Volume 100, Issue s3

Urinary incontinence affects between 13 and 17 million men and women in the United States, with an annual cost exceeding $26 billion. Overactive urinary bladder can be both neurologic (hyperreflexia) and nonneurologic (detrusor instability). The spontaneous involuntary detrusor contractions that occur with the overactive bladder often lead to urinary incontinence. Symptoms vary from patient to patient, with urgency, increased frequency, and urinary urge incontinence being the most bothersome complaints. Multiple components and interactions of the nervous system are required for appropriate storage and evacuation function of the bladder to occur normally. Thorough history taking and physical examination along with appropriate urodynamic testing are necessary for obtaining an accurate diagnosis and treatment planning. The quality of life for many patients with overactive bladder and the resulting incontinence can be dismal. Fortunately, most of these patients can be treated successfully.

As the population ages, urinary incontinence is becoming an important health issue. In the United States, urinary incontinence had an estimated annual cost of $26 billion in 1995. The author presents a literature review to inform primary care physicians about the most current medical and surgical treatment of urge incontinence. Developments in medical research have produced oral medications that are increasingly effective in controlling the symptoms of urge incontinence. This advance has resulted in a decreasing need for surgical intervention. Although surgical therapy has not been proven to be as effective as oral medications in the treatment of urge incontinence, it is still considered to be a viable therapy in select patient populations.

Multiple sclerosis is a common neurologic disorder that often affects the genitourinary system. One of the most common symptoms of multiple sclerosis is the hyperactive bladder. These patients will have symptoms that may affect their lifestyle, such as urinary incontinence, urgency, and frequency. They may also suffer from debilitating urinary tract symptoms, such as frequent or recurrent urinary tract infections and also on occasion, damage to the upper urinary tract. Fortunately, the neurogenic bladder dysfunction associated with multiple sclerosis can be treated with a reasonable chance of success. With proper treatment, related symptoms may be brought under control, allowing the physician to concentrate on the more debilitating aspects of this disease.

To evaluate the efficacy and safety of pentosan polysulfate sodium (PPS) in relieving symptoms of interstitial cystitis, the authors retrospectively reviewed charts of 260 patients in whom interstitial cystitis had been diagnosed. Subsequently, they conducted a follow-up phone interview or mail survey of those patients who were treated with PPS to investigate changes in the patients' symptoms, adverse effects, and change in quality of life. The control group consisted of patients whose interstitial cystitis had been diagnosed at cystoscopy and had a duration of at least 1 year and who had taken at least one or more oral medications for their symptoms. The average length of treatment was 9.3 months among the 27 subjects on PPS therapy. The mean length of time that they had diagnosed interstitial cystitis was 35.63 months and 48.78 months for the PPS-treated and control groups, respectively, with no statistically significant difference. Changes in frequency, urgency, and pain were greater in the treatment group and statistically significant (P = .11, P = .49, and P = .004, respectively). No change occurred in the rate of nocturia in the PPS-treated group compared with that in the control group. Symptoms of both groups improved over time, but improvement was statistically significantly greater in the treatment group (P = .001) over the treatment interval. The most common side effect attributable to PPS was diarrhea in 15% of subjects. Pentosan proved to be an efficacious option for reducing the debilitating symptoms of interstitial cystitis.