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Cerebral White Matter Disease and Response to Anti-Cholinergic Medication for Overactive Bladder in an Age-Matched Cohort

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Abstract

Objective

To determine if the presence of cerebral white matter disease (WMD) affects the response to anti-cholinergic medications.

Materials and Methods

This was a retrospective cohort of age-matched patients treated for OAB with anti-cholinergic medications between January 2010 and December 2017. Inclusion criteria were a chief complaint of OAB, never evaluated by a urogynecologist for OAB, treated with a maximum dose for a minimum of 4 weeks, and underwent head computed tomography (CT) within 12 months of starting therapy. Patients with WMD were matched 1:1 by age and number of prior failed antimuscarinics to controls with normal head CTs. Exclusion criteria included incomplete documentation of therapeutic response, non-WMD CT abnormalities, and non-idiopathic OAB. The primary outcome was anti-cholinergic treatment failure. Pairwise analysis between groups was performed using Wilcoxon rank-sum and Fisher’s exact test where appropriate. Univariate logistic regression was performed, and any variable that was associated with treatment failure and a p value ≤ 0.2 was included in the multivariable regression analysis.

Results

Sixty-eight cases were matched with 68 controls. Patients with WMD were more likely to have undergone hysterectomy (57.4% vs. 41.2%, p = 0.04) and to use diuretics (31.1% vs. 19.1%, p = 0.04). Patients with WMD were more likely to fail treatment compared with controls (60.7% vs. 29.4%, p = 0.004). After adjusting for confounders, WMD was strongly associated with an increased probability of failure (aOR = 7.31, 95% CI: 1.49–12.20). Additional significant risk factors for treatment failure were the previous number of failed medications (aOR = 3.65 per medication, 95% CI: 1.48–9.01) and a rising HbA1c (aOR: 1.39 per 1.0% increase, 95% CI: 1.0–1.91).

Conclusion

WMD is independently associated with anti-muscarinic treatment failure in women with overactive bladder symptoms.

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Avenue, Cleveland, OH, 44106, USA

    David Sheyn, Adonis Hijaz, Emily Slopnick & Graham Chapman

  2. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Sangeeta T. Mahajan & Sherif El-Nashar

  3. Division of Female Pelvic Medicine and Reconstructive Surgery, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Jeffrey M. Mangel

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  1. David Sheyn
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  2. Sangeeta T. Mahajan
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Correspondence to David Sheyn.

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Sheyn, D., Mahajan, S.T., Hijaz, A. et al. Cerebral White Matter Disease and Response to Anti-Cholinergic Medication for Overactive Bladder in an Age-Matched Cohort. Int Urogynecol J 30, 1755–1761 (2019). https://doi.org/10.1007/s00192-019-03988-9

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  • DOI: https://doi.org/10.1007/s00192-019-03988-9

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