Effect of anticholinergic use for the treatment of overactive bladder on cognitive function in postmenopausal women.

BACKGROUND: Overactive bladder (OAB) is a common condition affecting the elderly. The mainstay of treatment for OAB is medical therapy with anticholinergics. However, adverse events have been reported with this class of drugs, including cognitive changes. OBJECTIVE: The objective of this study was to investigate the effect of an anticholinergic medication, trospium chloride, on cognitive function in postmenopausal women being treated for OAB. METHODS: This was a prospective cohort study conducted at a urogynaecology clinic at one academic medical centre from January to December 2010, with 12-week follow-up after medication initiation. Women aged 55 years or older seeking treatment for OAB and opting for anticholinergic therapy were recruited. Baseline cognitive function was assessed via the Hopkins Verbal Learning Test-Revised Form (HVLT-R) [and its five subscales], the Orientation, Memory & Concentration (OMC) short form, and the Mini-Cog evaluation. After initiation of trospium chloride extended release, cognitive function was reassessed at Day 1, Week 1, Week 4 and Week 12. Bladder function was assessed via three condition-specific quality-of-life questionnaires. Secondary outcomes included change in bladder symptoms, correlation between cognitive and bladder symptoms, and overall medication compliance. The main outcome measure was change in HVLT-R score at Week 4 after medication initiation, compared with baseline (pre-medication) score. RESULTS: Of 50 women enrolled, 35 completed the assessment. The average age was 70.4 years and 77.1% had previously taken anticholinergic medication for OAB. At enrollment 65.7% had severe overactive bladder and 71.4% had severe urge incontinence. Cognitive function showed an initial decline on Day 1 in HVLT-R total score (p = 0.037), HVLT-R Delayed Recognition subscale (p = 0.011) and HVLT-R Recognition Bias subscale (p = 0.01). At Week 1 the HVLT-R Learning subscale declined from baseline (p = 0.029). All HVLT-R scores normalized by Week 4. OMC remained stable throughout. The Mini-Cog nadired at a 90.9% pass rate at Week 4. OAB symptoms did not improve until Week 4, based on questionnaire scores (p < 0.05). CONCLUSION: Cognitive function exhibited early changes after initiation of trospium chloride but normalized within 4 weeks. Cognitive changes occurred weeks prior to OAB symptom improvement. Surveillance for cognitive changes with anticholinergic use should be part of OAB management.

Validation of web-based administration of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12).

INTRODUCTION AND HYPOTHESIS: We studied a web-based version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). METHODS: A randomized crossover study in which subjects completed both a web-based and paper-based version of the PISQ-12, with a 2-week separation between the completion of the two versions. Demographic data and questionnaire preferences were also assessed. Group 1 completed the web version first, and group 2 completed the paper version first. RESULTS: We recruited 52 women and 50 (96.2%) completed the study. Demographic data were similar for the two groups. There was no difference in total PISQ-12 score (P = 0.41) and a high degree of correlation between versions (r = 0.88). Women preferred the web-based PISQ-12 (77.6%) over the paper-based version. CONCLUSION: The web-based version of the PISQ-12 is a reliable alternative to the standard paper-based version and was preferred by women in this study regardless of age, race, and education.

Body mass index as a risk factor for cystotomy during suprapubic placement of mid-urethral slings.

INTRODUCTION AND HYPOTHESIS: This study aims to investigate whether body mass index (BMI) is a risk factor for cystotomy during sling placement via suprapubic approach for stress urinary incontinence. METHODS: Retrospective chart review was performed for suprapubic mid-urethral sling placement between June 2005 and October 2007. Data collected included demographics, BMI, and history of prior and concomitant procedures. Primary outcome was cystotomy during sling placement. RESULTS: Of 198 women identified, 129 had a BMI < 30 kg/m2 and 69 had a BMI > or = 30 kg/m2. There were 18 (14.0%) cystotomies in the BMI < 30 kg/m2 group and three (4.3%) in the BMI > or = 30 kg/m2 group (p = 0.04). BMI < 30 kg/m2 remained a risk factor for cystotomy after controlling for confounders (OR 4.63, 95% CI 1.20-17.86), as did prior anti-incontinence surgery (OR 3.55, 95% CI 1.01-12.50). CONCLUSIONS: BMI < 30 kg/m2 may be a risk factor for cystotomy during sling placement utilizing the suprapubic approach.

Factors related to urinary incontinence in community-dwelling women.

Urinary incontinence (UI) is one of the most prevalent and costly health problems in the United States. Women participating in two clinical trials had experienced UI for a mean of 7.2 +/- 7.6 SD years. Hormone status, gynecologic surgery, alcohol intake, age, and educational attainment were significantly related to amount of urine loss. Amount of urine loss was also related to episodes of urine loss, caffeine and fluid intake, and quality of life.

Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy.

OBJECTIVE: The purpose of this study was to examine risk factors for mesh erosion, including concomitant hysterectomy, in abdominal sacral colpopexies. STUDY DESIGN: We conducted a retrospective cohort study of 313 women who underwent an abdominal sacral colpopexy. Data regarding patient demographics, operative techniques, length of follow-up, postoperative complications, and mesh erosion were collected. RESULTS: Of 313 subjects, 101 (32.3%) had concomitant hysterectomies and 212 (67.7%) had had previous hysterectomies. The overall rate of mesh erosion was 5.4%. In bivariate analysis, concomitant hysterectomy was not associated with erosion (6.9% vs 4.7% previous hysterectomy, P = .42); however, estrogen therapy was an effect modifier. In women on estrogen, hysterectomy (OR 4.9, CI 1.2-19.7) and anterior imbrication (OR 5.6, CI 1.1-28.6) were associated with mesh erosion. No risk factors were identified in women not on estrogen. CONCLUSION: In women on estrogen therapy, hysterectomy was associated with mesh erosion in abdominal sacral colpopexy.

Menopausal symptoms and treatment-related effects of estrogen and progestin in the Women's Health Initiative.

OBJECTIVE: To estimate the effects of estrogen plus progestin (E+P) therapy on menopausal symptoms, vaginal bleeding, gynecologic surgery rates, and treatment-related adverse effects in postmenopausal women. METHODS: Randomized, double-blind, placebo-controlled trial of 16,608 postmenopausal women, ages 50-79 (mean +/- standard deviation 63.3 +/- 7.1) years, with intact uterus, randomized to one tablet per day containing 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate (n = 8,506) or placebo (n = 8,102), and followed for a mean of 5.6 years. Change in symptoms and treatment-related effects were analyzed at year 1 in all participants. Bleeding and gynecologic surgery rates were analyzed through study close-out. RESULTS: Baseline symptoms did not differ between the treatment groups. More women assigned to E+P than placebo reported relief of hot flushes (85.7% versus 57.7%, respectively; odds ratio 4.40; 95% confidence interval 3.40-5.71), night sweats (77.6% versus 57.4%; 2.58; 2.04-3.26), vaginal or genital dryness (74.1% versus 54.6%; 2.40; 1.90-3.02), joint pain or stiffness (47.1% versus 38.4%; 1.43; 1.24-1.64), and general aches or pains (49.3% versus 43.7%; 1.25; 1.08-1.44). Women asymptomatic at baseline who were assigned to E+P more often developed breast tenderness (9.3% versus 2.4%, respectively; 4.26; 3.59-5.04), vaginal or genital discharge (4.1% versus 1.0%; 4.47; 3.44-5.81), vaginal or genital irritation (4.2% versus 2.8%; 1.52; 1.27-1.81), and headaches (5.8% versus 4.7%; 1.26; 1.08-1.46) than women on placebo. Estrogen plus progestin treatment prevented the onset of new musculoskeletal symptoms. Vaginal bleeding was reported by 51% of women on E+P and 5% of women on placebo at 6 months; most bleeding was reported as spotting. Gynecologic surgeries (hysterectomy and dilation and curettage) were performed more frequently in women assigned to E+P (3.1% versus 2.5% for hysterectomy, hazard ratio = 1.23, P = .026; 5.4% versus 2.4% for dilation and curettage, hazard ratio = 2.23, P < .001). CONCLUSION: Estrogen plus progestin relieved some menopausal symptoms, such as vasomotor symptoms and vaginal or genital dryness, but contributed to treatment-related effects, such as bleeding, breast tenderness, and an increased likelihood of gynecologic surgery.

Transdermal versus oral estrogen therapy in postmenopausal smokers: hemodynamic and endothelial effects.

OBJECTIVE: To test the hypothesis that, in postmenopausal smokers, transdermal estrogen would be more effective than oral estrogen in reducing blood pressure (BP) and vascular and norepinephrine responses to stress and in increasing endothelial function and vascular beta2-adrenoceptor responsivity. METHODS: By using a randomized, double-blind, placebo-controlled design, 82 healthy postmenopausal smokers were tested before and after 6 months of therapy with transdermal estrogen (0.05 mg/d) plus a progestin (2.5 mg/d; n = 31), oral conjugated equine estrogen (0.625 mg/d) plus a progestin (2.5 mg/d; n = 30), or placebo (n = 21). Dependent measures included resting and stress-induced increases in BP, total peripheral resistance, and plasma norepinephrine, as well as endothelial function and beta-adrenoceptor responsivity. RESULTS: When compared with placebo, the transdermal estrogen group showed more consistent reductions in total peripheral resistance at rest and in response to mental stress than the oral estrogen group. Only the transdermal group showed treatment-related reductions in behavioral stress norepinephrine, baseline rest, and behavioral stress BP levels, and increases in vascular beta2-adrenoceptor responsivity and endothelium-dependent vasodilation. Posttreatment concentrations of serum estradiol and estrone were lower and the serum estradiol/estrone ratio closer to pre-menopausal values in the group receiving transdermal estrogen compared with oral estrogen. CONCLUSION: Six months of transdermal estrogen therapy is associated with greater reductions in measures reflecting vascular sympathetic tone than oral estrogen therapy in healthy postmenopausal smokers. Thus, transdermal estrogen may be associated with a more favorable risk/ benefit ratio in postmenopausal smokers, a group at high risk of osteoporosis and cardiovascular disease.