Objective To compare the eBcacy and tolerability of equivalent. There was also a comparable increase in mean volume voided per micturition in the tolterodine tolterodine with that of oxybutynin in patients with an overactive bladder.(27%) and oxybutynin groups (31%), compared with 7% in the placebo group. Dry mouth was the most Patients and methods A randomized, double-blind, placebo-controlled, parallel group, multinational phasecommon adverse event and was reported with greater frequency and intensity among patients receiving III study was conducted in urology and gynaecology clinics in the UK, Republic of Ireland and Sweden.oxybutynin than among those receiving either tolterodine or placebo. In the oxybutynin group, more The study enrolled 293 patients with urodynamically confirmed bladder overactivity, increased frequency of patients also withdrew because of adverse events and a greater proportion required dose reduction as a micturition (Á8 micturitions/24 h) and symptoms of urgency and/or urge incontinence (Á1 episode/24 h).result of adverse events. Despite dose reduction, the frequency of adverse events and the intensity of dry Patients received either tolterodine (2 mg twice daily) or oxybutynin (5 mg three times daily) or placebo. mouth remained higher among those receiving oxybutynin (2.5 mg three times daily) than in patients who Doses could be reduced, to prevent withdrawal, to 1 mg or 2.5 mg, respectively. The main outcome remained on tolterodine 2 mg twice daily. Conclusion Tolterodine 2 mg twice daily is eCective and measures were the mean change from baseline in frequency of micturition/24 h, the number of incontiwell tolerated in the treatment of bladder overactivity. Tolterodine was better tolerated than oxybutynin, nent episodes/24 h and volume voided per micturition. Results After 12 weeks' treatment, the mean frequency particularly with respect to the frequency and intensity of dry mouth, but had comparable clinical eBcacy. of micturition decreased by 21% and 19.5% in those receiving tolterodine (n=118) and oxybutynin (n= The superior tolerability of tolterodine therefore allows more patients to remain on eCective therapy than the 118), respectively, and by 10.5% in those on placebo (n=57). Among those with urge incontinence at current most commonly prescribed agent for the treatment of the overactive bladder. baseline (75% of patients), the mean number of incontinent episodes decreased by 47%, 71% and 19%, Keywords Tolterodine, oxybutynin, antimuscarinic, overactive bladder respectively, in those receiving tolterodine, oxybutynin and placebo. The eCect of tolterodine and oxybutynin on these two micturition variables was statistically felt by suCerers and the misconception that this is part

The prognosis is poor in patients with deep lamina propria invasion (stage pT1b) treated with transurethral resection alone. Patients treated with radical cystectomy had excellent survival regardless of the depth of invasion in the lamina propria. Radiotherapy was associated with poor survival.

More than 90% of patients with stage Ta, WHO grade I have a benign form of bladder neoplasm, and few have truly malignant tumors. Future research should focus on reducing the number of recurrences and followup cystoscopies, and finding methods to identify malignant tumors so that pertinent treatment can be instituted. Subgrouping of WHO grade I bladder tumors as papillary neoplasm of low malignant potential and low grade papillary carcinoma seems to add valuable prognostic information.

A retrospective study was done on 176 patients with primary stages Ta and T1 bladder cancer treated between 1963 and 1972. One patient was lost to followup after 6 years, while the remainder were followed to death or for at least 20 years. In 1993, 13 patients had no evidence of disease, 39 died of bladder cancer and 123 died of intercurrent disease. Of 77 patients with a primary noninfiltrating tumor and 99 with a primary lamina propria invasive tumor 9 (11%) and 30 (30%), respectively, died of bladder cancer. Recurrences were noted on 10 or more cystoscopic studies in 16 patients and 10 died of bladder cancer 3.5 to 19 years after the primary transurethral resection. A total of 14 patients received repeated thiotepa instillations, all continued to have recurrences and 10 subsequently died of bladder cancer. Only 1 upper tract tumor was diagnosed on routine followup excretory urography. Invasive transitional cell carcinoma of the bladder developed in only 1 of 59 patients who had been tumor-free for 5 years. The results indicate that patients with recurrences on 10 or more cystoscopic studies will continue to have recurrences until death or cystectomy. Recurrence more than 4 years after the primary tumor operation is another ominous sign. Repeated thiotepa instillations did not influence the course of the disease in patients with a history of multiple recurrences. Followup cystoscopy may be discontinued 5 to 10 years after the last recurrence, at least in patients with a solitary low grade primary tumor. Routine followup urographic studies are neither cost-effective, clinically indicated nor justified in patients with superficial bladder cancer.