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Safety issues associated with using medication to treat overactive bladder.

George Araklitis1, Linda Cardozo1

  • 1a Department of Urogynaecology , King's College Hospital , London , UK.

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|September 12, 2017
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Summary
This summary is machine-generated.

This review highlights three safety concerns in overactive bladder (OAB) treatment: anticholinergic cognitive burden, botulinum toxin risks, and vaginal estrogen use in breast cancer survivors. Safer alternatives and improved risk assessment are needed.

Keywords:
Anticholinergic burdenanticholinergic loadbotoxbotulinum toxinbreast cancerclean intermittent self catheterization (CISC)hormone replacement therapy (HRT)overactive bladder (OAB)urinary tract infection (UTI)vaginal oestrogens

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Area of Science:

  • Urology
  • Geriatrics
  • Pharmacology

Background:

  • Overactive bladder (OAB) is commonly treated with anticholinergic medications, which have well-documented side effects.
  • This review examines three less-recognized safety issues associated with OAB treatments.
  • These include cognitive decline from anticholinergic burden, risks of botulinum toxin injections, and concerns regarding vaginal estrogen use in breast cancer patients.

Purpose of the Study:

  • To review and highlight less-discussed safety concerns in overactive bladder (OAB) management.
  • To discuss the risks associated with anticholinergic medications, botulinum toxin, and vaginal estrogens.
  • To provide expert opinion on improving OAB treatment safety and efficacy.

Main Methods:

  • Literature review focusing on safety aspects of OAB treatments.
  • Analysis of risks including cognitive decline, dementia, and mortality associated with anticholinergic load.
  • Evaluation of safety data for botulinum toxin and vaginal estrogens, particularly in vulnerable populations.

Main Results:

  • Increased anticholinergic load poses risks of cognitive decline, dementia, and mortality, especially in the elderly due to polypharmacy.
  • Botulinum toxin treatment carries risks of high urinary residuals, infections, and the need for self-catheterization.
  • Vaginal estrogen use is considered safe for OAB symptoms in breast cancer survivors, with negligible systemic absorption and no increased recurrence risk.

Conclusions:

  • Improved methods for assessing anticholinergic burden are necessary, potentially through a universal drug scale.
  • Alternative OAB treatments like Mirabegron or botulinum toxin can help avoid increasing anticholinergic load.
  • Further research is needed on prophylactic antibiotics for botulinum toxin injections, catheterization thresholds, and vaginal estrogen safety in patients using aromatase inhibitors.