Randomized trial of estradiol vaginal ring versus oral oxybutynin for the treatment of overactive bladder

Nelken, Rebecca S.; Özel, Begüm; Leegant, Ava; Felix, Juan C.; Mishell, Daniel R.

doi:10.1097/gme.0b013e3182104977

Cited by 71 publications

(33 citation statements)

References 17 publications

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“…The authors reported a significant decrease in voids per day in both groups but no significant difference between the groups. 22 While our study did not demonstrate a significant decrease in voids in the intravaginal estradiol group, we feel that the subjective symptom impact to be a more important primary outcome since the ultimate measure of treatment success and likelihood of long-term compliance is intrinsically linked to the patient’s perception of efficacy and symptom relief.…”

Section: Discussioncontrasting

confidence: 60%

Combined Tolterodine and Vaginal Estradiol Cream for Overactive Bladder Symptoms After Randomized Single-Therapy Treatment

Ellington¹,

Szychowski²,

Malek³

et al. 2016

Female Pelvic Med Reconstr Surg

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Objectives To compare 12 week outcomes of single-therapy tolterodine (Detrol LA ®) extended release to intravaginal estrogen (Estrace ®) for overactive bladder (OAB) symptoms and characterize 24 and 52 week outcomes in women undergoing combined therapy. Methods A single-site randomized, open-label trial in women with urinary frequency, urgency, nocturia, and/or urgency urinary incontinence symptoms was performed. Fifty-eight participants were randomized to oral tolterodine extended release daily or intravaginal estradiol cream nightly for six weeks then twice per week. The primary outcome was change in OAB-questionnaire (OAB-q) symptom bother score at 12 weeks. Secondary outcomes included the health-related quality of life (HRQL) of the OAB-q and a 3-day bladder diary. At 12 weeks, subjects were offered addition of the alternative therapy with follow-up at 24 and 52 weeks. Results There was no difference in symptom bother score improvement between the tolterodine and intravaginal estradiol groups baseline to 12 weeks (20.6±21.7, −15.8±23.3, respectively, p=0.45). There was a significant within group decrease in symptom bother score from baseline to 12 weeks (tolterodine, p < 0.0001, and intravaginal estradiol, p = 0.002). Secondary outcome improvement within groups was noted in the HRQL total, UI episodes and median voiding frequency (all p≤0.03) in the tolterodine group and in the HRQL total score (p=0.03) in the intravaginal estradiol group; with no differences between groups. Combined therapy outcomes at 24 and 52 weeks compared to single therapy at 12 weeks revealed significant improvement in symptom bother score in the intravaginal estradiol +tolterodine group at 24 and 52 weeks (20.0±23.9, p=0.008; −16.7±23.3, p=0.02, respectively) Conclusions Significant within group improvement in OAB-q symptom bother was noted in both the intravaginal estradiol and tolterodine groups for OAB symptoms, with no difference between groups. Greater improvement from 12 week single therapy to 24 and 52 weeks of combined therapy was noted in the group originally assigned to intravaginal estradiol. The role of combined medical therapy for OAB symptoms needs further investigation.

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Section: Discussioncontrasting

confidence: 60%

Combined Tolterodine and Vaginal Estradiol Cream for Overactive Bladder Symptoms After Randomized Single-Therapy Treatment

Ellington¹,

Szychowski²,

Malek³

et al. 2016

Female Pelvic Med Reconstr Surg

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“…Another randomised controlled trial in 80 women with overactive bladder syndrome, also comparing the effect of topical vaginal oestrogen therapy associated with tolterodine with that of tolterodine alone, found a significant improvement of objective parameters and quality of life when oestrogens were associated with tolterodine (LE2) [30]. Finally, a recent randomised trial comparing the efficiency of topical vaginal oestrogen therapy with that of oxybutynin for the treatment of overactive bladder syndrome found that the two products were similar in terms of efficiency (LE2) [31].…”

Section: Data Obtained From Random Studies Of Women Treated For Urinamentioning

confidence: 93%

Menopause, hormone treatment and urinary incontinence at midlife

et al. 2013

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“…Objective improvements continue at 12 weeks and are maintained to 1 year. Limited evidence suggests that vaginal ET may prevent recurrent urinary tract infections (268,269) and overactive bladder (270,271). No clear proof exists that vaginal ET prevents or improves pelvic prolapse (272), but it may be advantageous preoperatively (273).…”

Section: Evidencementioning

confidence: 98%

Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline

Stuenkel

Davis

Gompel

et al. 2015

The Journal of Clinical Endocrinology & Metabolism

680

419

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Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should individualize therapy based on clinical factors and patient preference. They should screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to prevent coronary heart disease, breast cancer, or dementia. Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not use MHT. Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures.

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Randomized trial of estradiol vaginal ring versus oral oxybutynin for the treatment of overactive bladder

Abstract: Ultralow-dose estradiol-releasing vaginal ring and oral oxybutynin seem to be similarly effective in decreasing the number of daily voids in postmenopausal women with overactive bladder.

Cited by 71 publications

References 17 publications

Combined Tolterodine and Vaginal Estradiol Cream for Overactive Bladder Symptoms After Randomized Single-Therapy Treatment

Combined Tolterodine and Vaginal Estradiol Cream for Overactive Bladder Symptoms After Randomized Single-Therapy Treatment

Menopause, hormone treatment and urinary incontinence at midlife

Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline

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