Changes in overactive bladder symptoms after discontinuation of successful 3-month treatment with an antimuscarinic agent: a prospective trial.

PURPOSE: We measured changes in overactive bladder (OAB) symptoms after the discontinuation of successful 3-month treatment with an antimuscarinic agent and the pretreatment factors that contributed to re-treatment.

MATERIALS AND METHODS: A total of 68 women who reported improvement in OAB symptoms after 4 weeks of treatment with 20 mg propiverine hydrochloride daily were prospectively enrolled in a protocol consisting of 8 more weeks of medication and a 4-week discontinuation period. Frequency-volume charts were assessed before treatment, after 12 weeks of therapy and 4 weeks after discontinuation along with a questionnaire assessing satisfaction with treatment and desire for further treatment. The Indevus Urgency Severity Score was used to quantify the degree of urgency and changes during treatment. Changes in frequency, nocturia, and urgency score at 12 and 16 weeks were evaluated. Pretreatment factors leading to re-treatment were determined, including patient characteristics, voiding symptom parameters and urodynamic indexes.

RESULTS: OAB symptoms at 16 weeks (4 weeks after the cessation of antimuscarinic medication) were improved compared with baseline but worse than after 12 weeks. At baseline, and 12 and 16 weeks mean daily frequency was 11.2, 7.3 and 8.3, mean nocturia frequency was 1.6, 0.4 and 0.8, and the urgency score was 1.7, 0.6 and 1.2, respectively. The re-treatment rate was 35.3%. Patients in the re-treatment group were significantly older (58.8 vs 47.3 years, p <0.001) and had higher initial urgency scores (1.9 vs 1.6, p = 0.034) than those requiring no further treatment. Of 23 patients who underwent a urodynamic study those without detrusor overactivity (DO) maintained significant improvement regarding frequency after cessation of medication, whereas those with DO did not, although their frequency was improved compared with baseline (p = 0.02). The re-treatment rate was higher in patients with DO but the difference was not statistically significant (60.9% vs 39.1%, p = 0.45).

CONCLUSIONS: Of patients 35% sought re-treatment 1 month after the discontinuation of antimuscarinic therapy. Patients older than 55 years or those with severe urgency may more frequently receive re-treatment and patients with DO may experience more rapid symptom recurrence after medication discontinuation.