The concomitant use of fesoterodine and topical vaginal estrogen in the management of overactive bladder and sexual dysfunction in postmenopausal women

OBJECTIVE - The objective of this study is to investigate the combination effect of anti-muscarinic medication and topical vaginal estrogen in the treatment of overactive bladder (OAB) and female sexual dysfunction in postmenopausal women.

STUDY DESIGN - After IRB approval, 23 female subjects who met the entry criteria were randomized into two groups: (1) fesoterodine (Toviaz®, Pfizer, NY) with topical vaginal estrogen (Premarin®, Pfizer, NY) once daily or (2) fesoterodine once daily alone. If 4 mg fesoterodine was tolerated at 1-week, the dose was increased to 8 mg.

MAIN OUTCOME MEASURES - Primary endpoints were improvement in OAB symptom severity (Overactive Bladder Questionnaire, OAB-Q SF), improvement in OAB health-related quality of life (HRQL) (OAB-Q SF), and sexual function (Sexual Quality of Life-Female, SQOL-F) after 12 weeks. Secondary endpoint was change in total number of micturitions.

RESULTS - After 12-weeks, the combination group had a significant improvement in OAB symptom severity (p = 0.006), HRQL (p = 0.029), and SQOL-F (0.0003). The fesoterodine alone group also had significant improvement in OAB symptom severity (p < 0.0001), HRQL (p = 0.0002), and SQOL-F (p = 0.02). When compared directly to the fesoterodine alone group, the combination group after 12-weeks had a reduced OAB symptom severity (10 versus 23.3; p = 0.35), higher HRQL (96.9 versus 84.6; p = 0.75), and higher SQOL-F (99 versus 81; p = 0.098). The total number of micturitions over 3 d was significantly reduced in the combination group (45-26, p = 0.03) between baseline and 12-weeks.

CONCLUSIONS - The combined effect of fesoterodine and topical vaginal estrogen improved OAB symptoms and sexual function in postmenopausal women.

Post reproductive health. 2016 Feb 16 [Epub ahead of print]

Bilal Chughtai, James C Forde, Jessica Buck, Tirsit Asfaw, Richard Lee, Alexis E Te, Steven A Kaplan

Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA  Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA., Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA., Department of Obstetrics and Gynecology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA., Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA., Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA., Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, NY, USA.

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