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The older polymorbid patient with overactive bladder syndrome (OAB) is becoming more and more frequent in daily medical practice. OAB is defined as urgency with or without incontinence, but often with frequency and nocturia without infection or other pathology. For the patient, OAB means an essential loss of quality of life. The therapeutic concept follows a graduated, stepwise scheme. Therapy includes behavioral training as well as pelvic floor training or pharmacological treatment, but there can be a lot of side effects and cross-reactions. In case of contraindication, complications of pharmacological treatment or an unsuccessful therapy, percutaneous posterior tibial nerve stimulation should be considered, which is minimally invasive, often successful and with rarely any side effects. An outpatient management is the standard procedure. [ABSTRACT FROM AUTHOR]

Although OAB is highly prevalent, it is often not diagnosed and therefore not treated. Treatment is symptomatic. While the diagnosis of overactive bladder is made clinically, simple office testing (e.g., urinalysis and culture, assessment of post-void residuel urine) should be part of the work-up of all patients with these symptoms. A voiding and intake diary is important for diagnosis and particularly useful to document success after treatment. A urogynecologic clarification with urodynamics is recommended in unclear situations and in the presence of mixed symptoms with symptoms of stress urinary incontinence or with patients who manifest a voiding dysfunction. The therapy takes place step by step. First-line management for OAB consists of lifestyle, behavioural therapy with pelvic floor exercises. Many patients also benefit from drug therapy. For decades, anticholinergics were the only drugs available. However, the long-term compliance is low.The new ß3 agonists have a similar effect, the side effect profiles differ among other things by the absence of dry mouth. In refractory OAB intravesical injection of Onabotulinumtoxin A is available as a very effective therapy. In rare cases, neuromodulation may be indicated. [ABSTRACT FROM AUTHOR]

About 15% of the women and 10% of the men past the age of 65 years suffer from urinary incontinence. In most cases, accurate history taking can help differentiate between urge incontinence, stress incontinence and overflow incontinence, and is essential in choosing the appropriate treatment. Initial diagnostic testing can be conducted by the general practitioner, especially tests to exclude urinary tract infections or to rule out an overactive bladder. Patient education on changes to fluid intake and voiding habits as well as advice on suitable incontinence products are important first steps in the management of urinary continence. Also, drug treatment can be initiated in general practice. Patients with refractory urinary incontinence, particularly those who did not respond to anticholinergic medication, should be referred to a urologist for further evaluation since there may be an underlying tumour or other disorder of the bladder that is causing the incontinence. [ABSTRACT FROM AUTHOR]

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Aims: Validate a new questionnaire to assess the side effects secondary to anticholinergics in neurogenic population suffering from Adult neurogenic lower urinary tract dysfunction (ANLUTD)., Methods: We conducted a prospective, monocentric study in a Neuro-urology Department of a University Hospital between February 2015 and April 2020. To allow a full psychometric validation of a questionnaire, the study protocol included 3 steps: qualitative interviews, feasibility study and validation study. The primary outcome was good psychometric properties defined with good internal consistency reliability (Cronbach's α>0.7) and good test-retest reliability (intraclass correlation coefficient (ICC)>0.7)., Results: we included 64 patients with ANLUTD secondary to neurogenic disorders. Feasibility study demonstrate very good acceptation and comprehension for 97% of patients. Validation study showed good internal consistency with Cronbach's α=0,69 and very good ICC=0,73. AQUA is composed with 8 items scoring 0 (no side effect) to 2 (major side effect) for a total score between 0 to 16. Time to fulfill is very quick. Mean score in our population was 4,1 (sd 2,9)., Conclusion: AQUA is the first validated tool to assess side effects secondary to antimuscarinic treatment for neurogenic population suffering from ANLUTD., Level of Proof: 2., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The overactive bladder syndrome (OAB) associates urgency, frequency, nycturia, more or less associated with urinary incontinence. Its frequency is between 16 to 45 %, in the general population; the number of affected people in the USA being estimated at 34 million. Symptomatology is primarily marked by the abrupt, irrepressible need to urinate, impossible to defer, but also by a diurnal and night high mictional frequency. This OAB is more frequent when patients age increases, and affects indifferently men and women. The OAB induces a known negative impact on the quality of life and can lead to depression, sexual disorders, sleep disorders and a professional absenteism. The OAB medical treatment is actively concerned by the research since the discovery of oxybutinine. Tolterodin, solifenacin, darifenacin, trospium chloride supplement the therapeutic arsenal. New formulations (immediate and extended releases), new administration mediums (intravesical, transdermic, vaginal, rectal), new active ingredients (botulinic toxin, capsaicine, resiniferatoxine) are currently tested. The therapeutic options multiply, aiming at reducing to the maximum symptomatology, as well as the induced side effects. [Copyright &y& Elsevier]

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Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Gynecologie--Obstetrique is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. – To determine if the addition of ipratropium bromide in the emergency department (ED) for the treatment of childhood asthma reduces rates of hospitalization and relapses for moderate and severe exacerbations.Methods. – Patients were given an oral corticosteroid treatment (2 mg/kg) and received every 20 minutes either three nebulizations with albuterol (0.15 mg/kg) and ipratropium bromide (250 μg) or six nebulizations with albuterol alone (control group). The primary end point was the need for hospitalization, additional nebulizations or a relapse during the following week. Secondary end point included the effect of age.Results. – One hundred and fourty three children, two to 15 years old, were randomized to ipratropium or control groups and 121 were evaluated on day seven. As a whole, the control group was less often hospitalized or in relapse than those treated with three nebulizations of albuterol and ipratropium (17.5% vs 37.9%, p <0.02). The ipratropium group reached the same result after three additional albuterol nebulizations. The benefit of anticholinergic therapy was observed for children less than six years of age who had a similar rate of success (73.5 vs 75.7%).Conclusion. – The association of ipratropium bromide to the first three doses of the albuterol protocol for acute asthma did not act as well as six nebulizations of albuterol alone. The effect was age dependent and two to six years old children needed more attention. Nevertheless the hospitalization rate did not support the use of ipratropium compared with repeated albuterol nebulizations. [Copyright &y& Elsevier]

Anticholinergic properties are well known to prescribers, notably in mental health, as a therapeutic strategy for i.e. extrapyramidal syndrome but also as a source of numerous adverse side effects. Herein, we propose a narrative literature review describing: (i) cholinergic pharmacology and anticholinergic properties; (ii) the importance of anticholinergic therapeutic properties in psychiatry; (iii) the existing anticholinergic drug scales and their usage limitations in Psychiatry and; last (iv) an update to the anticholinergic drug impregnation scale, designed for the French psychiatry practice. The anticholinergic side effects can appear both in the peripheral level (dry mouth, constipation, etc.) and in the central level (especially as cognitive deficits). Many of the so called « anticholinergic » drugs are in fact entirely or mostly antimuscarinic and act essentially as parasympathetic system antagonists. Overall, anticholinergic/antimuscarinic side effects are usually attributed to psychotropic medications: to certain antipsychotics, notably classical neuroleptics such as phenothiazine and also to tricyclic antidepressants. In practice, the impact of anticholinergic toxicity treatments is often highlighted due to their excessively prolonged use in patients on antipsychotics. Interestingly, these antipsychotic treatments are better known for their anticholinergic side effects, especially cognitive ones, with an early onset specially in elder patients and/or in the case of polymedication. In order to evaluate anticholinergic side effects, metrics known as anticholinergic burden scales were created in the last few decades. Nowadays, 13 different scales are documented and accepted by the international academic community, but only three of them are commonly used: the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB). All of them are based on a similar principle, consisting of grading treatments individually, and they are normally scored from 0 - no presence of side effects - to 3 - anticholinergic effects considered to be strong or very strong. Using these scales enables the calculation of the so-called "anticholinergic burden", which corresponds to the cumulative effect of using multiple medications with anticholinergic properties simultaneously. The application of anticholinergic scales to patients with psychiatric disorders has revealed that schizophrenic patients seem to be especially sensitive to anticholinergic cognitive side effects, while elder and depressed patients were more likely to show symptoms of dementia when exposed to higher anticholinergic burden. Unfortunately, these tools appear to have a low parallel reliability, and so they might induce large differences when assessing side effects predictability. In addition, the capacity of these scales to predict central adverse effects is limited due to the fact they poorly or do not differentiate, the ability of treatments to cross the blood-brain barrier. Finally, one last limitation on the validity of these scales is prescription posology is not accounted for side effects considered to be dose dependent. Recently, the MARANTE (Muscarinic Acetylcholine Receptor ANTagonist Exposure) scale has incorporated an anticholinergic burden weighting by posology. Nevertheless, this new model can be criticized, due to the limited number of medications included and due to testing a limited number of potency ranges and dosages for each treatment. Herein, we propose an update to the Anticholinergic Impregnation Scale, developed specifically for the French Psychiatry practice. The scale validation was based on an evaluation of the prescriptions correcting anticholinergic peripheral side effects (constipation, xerostomia and xeropthalmia). This indirect evaluation allowed us to show patients with an anticholinergic impregnation score higher than 5 received significantly more treatments for constipation and xerostomia. This strategy bypasses the bias of a cognitive evaluation in patients with severe mental health disorders. Moreover, the relevance of a tool developed specifically for French psychiatry is justified by the fact that some highly prescribed treatments for mental illness in France (cyamemazine and tropatemine) are strong anticholinergics, and also by the fact they are rarely included in the existing anticholinergic scales. This update of the original scale, published in 2017, includes information whether prescribed drugs cross the blood-brain barrier and thus makes possible a more accurate assessment when evaluating anticholinergic central side effects. Finally, the anticholinergic impregnation scale will soon be integrated into a prescription help software, which is currently being developed to take into consideration dose dependent adverse effects., (Copyright © 2021 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: To assess the feasibility and the accuracy of emptying cystometry in order to simplify the manometric follow-up of overactive detrusor in neurological patients under anticholinergic or botulinum toxin injections., Material: Female patients with a stable detrusor underwent both a conventional cystometry and sequential measurements of bladder pressure during emptying (emptying cystometry). At the end of the standard cystometry, a CH12 urinary catheter was introduced in the bladder and was connected to a three-way stopcock. The second way of the stopcock permitted the emptying. The third way of the stopcock was connected to a vertical graduated tube to measure the bladder pressure each 50mL during the bladder emptying., Results: Eleven female patients were included (mean age: 59.4years). Nine patients (82%) had neurogenic bladder. Mean cystometric capacity was 439mL (SD: 35mL). During the emptying cystometry, 8 to 10 measures were taken (mean: 9.4). The mean detrusor pressure was 1.7cmH 2 O (SD 2.1) for the filling cystometry and 2.3cmH 2 O (SD: 2.7) for the emptying cystometry. The agreement between the detrusor pressure between the two cystometries was good with intra-class correlation coefficient at 0.66 [0.48-0.77] - and the correlation was high (r=0.7; P<0.000001)., Conclusion: In a small, selected sample of patients, emptying cystometry provides similar results of detrusor pressure to filling cystometry. This technique could constitute a home monitoring of bladder pressures in a selected population of patients with intermittent catheterization in whom a manometric follow-up of detrusor overactivity is required., Level of Evidence: 4., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Aim: The aim of this study was to review the evidence regarding the cardiovascular effects of urinary anticholinergic drugs in the elderly., Methods: A literature review was conducted in October 2017 using the Medline/Pubmed database limiting the search to works in English or French., Results: In total, 602 articles between March 1964 and October 2017 have been reported, 60 studies were analyzed, 19 were prospective trials. Geriatric population has a high prevalence of cardiovascular diseases (24.4% of heart diseases on 65-74years and 36.9% on ≥75years). More than 20% of the geriatric population has overactive bladder history and 41.43% of them use of antimuscarinic drugs. Evaluating the cardiovascular adverse effects of antimusarinics in the geriatric population is not easy because of exclusion of high-risk patients in trials. However, serious cardiovascular adverse effects were reported like atrial fibrillation, atrioventricular block or torsade de pointe. Further studies are needed especially in the "real life" in order to precise the exact prevalence of such cardiovascular alterations., Conclusion: Without conclusive evidence, potential cardiovascular adverse effects of anticholinergic agents used in overactive bladder must lead to a cautious prescription., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Purpose: Some drugs have anticholinergic activity and can cause peripheral or central side effects. Several scales exist to evaluate the potential anticholinergic effect of prescribed drugs but: (i) they are validated in the elderly and mainly assess the cognitive side effect of treatments; (ii) they do not concern some of the drugs frequently used in clinical psychiatry in France. The aim of our study is to develop a new scale, the anticholinergic impregnation scale (AIS), with drugs used in France and based on an assessment of the drugs used against peripheral anticholinergic adverse effects., Methods: We assigned a score, ranging from 1 to 3, to a list of 128 drugs with a consensus approach obtained via literature data and expert opinions. We collected data from 7278 prescriptions in 34 French psychiatric facilities: age, sex, atropinic drugs, laxatives and treatments of xerophthalmia and xerostomia, in order to evaluate the association between AIS score and the prescription of drugs aiming to reduce peripheral anticholinergic side effects., Results: The most frequently prescribed drugs were cyamemazine (n=1429; 20%) and tropatepine (n=1403; 19%), two drugs marketed almost exclusively in France and with a score of 3. The frequency of patients with a high AIS score, greater than 5, was significantly higher in patients who received laxatives and treatments of xerostomia. AIS score represents the first validated solution to evaluate anticholinergic load in psychiatry settings in France., Conclusion: The anticholinergic problem remains underevaluated in mental health settings. In order to rule out the confounding factor of mental disease, assessment of peripheral side effects can be considered more objective than the evaluation of cognitive function in psychiatric patients. Building scales appropriate for each state also appear essential to obtain an useful and effective tool in clinical practice., (Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: To describe, using cluster analysis methods, the existence of a clinical typology specific to men, who are responding or not to anticholinergic treatment, and identify predictive factors associated with treatment success., Methods: An observational study was conducted in consecutive male patients who were prescribed anticholinergics for the first time. Sociodemographic data, patient characteristics, urinary symptom profile (USP) questionnaire, Ditrovie scale and symptom severity were assessed at inclusion and after 3 months of treatment. A cluster analysis according the hierarchical classification of Ward was used to discriminate two clusters (low and strong persistence of urinary disorders, respectively). Logistic regression was used to identify factors associated with evolution of treatment satisfaction and symptoms., Results: Out of 1018 patients evaluated, 410 had available follow-up data. A treatment with anticholinergic was prescribed to all of patient among which solifenacin represented 92.4% and 27.6% of patients received also an alpha-blocker. Cluster analysis identified two populations of responders. Recent symptoms, young age, absence of obesity or associated treatment, and urgency without incontinence were associated with a better clinical outcome under treatment. The USP questionnaire showed voiding difficulties in 12.4% of patients, and the only associated factor was symptom duration before consultation., Conclusions: Anticholinergics are efficacious for management of storage lower urinary tract symptom management in men. Clinical factors (age, obesity, treatments, urge urinary incontinence) could influence treatment outcome and allow a better patient selection for clinical decision-making., Level of Evidence: 4., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: We studied the pattern changes over time of medication prescriptions for COPD and their conformity with French and international recommendations using data from patients in the prospective French cohort "Initiatives BPCO"., Method: Eight hundred and forty-six patients have been included during a first period from August, 2001 till May 2006 (n=425) and a second period from June, 2006 till June, 2012 (n=421). The pivotal date was based on the tiotropium availability in France., Results: During period 1, we recruited older patients (average 65 vs 64 years), less often women (19 vs 26 %) and having less severe airflow obstruction (mean FEV1 48 vs 54 %). The ICS prescriptions decreased in mild COPD, but there was no change for inhaled long-acting beta-2 agonist (LABA) (68 %). The use of LABA+LAMA association without ICS increased from 0.9 to 7 %, but remained lower than the fixed LABA+ICS association (26 %), less often prescribed than the triple association LABA+ICS+LAMA (32.5 % in period 2). The use of long-acting bronchodilators increased from 68 to 80 % between both periods. Vaccinations and rehabilitation remained insufficiently prescribed. LAMA had been added but did not appear to replace other drugs., (Copyright © 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Objective: Study the efficacy and adverse events of different pharmacological lines in the treatment of idiopathic overactive bladder (iOAB)., Methods: PubMed research on meta-analyses and randomized controlled trials (RCT) focused on the efficacy and adverse effects of anticholinergics, botulinum toxin and mirabegron since 2005., Results: Ten meta-analyses of anticholinergics were selected; 16 randomized controlled trials (ERC) comparing botulinum toxin A to either anticholinergic or placebo and 10 ERC studying mirabegron. All the molecules studied showed efficacy compared to placebo in the treatment of iOAB. Anticholinergics remain the first-line pharmacological treatment allowing a significant reduction in the number (nb) of incontinence (-5/week) and in the number of urination (-4/week) as well as a perception of subjective improvement of the symptoms reported by 56 % of the patients treated against 41 % for the placebo group (RR: 1.39 [95 % CI: 1.28-1.51]). The most commonly reported side effect is dry mouth (30 % vs. 8 % in the placebo group). Injections of botulinum toxin A appear to be relatively comparable to anticholinergics in the first line with a decrease in urinary emergency incontinence (UTI) of 3.3/d in the toxin group versus 3.4/d in the anticholinergic group (P=0.81). There was also a higher rate of complete resolution of urinary incontinence in the toxin group (27 % vs. 13 % P=0.03) but significant adverse effects such as lower urinary tract infections (33 % vs. 13 % P>0.01). And the risk of using self-catheterization (5 % vs. 0 % P=0.01). In view of the invasive character of the toxin injections and their side effects, this treatment remains a 2nd line therapy. The same is true for mirabegron: similar efficacy (IUU number in the mirabegron group 50mg -1.74 vs. -1.53 In the solifenacin group 5mg, P>0.5) but different side effects with arterial hypertension (the oral dryness rate being comparable to that in the placebo group). The choice of use of anticholinergic or mirabegron should be based on the balance of efficacy/tolerance to be estimated for each patient., Conclusion: The different molecules have shown their efficacy in the treatment of iOAB with acceptable tolerance. There is a lack of direct comparisons between treatments available. Further studies are needed to evaluate the possible interest of a combination of these molecules as well as the search for predictive factors of response to these different therapies., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Résumé Objectif Chez l’homme, l’hyperactivité vésicale peut soit être idiopathique, soit liée à une pathologie vésicale ou neurologique, soit enfin être la conséquence d’une obstruction sous-vésicale (OSV). Cette OSV est le plus souvent secondaire à une hyperplasie bénigne de la prostate (HBP). L’objectif de ce travail était de définir la place des anticholinergiques (ACh) dans la prise en charge de l’HBP. Méthode Analyse des intitulés des autorisations de mise sur le marché (AMM) délivrées par les autorités de santé, revue de littérature et analyse des recommandations nationales et internationales de bonne pratique. Résultats Les ACh ont une AMM dans l’hyperactivité vésicale chez l’homme et la femme. La rétention d’urine en est la principale contre-indication. La littérature et les recommandations qui en découlent s’accordent sur une utilisation possible des ACh chez l’homme en cas d’hyperactivité vésicale isolée. En présence d’une d’hyperactivité vésicale associée à une obstruction sous-vésicale par HBP, les ACh peuvent être utilisés en association aux alpha-bloquants et de préférence après avoir constaté une persistance des symptômes de la phase de remplissage malgré une monothérapie par alpha-bloquant. Quelques études ont aussi évalué positivement l’association des ACh aux inhibiteurs de la 5 alpha réductase. Conclusion Les anticholinergiques peuvent être utilisés dans le traitement de l’HBP en association aux alpha-bloquants, en prenant soin de vérifier l’absence de rétention chronique d’urine. Summary Aim In men, overactive bladder (OAB) might be either idiopathic, secondary to neurological or bladder disease. Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) might also lead to OAB. The aim of this work was to define the role of anticholinergic agents (ACh) in the management of BPH. Method Analysis of drug guidelines delivered by health authorities, of literature, and of national and international practice guidelines. Results ACh have marketing authorization for men and women suffering OAB. Urinary retention is its main contra-indication. Regarding literature and practice guidelines, ACh can be used in men with isolated OAB. In case of OAB combined with BPH related BOO, ACh can be used in association with alpha-blockers, preferably when storage symptoms persist under alpha-blocker therapy alone. The association of 5 alpha reductase inhibitors with ACh was reported in several studies. Conclusions ACh might be used for BPH treatment in association with alpha-blockers, after verifying for the absence of urinary retention. [ABSTRACT FROM AUTHOR]

Aims: To determine the prevalence of overactive bladder (OAB) syndrome in France and gather data about initial patient trajectories in the healthcare system., Methods: A dedicated questionnaire (41 questions) has been sent to a 12,000 sample of people representative of the global population. The following data were investigated: social and demographic features, medical history, Urinary Symptom Profile questionnaire, bother, history of symptoms, care seeking and treatments received. Patient were considered having OAB in case if presenting at least two episodes of urgency per week, or being under treatment of OAB. OAB prevalence was the main outcome, and associated factors were characterized by univariate and multivariate analysis., Results: Based on 8842 available questionnaires, the global prevalence of OAB was estimated to be 14.4%. Prevalence was significantly higher in women, older age groups, as well as obesity, irritable bowel syndrome, urinary tract infections, enuresia, constipation, anxiety/depression, neurological diseases, sleep apnea syndrome, asthma, chronic obstructive pulmonary disease, diabetes and hypertension. Only 34.6% of patients with OAB had visited a health practitioner for this problem. General practitioners were most frequently implicated in patient primary care and evaluation. Seventy-two percent of patients with OAB had had additional investigations (mostly a urine culture) and only 6% of patients had to complete a bladder diary. The most frequent treatment option was oral antimuscarinics. Physical therapy and rehabilitation have been prescribed in 26% of cases, as well as dietary advice., Conclusions: OAB is a frequent syndrome. Its prevalence increases with age, and OAB frequently concern elderly frail people with many other associated diseases., Level of Evidence: 3., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Aim: Determine if the initiation of an anticholinergic treatment affects the sexual function in women diagnosed with multiple sclerosis (MS)., Methods: It was a single-centre prospective open label study on 18 women affected by MS, with a clinical overactive bladder syndrome, and examined before and after anticholinergic treatment. Several variables were studied before and after treatment: the total anticholinergic load (Anticholinergic Drug Scale [ADS]), the Female Sexual Function Index, the Urinary Symptom Profile (USP) and functional status (EDSS, MIF). Quantitative variables were analyzed using Student's test., Results: Eighteen women with an average age of 48.3 years old (±10.7 years), average EDSS of 4.6 (±1.5) were examined before and after anticholinergic treatment (solifenacin and trospium). Anticholinergic load at baseline was 0.33 (±0.5) and 3.44 (±0.70) after treatment (P<0.0001). The initiation of an anticholinergic treatment allowed a significant improvement on the subscore OAB USP (10.25±4.3 to 6.22±3 P=0.01). No significant impacts of the anticholinergic load on the Female Sexual Function Index (FSFI) score (18.9±10.8 to 21.2±10.8 P=0.06) and sub-items lubrification (3.6±2.2 to 3.7±2.2 P=0.6), pain (3.6±2.5 to 4.2±2.3 P=0.4), desire (3±1.2 to 3±1.5 P=0.7), orgasm (2.7±2.1 to 3±2.4 P=0.4), satisfaction (3.9± to 4±2 p=0.9), arousal (2.9±2 to 3.3±1.8 P=0.8) was evidenced., Conclusion: In this limited series of "naive" patients with MS, no impact of anticholinergic therapy on vaginal lubrication or sexual quality was observed., Level of Evidence: 4., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Aim: Systematically review literature on the efficacy and tolerability of botulinum toxin A (onabotulinumtoxineA, BOTOX(®), Allergan, CA, USA) in refractory idiopathic overactive bladder (iOAB) METHODS: Pubmed search on the efficacy, toxicity and adverse events of onabotulinumtoxinA in clinical trials only with level 1 and 2 evidence., Results: Eleven controlled randomised trials have been selected, of which 3 phase III trials. The studies published data of 1008 patients with refractory iOAB treated with onabotulinumtoxineA. In the phase II and III trials, doses from 50 U to 300 U have been evaluated; more than half of the patients (n = 676) with 100 U. In the 2 main phase III trials, onabotulinumtoxinA has demonstrated to be more efficient compared to placebo on continence, symptoms and quality of live (QoL). Urodynamic results, reported in the phase II trials, demonstrated higher changes compared to placebo only from dose 100 U on, although not always significant. Adverse events (urinary retention, dysuria, urinary tract infection) were easily treated and did not influence patient's QoL., Conclusion: Intradetrusor injections of onabotulinumtoxinA (BOTOX(®)), a minimally-invasive procedure, seem to be efficient and well tolerated in the treatment of refractory iOAB., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Abstract: Parkinson''s disease related to degeneration of the extrapyramidal structures is characterized in its typical form by the classic triad of tremors, rigidity and akinesia, constituting Parkinson''s syndrome. These are combined with neurovegetative disorders, responsible for sexual and bladder sphincter dysfunction. The latter occurs in from 30 to 90 % of cases, depending on the stage of progression of the disease. The dopamine deficiency in the nigrostriatal tract leads to a lifting of the inhibition which is probably the cause of the bladder hyperreflexia. Irritative signs are most frequently observed. The flowmetry data are contradictory, depending on the publication whereas the bladder overactivity, objectified by cystomanometry, is described in most of the studies although certain authors report, on the contrary, bladder hypoactivity. Conflicting data have also been published on bladder sphincter dyssynergia although in most studies, micturition was described as synergic in Parkinson''s disease patients. L-dopa, the main drug for Parkinson''s disease, has, according to the publication, either no action, or contradictory effects with bladder hypoactivity or hyperactivity. Anticholinergics are effective on overactive bladder, the alphablockers on the urethral hypertonia at the price of a higher risk of arterial hypotension in this diathesis. The indication for prostatic surgery must be carefully considered and preceded by precise clinical, urodynamic and sometimes electromyography evaluation. There is a high risk of post surgical incontinence. Endourethral prostheses provide an attractive alternative in the case of prostatic obstruction. [Copyright &y& Elsevier]

About 15% of the women and 10% of the men past the age of 65 years suffer from urinary incontinence. In most cases, accurate history taking can help differentiate between urge incontinence, stress incontinence and overflow incontinence, and is essential in choosing the appropriate treatment. Initial diagnostic testing can be conducted by the general practitioner, especially tests to exclude urinary tract infections or to rule out an overactive bladder. Patient education on changes to fluid intake and voiding habits as well as advice on suitable incontinence products are important first steps in the management of urinary continence. Also, drug treatment can be initiated in general practice. Patients with refractory urinary incontinence, particularly those who did not respond to anticholinergic medication, should be referred to a urologist for further evaluation since there may be an underlying tumour or other disorder of the bladder that is causing the incontinence.

Objectives: Describe the central nervous system (CNS) adverse effects of anticholinergic drugs used for the treatment of overactive bladder (OAB) in the elderly., Patients and Methods: Relevant data from the literature were identified primarily through a Medline search of articles published through December 2013. The search terms included overactive bladder, central nervous system, elderly, anticholinergic, and antimuscarinic. Articles were chosen for inclusion based on their pertinence to the focus on treatment of OAB in the elderly., Results: Several anticholinergic drugs are available for the treatment of OAB, including oxybutinin, tolterodine, trospium chloride, solifenacine, fesoterodine. Among the agents reviewed, penetration of the blood-brain barrier (as predicted by lipophilicity, polarity, and molecular size and structure) is highest for oxybutinin, lower for tolterodine, solifenacine, and darifenacine, and lowest for fesoterodine and trospium chloride. Unwanted CNS adverse effects depend in part on patient specific variability in pharmacokinetic parameters, blood-brain barrier permeability, degree of cholinergic neuronal degeneration, total anticholinergic drug burden and patient's baseline cognitive status. The spectrum of anticholinergic CNS adverse effects ranges from drowsiness to hallucinations, severe cognitive impairment, and coma. Among the different anticholinergic agents, oxybutinin has been associated with cognitive impairment and trospium chloride and fesoterodine have shown favorable CNS tolerability., Conclusions: Anticholinergic drugs improve significatively overactive bladder symptoms in older adults. However, potential CNS adverse effects of anticholinergic agents used in OAB must lead to a full evaluation before and during the treatment in order to evaluate benefice, risks and central side effects in this frail population., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Purpose: To perform an update on the treatment of masculine urinary incontinence due to idiopathic overactive bladder., Method: A systematic review was conducted using PubMed/MEDLINE with the following keywords: "overactive bladder", "male urinary incontinence", "urgency", "antimuscarinic", "onabotulinumtoxinA", "neurostimulation", "cystoplasty"., Results: Antimuscarinic treatments were the first line option for overactive bladder incontinence (decreased incontinence under tolterodine versus placebo respectively -71% vs. -40%, P < 0.05). Their main side effects were dry mouth (16-29.6%) and constipation (4%), which might decrease the observance. In case of failure, neuromostimulation could be prosed with a 67% efficacy rate. Intra-detrusorian injections of onabotulinumtoxinA were an option, however there were still not validated for this indication and their efficacy decreases with time and after repeated injections. The ultimate option in case of refractory major over-activity was cystoplasty, which involves major morbidity for inconstant efficacy., Conclusions: The same treatments are available for non-neurologic urinary incontinence by bladder over-activity for men and women: antimuscarinic drugs, neurostimulation, onabotulinumtoxinA. However, only few data is available for masculine population exclusively., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Aim: To describe drugs targeting urinary bladder to treat bladder dysfunctions such as OAB, NDO and bladder pain syndrome., Method: Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM)., Results: Anticholinergics antimuscarinics remain the first-line treatment option for both OAB and NDO. Beta-3 adrenergics emerges as a new therapeutic class for OAB. Post approval safety as well as association with other micturition cycle's drugs need to be evaluated. Phosphodiesterase 5 inhibitors are effective to treat BPH-related LUTS including storage symptoms. Botulinum toxin type A injections within the detrusor are effective and approved to treat NDO in MS and spinal cord injured patients voiding with clean intermittent catheterization. Evaluation of such approach to treat OAB is ongoing. Drug therapy for bladder pain syndrome has limited efficacy including pentosan polyphosphate despite it has a temporary autorisation. There is no drug treatment to restore or improve bladder contraction., Conclusion: Armamenterium to treat bladder dysfunction has recently increased. Three new therapeutic classes emerged. Careful post approval evaluation is mandatory and study of these drugs' combination is expected. Results should drive changes in bladder dysfunction treatment algorithms., (Copyright © 2013. Published by Elsevier Masson SAS.)