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Title: Tolterodine Restores Urethral Sensation in Women With Urge Urinary Incontinence: Presented at AUGS

"Tolterodine Restores Urethral Sensation in Women With Urge Urinary Incontinence: Presented at AUGS"

By Laura Gater CHICAGO -- September 9, 2008 -- The use of tolterodine to treat urge urinary incontinence (UUI) appears to improve urethral sensitivity after 2 months of therapy, according to a study presented here at the American Urogynecologic Society 29th Annual Scientific Meeting (AUGS). Kimberly Kenton, MD, Loyola University Stritch School of Medicine, Maywood, Illinois, presented the study findings on September 4. Antimuscarinic agents are the standard of treatment for UUI, despite a lack of understanding as to these drugs' mechanism of action. The study was conducted to determine if the use of tolterodine would result in changes in bladder and/or urethral sensation in women with UUI. Dr. Kenton and colleagues enrolled 17 women (mean age 62) who had a median of 14 UUI episodes per week. The women underwent current perception threshold (CPT) testing at baseline and after 6 months, and completed the validated Medical, Epidemiological, and Social Aspects of Aging (MESA) Incontinence Questionnaire. The CPT tests were obtained at 3 frequencies in the urethra (2,000 Hz, 250 Hz, and 5 Hz) corresponding to A-beta, A-delta, and C fibres. CPT testing was conducted with a neurometer connected to a ring electrode on a 14 French catheter. Baseline and post-treatment measures were compared via a Wilcoxon Signed Rank Test. Subjects were a mean of 62 years old; they had a median vaginal parity of 2 (range 0-4), and a median of 14 (1-40) UUI episodes per week on a 7-day diary. Treatment consisted of long-acting tolterodine 4 mg daily for 2 months. Four patients (24%) discontinued the medication due to adverse effects and were not included in the study analysis. The urethral CPTs before tolterodine were a median of 2.6 for 2,000 Hz and 1.7 post-treatment ([P = .92). The CPT median was 1.3 at baseline for 250 Hz and 0.75 post-treatment (P = .003). For 5 Hz, the CPT median was 1.1 at baseline and 0.84 post-treatment (P = .06).

Urethral CPT at 250 Hz was much lower after treatment with tolterodine, indicating improved sensation; the urethral CPT at 5 Hz indicated a significant decrease as well.

Mean MESA urge subscale scores improved significantly from baseline to post-treatment (10 and 6.5, P = .007).

Funding for this study was provided by Pfizer Inc. and Allergan Inc.

[Presentation title: Tolterodine Causes Measurable Restoration of Urethral Sensation in Women With Urge Urinary Incontinence. Paper 56]

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