Charles R. Rardin, MD
Alpert Medical School of Brown University
Providence, Rhode Island
Rengananthan A, Robinson D, Cardozo L, Srikrishna S, Cartwright R. Do women with overactive bladder have realistic expectations for therapy? Int Urogyn J. 2010;21:409-414.
The impact of urgency and urge incontinence on quality of life has been well-documented; however, the complicated relationships between therapies, costs and adverse effects, and the objective and subjective tools used to measure lower urinary tract symptoms make definition of “cure” elusive. This study sought to determine what women with overactive bladder perceived as “cure,” and to elucidate the correlation between quality of life impairment and expectations from therapy.
153 women with bothersome OAB, and without report of stress incontinence, voiding dysfunction or prolapse, were recruited; of note, all patients were treatment-naïve. Patients filled out the King’s Health Questionnaire (KHQ) as well as a novel questionnaire instrument designed, based on qualitative clinical interviews, to assess patient expectations and attitudes about the following:
- Willingness to accept the problems
- Willingness to modify lifestyle
- Tolerance of side effects
- Paying for treatment
- Frequency of visits
- Accepting side effects
- Expectations from treatment
Prior to initiation of treatments, the following observations were made:
- Of the 153 women who completed the questionnaires, 47% indicated that urge incontinence was their most bothersome symptom; 31% indicated urgency as the most bothersome symptom of OAB
- 65% expected to have complete cessation of incontinence once treated
- 24% expected complete cure of all symptoms
- The majority of women considered bladder retraining and lifestyle modifications acceptable (73% and 67%, respectively)
- Most women found tablets used “as needed” acceptable (69%); however, this number dropped to 33% when asked to consider lifelong medication
- 62% of women indicated they were prepared to tolerate dry mouth as a treatment side effect; only 20% were prepared to tolerate constipation. 36% indicated they would not tolerate any treatment-related blurred vision
- The degree of quality of life impairment was not associated with different expectations of treatment success, tolerance of residual symptoms, or tolerance of side effects from treatment
This study helps to understand the low compliance rates observed with anticholinergic use. While 65% of women expected complete cure of incontinence, and 24% expected cure of all symptoms, few anticholinergic trials have demonstrated that level of performance. Perhaps most instructive, though, is the a priori reluctance to accept long-term medication as a treatment strategy. Although there are some limitations to the present study, including the use of a non-validated questionnaire tool and a relatively small sample size, there are insights that are likely to aid the clinician in helping patients develop treatment goals and expectations that are realistic and acceptable.