Stopped Taking Oxubutnin No Incontinence for 1 Month Does It Return Again
Can Urol Assoc J. 2018 Sep; 12(9): E378–E383.
How long do we have to treat overactive float syndrome? A questionnaire survey of Canadian urologists and gynecologists
Mikolaj Przydacz
oneSection of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
Lysanne Campeau
1Section of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
Jens-Erik Walter
2Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
Jacques Corcos
1Department of Urology, Jewish General Infirmary, McGill University, Montreal, QC, Canada
Abstract
Introduction
Overactive bladder (OAB) syndrome is a highly prevalent and costly condition worldwide, with negative impact on health-related quality of life. Although many guidelines exist and anticholinergics are considered to exist the mainstay of pharmacological treatment, data are lacking regarding optimal handling elapsing. Therefore, the aim of this report was to determine practice patterns of Canadian urologists and gynecologists regarding duration of OAB pharmacotherapy.
Methods
A fourteen-question survey was designed and survey links (English language and French) were sent by email to all practicing urologists and gynecologists registered with the Canadian Urological Association and the Lodge of Obstetricians and Gynecologists of Canada via the associations' email lists. The SurveyMonkey website served as platform where responses were collected and stored.
Results
A total of 301 physicians completed the questionnaire; 250 respondents (83%) prescribe anticholinergics or beta-3-adrenoceptor agonist (mirabegron) in their practice, and 202 (81%) kickoff patient treatment with the everyman recommended medication dose. One hundred and twelve respondents (45% of those who prescribe OAB medications) classified OAB pharmacotherapy as a lifelong management strategy, whereas 130 (52% of those who prescribe OAB medications) think that OAB pharmacotherapy should be administered for a defined time catamenia. Six-month and one-year time periods of drug treatments are the most commonly chosen answers given by physicians who treat their patients for a defined duration.
Conclusions
There is general understanding amid Canadian urologists and gynecologists that OAB treatment should be started with the lowest recommended medication dose. A slim majority of respondents think that OAB pharmacotherapy should be administered for a defined duration.
Introduction
Overactive float (OAB) syndrome is defined past the International Continence Society as "urinary urgency, usually accompanied past frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathologies."1 Although OAB is non a life-threatening condition, its impact on quality of life (QoL) plays a major part in the decision to treat patients. Information technology has been demonstrated that OAB significantly affects patients' health status, including physical, emotional, social, sexual, and mental operation.two – 4 The chronic nature of this condition and its impact can be lifelong, negatively influencing the QoL of affected patients.5
For many years, anti-muscarinic medications accept been administered in the management of OAB symptoms and are currently recommended by the Canadian Urological Clan (CUA) equally 2nd-line treatment.6 The commercially available beta-iii-adrenoceptor agonist mirabegron is also currently recommended as an OAB pharmacotherapy option. Adverse issue profile and possible contraindications should exist considered when prescribing drugs of choice as 2nd-line treatments. Presently-available OAB medications have proven their efficacy and are considered safe and well-tolerated overall. However, available literature does not provide recommendations about how long OAB should exist managed pharmacologically.
The purpose of the nowadays study is to ascertain current practices amidst Canadian urologists and gynecologists regarding OAB pharmacotherapy duration and review available data on this result to depict standards for this clinical concern.
Methods
An up to 14-question survey (depending on respondent answers to three skip-logic questions) was designed to assess electric current Canadian practices in terms of OAB handling duration. The institutional research ethics commission canonical the study, and the principle of unsaid consent applied: thus, formal consent was not required. Study and consent details were clearly communicated before respondents began answering the questionnaire. Participation was voluntary, and no bounty was given. Survey links (English and French versions) were sent by email to all urologists and gynecologists registered with the CUA and the Society of Obstetricians and Gynecologists of Canada via the associations' electronic mail lists.
Specifically, 623 urologists and 790 gynecologists were invited to participate in the survey over a three-month flow. To increase the response rate, a reminder was sent 1 month after initial contact. The SurveyMonkey website served as platform where responses were collected and stored. The survey was mobile-responsive and optimized for desktop, tablet, and mobile resolutions on Android and iOS devices. Responses were anonymous, and no personal information was collected.
Responses were summarized as descriptive statistics with proportions and percentages. All answers were included in the assay, irrespective of whether the entire questionnaire was completed or non. Associations between demographic information and other responses were explored by Chisquare test, with p value gear up at <0.05 to ascertain statistical significance. Information analysis was conducted with IBM SPSS Statistics, version 23.0 (IBM Corporation, Armonk, NY, U.S.).
Results
Respondent characteristics
A total of 301 physicians completed the questionnaire. The response rate for urologists and gynecologists was 31% (190/623) and 14% (111/790), respectively. Tabular array one details the demographic characteristics of respondents.
Tabular array ane
Demographic characteristics of respondents
| Urologists n=190 (%) | Gynecologists n=111 (%) | All respondents n=301 (%) | |
|---|---|---|---|
| Gender | |||
| Male | 144 (76%) | 24 (22%) | 168 (56%) |
| Female person | 32 (17%) | 82 (74%) | 114 (38%) |
| Number of years of practice | |||
| <5 | 41 (22%) | 33 (30%) | 74 (25%) |
| 5–10 | 36 (nineteen%) | 21 (19%) | 57 (19%) |
| 11–20 | 46 (24%) | 35 (32%) | 81 (27%) |
| >20 | 53 (28%) | 17 (15%) | 70 (23%) |
| Do | |||
| Academic | 53 (28%) | 37 (33%) | 90 (30%) |
| Community | 83 (44%) | 39 (35%) | 122 (41%) |
| Bookish and community | 40 (21%) | 30 (27%) | 70 (23%) |
| Fellowship | |||
| Functional urology/neurourologytrained | 35 (18%) | 7 (6%) | 42 (xiv%) |
| Other fellowship-trained | 73 (38%) | 38 (34%) | 111 (37%) |
| Non-fellowship-trained | 68 (36%) | 61 (55%) | 129 (43%) |
Specific questions
Two hundred fifty respondents (83%) prescribe anticholinergics or beta-iii-adrenoceptor agonist (mirabegron) in their do. They include 181 urologists (95% of participating urologists) and 69 gynecologists (62% of participating gynecologists); 202 (81%) of these physicians start patient treatment with the everyman recommended medication dose. They include 140 urologists (77% of those who prescribe OAB medications) and 62 gynecologists (xc% of those who prescribe OAB medications). Thirty-four urologists (19%) and six gynecologists (5%) declared that they start treatment with the highest recommended dose. In this specific group of respondents, the majority are male (35, 88%), with more than 10 years of clinical experience (24, threescore%), simply not specifically trained in functional urology with adequate fellowship (35, 88%). Table 2 details the demographic characteristics of physicians who answered this question. Statistically meaning correlations are found between specialization/gender and dose preference (p=0.04 and p=0.0007, respectively).
Tabular array 2
Demographic characteristics of respondents who answered the question: Practice y'all outset handling with the lowest or highest recommended medication dose?
| Lowest dose | Highest recommended dose | |
|---|---|---|
| Number of answers | 202 (81% of physicians treating OAB) | 40 (16% of physicians treating OAB) |
| Specialization (p=0.04) | ||
| Urology | 140 (77% of urologists treating OAB) | 34 (19% of urologists treating OAB) |
| Gynecology | 62 (56% of gynecologists treating OAB) | 6 (5% of gynecologists treating OAB) |
| Gender (p=0.0007) | ||
| Male person | 122 (78% of male physicians treating OAB) | 35 (22% of male physicians treating OAB) |
| Female person | 76 (95% of female person physicians treating OAB) | 4 (five% of female person physicians treating OAB) |
| Number of years of practice (p=0.23) | ||
| <5 | 55 (92% of those practicing <five years and treating OAB) | 5 (8% of those practicing <five years and treating OAB) |
| 5–ten | 36 (78% of those practicing five–10 years and treating OAB) | ten (22% of those practicing 5–10 years and treating OAB) |
| 11–20 | 57 (83% of those practicing 11–twenty years and treating OAB) | 12 (17% of those practicing 11–20 years and treating OAB) |
| >20 | fifty (81% of those practicing >twenty years and treating OAB) | 12 (xix% of those practicing >20 years and treating OAB) |
| Practice (p=0.15) | ||
| Academic | 67 (91% of academics treating OAB) | vii (9% of academics treating OAB) |
| Community | 86 (80% of those working at community hospitals and treating OAB) | 21 (twenty% of those working at community hospitals and treating OAB) |
| Academic and community | 45 (lxxx% of those working at either bookish or community hospitals and treating OAB) | eleven (20% of those working at either bookish or community hospitals and treating OAB) |
| Fellowship (p=0.41) | ||
| Functional urology/neurourologytrained | 38 (90% of functional urology-trained physicians) | 4 (ten% of functional urology-trained physicians) |
| Other fellowship-trained | 74 (82% of other fellowship-trained physicians treating OAB) | 16 (18% of other fellowship-trained physicians treating OAB) |
| Non-fellowship-trained | 86 (82% of not-fellowship-trained physicians treating OAB) | 19 (18% of non-fellowship-trained physicians treating OAB) |
Participants were asked when they wish to see their patients after they started treatment and whether they realistically encounter them. Fig. one presents the overall results. One hundred and x respondents (44%) wish to see their patients 4–eight weeks after they started treatment, whereas 96 (38%) like to follow them upwards viii–12 weeks afterward initiating pharmacotherapy. In reality, however, 92 (37%), 76 (30%), and 69 (28%) of respondents admitted to seeing their patients viii–12 weeks, >12 weeks, or four–eight weeks, respectively, after initiation of treatment.
Distribution of answers to the questions: When exercise you wish to run across your patients later starting their treatment? and When do you realistically come across your patients later on starting their treatment?
Further questions aimed to standardize OAB treatment duration. Physicians were queried whether OAB pharmacotherapy (medications) is needed lifelong or just for a defined time menstruum. One hundred and twelve respondents (45% of those who prescribe OAB medications) classified OAB pharmacotherapy every bit a lifelong management strategy; 130 (52% of those who prescribe OAB medications) thought that OAB pharmacotherapy should be given for a defined time period. Table 3 reports the demographic aspects of this question. Correlations between urologists and gynecologists are statistically significant (p=0.03).
Table 3
Demographic characteristic of respondents who answered the question: Do you lot call up that OAB pharmacotherapy (medications) needs to be given lifelong or for a defined time menses?
| Lifelong | Time period | |
|---|---|---|
| Number of answers | 112 (45% of physicians treating OAB) | 130 (52% of physicians treating OAB) |
| Specialization (p=0.03) | ||
| Urology | 73 (40% of urologists treating OAB) | 101 (56% of urologists treating OAB) |
| Gynecology | 39 (57% of gynecologists treating OAB) | 29 (42% of gynecologists treating OAB) |
| Gender (p=0.43) | ||
| Male | 70 (45% of male physicians treating OAB) | 87 (55% of male person physicians treating OAB) |
| Female | forty (50% of female physicians treating OAB) | twoscore (l% of female physicians treating OAB) |
| Number of years of practise (p=0.08) | ||
| <five | 31 (52% of those practicing <5 years and treating OAB) | 29 (48% of those practicing <five years and treating OAB) |
| 5–ten | 15 (33% of those practicing five–10 years and treating OAB) | 31 (67% of those practicing v–ten years and treating OAB) |
| 11–xx | 38 (55% of those practicing 11–20 years and treating OAB) | 31 (45% of those practicing 11–20 years and treating OAB) |
| >20 | 26 (42% of those practicing >20 years and treating OAB) | 36 (58% of those practicing >20 years and treating OAB) |
| Exercise (p=0.52) | ||
| Academic | 32 (43% of academics treating OAB) | 42 (57% of academics treating OAB) |
| Community | 54 (50% of those working at community hospitals and treating OAB) | 53 (50% of those working at community hospitals and treating OAB) |
| Academic and community | 24 (43% of those working at either bookish or community hospitals and treating OAB) | 32 (57% of those working at either bookish or community hospitals and treating OAB) |
| Fellowship (p=0.08) | ||
| Functional urology/neurourologytrained | 24 (57% of functional urology-trained physicians) | xviii (43% of functional urology-trained physicians) |
| Other fellowship-trained | 34 (38% of other fellowship-trained physicians treating OAB) | 56 (62% of other fellowship trained physicians treating OAB) |
| Not-fellowship-trained | 52 (fifty% of not-fellowship-trained physicians treating OAB) | 53 (50% of not-fellowship-trained physicians treating OAB) |
In a grouping of respondents who think that OAB medications should be prescribed for a defined fourth dimension period, the leading answers are "six months" indicated by 53 physicians (41%), and "one year" (32, 25%); 99 physicians (76%) treating OAB for a divers fourth dimension period suggest cocky-titration of the medication dose by patients, and 95 (73%) encounter their patients at the cease of treatment. Those who run into their patients at the finish of treatment were further asked near when it usually takes place. The leading answer is "three months" (32, 34%), followed by "as needed basis" (21, 22%), "one month" (18, 19%), "vi months" (12, 13%), "1 year" (vi, six%) and "immediately" (6, vi%). The remaining physicians who care for OAB for a defined time period do not see patients or inquire them to contact their family doc if needed (35, 27%).
Discussion
Pharmacotherapy has been at the centre of treatment regimens for OAB management. The efficacy of anti-muscarinics and mirabegron in OAB patients is well-documented.7 – ix Whereas meaning therapeutic effects are expected from most of these drugs seven days from the offset of treatment,10 data on treatment duration are sparse, although many clinical studies on OAB pharmacotherapy accept been published.
The resolution of bothersome symptoms has been given equally ane of the most common reasons for termination of treatment and may be achieved in more one-third of OAB cases.eleven – xv Other common reasons for medication discontinuation are adverse effects and/or failure of expected clinical result. There is no consensus regarding the optimal duration of OAB treatment, equally in the vast majority of available clinical trials, time periods of drug administration have been reported to range from two weeks to 12 months.16 It could exist speculated that these studies may underestimate drug efficacy with brusk time periods of drug administration,17 – 19 whereas handling elapsing may be lengthier than necessary. 20 , 21 To make matters even more circuitous, a specific definition of refractory OAB has not yet been established, resulting in different initiation fourth dimension points with other medications or treatment modalities.22
Canadian urologists and gynecologists mostly agree that OAB treatment should be started with the lowest recommended medication dose. Our survey revealed that a slim bulk of respondents (52% vs. 45%) recommend OAB pharmacotherapy for a defined time period rather than lifelong. Interestingly, practice patterns of express treatment duration are more typical for urologists than for gynecologists, who prefer lifelong direction. Furthermore, a college percent of urologists are more inclined to start treatment with the highest recommended medication dose. Six-calendar month and ane-year time periods of OAB pharmacotherapy are the virtually ordinarily chosen answers by physicians who treat their patients for a defined fourth dimension period (41% and 25%, respectively).
In the current literature, the indicate at which to discontinue OAB pharmacotherapy and the time during which therapeutic efficacy is sustained afterwards discontinuation of drug administration notwithstanding remain in dispute. Hsiao et al,16 in their prospective report, proposed that minimal duration of anti-muscarinic assistants for OAB control should exist iii months. Enrolled patients (n=164) were prescribed 5 mg of solifenacin or 4 mg of tolterodine extended-release capsules daily and so monitored for a mean follow upwardly of 1 month during a six-month menses in order to investigate handling efficacy and discontinuation patterns.
Other researchers have assessed the furnishings of drug cessation after dissimilar treatment periods. Choo et al23 measured changes in OAB symptoms in patients (n=68) after discontinuation of successful three-calendar month treatment with twenty mg of propiverine hydrochloride daily. Four weeks after the cessation of anti-muscarinic medication, the retreatment rate of 35.3% was due to worsening symptoms. Patients in the retreatment group were significantly older and had higher initial urgency scores than those requiring no further treatment. Patients who underwent urodynamic written report (due north=23) and demonstrated detrusor overactivity experienced more than rapid symptom recurrence after medication discontinuation than those without detrusor overactivity. However, this correlation was not statistically significant. The authors concluded that, although three months of OAB pharmacotherapy was effective, it could not sustain symptom improvement for one calendar month after discontinuation. These results line up with those reported by a British grouping with exactly the aforementioned time periods in patients (n=251) treated with flexible-dose fesoterodine (4 and 8 mg).24 OAB symptoms were significantly improved later the 12-calendar week handling period just, at four weeks after fesoterodine discontinuation, 61% of patients showed increased micturition frequency, added severity of bladder-related problems, and reduced wellness-related QoL. Dose escalation from 4 to 8 mg at calendar week 4 did non appear to influence the level of deterioration. In view of these findings, it can be stated that the beneficial effects on OAB symptoms and patient-reported outcomes after 12 weeks of treatment with an anti-muscarinic drug are not maintained as early as iv weeks subsequently handling stoppage.
Another study analyzed retreatment patterns in 108 OAB patients randomized to 3 different groups with different time periods of OAB pharmacotherapy: tolterodine extended-release four mg daily.14 Subsequently the completion of one-, three- or six-month treatment, patients stopped the medication and were followed up for some other three months to assess symptom relapse and retreatment rates. Three months later handling discontinuation, 65% of patients requested retreatment and 62% experienced symptom relapse, including increased micturition frequency, urgency episodes, urgency severity, and incontinence events, compared to these parameters at the end of treatment. Furthermore, longer handling did not prevent symptom relapse or retreatment. Nevertheless, the authors proposed that, in patients with improved symptoms, information technology might exist possible to discontinue medication subsequently consultation on the risks of symptom relapse and retreatment. They also stressed that physicians need to pay more than attention to patients whose baseline QoL has deteriorated severely considering of OAB symptoms, equally they are at higher take a chance of retreatment.
A recently published study enrolled 371 OAB patients who took anti-muscarinic agents for more than 12 weeks and responded favourably.25 They then discontinued anti-muscarinics and were evaluated for recurrence of bothersome symptoms at baseline, one, three, and six months, with a express number of patients followed upwardly for 12 months. Cumulative recurrence rates at ane, three, and six months were concurrent with earlier studies and were 25.6%, 42.3%, and 52.two%, respectively. However, a recurrence charge per unit of 9.seven% was seen in patients analyzed at the 12-month period. Patients without symptom recurrence until six months tended to persist with symptom-gratis status until 12 months of therapy discontinuation. These authors as well demonstrated that patients who initially presented with concomitant urinary incontinence had greater gamble of symptom recurrence.
A prospective, randomized study of the anti-muscarinics imidafenacin 0.one mg twice daily and solifenacin 5 mg one time daily gave amazing results, with a 12-month treatment regimen in 109 patients.21 It disclosed that among those who discontinued treatment because of improvement, three of 12 patients on imidafenacin (25.0%) and seven of 13 patients on solifenacin (53.8%) had recurring OAB symptoms and required medication inside 12 months. Thus, it can be hypothesized that required handling duration may vary between different OAB drugs.
A retrospective study from the U.South., with information from the IMS LifeLink Health Plan Claims Database, showed that 34.half-dozen% of 103 250 patients reinitiated handling by the finish of ii years, with approximately one-fifth of patients (24.one%) restarting after 1 yr.26 Of those who reinitiated anticholinergic therapy, 65.vi% did and then with their index anticholinergic agent, whereas 34.iv% went with a different anticholinergic.
A prospective study from Japan (n=73), assessing persistence rates of solifenacin 5 mg daily handling during a 3-yr period, demonstrated that 25% of patients required retreatment at an average 10 months afterward termination.12
Until at present, there is paucity of data on the bear on of physiotherapy on OAB recurrence later on treatment cessation. Further research in this area is warranted, as behavioural therapies, including pelvic floor musculus exercises, are relatively non-invasive and could benefit patient health overall.
To sum upwards, optimal elapsing of OAB pharmacotherapy and efficacy sustenance have non withal been determined. Based on our survey and literature review, it is proposed that OAB patients tin be treated for their symptoms for half dozen–12 months and persistence to the drug therapy should be encouraged. Then, treatment abeyance can be considered. If patients withal need medications, lifelong or long-term OAB pharmacotherapy may be required. Thus, the optimal duration of OAB pharmacotherapy should be individualized, as OAB encompasses a heterogeneous patient population with various symptoms, severities, and pathophysiologies. Consideration should be given to possible etiologies and improving bladder health through preventive measures to stop OAB progression. The presented approach could help physicians avoid the assistants of ineffective medications and potential drug-related adverse effects.
Conclusion
At that place is general understanding among Canadian urologists and gynecologists that OAB treatment should be started with the lowest recommended medication dose. A slim majority of respondents think that OAB pharmacotherapy should be given for a defined time period. Practice patterns of limited treatment duration are more typical for urologists than for gynecologists, who adopt lifelong direction.
Footnotes
Competing interests: Dr. Przydacz has participated in clinical trials supported by Bristol-Myers Squibb. Dr. Campeau has attended advisory boards for Astellas and Pfizer; has been a speaker for Astellas, Duchesnay, and Pfizer; has received payments/grants/honoraria from Astellas and Pfizer; and has participated in clinical trials supported by Pfizer. Dr. Walter has attended advisory boards for Boston Scientific, Kimberly-Clark, and Duchesnay; has received payments/grants/honoraria from Astellas, Duchesnay, Boston Scientific, Kimberly-Clark, and Ethicon Gynecare. Dr. Corcos has attended advisory boards for Allergan, Astellas, Pfizer; has been a speaker for Allergan and Duchesnay; has received payments/grants/honoraria from Astellas; and has participated in clinical trials supported by Allergan and Ipsen.
This paper has been peer-reviewed.
References
1. Abrams P, Cardozo L, Autumn M, et al. The standardization of terminology of lower urinary tract part: Report from the Standardization Subcommittee of the International Continence Order. Neurourol Urodyn. 2002;21:167–78. doi: 10.1002/nau.10052. [PubMed] [CrossRef] [Google Scholar]
2. Kinsey D, Pretorius South, Glover L, et al. The psychological impact of overactive bladder: A systematic review. J Health Psychol. 2016;21:69–81. doi: 10.1177/1359105314522084. [PubMed] [CrossRef] [Google Scholar]
three. Golabek T, Skalski Chiliad, Przydacz Thou, et al. Lower urinary tract symptoms, nocturia, and overactive float in patients with low and anxiety. Psychiatr Political leader. 2016;50:417–thirty. [PubMed] [Google Scholar]
iv. Przydacz Grand, Golabek T, Sobanski J, et al. Perception of lower urinary tract symptoms past psychiatrists in mentally affected patients. Psychiatr Pol. 2017;51:963–78. https://doi.org/ten.12740/PP/74365. [PubMed] [Google Scholar]
5. Coyne KS, Wein A, Nicholson Southward, et al. Comorbidities and personal burden of urgency urinary incontinence: A systematic review. Int J Clin Pract. 2013;67:1015–33. doi: 10.1111/ijcp.12164. [PubMed] [CrossRef] [Google Scholar]
6. Corcos J, Przydacz M, Campeau L, et al. CUA guideline on adult overactive bladder. Can Urol Assoc J. 2017;xi:E142–73. doi: ten.5489/cuaj.4586. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]
7. Madhuvrata P, Cody JD, Ellis G, et al. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2012;1:Cd005429. doi: x.1002/14651858.CD005429.pub2. [PubMed] [CrossRef] [Google Scholar]
viii. Chapple CR, Khullar V, Gabriel Z, et al. The effects of anti-muscarinic treatments in overactive float: An update of a systematic review and meta-analysis. Eur Urol. 2008;54:543–62. doi: 10.1016/j.eururo.2008.06.047. [PubMed] [CrossRef] [Google Scholar]
9. Tubaro A, Batista JE, Nitti VW, et al. Efficacy and safety of daily mirabegron 50 mg in male patients with overactive bladder: A critical analysis of v phase 3 studies. Ther Adv Urol. 2017;9:137–54. doi: 10.1177/1756287217702797. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
ten. Przydacz Yard, Corcos J. Onset of medication efficacy in patients with overactive bladder: What should we tell them? Neurourol Urodyn. 2017;36:1429–30. doi: x.1002/nau.23139. [PubMed] [CrossRef] [Google Scholar]
11. Sung HH, Han DH, Kim TH, et al. Interventions practise not heighten medication persistence and compliance in patients with overactive bladder: A 24-week, randomized, open up-label, multi-middle trial. Int J Clin Pract. 2015;69:1309–fifteen. doi: 10.1111/ijcp.12705. [PubMed] [CrossRef] [Google Scholar]
12. Tanaka Y, Tanuma Y, Masumori Northward. Long-term, prospective study of the persistence of solifenacin succinate in previously untreated Japanese female patients with overactive bladder. Int J Urol. 2016;23:866–72. doi: ten.1111/iju.13174. [PubMed] [CrossRef] [Google Scholar]
thirteen. Krhut J, Gartner M, Petzel M, et al. Persistence with first line anticholinergic medication in handling-naive overactive bladder patients. Scand J Urol. 2014;48:79–83. doi: 10.3109/21681805.2013.814707. [PubMed] [CrossRef] [Google Scholar]
14. Lee YS, Choo MS, Lee JY, et al. Symptom change subsequently discontinuation of successful anti-muscarinic treatment in patients with overactive float symptoms: A randomized, multicentre trial. Int J Clin Pract. 2011;65:997–1004. doi: 10.1111/j.1742-1241.2011.02728.x. [PubMed] [CrossRef] [Google Scholar]
15. Shim EJ, Yoo EH, Kim YM, et al. Factors affecting medication discontinuation in patients with overactive bladder symptoms. Obstet Gynecol Sci. 2015;58:507–13. doi: 10.5468/ogs.2015.58.half dozen.507. [PMC costless commodity] [PubMed] [CrossRef] [Google Scholar]
16. Hsiao SM, Liao CH, Lin HH, et al. Duration of anti-muscarinic administration for treatment of overactive bladder before which one can assess efficacy: An assay of predictive factors. Int Neurourol J. 2015;xix:171–7. doi: ten.5213/inj.2015.19.3.171. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
17. Jacquetin B, Wyndaele J. Tolterodine reduces the number of urge incontinence episodes in patients with an overactive float. Eur J Obstet Gynecol Reprod Biol. 2001;98:97–102. doi: 10.1016/S0301-2115(00)00561-3. [PubMed] [CrossRef] [Google Scholar]
18. Altan-Yaycioglu R, Yaycioglu O, Aydin Akova Y, et al. Ocular side effects of tolterodine and oxybutynin, a single-bullheaded, prospective, randomized trial. Br J Clin Pharmacol. 2005;59:588–92. doi: x.1111/j.1365-2125.2005.02356.x. [PMC costless article] [PubMed] [CrossRef] [Google Scholar]
19. Herschorn S, Stothers L, Carlson 1000, et al. Tolerability of 5 mg solifenacin in one case daily vs. 5 mg oxybutynin immediate release three times daily: Results of the VECTOR trial. J Urol. 2010;183:1892–8. doi: 10.1016/j.juro.2010.01.012. [PubMed] [CrossRef] [Google Scholar]
20. Halaska M, Ralph Chiliad, Wiedemann A, et al. Controlled, double-blind, multicentre clinical trial to investigate long-term tolerability and efficacy of trospium chloride in patients with detrusor instability. World J Urol. 2003;20:392–9. [PubMed] [Google Scholar]
21. Yokoyama T, Koide T, Hara R, et al. Long-term prophylactic and efficacy of ii unlike anti-muscarinics, imidafenacin and solifenacin, for treatment of overactive bladder: A prospective, randomized, controlled study. Urol Int. 2013;90:161–7. doi: 10.1159/000345055. [PubMed] [CrossRef] [Google Scholar]
22. Nitti VW, Kopp Z, Lin AT, et al. Can we predict which patient will neglect drug handling for overactive bladder? A recollect tank discussion. Neurourol Urodyn. 2010;29:652–7. doi: 10.1002/nau.20910. [PubMed] [CrossRef] [Google Scholar]
23. Choo MS, Song C, Kim JH, et al. Changes in overactive bladder symptoms later on discontinuation of successful 3-month treatment with an anti-muscarinic agent: A prospective trial. J Urol. 2005;174:201–four. doi: 10.1097/01.ju.0000161597.30736.21. [PubMed] [CrossRef] [Google Scholar]
24. Khullar V, Cardozo L, Kelleher CJ, et al. Furnishings of drug cessation after flexible-dose fesoterodine in patients with overactive bladder. BJU Int. 2013;112:820–ix. doi: 10.1111/bju.12006. [PubMed] [CrossRef] [Google Scholar]
25. Kim A, Lee KS, Kim TB, et al. Incidence and risk factors of recurrence of overactive bladder symptoms after discontinuation of successful medical treatment. Investig Clin Urol. 2017;58:42–7. doi: 10.4111/icu.2017.58.ane.42. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
26. Chancellor MB, Migliaccio-Walle Thou, Bramley TJ, et al. Long-term patterns of employ and handling failure with anticholinergic agents for overactive float. Clin Ther. 2013;35:1744–51. doi: 10.1016/j.clinthera.2013.08.017. [PubMed] [CrossRef] [Google Scholar]
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