Age-associated changes in detrusor sensory function in women with lower urinary tract symptoms.

This study examined changes in bladder sensation which occur with age in women. 1381 women (age range 20-95 years, mean 54.9) with symptoms of lower urinary tract dysfunction underwent urodynamic study. The bladder capacity at which they first became aware of the desire to void was taken as a quantitative measure of bladder sensation. Maximum bladder capacity fell in the eighth and ninth decades (H = 95.84, df = 7, P = 0.00), but by contrast bladder capacity at first desire to void rose progressively in association with age, both in the group as a whole (H = 17.13, df = 7, P = 0.017) and in a subgroup with detrusor instability (n = 952, H = 15.42, df = 7, P = 0.032). This rise in capacity points to a decrease in bladder sensation in association with age. This is not due to neurological disease, anti-muscarinic drugs or oestrogens, as the median capacity at first desire to void of these three subgroups did not differ significantly from that of the group as a whole.

Oxybutynin with bladder retraining for detrusor instability in elderly people: a randomized controlled trial.

The aim of this study was to examine the efficacy of oxybutynin plus bladder training in the treatment of detrusor instability in frail elderly patients living independently in the community. It was a randomized, double-blind, placebo-controlled parallel-group trial of oxybutynin in 57 elderly patients (mean age 82.2, SD 6.06), with frequency and incontinence due to detrusor instability. After a 2-week run-in period patients received a bladder training and drug or placebo for the next 6 weeks. Outcome measures were changes in frequency and incontinence, recorded throughout on diary charts, and subjective evaluation of symptoms ('better'/'not better', and using a four-point scale 'cure' to 'no change'). Oxybutynin was superior to placebo in reducing daytime frequency [95% confidence interval (CI) of difference in change in frequencies totalled over 14 days was -27.0, -6.0; p = 0.003] and in producing subjective benefit (at day 29 only), when 24/28 (86%) patients on oxybutynin described benefit compared with 16/29 (55%) on placebo (p = 0.02). There was no difference between the groups in reduction of incontinent episodes. The median dose of oxybutynin titrated for therapeutic effect was 5 mg/day, and for placebo 10 mg/day (CI of difference 0.001, 5.001; p = 0.05). Side-effects reported were of similar frequency (50%) in the two groups. We conclude that oxybutynin with bladder training is superior to bladder training alone in reducing frequency due to detrusor instability in very elderly people living at home.

Complement activation and spleen function in erythema multiforme associated with herpes simplex virus reactivation.

Plasma C3d concentrations were measured in patients with erythema multiforme (EM) complicating herpes labialis. C3d levels were raised during cold sores but not during EM. Heat damaged red cell clearance was prolonged during EM. These observations support the concept that immune complexes disseminate herpes simplex virus (HSV) antigens to skin before the onset of EM.