title: A randomized, double-blind, solifenacin succinate versus placebo control, phase 4, multicenter study evaluating urinary continence after robotic assisted radical prostatectomy.
abstract: OBJECTIVE
  Bladder dysfunction influences recovery of urinary continence after radical prostatectomy. We performed a multicenter, randomized, double-blind study evaluating solifenacin vs placebo on return to continence in patients who were still incontinent 7 to 21 days after catheter removal after robot-assisted radical prostatectomy.
  
  
  METHODS
  A wireless personal digital assistant was given to patients the day of catheter removal. Encrypted answers were transmitted daily to dedicated servers. After a 7 to 21-day treatment-free washout period, patients requiring 2 to 10 pads per day for 7 consecutive days were randomized (1:1) to 5 mg solifenacin daily or placebo. The primary end point was time from first dose to continence defined as 0 pads per day or a dry security pad for 3 consecutive days. Secondary end points included proportion of patients continent at end of study, average change in pads per day number and quality of life assessments.
  
  
  RESULTS
  A total of 1,086 screened patients recorded personal digital assistant information. Overall 640 patients were randomized to solifenacin vs placebo and 17 failed to take medication. There was no difference in time to continence (p=0.17). Continence was achieved by study end in 91 of 313 (29%) vs 66 of 309 (21%), respectively (p=0.04). Pads per day change from baseline was -3.2 and -2.9, respectively (p=0.03). Dry mouth was the only common adverse event seen in 6.1% and 0.6%, respectively. Constipation rates were similar. The overall rate of continence in the entire population from screening to end of study was 73%.
  
  
  CONCLUSIONS
  There was no effect on primary outcome but some secondary end points benefited the solifenacin arm. The study provides level 1B clinical evidence for continence outcomes after robot-assisted radical prostatectomy.
authors.affiliation: Urological Research Network, Miami, Florida.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Bianco
authors.affiliation: Associated Medical Professionals, Syracuse, New York.
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.affiliation: Urologic Consultants of Southeastern Pennsylvania, Bala Cynwyd, Pennsylvania.
authors.forename: Laurence H
authors.initials: LH
authors.lastname: Belkoff
authors.affiliation: Houston Methodist Research Institute, Houston, Texas.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Miles
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Astellas, Northbrook, Illinois.
authors.forename: Weizhong
authors.initials: W
authors.lastname: He
authors.affiliation: Astellas, Northbrook, Illinois.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Bradt
authors.affiliation: Astellas, Northbrook, Illinois.
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Haas
authors.affiliation: UC Irvine, Orange, California.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Ahlering
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011812:Quinuclidines / Q000627:therapeutic use*; D065287:Robotic Surgical Procedures; D000069464:Solifenacin Succinate; D044005:Tetrahydroisoquinolines / Q000627:therapeutic use*; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000209:etiology
chemical_list: D018727:Muscarinic Antagonists; D011812:Quinuclidines; D044005:Tetrahydroisoquinolines; D000069464:Solifenacin Succinate
keywords: prostatectomy; prostatic neoplasms; robotics; treatment outcome; urinary incontinence