Anticholinergic drugs or botulinum toxin for urge incontinence?BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6732 (Published 10 October 2012) Cite this as: BMJ 2012;345:e6732
Oral anticholinergic drugs and injections of botulinum toxin into the detrusor muscle are both accepted treatments for women with urge incontinence. A head to head trial suggests they can work equally well but have very different side effects. Women in both groups had five episodes a day of urge incontinence at the start of the trial. They reported roughly three fewer episodes a day six months after randomisation (3.4 fewer for women taking anticholinergics, 3.3 fewer for women given botulinum toxin). Both treatments improved quality of life.
Dry mouth was a bigger problem for women taking anticholinergic drugs (46% (58/127) v 31% (37/120)). Women in the botulinum toxin group (one injection of toxin and a daily placebo pill) had more voiding problems, were more likely to need catheterising (5% (6/117) v 0% at two months), and had more urinary tract infections (33% (40/120) v 13% (16/127)). However, they were also more likely to report complete resolution of incontinence, a secondary outcome (27% (30/112) v 13% (16/119)). All these differences were significant.
The authors chose solifenacin as their first line anticholinergic. The design included one dose escalation and the option to switch to trospium if symptoms didn’t improve. Women in the comparator group had one 100 U injection of onabotulinumtoxinA, delivered cystoscopically. The trial was double blind.
Women still have a choice, say the authors. But now they can be better informed about the trade-offs to consider when deciding between treatments.
Cite this as: BMJ 2012;345:e6732