Frequent leaks or dribbles of urine in the elderly may not only be bothersome, but caregivers might also end up spending a fortune on liners and institutional care.
According to a new study, this condition - known as urgency urinary incontinence - can be treated safely with a medication commonly used to prevent urine leaks in overactive bladder patients.
Fesoterodine (brand name: Toviaz) reduced the number of urinary incontinence episodes and led to better quality of life, says the study.
This study was conducted by Catherine E. DuBeau, MD, at the University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, along with colleagues.
The aim of the study was to look at the safety and effectiveness of fesoterodine in elderly subjects who had urgency urinary incontinence.
Urgency urinary incontinence, the inability to control the urge to urinate, is common in old age. In older individuals, the condition is associated with an increased risk of being institutionalized.
Fesoterodine is commonly used to treat overactive bladder, a condition in which bladder muscles contract uncontrollably and cause frequent urination. The drug is a member of the family of antimuscarinic drugs that work by relaxing certain kinds of muscles, including bladder muscles.
According to S. Adam Ramin, MD, urologic surgeon and founder of Urology Cancer Specialists in Los Angeles, “Urgency incontinence means uncontrolled urine leakage that occurs with a strong urge to urinate before reaching the bathroom. Medications that belong to the antimuscarinic family treat urgency incontinence, but they are associated with constipation, dry mouth and reduced mental capacity in elderly patients.
“Fesoterodine is the first drug in this family to have been studied on elderly patients at higher risk for side effects,” said Dr. Ramin, who was not associated with the study.
For this study, the researchers looked at 562 patients aged 65 years or older, living in a retirement community. The subjects had two to 15 urgency urinary incontinence episodes each day.
The patients in the study were vulnerable elderly patients, which means that they received a score of 3 or more on the VES-13 survey, a 13 question survey. A higher score indicates poor ability to perform regular day-to-day tasks independently.
The patients also had other conditions, including muscle and joint disorders, high blood pressure and gastrointestinal problems.
Subjects were randomly divided into different groups. One group received fesoterodine once a day for 12 weeks and another group received a fake pill called a placebo.
The researchers measured the change in number of urgency urinary incontinence episodes per day and a few other quality of life measures. Patients also recorded what percentage of time they stayed dry (called dry-rate) and the other symptoms they had.
After 12 weeks of treatment, incontinence episodes fell by 2.84 episodes per day in the group that received fesoterodine as compared to the placebo group, who had a reduction of 2.2 episodes per day.
Patients who received fesoterodine recorded a higher dry-rate (50.8 percent) versus those who received a placebo (36 percent).
The adverse effects of fesoterodine, such as the risk for urinary retention (inability to empty the bladder), were similar to younger populations.
Overall, the researchers concluded that fesoterodine led to a significant improvement in urinary incontinence episodes in elderly patients.
“The study revealed fesoterodine did not significantly affect the mental capacity of elderly men and women and helped reduce their episodes of urgency incontinence. It appears that elderly patients are now good candidates for treatment of their urgency incontinence with fesoterodine,” said Dr. Ramin.
The results of this study were published August 22 in The Journal of Urology.
The study was funded by Pfizer, the maker of fesoterodine. A Pfizer employee contributed substantially to study design, supervision and reporting.