ABSTRACT

Objectives: The performance management of the long-term results of treatment of overactive bladder (OAB) in elderly men.

Patients and Methods: The focus of the study was a search for an optimal maintenance regimen that would secure the initial effect of treatment with double doses of antimuscarinics and decrease the risk of the recurrence of OAB. One hundred and ninety-seven men (average age 68.7 years, from 65 to 77 years of age), suffering from urodynamically and clinically confirmed OAB, were included in this study. All examined patients received the most effective treatment regimen according to the data of the initial study (60 mg trospium and 40 mg solifenacin daily for 6 weeks) with a positive result, and then were distributed into 4 groups based on the type of maintenance therapy. Group A (49 persons): trospium (60 mg daily) and solifenacin (40 mg daily) during 1 month. Group B (41 persons): electrical stimulation of the detrusor during 1 month. Group C (43 persons): laser puncture during 1 month. Group D (48 persons): placebo. The cycle of maintenance therapy was conducted in 2.5 months after primary treatment had been completed. The monitoring of patient conditions was performed through the OAB-q questionnaire (during 1 year) and urodynamic examination (sixth and twelfth month from the beginning of the study).

Results: A monthly course of treatment with 2 high doses of trospium and solifenacin, conducted in Group A in 2.5 months after a main cycle with similar content, enabled the maintenance of the initial clinical and urodynamic results for a long period of time (no less than 7 months). The average number of daily incontinence events decreased after an initial cycle of antimuscarinics from 5.2 (1.3) to 1.3 (0.4) and remained consistently low in the sixth month, 1.5 (0.5), the ninth month, 1.5 (0.5), and twelfth month, 1.9 (1.1), differing from the initial level, with P < 0.05. Indices reflex volume, bladder capacity, and detrusor compliance showed improvements after the first cycle; after the second cycle of antimuscarinics these indices remained stable during all periods of monitoring.

Conclusion: An additional cycle of treatment with a combination of high-dosed trospium and solifenacin, conducted 2 months after the primary treatment, significantly decreased the probability of recurring OAB in elderly men during 1 year, with low-level side effects.

Kirill Vladimirovich Kosilov, Sergey Alexandrovich Loparev, Yuliya Igorevna Gainullina, Marina Anatolyevna Ivanovskaya, Liliya Victorovna Kosilova

Far Eastern Federal University, Vladivostok, Russian Federation

Submitted October 5, 2013 - Accepted for Publication November 15, 2013

KEYWORDS: Overactive bladder, elderly men, antimuscarinic, physiotherapy

CORRESPONDENCE: Kirill Vladimirovich Kosilov, Ph. D., M. D., Far Eastern Federal University, Vladivostok, Russian Federation ()

CITATION: UroToday Int J. 2013 December;6(6):art 67. http://dx.doi.org/10.3834/uij.1944-5784.2013.12.02