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Objective: To evaluate patient-reported reasons for discontinuing antimuscarinic prescription medications for overactive bladder (OAB)., Patients and Methods: A phase 1 screening survey was sent to a representative sample of 260 000 households in the USA to identify patients using antimuscarinic agents for OAB. A detailed phase-2 follow-up survey was sent to 6577 respondents with one or more antimuscarinic prescriptions for OAB in the 12 months before the phase 1 survey. The follow-up survey included questions about demographics, clinical characteristics, antimuscarinic use, beliefs about OAB, treatment expectations, OAB symptom bother, and pre-coded reasons for discontinuation. Patients who reported discontinuing one or more OAB medication during the 12 months before phase 2 were grouped by reason, using latent class analysis (LCA); the Lo-Mendell-Rubin likelihood statistical test was used to determine the number of classes. Conditional probabilities of reasons for discontinuation were calculated for each class. Multivariable logistic regression was used to assess the influence of demographic and clinical characteristics on class assignment., Results: In all, 162 906 (63%) and 5392 (82%) useable responses were returned in phases 1 and 2, respectively; the demographics were similar in respondents and nonrespondents in both phases. In all, 1322 phase 2 respondents (24.5%) reported discontinuing one or more antimuscarinic drugs during the 12 months before phase 2. LCA identified two classes (Lo-Mendell-Rubin statistic, P = 0.01) based on reasons for discontinuation. Most respondents (89%) reported discontinuing OAB medication primarily due to unmet treatment expectations and/or tolerability; many respondents in this class switched to a new antimuscarinic agent. A smaller group (11%) indicated a general aversion to taking medication. Age, sex, race, income, and history of incontinence were not predictive of class assignment., Conclusions: Expectations about treatment efficacy and side-effects are the most important considerations in discontinuing OAB medications for most patients. Interventions to promote realistic expectations about treatment efficacy and side-effects might enhance adherence.

Objective: To identify predictors of self-reported discontinuation of overactive bladder (OAB) medication using a three-phase survey., Patients and Methods: In January 2005, a phase 1 survey was sent to 260 000 households in the USA to assess the prevalence of OAB symptom bother, treatment patterns and healthcare consulting behaviour. In July 2005, a detailed phase 2 follow-up survey was sent to 6577 phase 1 respondents who had used one or more OAB medications within the 12 months before phase 1; the phase 2 survey included questions about respondents' sociodemographic characteristics, general health status, OAB symptom bother, healthcare consulting behaviour, beliefs about OAB and treatment options, and medication usage. Six months later, a phase 3 survey was sent to 3387 phase-2 respondents who were persistent with OAB medication or had discontinued within <18 months of phase 2; the phase 3 survey measured the same variables as phase 2. Only phase 3 respondents who were persistent with OAB medication at phase 2 were included in the analyses reported here. Assessed were the proportions of respondents who were still persistent with OAB medication at phase 3 and who discontinued OAB medication between phases 2 and 3. The variables measured during the phase 2 survey were screened as potential predictors of discontinuation at phase 3 using univariate analysis and then assessed using multivariate logistic regression., Results: Among 2838 respondents at phase 3 (84% response rate), 1194 had recently discontinued and 1644 were persistent with medication at phase 2. Among phase-3 respondents who were persistent at phase 2, 1040 (66%) continued to be persistent at phase 3, 280 (18%) had discontinued between phases 2 and 3, and 261 (17%) had switched medication between phases 2 and 3; 63 respondents had missing prescription information at phase 3. Predictors of discontinuing at phase 3 included smoking (odds ratio 1.80; 95% confidence interval 1.15-2.83; P = 0.010), not knowing whether treating bladder problems requires multiple daily doses of medication (1.71, 1.10-2.67; P = 0.018), believing (2.11, 1.34-3.33; P = 0.001) or not knowing (1.76, 1.23-2.52; P = 0.002) whether adverse effects of OAB medications are often severe, and being bothered 'quite a bit or more' by a sudden urge to urinate (1.54, 1.05-2.26; P = 0.028). Respondents taking two or more medications were less likely to discontinue (odds ratio 0.45-0.58; P < 0.05)., Conclusion: Persistence with OAB medications might be improved by addressing predictors of discontinuation in the management of OAB, by proactively informing patients about the severity of antimuscarinic adverse effects, and dosing regimens. Bother associated with the key OAB symptom, urgency, is a predictor of discontinuation of treatment.

Objective: To compare interpretations of electromyographic (EMG) recordings from perineal surface patch electrodes (PSPEs) to those from urethral concentric needle electrodes (CNEs) during voiding., Patients and Methods: Consenting women underwent urodynamic testing with a 30 G, 3.8 cm CNE at the 12 o'clock position in the striated urethral sphincter muscle, and with PSPEs placed at the 2 and 10 o'clock positions around the anus. Pressure-flow studies were conducted with simultaneous input from both EMG electrodes. Representative, de-identified paper copies of EMG signals were assembled by chronology and electrode type. Six examiners unaware of the patient details were asked to determine if the tracings were interpretable and whether there was quiescence of the urethral sphincter motor unit during voiding. The agreement between the interpretations of each tracing was assessed using McNemar and kappa statistics., Results: Twenty-two women undergoing urodynamic testing for incontinence (16), voiding dysfunction (two) or urinary retention (four) participated in this study. CNE tracings were consistently more interpretable than PSPE tracings (mean 89% vs 67%). When tracings were interpretable, a significantly higher percentage of CNE EMG tracings (mean 79%) had urethral sphincter motor unit quiescence than PSPE EMG tracings (mean 28%). The kappa values for agreement among the reviewers' interpretations were highly variable and none were statistically significant. Reviewers unanimously agreed on only 12 of the 44 tracings, and 11 of these showed quiescence when using a CNE., Conclusions: CNEs are more often interpretable than PSPEs for determining motor unit quiescence during voiding. CNE EMG appears to have greater clinical utility for central reading than PSPEs.

Objective: To quantify clinically important differences in common diary variables between asymptomatic controls and women with symptoms of overactive bladder (OAB), controlling for the effects of age and race., Patients, Subjects and Methods: The 24-h urinary diaries of 49 women with symptoms of OAB were compared to those of age- and race-matched asymptomatic controls. Control subjects did not have a physical examination., Results: The 49 patients with OAB symptoms had a median (range) age of 51 (20-85) years, a body mass index of 25 (17-46) kg/m(2) and a parity of 2 (0-5). The median number of voids was significantly greater in women with OAB than asymptomatic controls (P < 0.001). The median value for mean voided volume was significantly lower in women with OAB than asymptomatic controls (P = 0.014). There was no difference in the maximum voided volume, total voided volume, daytime or night-time diuresis rates, voids per litre intake, or total fluid intake., Conclusions: This preliminary study suggests that a median reduction of three voids/24 h and an increase of 70 mL in the mean voided volume might be clinically important goals in therapeutic trials for treating OAB symptoms. This remains to be confirmed by further studies linking improvements in quality of life and the overall impression of bladder health with these quantitative diary variable changes.

The first paper in this section is a review by several highly respected authors of diagnostic criteria for evaluating patients with symptomatic stress urinary incontinence, and is followed by a review of the role of urgency and its measurement in the overactive bladder symptom syndrome, with emphasis on current concepts and future prospects. These are two important papers, which point the reader in the direction of a greater understanding of these conditions. The concept of alpha-blockade before a trial without catheter after acute urinary retention is revisited by authors from the UK, who used tamsulosin in a randomized controlled trial. They found that it is appropriate to recommend tamsulosin for such use in this condition.