Bush Beats
Bush Beats 2014 › Bush Beats Issue 8, 2014

Urinary incontinence in primary practice

Urinary incontinence – both men and women are affected

Urinary incontinence – defined by the incontinence society as “the complaint of any involuntary urinary leakage” – is one of the most common chronic medical conditions seen in clinical practice.1Weiss BD. Am Fam Physician 2005;71:315-22, 329.   The disease influences not only the physical health of the persons, but also their activities, emotional status, working capacity, and social communication.2Abrams P, Cardozo L, Fall M, et al; Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78.  ,3Skaudickas D, Kévelaitis E. Medicina (Kaunas). 2010;46(7):496-503.  Incidence of urinary incontinence increases with age, with women being twice more likely to be affected than men, because of anatomical differences in pelvic region and the changes induced by pregnancy and childbirth.4National Kidney and Urologic Diseases Information Clearinghouse. NIH Publication No. 07-5280. June 2007.   This gender variation however vanishes after 85 years of age when the prevalence becomes equal in both sexes.

Prevalence estimates

Involuntary urine loss has been reported to occur in 5-69% of women and in 1-39% of men.5Thuroff JW, Abrams P, Andersson K, et al. European Urology 2011;5(9):387-400.   In this context, the EPIC study – a large population based survey – provides wide estimates regarding prevalence rates of urinary incontinence, overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) (Figure 1).6Irwin DE, Milsom I, Hunskaar S, et al. Eur Urol. 2006;50(6):1306-14; discussion 1314-5.   Actual incidence of urinary incontinence in community may however be under-estimated due to the associated social stigma.7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.   Majority of patients often dodges to report to the doctor about their existing complaints, either because of embarrassment or belief that it is occurring as a consequence of ageing. This frequently results in under-diagnosis and under-treatment, and most such patients continue to be afflicted despite availability of effective treatment in most cases.8Stephan E, Hajjar RR. J Med Liban. 2012;60(4):220-7.  ,9Davis S, Wailoo A. Health Qual Life Outcomes. 2013;11:20.   Herein, it is believed that patient education and careful selection of treatment modalities according to patients’ needs can significantly improve urinary incontinence.

Causes of urinary incontinence

Though common with advancing age10Culligan PJ, Heit M. Am Fam Physician. 2000;62(11):2433-2444.  , incontinence is not an inevitable consequence of aging, albeit multiple anatomic and physiologic age-related changes increase the risk with advancing age, for instance declines in outlet resistance in females and prostate enlargement in males (Table 1).5Thuroff JW, Abrams P, Andersson K, et al. European Urology 2011;5(9):387-400.  ,7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.  ,8Stephan E, Hajjar RR. J Med Liban. 2012;60(4):220-7.  ,11Vogel SL. Ochsner J. 2001; 3(4): 214-218.   As well, causes may be secondary to a variety of diseases,

Figure 1. Urinary symptoms in men vs. women6Irwin DE, Milsom I, Hunskaar S, et al. Eur Urol. 2006;50(6):1306-14; discussion 1314-5.  
Table 1. Risk factors for urinary incontinence5Thuroff JW, Abrams P, Andersson K, et al. European Urology 2011;5(9):387-400.  
Women Men
Pregnancy Increasing age
Vaginal delivery Lower urinary tract symptoms
Diabetes mellitus Urinary tract infection
Oral estrogen substitution Functional and cognitiveimpairment
Body mass index Neurologic disorders
Mild loss of cognitive function – although not a risk factor, it increases the impact of urinary incontinence Prostatectomy

or cerebral insults, such as cerebrovascular disease (strokes), spinal cord lesions, Alzheimer’s disease, and Parkinson’s disease. Many reversible causes of urinary incontinence have also been identified, and include urinary tract infections (UTIs), stool impaction, and various other triggers – remember the acronym DIAPERS (Figure 2).7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.  ,12Petrou SP, Baracat F. Braz J Urol 2001;27:165-170.   Furthermore, certain drugs and drug classes can also cause and/or exacerbate an existing incontinence problem. Particularly, drugs with anticholinergic properties can cause urinary retention in overflow incontinence7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.  ; which is an important concern especially in the more prone elderly population.

Figure 2. Urinary incontinence mnemonic7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.  ,12Petrou SP, Baracat F. Braz J Urol 2001;27:165-170.  

Clinical classification

Dependent on the underlying etiology and clinical presentation, most cases of urinary incontinence can be grouped under one of three major subtypes: urge, stress, or mixed (Table 2).2Abrams P, Cardozo L, Fall M, et al; Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78.  ,12Petrou SP, Baracat F. Braz J Urol 2001;27:165-170.  –16MacDiarmid S, Rogers A. Curr Urol Rep. 2007;8(1):66-73.   Herein, leakage accompanied or immediately preceded by urgency characterizes urge incontinence, whilst stress incontinence is associated with effort, exertion, sneezing or coughing. The former one – urge urinary incontinence – is the most common cause of incontinence in the elderly, pathophysiology of which is primarily attributable to detrusor muscle overactivity, resulting in uncontrolled, uninhibited,

Table 2. Common urinary incontinence types2Abrams P, Cardozo L, Fall M, et al; Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78.  ,7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.  ,12Petrou SP, Baracat F. Braz J Urol 2001;27:165-170.  –16MacDiarmid S, Rogers A. Curr Urol Rep. 2007;8(1):66-73.  
Type Definition Possible etiopathology
Urge urinary incontinence Complaint of involuntary leakage accompanied by or immediately preceded by urgency (an abrupt desire to void) Detrusor instability associated with overactivity of detrusor muscle

  • Intrinsic bladder lesion
  • Infection
  • Idiopathic

Detrusor hyperreflexia associated with a known neurologic cause Neurologic disorder
Stress urinary incontinence Complaint of involuntary leakage of urine on effort or exertion, or on sneezing or coughing, or lifting heavy objects (conditions associated with increased intraabdominal pressure) Weakened pelvic floor
Bladder sphincter dysfunction
Urethral hypermotility
Bladder neck prolapse
Mixed urinary incontinence Complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing  
Overactive bladder Urinary frequency and urgency, with or without urge incontinence Detrusor overactivity, bladder outlet obstruction, or both
Overflow incontinence Complaints of LUTS, such as feeling of incomplete emptying of bladder, nocturia, and dribbling associated with large urine residuals in the bladder
A high postvoid residual volume is the hallmark		 An overfilled bladder secondary to obstruction, bladder prolapse, or alignment problems

  • Bladder outlet obstruction/benign prostatic hyperplasia
  • Detrussor muscle weakness
  • Autonomic neuropathy
  • Medication side effect (anticholinergics)

or involuntary bladder muscle contractions.7 As such, subsets of patients with OAB, with its hallmark symptom of urgency, also present with urge urinary incontinence.15Cornu JN. Minerva Urol Nefrol. 2013;65(1):21-35.  ,16MacDiarmid S, Rogers A. Curr Urol Rep. 2007;8(1):66-73.   Alternatively, stress incontinence is the most common form of incontinence in elderly women, and is primarily attributable to bladder sphincter dysfunction, resulting in urine leakage at inappropriate times. Although urgency and nocturia may be absent in pure stress incontinence, many of these patients may have mixed forms of incontinence with features of urgency. In most such cases, or otherwise, the term mixed incontinence may be used when features of both stress and urge incontinence simultaneously present in a patient.9Davis S, Wailoo A. Health Qual Life Outcomes. 2013;11:20.  

Overflow incontinence is another important clinical subtype, best described as an overfilled and distended bladder secondary to obstruction, bladder prolapse, or alignment problems. It is most commonly seen in males with benign prostatic hyperplasia (BPH), though can also be caused by obstructed urinary outflow because of fecal impaction, urethral stricture, or urethral constriction related to alphaadrenergic agonist medications.7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.  ,17Weiss BD. Am Fam Physician. 1998;57(11):2675-2684.   Additionally, underactive bladder contractions secondary to medications relaxing the bladder detrusor muscle (e.g., anticholinergic agents), or denervation of detrusor because of damage or neurologic abnormality affecting bladder innervations, can also cause or precipitate overflow incontinence. Clinical presentation of this form is described by LUTS, including a sense of incomplete bladder emptying after urination, nocturia, and dribbling; while presence of urgency symptoms can often make diagnosis and treatment challenging.7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.  

Alternatively, people with physical and medical problems interfering with thinking, moving, or communicating may also have trouble reaching a toilet, and can present with functional incontinence. These patients often have an OAB in relation to their ability or speed with which they can get to the toilet. Pure functional incontinence is however a diagnosis of exclusion since many functionally impaired persons can also have other types of urinary incontinence that may respond to specific treatments.10Culligan PJ, Heit M. Am Fam Physician. 2000;62(11):2433-2444.  ,17Weiss BD. Am Fam Physician. 1998;57(11):2675-2684.  ,18National Kidney and Urologic Diseases Information Clearinghouse. National Institutes of Health. NIH Publication No. 08-4132.2007.  

Diagnosis of urinary incontinence

An initial evaluation of urinary incontinence generally does not require urologic or gynecologic evaluation since a basic workup – history and physical examination – can identify possible reversible causes in most cases. If a reversible cause is not identified, the next step should be aimed at determining the type of incontinence (urge, stress, mixed, or overflow), and the urgency with which it should be treated. These determinations can be made using a simple patient questionnaire (Table 3)10Culligan PJ, Heit M. Am Fam Physician. 2000;62(11):2433-2444.  ,19Khandelwal C, Kistler C. AAFP 2013;87(8):543-50.  , an assessment of other medical problems possibly contributing to incontinence, a discussion of the effect of symptoms on patient’s quality of life, a review of patient’s completed voiding diary, a complete physical examination to identify possible etiology, and a cough/ bladder stress test if stress incontinence is suspected

Table 3. Key questions in evaluating patients for urinary incontinence10Culligan PJ, Heit M. Am Fam Physician. 2000;62(11):2433-2444.  ,19Khandelwal C, Kistler C. AAFP 2013;87(8):543-50.  
Question Probable diagnosis (if answer is yes)
Q1. During the past three months, did you leak urine most often:
A. When performing some physical activity, such as sneezing, coughing, lifting, or exercising? Stress only or stress predominant urinary incontinence
B. When having the urge or feeling that you needed to empty your bladder but could not get to the toilet fast enough? Urge only or urge predominant urinary incontinence (see question 2 also)
C. About equally as often with physical activity as with a sense of urgency? Mixed urinary incontinence
D. Without physical activity and sense of urgency? Other cause only or other cause predominant urinary incontinence (see question 3 also)
Q2a. Do you ever leak urine when you have a strong urge on the way to the bathroom? How often?
Q2b. How many times do you get up to urinate after going to sleep? Is it the urge to urinate that wakes you?		 Overactive bladder
Q3a. Do you ever feel that you are unable to completely empty your bladder?
Q3b. Does it hurt when you urinate?		 Outlet obstruction, interstitial cystitis or urinary tract infection
Box 1. Common tests in urinary incontinence17Weiss BD. Am Fam Physician. 1998;57(11):2675-2684.  ,18National Kidney and Urologic Diseases Information Clearinghouse. National Institutes of Health. NIH Publication No. 08-4132.2007.  
  • Bladder stress test
  • Urinalysis and urine culture
  • Ultrasound
  • Cystoscopy
  • Urodynamic testing
Box 2. Conditions associated with urinary incontinence that may require further evaluation/referral11Weiss BD. Am Fam Physician 2005;71:315-22, 329.  ,11Vogel SL. Ochsner J. 2001; 3(4): 214-218.  ,19Khandelwal C, Kistler C. AAFP 2013;87(8):543-50.  
  • Hematuria
  • Recurrent urinary tract infections
  • Prior incontinence surgery
  • Gross pelvic prolapse
  • Recent onset (within 1 to 2 months) of irritative voiding symptoms like urgency or urge incontinence
  • Prior pelvic radiation
  • Prior radical pelvic surgery

(Box 1).18National Kidney and Urologic Diseases Information Clearinghouse. National Institutes of Health. NIH Publication No. 08-4132.2007.   Other components of evaluation include laboratory tests, urinalysis, pad/cotton-swab testing; and measurement of postvoid residual urine volume (PVR) to detect overflow bladder. Finally, a urologist or urogynecologist consultation/referral should be considered if the type of urinary incontinence is still not clear, or if red-flag signs, such as hematuria, obstructive symptoms, or recurrent UTIs, are present, or if treatment fails (Box 2).1Weiss BD. Am Fam Physician 2005;71:315-22, 329.  ,11Vogel SL. Ochsner J. 2001; 3(4): 214-218.  ,19Khandelwal C, Kistler C. AAFP 2013;87(8):543-50.   Because; this might require more sophisticated tests to be performed to define the cause and determine the best treatment (Box 1).17Weiss BD. Am Fam Physician. 1998;57(11):2675-2684.  

Treatment approaches

A generalization and analysis of different methodologies of treatment in clinical practice recommends conservative treatment methods in the primary stage of urinary incontinence; and surgical treatment methods should only be reserved for non-responding and refractory cases.2Abrams P, Cardozo L, Fall M, et al; Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78.   As such, clinical management of urinary incontinence requires a stepped-care approach that advances from least invasive to more invasive interventions.13Hersh L, Salzman B. Am Fam Physician. 2013;87(9):634-40.   Pharmacotherapy frequently bridges behavioral modification and surgery, and is important as a strategic window of opportunity in almost all cases. Even so, while patients with urge incontinence respond well to pharmacotherapy, limited or conflicting evidence exists for use of medications for pure stress incontinence. Careful patient selection is therefore important in this regard to optimize treatment outcomes in primary practice.

Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urinary incontinence. Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for patients not responding to behavioral therapy. Such nonpharmacologic therapies improve bladder control by modifying lifestyle and behavior to prevent urine loss, but require patient and caregiver motivation and can be time consuming. Improved results may be obtained by combining these strategies with pharmacotherapy or by means of pharmacotherapy alone.13Hersh L, Salzman B. Am Fam Physician. 2013;87(9):634-40.  ,20Erdem N, Chu FM. Am J Med. 2006;119(3 Suppl 1):29-36.  ,21Cornu JN. Minerva Urol Nefrol. 2013 Mar;65(1):21-35.   Surgically implanted sacral nerve stimulators have also been shown to improve symptoms of urge incontinence, but are invasive.

For stress incontinence, many therapies are available, including pelvic floor muscle exercises, intravaginal support devices, pessaries, periurethral injections, magnetic chairs, and intraurethral inserts.1Weiss BD. Am Fam Physician 2005;71:315-22, 329.   Minimally invasive procedures, including radiofrequency denaturation of the urethra and injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments. Surgical interventions are reserved for stress incontinence that has not responded to other treatments.13Hersh L, Salzman B. Am Fam Physician. 2013;87(9):634-40.   In this context, the most commonly performed surgeries for stress urinary incontinence include full-length mesh midurethral slings.22Kirby AC, Nager CW. Clin Obstet Gynecol. 2013;56(2):257-75.  

Treatment of overflow incontinence caused by BPH extends from watchful waiting and eliminating potential triggers to surgical options, such as transurethral resection of the prostate (TURP) or newer, less-invasive laser procedures. Nonetheless, effective pharmacologic options are available and should be considered before considering surgical intervention.

Medications

Anticholinergics/antimuscarinics

Anticholinergic drugs are used in urge incontinence to control bladder detrusor muscle overactivity and help relax bladder muscles and prevent bladder spasms by their action on bladder muscarinic (M) receptors; resulting in a reduction in urgency

Table 4. Anticholinergic/antimuscarinic side effects7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.  
Organ system Receptors Anticholinergic effects
Salivary glands M1, M3, M4 Dry mouth
Cardiac tissue M2 Tachycardia, palpitations
Gastrointestinal tract M1, M2, M3 Constipation, slowing of transit time, effects on sphincter tone and gastric acid secretion
Eye (ciliary muscle iris) M3, M5 Dry eyes, blurred vision, mydriasis
Bladder (detrusor muscle) M2, M3 Decreased contraction, urinary retention
Central nervous system, brain (cortex and hippocampus) M1, M2, M3, M4, M5 Effects on memory, cognition and psychomotor speed; confusion, delirium, sedation, hallucinations, sleep disruption

symptoms and improvements in bladder control. However, since muscarinic receptors are also located in other organ systems throughout the body, and since antimuscarinic drugs are frequently non-selective, numerous other effects or rather adverse effects may result from their use. The treatment is therefore not always effective and is associated with side-effects to limit their clinical use.23Andersson KE. Lancet Neurol. 2004;3(1):46-53.   Both peripheral and central adverse reactions have been reported with use of anticholinergic/antimuscarinic drugs (Table 4).7DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.   Dry mouth is the most common side effect, though larger doses may cause blurred vision, constipation, a faster heartbeat, and flushing.18National Kidney and Urologic Diseases Information Clearinghouse. National Institutes of Health. NIH Publication No. 08-4132.2007.   Other adverse effects, such as confusion, delirium, constipation, memory loss, and acute urinary retention (AUR) in overflow incontinence, are of particular concern in the more vulnerable elderly population.11Vogel SL. Ochsner J. 2001; 3(4): 214-218.  

Importantly, this concern regarding AUR development in men with bladder outlet obstruction likely attributes to reluctance to initiate treatment with cholinergic antagonists. These drugs may precipitate urinary retention by inhibiting detrusor contractility, and therefore warrant caution in men with underlying BPH. Elderly patient frequently on polytherapy might be at particular risk, given that most medications administered for depression, allergies, Parkinson disease and OAB have anticholinergic properties.24Lepor H. Rev Urol. 2005; 7(Suppl 8): S26-S33.  

Flavoxate – the preferred antispasmodic

Use of antispasmodic drugs is indicated in OAB, as they have been proven to be effective in suppressing premature detrusor contractions, enhancing bladder storage, and relieving symptoms of OAB. The first drug in this class to be approved for this indication by the Food and Drug Administration (FDA) was flavoxate.25Hesch K. Proc (Bayl Univ Med Cent) 2007;20(3):307-314.   It is a flavone derivative with smooth muscle relaxing activity with its major application in the treatment of urge incontinence and OAB; of note, with valid therapeutic efficacy and excellent tolerability.26Ruffmann R, Sartani A. Drugs Exp Clin Res. 1987;13(1):57-62.  

The mode of action of flavoxate can be related to a superimposition of myotropic, calcium antagonistic and local anesthetic activity. Particularly, its antispasmodic activity can be correlated with inhibition of cyclic AMP phosphodiesterase.27Cazzulani P, Panzarasa R, Luca C, et al. Arch Int Pharmacodyn Ther. 1984;268(2):301-12.   In this context, experimental evidence related to flavoxate has demonstrated its spasmolytic effects in the detrusor muscle, moderate antihistaminic effect, local anesthetic effect equivalent to that of lidocaine, and mild analgesic effect as well.

The comparative efficacy of flavoxate in patients with varied symptoms of urinary incontinence has been documented in multiple studies. In a study by Gaudenz and Weil28Gaudenz R, Weil A. Urol Int. 1980;35(1):1-12.  , of several hundred cases of motor urge incontinence in the females, a comparison of flavoxate, emepronium, propantheline and a placebo for the treatment of urinary incontinence due to bladder instability was made. The results showed high efficacy and tolerability for flavoxate, with improved volume at capacity and detrusor uninhibited contractions. In another study of 40 female patients with urge incontinence treated with flavoxate, 65% of the patients improved under flavoxate treatment. Urodynamic investigations found an increased bladder capacity in the standing position and a decreased frequency of detrusor contractions.29Briel RC, Gassner K. Geburtshilfe Frauenheilkd. 1980 Mar;40(3):242-5.  

Furthermore, in a subsequent study that involved 336 evaluable patients, Gu FL et al30Gu FL, Reng ZY, Shang GZ, et al. J Int Med Res. 1987;15(5):312-8.   found that flavoxate completely cured or improved symptoms of urgency/incontinence in 87% patients with

Table 5. Incidence of adverse events associated with anticholinergic agents25Hesch K. Proc (Bayl Univ Med Cent) 2007;20(3):307-314.  
Adverse event FlavoxateaIncidence not defined.   Darifenacin Solifenacin OxybutyninbOxybutynin transdermal system adverse events also include local reactions (i.e., erythema, pruritus, rash, vesicles, or macules at the application site).   Tolterodine Trospium
Dry mouth * 20.2%-35.3% 10.9%-27.6% 29%-61% 23% 20.1%
Constipation * 14.8%-21.3% 5.4%-13.4% 7%-13% 6% 9.6%
Upper abdominal pain No report 2.4%-3.9% 1.2%-1.9% < 5 4% 1.5%
Dyspepsia * 2.7%-8.4% 1.4%-3.9% 5%-7% 3% 1.2%
Nausea * 1.5%-2.7% 1.7%-3.3% 2%-9% * >0.5%
Diarrhea * 0.9%-2.1% No report 7%-9% * No report
Urinary retention * No report 1.4% <5% No report 1.2%
Urinary tract infection No report 4.5%-4.7% 2.8%-4.8% 5% 1% 1.2%
Vertigo * 1.3%-2.1% 1.9% 4%-6% 2% No report
Blurred vision * >1% 3.8%-4.8% 1%-8% 1% >0.5%
Drowsiness * 0.9%-2.1% 1.0%-2.1% 2%-12% 3% 1.9%
Headache * No report No report 6%-10% 6% 4.2%
Dry eyes * 1.5%-2.1% 0.3%-1.6% 3%-6% 3% No report

a   Incidence not defined.

b   Oxybutynin transdermal system adverse events also include local reactions (i.e., erythema, pruritus, rash, vesicles, or macules at the application site).

urgency/incontinence of various types, and was effective in 77.4% of patients refractory to previous anticholinergic treatment. Importantly, flavoxate treatment significantly increases the bladder capacity in OAB patients, without increasing the end-residual urine volume.31Novara G, Galfano A, Secco S, et al. Eur Urol. 2008;54(4):740-63.  ,32Pedersen E. Urol Int. 1977;32(2-3):202-8.   The drug can be used either alone or in combination with an alpha-1 adrenoreceptor blocker to alleviate the symptoms of LUTS and OAB.

Favorable safety profile of flavoxate

Flavoxate acts as a spasmolytic agent with no antimuscarinic activity, and is thus largely devoid of antimuscarinic/anticholinergic side effects seen with other drugs; thereby exhibiting an excellent tolerability profile (Table 5).25Hesch K. Proc (Bayl Univ Med Cent) 2007;20(3):307-314.  ,33Milani R, Scalambrino S, Carrera S, et al. J Int Med Res. 1988;16(3):244-8.   While Gaudenz and Weil28 showed the drug to be well-tolerated than emepronium, propantheline; Gu FL et al30Gu FL, Reng ZY, Shang GZ, et al. J Int Med Res. 1987;15(5):312-8.  , in their study, documented that adverse events occurred only in 1.3% patients with urgency and urge incontinence treated with flavoxate. Furthermore, the Cochrane meta-analysis by Roxburgh C and colleagues also demonstrated a higher incidence and severity of adverse effects in the anticholinergic groups, with Risk Ratio favoring flavoxate over anticholinergics (Figure 3).34Roxburgh C, Cook J, Dublin N. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003190. DOI: 10.1002/14651858.CD003190.pub4.   Such favorable tolerability profile of

Figure 3. Anticholinergics vs. flavoxate; number experiencing adverse effects34Roxburgh C, Cook J, Dublin N. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003190. DOI: 10.1002/14651858.CD003190.pub4.  
Clinically proven facts about flavoxate

flavoxate indeed suggests its wide applicability in subpopulations of patients with OAB and urinary incontinence.

Conclusion

Urinary incontinence of various types/causes is a common problem in daily practice, but remains under-reported and under-treated. This is despite the availability of effective pharmacologic agents targeting the basic pathophysiology of the incontinence syndrome. The pharmacologic options may be used in conjunction with behavior modification that is the first line treatment. In this context, the antispasmodic flavoxate can be widely used in subpopulations of patients with urinary incontinence, founded on its favorable tolerability and efficacy. The drug is free from side effects seen with anticholinergic medications. Treatment should however be tailored according to individual needs of the patients, considering the most bothersome symptomatic presentation(s), and decision favoured by patients’ characteristics and physician knowledge and discretion based on evidence based medicine.

References

  1. Weiss BD. Am Fam Physician 2005;71:315-22, 329.
  2. Abrams P, Cardozo L, Fall M, et al; Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78.
  3. Skaudickas D, Kévelaitis E. Medicina (Kaunas). 2010;46(7):496-503.
  4. National Kidney and Urologic Diseases Information Clearinghouse. NIH Publication No. 07-5280. June 2007.
  5. Thuroff JW, Abrams P, Andersson K, et al. European Urology 2011;5(9):387-400.
  6. Irwin DE, Milsom I, Hunskaar S, et al. Eur Urol. 2006;50(6):1306-14; discussion 1314-5.
  7. DeMaagd G. Urinary incontinence. US Pharm. 2007;32(6): 34-44.
  8. Stephan E, Hajjar RR. J Med Liban. 2012;60(4):220-7.
  9. Davis S, Wailoo A. Health Qual Life Outcomes. 2013;11:20.
  10. Culligan PJ, Heit M. Am Fam Physician. 2000;62(11):2433-2444.
  11. Vogel SL. Ochsner J. 2001; 3(4): 214-218.
  12. Petrou SP, Baracat F. Braz J Urol 2001;27:165-170.
  13. Hersh L, Salzman B. Am Fam Physician. 2013;87(9):634-40.
  14. Scherr D. Chapter 6, Urology. Last Minute Internal Medicine: A Concise Review for the Specialty Boards. DeLaMora PA. Available at http://www.robotic-prostatectomy.com/resources/last-minute-internal-medicine [Accessed on 28/11/2013].
  15. Cornu JN. Minerva Urol Nefrol. 2013;65(1):21-35.
  16. MacDiarmid S, Rogers A. Curr Urol Rep. 2007;8(1):66-73.
  17. Weiss BD. Am Fam Physician. 1998;57(11):2675-2684.
  18. National Kidney and Urologic Diseases Information Clearinghouse. National Institutes of Health. NIH Publication No. 08-4132.2007.
  19. Khandelwal C, Kistler C. AAFP 2013;87(8):543-50.
  20. Erdem N, Chu FM. Am J Med. 2006;119(3 Suppl 1):29-36.
  21. Cornu JN. Minerva Urol Nefrol. 2013 Mar;65(1):21-35.
  22. Kirby AC, Nager CW. Clin Obstet Gynecol. 2013;56(2):257-75.
  23. Andersson KE. Lancet Neurol. 2004;3(1):46-53.
  24. Lepor H. Rev Urol. 2005; 7(Suppl 8): S26-S33.
  25. Hesch K. Proc (Bayl Univ Med Cent) 2007;20(3):307-314.
  26. Ruffmann R, Sartani A. Drugs Exp Clin Res. 1987;13(1):57-62.
  27. Cazzulani P, Panzarasa R, Luca C, et al. Arch Int Pharmacodyn Ther. 1984;268(2):301-12.
  28. Gaudenz R, Weil A. Urol Int. 1980;35(1):1-12.
  29. Briel RC, Gassner K. Geburtshilfe Frauenheilkd. 1980 Mar;40(3):242-5.
  30. Gu FL, Reng ZY, Shang GZ, et al. J Int Med Res. 1987;15(5):312-8.
  31. Novara G, Galfano A, Secco S, et al. Eur Urol. 2008;54(4):740-63.
  32. Pedersen E. Urol Int. 1977;32(2-3):202-8.
  33. Milani R, Scalambrino S, Carrera S, et al. J Int Med Res. 1988;16(3):244-8.
  34. Roxburgh C, Cook J, Dublin N. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003190. DOI: 10.1002/14651858.CD003190.pub4.
  35. Milani R, Scalambrino S, Milia R, et al. International Urogynecology Journal 1993;4(1):pp 3-8.
  36. Fehrmann-Zumpe P, Karbe K, Blessman G. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(2):91-5.
  37. Baert L. Curr Med Res Opin. 1974-1975;2(10):631-5.
  38. Jonas U, Petri E, Kissel J. Eur Urol. 1979;5(2):106-9.
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