Tolterodine extended release with or without tamsulosin in men with lower urinary tract symptoms including overactive bladder symptoms: effects of prostate size. Initial combined treatment with anticholinergics and α-blockers for men with lower urinary tract symptoms related to BPH and overactive bladder: a prospective, randomized, multi-center, double-blind, placebo-controlled study Effects of serum PSA on efficacy of tolterodine extended release with or without tamsulosin in men with LUTS, including OAB. Tolterodine treatment improves storage symptoms suggestive of overactive bladder in men treated with alpha-blockers. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Solifenacin as add-on therapy for overactive bladder symptoms in men treated for lower urinary tract symptoms--ASSIST, randomized controlled study. Dose and aging effect on patients reported treatment benefit switching from the first overactive bladder therapy with tolterodine ER to fesoterodine: post-hoc analysis from an observational and retrospective study Efficacy of tolterodine on overactive bladder symptoms and sexual and emotional quality of life in sexually active women Health-related quality of life of Japanese patients with overactive bladder treated with extended-release tolterodine or immediate-release oxybutynin: a randomized, placebo-controlled trial Symptom-specific efficacy of tolterodine extended release in patients with overactive bladder: the IMPACT trial. Efficacy and tolerability of fesoterodine versus tolterodine in older and younger subjects with overactive bladder: a post hoc, pooled analysis from two placebo-controlled trials. Is there a synergistic effect of topical oestrogens when administered with antimuscarinics in the treatment of symptomatic detrusor overactivity? [A Crossover Comparison Study on Lower Urinary Tract Symptoms with Overactive Bladder Secondary to Benign Prostatic Hyperplasia: Naftopidil versus Tamsulosin with Solifenacin]. A comparison of the efficacy and tolerability of solifenacin succinate and extended release tolterodine at treating overactive bladder syndrome: results of the STAR trial. A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women. Efficacy and tolerability of fesoterodine in women with overactive bladder Patient-reported outcomes in patients with overactive bladder treated with mirabegron and tolterodine in a prospective, double-blind, randomized, two-period crossover, multicenter study (PREFER) Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. Randomized double-blind, active-controlled phase 3 study to assess 12-month safety and efficacy of mirabegron, a β(3)-adrenoceptor agonist, in overactive bladder. Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: Combined Treatment with Fesoterodine Fumarate Extended-Release and Tamsulosin - A Prospective Study Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. Clinical efficacy and tolerability of extended‐release tolterodine and immediate‐release oxybutynin in Japanese and Korean patients with an overactive bladder: a randomized, placebo‐controlled trial
BACKGROUND Some men with lower urinary tract symptoms ( LUTS ) including overactive bladder ( OAB ) symptoms may benefit from antimuscarinic therapy , with or without an alpha-adrenergic antagonist . OBJECTIVES To evaluate the safety and efficacy of tolterodine extended release ( ER ) , tamsulosin , or tolterodine ER+tamsulosin in men meeting symptom entry criteria for OAB and prostatic enlargement trials , stratified by prostate size . DESIGN , SETTING , AND PARTICIPANTS Subjects with an International Prostate Symptom Score ( IPSS ) > or=12 ; frequency and urgency , with or without urgency urinary incontinence ; postvoid residual volume ( PVR ) < 200 mL ; and maximum urinary flow rate ( Q(max ) ) > 5 mL/s were r and omized to receive placebo , tolterodine ER ( 4 mg ) , tamsulosin ( 0.4 mg ) , or tolterodine ER+tamsulosin for 12 wk . Data were stratified by median baseline prostate volume ( < 29 mL vs > or=29 mL ) . MEASUREMENTS Endpoints included week 12 changes in bladder diary variables , IPSS scores , and safety variables . RESULTS AND LIMITATIONS Among men with larger prostates , tolterodine ER+tamsulosin significantly improved frequency ( p=0.001 ) ; urgency ( p=0.006 ) ; and IPSS total ( p=0.001 ) , storage ( p<0.001 ) , and voiding scores ( p<0.013 ) . Tamsulosin significantly improved IPSS voiding scores ( p=0.030 ) . Among men with smaller prostates , tolterodine ER significantly improved frequency ( p=0.016 ) , UUI episodes ( p=0.036 ) , and IPSS storage scores ( p=0.005 ) . Tolterodine ER+tamsulosin significantly improved frequency ( p=0.001 ) and IPSS storage scores ( p=0.018 ) . Tamsulosin significantly improved nocturnal frequency ( p=0.038 ) and IPSS voiding ( p=0.036 ) and total scores ( p=0.044 ) . There were no clinical ly or statistically significant changes in Q(max ) or PVR ; incidence of acute urinary retention ( AUR ) was low in all groups ( < or=2 % ) . CONCLUSIONS Men with smaller prostates and moderate-to-severe LUTS including OAB symptoms benefited from tolterodine ER . Therapy with tolterodine ER+tamsulosin was effective regardless of prostate size . Tolterodine ER , with or without tamsulosin , was well tolerated and not associated with increased incidence of AUR We aim ed to evaluate the efficacy and safety of combination treatment using anticholinergics with α-blocker for initial treatment of both overactive bladder ( OAB ) and other lower urinary tract symptoms ( LUTS ) , secondary to BPH . A 12-week , r and omized , double-blind , placebo-controlled trial was conducted at four urology clinics in Korea , involving men , aged 50 years or older , with LUTS related to BPH and OAB . A total of 176 patients were r and omly assigned to receive doxazosin ( 4 mg ) plus placebo or doxazosin ( 4 mg ) plus tolterodine SR ( 4 mg ) , once a day for 12 weeks . Changes from baseline in total International Prostate Symptom Score ( IPSS ) , bladder diary variables , patient perception of bladder condition ( PPBC ) , uroflowmetry , postvoid residual volume and IPSS subscores ( voiding and storage ) were analyzed . Of the 176 enrolled patients , 91 had doxazosin gastrointestinal therapeutic system ( GITS ) and placebo , and 85 had combined medication with doxazosin GITS and tolterodine SR . Compared with the doxazosin plus placebo group , the doxazosin plus tolterodine group showed significant reductions in IPSS storage subscore and improvement in the quality of life item , urgency episodes , as well as in micturition frequency at weeks 4 and 12 . However , it failed to improve PPBC at week 4 as well as at week 12 . Earlier intervention with anticholinergics plus α-blocker was tolerated well , including the questions about urinary retention ( n=1 ) and dry mouth ( n=2 ) . Initial combination treatment of anticholinergics plus α-blocker showed positive results for men with LUTS related to BPH and OAB symptoms and did not increase the risk of urinary retention OBJECTIVES To evaluate the efficacy of tolterodine extended release ( ER ) , tamsulosin , and tolterodine ER plus tamsulosin in men with symptoms of overactive bladder and benign prostatic hyperplasia stratified by prostate-specific antigen ( PSA ) level . METHODS We performed a post hoc analysis of data from men > or=40 years old with frequency and urgency ( with or without urge urinary incontinence ) , postvoid residual urine volume < 200 mL , maximal urinary flow rate > 5 mL/s , International Prostate Symptom Score ( IPSS ) of > or=12 , and quality -of-life score of > or=3 . They had been r and omized to placebo , tolterodine ER ( 4 mg ) , tamsulosin ( 0.4 mg ) , or tolterodine ER plus tamsulosin for 12 weeks . The men were stratified by the median baseline PSA level ( > or=1.3 vs < 1.3 ng/mL ) . Assessment s included changes in bladder diary variables and IPSSs . The men rated the urgency level of each micturition , and the frequency-urgency sum was defined as the total of these ratings . RESULTS The PSA level correlated significantly with prostate size . Men with a PSA level of > or=1.3 ng/mL receiving tolterodine ER plus tamsulosin showed significantly greater improvements in 24-hour frequency , daytime frequency , the frequency-urgency sum , total IPSS , and IPSS storage score compared with those receiving placebo . Tamsulosin significantly improved the IPSS voiding scores , but tolterodine ER was ineffective . In men with a PSA level < 1.3 ng/mL , tolterodine ER alone and tolterodine ER plus tamsulosin significantly improved the 24-hour frequency , daytime frequency , frequency-urgency sum , and IPSS storage scores compared with those receiving placebo ; tamsulosin alone was ineffective . No significant changes were found in the postvoid residual urine volume or maximal urinary flow rate in any group , and the acute urinary retention rates were low . CONCLUSIONS The results of our study have shown that tolterodine ER was efficacious in men with lower urinary tract symptoms , including overactive bladder , who had lower PSA levels ( < 1.3 ng/mL ) BACKGROUND Some men receiving alpha-blocker therapy for lower urinary tract symptoms report persistent storage symptoms suggestive of overactive bladder ( OAB ) . OBJECTIVE To evaluate the efficacy of tolterodine extended release ( ER ) in men on alpha-blocker therapy . DESIGN , SETTING , AND PARTICIPANTS This double-blind trial included men aged > or = 40 yr with frequency , urgency , and at least moderate problems reported on the Patient Perception of Bladder Condition ( PPBC ) , despite being on a stable dose of alpha-blocker for > or = 1 mo . INTERVENTIONS Subjects were r and omized to tolterodine ER 4 mg per day or placebo for 12 wk while continuing their prescribed alpha-blocker therapy . MEASUREMENTS At baseline and week 12 , subjects completed the PPBC , International Prostate Symptom Score ( IPSS ) , Overactive Bladder Question naire ( OAB-q ) , and 5-d bladder diaries using the five-point Urinary Sensation Scale ( USS ) . Frequency-urgency sum was defined as the sum of USS ratings for all micturitions . RESULTS AND LIMITATIONS PPBC improvement from baseline to week 12 was reported by 63.6 % and 61.6 % of subjects receiving tolterodine ER plus alpha-blocker and placebo plus alpha-blocker , respectively ; this treatment difference , which was the primary end point , was not statistically significant ( p>0.6699 ) . At week 12 , subjects receiving tolterodine ER plus alpha-blocker had significantly greater improvements versus placebo plus alpha-blocker in 24-h micturitions ( -1.8 vs -1.2 ; p=0.0079 ) and daytime micturitions ( -1.3 vs -0.8 ; p=0.0123 ) ; 24-h urgency episodes ( -2.9 vs -1.8 ; p=0.0010 ) , daytime urgency episodes ( -2.2 vs -1.4 ; p=0.0017 ) , and nocturnal urgency episodes ( -0.5 vs -0.3 ; p=0.0378 ) ; frequency-urgency sum ( -7.8 vs -5.1 ; p=0.0065 ) ; IPSS storage subscale ( -2.6 vs -2.1 ; p=0.0370 ) ; and OAB-q symptom bother scale ( -17.9 vs -14.4 ; p=0.0086 ) and coping domain ( 15.4 vs 12.4 ; p=0.0491 ) . Acute urinary retention requiring catheterization occurred in < 1 % of either group . There were no clinical ly meaningful changes in postvoid residual volume or maximum urinary flow rate .  CONCLUSIONS Men with bothersome OAB symptoms despite continued alpha-blocker therapy showed significantly greater improvements in diary variables , IPSS Storage scores , and symptom bother when receiving additional tolterodine ER versus placebo plus alpha-blocker OBJECTIVE Estimate the prevalence of urinary incontinence ( UI ) , overactive bladder ( OAB ) , and other lower urinary tract symptoms ( LUTS ) among men and women in five countries using the 2002 International Continence Society ( ICS ) definitions . METHODS This population -based , cross-sectional survey was conducted between April and December 2005 in Canada , Germany , Italy , Sweden , and the United Kingdom using computer-assisted telephone interviews .  A r and om sample of men and women aged > /= 18 yr residing in the five countries and who were representative of the general population s in these countries was selected . Using 2002 ICS definitions , the prevalence estimates of storage , voiding , and postmicturition LUTS were calculated . Data were stratified by country , age cohort , and gender . RESULTS A total of 19,165 individuals agreed to participate ; 64.3 % reported at least one LUTS . Nocturia was the most prevalent LUTS ( men , 48.6 % ; women , 54.5 % ) . The prevalence of storage LUTS ( men , 51.3 % ; women , 59.2 % ) was greater than that for voiding ( men , 25.7 % ; women , 19.5 % ) and postmicturition ( men , 16.9 % ; women , 14.2 % ) symptoms combined . The overall prevalence of OAB was 11.8 % ; rates were similar in men and women and increased with age . OAB was more prevalent than all types of UI combined ( 9.4 % ) . CONCLUSIONS The EPIC study is the largest population -based survey to assess prevalence rates of OAB , UI , and other LUTS in five countries . To date , this is the first study to evaluate these symptoms simultaneously using the 2002 ICS definitions . The results indicate that these symptoms are highly prevalent in the countries surveyed OBJECTIVES To assess the efficacy and safety of solifenacin add-on therapy to tamsulosin in lower urinary tract symptoms ( LUTS ) men with residual overactive bladder ( OAB ) symptoms despite tamsulosin monotherapy . METHODS In this r and omized , multicenter , double-blind study , male LUTS patients aged≥50 years with urgency episodes/24 hours≥2 and micturitions/24 hours≥8 were r and omized to 3 groups : 12-weeks tamsulosin plus placebo ( TAM+PBO ) , tamsulosin plus solifenacin 2.5 mg ( TAM+SOL ) , and tamsulosin plus solifenacin 5 mg ( TAM+SOL ) . Changes from baseline to end of treatment in the number of urgency episodes/24 hours ( primary endpoint ) , micturitions , nocturia , urgency incontinence episodes , International Prostate Symptom Scores ( IPSS ) , and Overactive Bladder Symptom Score ( OABSS ) were compared between the TAM+SOL groups and TAM+PBO . Safety was assessed on adverse events , postvoid residual volume , and maximal urinary flow rate ( Qmax . ) . RESULTS Six-hundred thirty-eight men were r and omized . Urgency was reduced by 2.2 and 2.4 episodes in the TAM+SOL 2.5 and 5 mg groups , respectively . The TAM+SOL 5 mg group showed significant improvement compared with TAM+PBO ( -2.4 vs -1.9 , P=.049 ) . The number of micturitions in both TAM+SOL groups were significantly reduced compared with TAM+PBO ( both P<.001 ) . IPSS storage symptom score and OABSS significantly improved in both TAM+SOL groups compared with TAM+PBO . Changes in IPSS voiding symptom score and Qmax . were similar in all groups . Four patients ( 1.9 % ) in the TAM+SOL 5 mg group had urinary retention , but all recovered after catheterization . CONCLUSIONS In male LUTS patients with residual OAB symptoms  despite tamsulosin monotherapy , TAM+SOL showed efficacy on urgency , which represents OAB symptoms and was well tolerated Background Previous r and omized studies have demonstrated that fesoterodine significantly improves the Overactive Bladder ( OAB ) symptoms and their assessment by patients compared with tolterodine extended-release ( ER ) . This study aim ed to assess the effect of aging and dose escalation on patient-reported treatment benefit , after changing their first Overactive Bladder ( OAB ) therapy with tolterodine-ER to fesoterodine in daily clinical practice . Methods A post-hoc analysis of data from a retrospective , cross-sectional and observational study was performed in a cohort of 748 OAB adults patients ( OAB-V8 score ≥8 ) , who switched to fesoterodine from their first tolterodine-ER-based therapy within the 3–4 months before study visit . Effect of fesoterodine doses ( 4 mg vs. 8 mg ) and patient age ( < 65 yr vs. ≥65 yr ) were assessed . Patient reported treatment benefit [ Treatment Benefit Scale ( TBS ) ] and physician assessment of improvement with change [ Clinical Global Impression of Improvement subscale ( CGI-I ) ] were recorded . Treatment satisfaction , degree of worry , bother and interference with daily living activities due to urinary symptoms were also assessed . Results Improvements were not affected by age . Fesoterodine 8 mg vs. 4 mg provides significant improvements in terms of treatment benefit [ TBS 97.1 % vs. 88.4 % , p < 0.001 ; CGI-I 95.8 % vs. 90.8 % p < 0.05 ) ] , degree of worry , bother and interference with daily-living activities related to OAB symptoms ( p < 0.05 ) . Conclusions A change from tolterodine ER therapy to fesoterodine with dose escalation to 8 mg in symptomatic OAB patients , seems to be associated with greater improvement in terms of both patient-reported-treatment benefit and clinical global impression of change . Improvement was not affected by age We evaluated  overactive bladder ( OAB )  symptoms and sexual and emotional health in sexually active women with OAB/urgency urinary incontinence ( UUI ) treated with tolterodine extended release ( ER ) . Sexually active women with OAB symptoms were r and omized to placebo or tolterodine ER . Five-day bladder diaries , Sexual Quality of Life Question naire — Female ( SQOL-F ) , Pelvic Organ Prolapse/Urinary Incontinence Sexual Question naire ( PISQ ) , and Hospital Anxiety and Depression Scale ( HAD ) were completed at baseline and week 12 . Tolterodine ER ( n = 201 ; mean ± SD age , 49 ± 12 years ) reduced UUI episodes ( P = 0.0029 ) , total ( P = 0.0006 ) and OAB ( P < 0.0001 ) micturitions , and pad use per 24 h ( P = 0.0024 ) , and was associated with improvements in SQOL-F ( P = 0.004 ) , PISQ total ( P = 0.009 ) , and HAD Anxiety ( P = 0.03 ) scores versus placebo ( n = 210 ; mean ± SD age , 47 ± 12 years ) . OAB symptoms improved with tolterodine ER as did the scores of sexual health and anxiety measures in sexually active women with OAB Overactive bladder ( OAB ) has a significant impact on a patient ’s health-related quality of life ( HRQoL ) . This study assessed the HRQoL of Japanese OAB patients following 12 weeks ’ treatment with tolterodine extended release ( ER ) or oxybutynin .  A total of 293 patients with symptoms of OAB were r and omized for treatment with tolterodine ER 4 mg once daily ( n=114 ) , oxybutynin 3 mg three times daily ( n=122 ) or a placebo ( n=57 ) . Treatment efficacy and safety assessment s were made over the 12-week period . HRQoL was assessed using the King ’s Health Question naire ( KHQ ) . Patients receiving tolterodine ER or oxybutynin showed a significant ( P<0.05 ) improvement in the Incontinence Impact , Role Limitations and most other KHQ domains compared with the placebo . These changes in HRQoL corresponded with significant ( P<0.05 ) improvements in micturition diary variables for patients receiving tolterodine ER and oxybutynin compared with placebo . Our findings demonstrate that Japanese OAB patients receiving tolterodine ER or oxybutynin experienced overall improvement in their quality of life We evaluated the efficacy of tolterodine extended release ( ER ) for patients ' most bothersome overactive bladder ( OAB ) symptom in a primary care setting . Patients with OAB symptoms for > or=3 months received tolterodine ER  ( 4 mg q.d . ) for 12 weeks . Among incontinent patients ( n = 772 ) , the most bothersome OAB symptoms were daytime frequency ( 28 % ) , urgency urinary incontinence ( UUI ; 27 % ) , nocturnal frequency ( 26 % ) and urgency ( 19 % ) ; among continent patients ( n = 91 ) , they were daytime frequency ( 47 % ) , nocturnal frequency ( 42 % ) and urgency ( 10 % ) . Sixty-nine per cent of patients had one or more comorbid conditions . By week 12 , there were significant reductions in patients ' most bothersome symptom : -80 % for UUI , -78 % for urgency episodes , -40 % for nocturnal frequency and -30 % for daytime frequency ( p < 0.0001 ) . The most common adverse events were dry mouth ( 10 % ) and constipation ( 4 % ) . In primary care practice , bothersome OAB symptoms can be effectively and safely treated with tolterodine ER , even in patients with comorbid conditions AIMS To assess the efficacy and tolerability of fesoterodine 8 mg versus tolterodine extended release ( ER ) 4 mg in subjects with overactive bladder ( OAB ) stratified by age ( < 65 , 65 - 74 , and ≥75 years ) . METHODS This was a post hoc analysis of data from two double-blind trials . Subjects reporting ≥1 urgency urinary incontinence ( UUI ) episode and ≥8 micturitions/24 hr at baseline were r and omized  to fesoterodine ( 4 mg for 1 week , 8 mg for 11 weeks ) , tolterodine ER 4 mg , or placebo . Subjects completed 3-day bladder diaries , Urgency Perception Scale ( UPS ) , Patient Perception of Bladder Condition ( PPBC ) , and OAB question naire ( OAB-q ) at baseline and week 12 . The primary endpoint in both studies was change from baseline to week 12 in UUI episodes . RESULTS Among subjects < 65 years ( n = 2,670  ) , improvements in UUI episodes , micturitions , urgency episodes , severe urgency episodes , frequency-urgency sum , UPS , PPBC , and all OAB-q scales and domains were significantly greater with fesoterodine versus tolterodine ER , and diary-dry rates were significantly higher . Among subjects 65 - 74 years ( n = 990 ) , improvements in mean voided volume per void , PPBC , and OAB-q Symptom Bother and Coping were significantly greater with fesoterodine versus tolterodine ER . Among subjects aged ≥75 years ( n = 448 ) , improvements in urgency episodes , severe urgency episodes , frequency-urgency sum , UPS , and OAB-q Symptom Bother were significantly greater with fesoterodine versus tolterodine ER . Both active treatments produced significant improvements in most outcomes versus placebo across age groups . Adverse event rates were similar among age groups . CONCLUSIONS Fesoterodine 8 mg consistently improved several OAB-related variables versus tolterodine ER 4 mg in subjects aged < 65 , 65 - 74 , and ≥75 years , with some differences reaching statistical significance , and was generally well tolerated BACKGROUND No authors have investigated whether the administration of local oestrogens in addition to antimuscarinics could have a synergistic effect in the therapy of overactive bladder ( OAB ) . OBJECTIVES To compare the efficacy of antimuscarinics alone versus antimuscarinics in combination with local oestrogens for OAB ; to verify whether risk factors for lower antimuscarinic efficacy can be overcome by the concomitant use of local oestrogens . DESIGN , SETTING , AND PARTICIPANTS Some 229 postmenopausal women with symptomatic urodynamically proven detrusor overactivity were prospect ively enrolled at a tertiary level urogynaecology centre and divided into two groups . INTERVENTION Women in group 1 ( n=129 ) were prescribed tolterodine extended release ( ER ) 4 mg once daily ; women in group 2 ( n=100 ) were prescribed both tolterodine ER 4 mg and concomitant oestriol cream application once daily . MEASUREMENTS All women underwent clinical evaluation and urodynamics in accordance with the Good Urodynamic Practice s Guidelines . After 12 wk of treatment the two groups were compared in terms of subjective efficacy for OAB symptom improvement using a three-point scale . Nonresponders were compared to the patients who improved or were cured in order to identify risk factors for resistance to therapy . RESULTS AND LIMITATIONS There was no significant difference between the two groups in terms of efficacy of therapy : 80.6 % in group 1 versus 82 % in group 2 ( p=0.86 ) . Patients with urodynamically proven detrusor overactivity ( DO ) occurring during provocative manoeuvres and patients with coital incontinence during orgasm reported a higher failure rate both in the overall study population and in group 2 . A possible limitation of the study is the nonr and omised design . CONCLUSIONS No synergistic effect of local oestrogens and antimuscarinics in the treatment of OAB was found . Antimuscarinic treatment has lower cure rates in women with symptomatic DO complaining of incontinence at orgasm or in patients with DO following provocative manoeuvres . The association of local oestrogens does not influence the role of the two mentioned risk factors We compared the efficacy of naftopidil monotherapy with combination therapy using tamsulosin hydrochloride and solifenacin succinate in the treatment of lower urinary tract symptoms ( LUTS ) with overactive bladder ( OAB ) secondary to benign prostatic hyperplasia ( BPH ) . Thirty one patients were enrolled in a r and omized crossover study . Fourteen patients were initially prescribed naftopidil 75 mg ( N ) for 8 weeks , followed by tamsulosin 0.2 mg and solifenacin 5 mg ( TS ) for 8 weeks ( group N ) ; another 17 were initially prescribed TS , followed by N ( group TS ) . The efficacy variables were the changes in international prostate symptom score ( I-PSS ) , quality of life ( QOL ) score , overative bladder symptom score ( OABSS ) , and post-void residual ( PVR ) urine volume . After the study , a question naire survey was carried out about the choice of treatment . After treatment with each agent , total I-PSS , storage symptom score , QOL score and OABSS except for the daytime frequency were significantly improved from baseline . PVR was significantly increased after TS treatment . There were no significant differences between the two treatments except for PVR . As a result of the question naire survey , 13 patients chose N and 17 chose TS . In conclusion , N monotherapy can be expected to have an equal effect in the treatment of LUTS with OAB secondary to BPH in comparison with TS combination therapy OBJECTIVE To compare two new generation antimuscarinics at their recommended doses for treatment of overactive bladder syndrome ( OAB ) . METHODS A prospect i ve , double blind , double-dummy , two-arm , parallel-group , 12-week study was conducted to compare the efficacy and safety of solifenacin 5 or 10 mg and tolterodine extended release ( ER ) 4 mg once daily in OAB patients . After 4 weeks of treatment patients had the option to request a dose increase but were dummied throughout as approved product labelling only allowed an increase for those on solifenacin . RESULTS Solifenacin , with a flexible dosing regimen , showed greater efficacy to tolterodine in decreasing urgency episodes , incontinence , urge incontinence and pad usage and increasing the volume voided per micturition . More solifenacin treated patients became continent and reported improvements in perception of bladder condition assessment s. The majority of side effects were mild to moderate in nature , and discontinuations were comparable and low in both groups . CONCLUSIONS Solifenacin , with a flexible dosing regimen , was found to be superior to tolterodine ER with respect to the majority of the efficacy variables BACKGROUND Female urinary incontinence ( UI ) , overactive bladder ( OAB ) , and other lower urinary tract symptoms ( LUTS ) are highly prevalent conditions with a profound influence on well-being and quality of life . There are a few studies describing progression as well as remission , in the short term , of UI in the general population as well as in selected groups ; at present , there are very few population -based studies describing the natural course of other LUTS in the same women , and there are no long-term longitudinal studies . OBJECTIVE To describe the prevalence of UI , OAB , and other LUTS in the same women studied prospect ively over time and , thus , to assess possible progression or regression . DESIGN , SETTING , AND PARTICIPANTS A longitudinal population -based study was performed in one primary health care district in the city of Gothenburg , Sweden . The participants were a sample of women aged > or = 20 yr who were r and omly selected from the Swedish National Population Register , assessed in 1991 ( n=2911 ) , and available for re assessment in 2007 ( n=1408 ) . METHODS A self-administered postal question naire regarding UI , OAB , and other LUTS was returned by 77 % of the contacted women in 1991 . The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal question naire . RESULTS AND LIMITATIONS In 2007 , 1081 of the available 1408 women responded to the question naire ( 77 % ) . The overall prevalence of UI , OAB , nocturia , and daytime micturition frequency of eight or more times per day increased by 13 % , 9 % , 20 % ( p<0.001 ) , and 3 % ( p<0.05 ) , respectively , from 1991 to 2007 . The incidence of UI and OAB were 21 % and 20 % , respectively , and the corresponding remission rates were 34 % and 43 % , respectively . Women with OAB symptoms were classified as OAB dry or OAB wet , depending on the presence or absence of concomitant UI . The prevalence of OAB dry did not differ between the two assessment occasions ( 11 % and 10 % , respectively ) , but the prevalence of OAB wet increased from 6 % to 16 % ( p<0.001 ) . CONCLUSIONS UI and other LUTS constitute dynamic conditions . In this study , there was a marked overall increase in the prevalence of UI , OAB , and nocturia in the same women from 1991 to 2007 . Both incidence and remission of most symptoms were considerable Introduction and hypothesisWe assessed fesoterodine  efficacy and tolerability in women with overactive bladder ( OAB ) . Methods This post hoc analysis of pooled data from two clinical trials included 1,548 women with OAB r and omized to placebo , fesoterodine 4 or 8 mg , or tolterodine extended release ( ER ) 4 mg ( in 1 trial ) for 12 weeks . Subjects completed 3-day bladder diaries at baseline and weeks 2 and 12 and rated Treatment Response at weeks 2 and 12 . Results By weeks 2 and 12 , all active-treatment groups showed significant improvements in all five bladder diary variables assessed and greater Treatment Response rates vs placebo . Fesoterodine 8 mg was significantly more efficacious than fesoterodine 4 mg and tolterodine ER in improving urgency urinary incontinence episodes and continent days per week . The most common adverse events were dry mouth and constipation , which were predominately mild or moderate . Conclusions Fesoterodine is efficacious and well tolerated in women with OAB Background The PREFER study was an assessment of medication tolerability , treatment preference and symptom improvement during treatment with mirabegron ( M ) and tolterodine ( T ) extended release ( ER ) in patients with overactive bladder ( OAB ) . In this analysis of PREFER , patient-reported outcomes ( PROs ) were assessed during treatment . Methods PREFER was a two-period , 8-week crossover , double-blind , phase IV study ( NCT02138747 ) of treatment-naïve adults with OAB ≥3 months r and omized to 1 of 4 treatment sequences ( M/T ; T/M ; M/M ; T/T ) , separated by a 2-week washout . Tolterodine ER was dosed at 4 mg for 8 weeks and mirabegron was dosed at 25 mg for 4 weeks then increased to 50 mg for the next 4 weeks . At each visit , PROs related to treatment satisfaction , quality of life and symptom bother were assessed using the OAB Satisfaction ( OAB-S ; 3 independent scales/5 single-item overall assessment s ) , OAB-q ( total health-related QoL [ HRQoL ] and subscales [ Sleep , Social , Coping , Concern ] and Symptom Bother scale ) and Patient Perception of Bladder Condition ( PPBC ) question naires . Responder rates were reported for OAB-q subscales based on a minimal important difference ( MID ; ≥ 10-point improvement ) and OAB-S Medication Tolerability score ≥ 90 . Results In total , 358 r and omized patients received ≥1 dose of double-blind study medication and completed ≥1 post-baseline value ( OAB-S scale , OAB-q , PPBC ) : M/T ( n = 154 ) , T/M ( n = 144 ) , M/M ( n = 30 ) or T/T ( n = 30 ) . At end of treatment ( EoT ) , mirabegron and tolterodine ER were associated with similar mean improvements in 7 of the 8 OAB-S scores investigated , OAB-q scales and PPBC . A higher percentage of patients achieved clinical ly relevant improvements ( MID ) in OAB-q scales and OAB-S Medication Tolerability score during treatment with mirabegron than tolterodine ER . Conclusions On average , patients with OAB experienced improvements in treatment satisfaction , HRQoL and symptom bother that were of a similar magnitude during treatment with mirabegron or tolterodine ER . However , during mirabegron treatment , patients were more likely to achieve clinical ly relevant improvements in tolerability and HRQoL ( as measured by the MID for the OAB-q or an OAB-S Medication Tolerability score ≥ 90 ) than during tolterodine ER treatment . Trial registration NCT02138747 ; registered May 13 , 2014 PURPOSE Antimuscarinic therapy for men with OAB and BOO is perceived as a potential risk for urinary retention . Using pressure flow urodynamics , we evaluated the safety of tolterodine vs placebo in men with OAB and BOO . MATERIAL S AND METHODS Men ( older than 40 years ) with BOO and confirmed detrusor overactivity were r and omized to tolterodine ( 2 mg twice daily in 149 ) or placebo ( in 72 ) for 12 weeks . Primary end points were Qmax and pdetQmax . RESULTS Median treatment differences in Qmax ( -0.7 ml per second , 95 % CI -1.6 to 0.4 ) and pdetQmax ( -7 cm H2O , 95 % CI -3 to 11 ) were comparable . Tolterodine significantly reduced the BOOI vs placebo ( -9 vs 0 , p < 0.02 ) . There were significant treatment differences in volume to first detrusor contraction ( + 59 ml , 95 % CI 19 - 100 ) and maximum cystometric capacity ( + 67 ml , 95 % CI 35 - 103 ) , favoring tolterodine over placebo ( p < 0.003 ) . Change in PVR was significantly greater among patients treated with tolterodine ( + 25 ml ) than placebo ( 0 ml , p < 0.004 ) . There were no significant between-group differences in the incidence of adverse events . Urinary retention was reported by 1 patient treated with placebo . CONCLUSIONS Tolterodine did not adversely affect urinary function in men with OAB and BOO .  Urinary flow rate was unaltered , and there was no evidence of clinical ly meaningful changes in voiding pressure and PVR or urinary retention .  Tolterodine was well tolerated . These results suggest that antimuscarinics can be safely administered in men with BOO BACKGROUND Despite several antimuscarinic treatment options for overactive bladder ( OAB ) , there is still a need for distinct treatment approaches to manage this condition . Mirabegron , a β(3)-adrenoceptor agonist , has demonstrated efficacy and tolerability for up to 12 wk in phase 3 trials . OBJECTIVE To assess the 12-mo safety and efficacy of mirabegron . DESIGN , SETTING , AND PARTICIPANTS Patients ≥ 18 yr of age with OAB symptoms for ≥ 3 mo . INTERVENTIONS After a 2-wk single-blind placebo run-in , patients with eight or more micturitions per 24h and three or more urgency episodes in a 3-d micturition diary were r and omized 1:1:1 to once-daily mirabegron 50 mg , mirabegron 100 mg , or tolterodine extended release ( ER ) 4 mg for 12 mo . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary variable : incidence and severity of treatment-emergent AEs ( TEAEs ) . Secondary variables : change from baseline at months 1 , 3 , 6 , 9 , and 12 in key OAB symptoms . RESULTS AND LIMITATIONS A total of 812 , 820 , and 812 patients  received mirabegron 50 mg , mirabegron 100 mg , and tolterodine ER 4 mg , respectively . Baseline demographic and OAB characteristics were similar across groups . TEAEs were reported in 59.7 % , 61.3 % , and 62.6 % of patients , respectively ; most were mild or moderate . Serious TEAEs were reported in 5.2 % , 6.2 % , and 5.4 % of patients , respectively . The most common TEAEs were similar across groups . Dry mouth was reported by 2.8 % , 2.3 % , and 8.6 % of patients , respectively . Adjusted mean changes from baseline to final visit in morning systolic blood pressure were 0.2 , 0.4 , and -0.5 mm Hg for mirabegron 50 mg , 100 mg , and tolterodine ER 4 mg , respectively . Mirabegron and the active control , tolterodine , improved key OAB symptoms from the first measured time point of 4 wk , and efficacy was maintained throughout the 12-mo treatment period . The study was not placebo controlled , which was a limitation . CONCLUSIONS The safety and tolerability of mirabegron was established over 1 yr , with sustained efficacy observed over this treatment period . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00688688 Objective : To evaluate the efficacy and safety of fesoterodine extended-release ( ER ) plus tamsulosin in men with lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) . Patients and Methods : Men aged ≥50 years , with LUTS , prostate volume ≤60 ml and International Prostate Symptom Score ( IPSS ) ≥13 were enrolled in this study . 173 consecutive patients were treated initially with tamsulosin ( 0.4 mg ) for 1 week . At the second visit , 47 patients out of the sample of 173 who were still experiencing inconvenient LUTS were r and omized into two groups . The first group received a therapy with tamsulosin and fesoterodine combination ( group 1 , n = 24 ) while the second continued the therapy with the single administration of tamsulosin ( group 2 , n = 23 ) for an additional 4-week period . Results : There was no statistically significant difference in age , prostate volume , Qmax , and postvoid residual urine between the two groups . A statistical significance appeared in the combination group regarding the storage and the total IPSS values among the second and third visits ( 10.5 ± 1.4 to 8.5 ± 1.3 and 16.1 ± 1.8 to 13.7 ± 1.5 respectively ) . Conclusion : Regarding bothersome LUTS and storage symptoms  , fesoterodine ER and tamsulosin combination was significantly more effective than the single administration of tamsulosin PURPOSE In this open label , prospect i ve study we determined the efficacy and tolerability of tolterodine extended release ( ER ) in men with benign prostatic hyperplasia ( BPH ) and lower urinary tract symptoms ( LUTS ) in whom previous alpha-blocker therapy had failed . MATERIAL S AND METHODS A total of 43 consecutive men with BPH and LUTS in whom a mean of 5.7 months of alpha-blocker therapy had failed due to adverse events ( 11 ) or a lack of efficacy ( 32 ) received tolterodine ER ( 4 mg daily ) for 6 months . Primary efficacy end points were American Urological Association symptom score , and mean daytime and nighttime micturition frequency . Secondary end points were the peak urinary flow rate , post-void residual volume , the incidence of urinary retention , total score on the erectile function domain of the International Index of Erectile Function and adverse events . RESULTS A total of 39 men ( 91 % ) with a mean age of 61 years completed the 6-month trial .  Mean 24-hour micturition frequency decreased from 9.8 to 6.3 voids and nocturia decreased from 4.1 to 2.9 episodes nightly . Significant changes in mean American Urological Association symptom scores ( -6.1 ) , the peak urinary flow rate ( 1.9 ml per second ) and post-void residual volume ( -22 ml ) were also observed . Of the men 27 ( 63 % ) were potent at baseline and 29 ( 67 % ) were potent after 6 months of tolterodine ER treatment . Mean International Index of Erectile Function erectile function domain scores increased ( 6.9 ) . Four men ( 9 % ) discontinued therapy because of intolerable dry mouth . There were no reports of urinary retention . CONCLUSIONS Treatment with tolterodine ER in men with BPH and LUTS may be a reasonable therapeutic option as initial therapy or after failed treatment with alpha-blockers PURPOSE In this open label , prospect i ve study we determined the efficacy and tolerability of tolterodine extended release ( ER ) in men with benign prostatic hyperplasia ( BPH ) and lower urinary tract symptoms ( LUTS ) in whom previous alpha-blocker therapy had failed . MATERIAL S AND METHODS A total of 43 consecutive men with BPH and LUTS in whom a mean of 5.7 months of alpha-blocker therapy had failed due to adverse events ( 11 ) or a lack of efficacy ( 32 ) received tolterodine ER ( 4 mg daily ) for 6 months . Primary efficacy end points were American Urological Association symptom score , and mean daytime and nighttime micturition frequency . Secondary end points were the peak urinary flow rate , post-void residual volume , the incidence of urinary retention , total score on the erectile function domain of the International Index of Erectile Function and adverse events . RESULTS A total of 39 men ( 91 % ) with a mean age of 61 years completed the 6-month trial .  Mean 24-hour micturition frequency decreased from 9.8 to 6.3 voids and nocturia decreased from 4.1 to 2.9 episodes nightly . Significant changes in mean American Urological Association symptom scores ( -6.1 ) , the peak urinary flow rate ( 1.9 ml per second ) and post-void residual volume ( -22 ml ) were also observed . Of the men 27 ( 63 % ) were potent at baseline and 29 ( 67 % ) were potent after 6 months of tolterodine ER treatment . Mean International Index of Erectile Function erectile function domain scores increased ( 6.9 ) . Four men ( 9 % ) discontinued therapy because of intolerable dry mouth . There were no reports of urinary retention . CONCLUSIONS Treatment with tolterodine ER in men with BPH and LUTS may be a reasonable therapeutic option as initial therapy or after failed treatment with alpha-blockers To compare extended‐release ( ER ) tolterodine and immediate‐release ( IR ) oxybutynin with placebo in Japanese and Korean patients with an overactive bladder ( OAB )
The efficacy and tolerability of tolterodine ER Vs .
A recent meta- analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h , urinary leakage episodes/24 h , urgency episodes/24 h , and urgency incontinence episodes/24 h. With regard to adverse events , tolterodine ER was associated with a good adverse event profile result ing in the third most favorable antimuscarinic .
Conclusion Tolterodine ER result ed effective in reducing frequency urgency and nocturia and urinary leakage in male patients with OAB/storage LUTS .
Dry mouth and constipation are the most frequently reported adverse events
Background Overactive bladder (OAB)/ storage lower urinary tract symptoms ( LUTS ) have a high prevalence affecting up to 90 % of men over 80 years .
The role of sufficient therapies appears crucial .
In the present review , we analyzed the mechanism of action of tolterodine extended-release ( ER ) with the aim to clarify its efficacy and safety profile , as compared to other active treatments of OAB/storage LUTS .
Antimuscarinic drugs are the mainstay of pharmacological therapy for OAB / storage LUTS ; several studies have demonstrated that tolterodine ER is an effective and well tolerated formulation of this class of treatment .