Long-term efficacy and safety of questionnaire-based initiation of urgency urinary incontinence treatment

• Published in: American journal of obstetrics and gynecology 2013-09, Vol.209 (3), p.244.e1-244.e9
• Main Authors: Hess, Rachel, MD, MS, Huang, Alison J., MD, MAS, Richter, Holly E., PhD, MD, Ghetti, Chiara C., MD, Sung, Vivian W., MD, MPH, Barrett-Connor, Elizabeth, MD, Gregory, W. Thomas, MD, Pinkerton, JoAnn V., MD, Bradley, Catherine S., MD, MSCE, Kraus, Stephen R., MD, Rogers, Rebecca G., MD, Subak, Leslee L., MD, Johnson, Karen C., MD, MPH, Arya, Lily A., MD, Schembri, Michael, BS, Brown, Jeanette S., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Benzhydryl Compounds - adverse effects; Benzhydryl Compounds - therapeutic use; Female; Humans; Middle Aged; Muscarinic Antagonists - therapeutic use; Obstetrics and Gynecology; Patient Satisfaction; primary care; Surveys and Questionnaires; treatment; urgency urinary incontinence; Urinary Incontinence - drug therapy
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2013.05.008

Objective The objective of the study was to determine the longer-term efficacy and safety of initiating treatment for urgency-predominant urinary incontinence (UUI) in women diagnosed using a simple questionnaire rather than an extensive evaluation. Study Design Women completing a 12 week randomized controlled trial of fesoterodine therapy for UUI diagnosed by questionnaire were invited to participate in a 9 month, open-label continuation study. UUI and voiding episodes were collected using voiding diaries. Participant satisfaction was measured by questionnaire. Safety was assessed by the measurement of postvoid residual volume and adverse event monitoring; if necessary, women underwent a specialist evaluation. The longitudinal changes in UUI and voiding episodes were evaluated using linear mixed models adjusting for baseline. Results Of the 567 women completing the randomized trial, 498 (87.8%) took at least 1 dose of medication during this open-label study. Compared with the baseline visit in the randomized trial, fesoterodine was associated with a reduction in total incontinence episodes per day and urgency incontinence episodes per day at the end of the open-label study (adjusted mean [SE], 4.6 [0.12] to 1.2 [0.13] and 3.9 [0.11] to 0.9 [0.11], respectively, P < .0001 for both). Most women were satisfied with treatment (89%, 92%, and 93% at 3, 6, and 9 months, respectively). Twenty-six women experienced 28 serious adverse events, 1 of which was considered possibly treatment related. Twenty-two women had a specialist evaluation: 5 women's incontinence was misclassified by the 3 Incontinence Questions; none experienced harm because of misclassification. Conclusion Using a simple validated questionnaire to diagnose and initiate treatment for UUI in community-dwelling women is safe and effective, allowing timely treatment by primary care practitioners.