Objectification of changes in lower urinary tract urodynamics when prescribing M-anticholinergics in women with urinary incontinence

Background. The absence of connection between the results of clinical assessment and urodynamic instrumental diagnostics in women with urinary incontinence is relevant problem.

Objective. Objectification of lower urinary tract urodynamic measurements when prescribing M-anticholinergics to women with mixed urinary incontinence.

Methods. Due to the lack of sufficient accuracy of recording using urination diaries, the assessment was based only on the results of home uroflow monitoring. The choice of the indicator of the mean effective volume (MEV) of the bladder is attributable to the fact that it determines the severity of pollakiuria, nocturia, the intensity of imperative urges and the number of cases of urgent urinary incontinence. The material was obtained as a result of a retrospective analysis of data from a non-invasive urodynamic examination of a group of patients (80 cases) with a mixed form of urinary incontinence aged from 31 to 78 years (average age – 54 years). In 36 patients included in the 1st subgroup, the MEV value during home uroflow monitoring was in the range from 43 to 150 ml. In the remaining 44 cases (2nd subgroup), the MEV was 213 ml. After the examination, an M-anticholinergic was prescribed during the preparation for surgery. After the performing trocar synthetic sling (TSS) according to the Danilov-Volnykh method, 48-hour home uroflow monitoring was repeated in the period from 3 months to 1 year.

Results. The effectiveness of the therapy during the period of M-anticholinergic prescription was no more than 76%. In a quarter (20 women) of patients, taking the drug did not have an effect in the form of an increase in the MEV of the bladder (P<0.1). The average values of the maximum emptying rate (Qmax) of the bladder in the general group initially amounted to 28.5 ml/s, and after the appointment of therapy and the implementation of TSS, they decreased to 20.3 ml/s. In the general group, an increase in the MEV was noted, but at the same time, a significant increase in the minimum released volumes from 35 to 57 ml was observed (P<0.01), while the maximum capacities, on the contrary, decreased from 454 to 432 ml. The volumetric micturition profile almost normalized, and in the range of volumes up to 100 ml, the occurrence decreased by 1.5 times (P<0.01). In the area of 101–200 ml, the percentage of occurrence of volume values did not change, and the volume profile in areas over 200 ml radically changed for the better.

Conclusion. Conservative therapy in the preoperative period allows to level out the urgent component of the disease. In this case, the specific weight of the stress component increases, and accordingly, the manifestations of urinary incontinence during physical exertion become more contrasting, and the functional state of the lower urinary tract changes. Trospium chloride can be easily dosed when prescribed, which ensures personalization of therapy. In addition, this drug is well combined with nootropics, α1-adrenergic blockers and can be prescribed for a long time.