls.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. Electronic address: mauserati@hotmail.com.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Braga
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Sorice
authors.affiliation: Department of Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Clinical Institute, Rozzano, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Siesto
authors.affiliation: Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvatore
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D011812:Quinuclidines / Q000627:therapeutic use*; D000069464:Solifenacin Succinate; D053825:Suburethral Slings; D044005:Tetrahydroisoquinolines / Q000627:therapeutic use*; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D018727:Muscarinic Antagonists; D011812:Quinuclidines; D044005:Tetrahydroisoquinolines; D000069464:Solifenacin Succinate
keywords: drug evaluation; overactive; solifenacin; suburethral slings; urethra; urinary bladder