The treatment of detrusor instability in postmenopausal women with oxybutynin chloride: a double blind placebo controlled study

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.

Comparison of Urodynamic Findings and Response to Oxybutynin in Nocturnal Enuresis

“…Owing to antispasmodic and anticholinergic properties, in addition to analgesic and local anesthetic effects, objective improvement of urody namic parameters has been demonstrated in neurogenic bladders [1-3, 17]. In accordance, subjective improve ment is unanimously reported in urge incontinence, al though significant changes in objective urodynamic vari ables remain controversial [14,[18][19][20]. Objective param eters specifying the quality of treatment response in en uresis are still lacking.…”

Multimodality pelvic physiotherapy treatment of urinary incontinence in adult women

“…Detrusor instability drug therapy included oxybutynin chloride (Ditropan) and imipramine (Tofranil) at standard dosages. Tapp and colleagues, utilizing oxybutynin at a higher dosage, demonstrated a 62% response rate in women with detrusor instability compared to a 42% response rate for placebo [8]. There was, however, a significant incidence of side effects which resulted in reduced patient satisfaction.…”

“…Disciplined, timed voiding has also been shown to decrease the severity and frequency of incontinence episodes, especially in the elderly [6]. Drug therapy with vaginal estrogen cream for those with atrophic urethritis/vaginitis, and anticholinergic medicines if detrusor instability is present, has demonstrated efficacy in incontinence therapy [7,8].…”

Treatment of detrusor instability with oxybutynin rectal suppositories

“…Pharmacologic therapy has been the mainstay in the treatment of detrusor instability. To this end, numerous studies have shown that oral oxybutynin has a well documented therapeutic effect in such patients [2][3][4][5][6]. However, the high incidence of antimuscarinic side effects often results in dosage reduction or discontinuation of the medication.…”