No abstract

Summary. Idiopathic detrusor instability is a common cause of incontinence in the elderly for which anticholinergic agents arc regularly prescribed. Oxybutynin chloride combines anticholinergic action with direct muscle relaxant properties. We performed a double blind placebo controlled fixed dose cross over study of oxybutynin chloride in postmenopausal women suffering from detrusor instability. We found oxybutynin chloride significantly more effective than placebo at reducing the symptoms of urgency and urge incontinence and more effective at reducing the height of the highest unstable detrusor contraction. This was at the expense of an increased residual urine and considerable side effects.

We found that 8.4% of women sustained a repeat OASIS in a subsequent vaginal birth with this risk being associated with the presence of a short second labour and certain features from the first labour.

To investigate the actiological role of vaginal delivery in genuine stress incontinence we compared two groups of women who underwent full urodynamic assessment in our department. The women in the first group had competent urethral sphincter mechanisms and those in the second group had genuine stress incontinence. There were no differences between the two groups in respect of parity, number of vaginal deliveries or birthweight of the heaviest baby. The group with competent urethral sphincter mechanisms did show some cvidencc to implicate an increased number of vaginal dcliverics in poor function of the distal part of the urcthral sphincter rncchanism.Genuine stress incontinence i s the tnost common cause of feniale urinary incontinence and has traditionally been associated with pregnancy. vaginal delivery, previous incontinence surgery, congenital weakness and the menopause. Thomas (1984) found that the prevalence of strcss incontincnce increased with increasing parity. Rcccnt corroborative evidence that vaginal delivery may be an important actiulogical factor has been provided by investigations of urcthral and anal sphincter electrophysiology. and urethral prcssure mcasurernents.Paticnts with genuine stress incontinence have abnormal conduction in the perineal branch of the pudcndal nerve which innervates the peri-JULIA MON'I'GOMERY RPsrarrh R q i s / m r J OH N S'I 'U DD C'o/zsulrcm Correspondence: A Tapp, Kegislrar, Department 01 Obstetrics arid Gyn;iccolog>. Grcenwicli District Hospital. Vanbrugh Hill, 1,ondon SElO YHE fernale continence. Bv !Wed J 292, 166-167. 72, S 15-17.

Idiopathic detrusor instability is a common cause of lower urinary tract symptoms at all ages and in both sexes. Treatment initially is conservative and often includes drug therapy. Terodiline has the theoretical advantage of being a drug with anticholinergic and calcium channel blocking effects. Theoretically, by using a drug with dual action the beneficial effect of reduced detrusor overactivity might occur at a dosage below that likely to lead to the troublesome side effects experienced by patients who take pure anticholinergic agents. A total of 70 female patients completed a study characterized by extremely strict inclusion criteria and a tight protocol. Other novel elements to the study were the extensive use of urinary diaries for symptom evaluation, standardized urodynamic studies agreed upon by the participating centers and the dose titration design of the trial. Terodiline has been demonstrated to be a safe, well tolerated and effective drug in the treatment of idiopathic detrusor instability. Drug treatment led to significant decreases in urinary frequency and incontinence episodes. Pre-micturition symptoms, such as urgency, were markedly reduced and the voided volume was significantly increased. Although there were consistent trends towards greater improvement in the urodynamic measurements, when the terodiline and placebo groups were compared these did not reach statistical significance, partly due to a large improvement in the placebo group. Nevertheless, terodiline has been shown to be a useful drug for conservative management of patients with detrusor instability.