Pharmacological Management of Stress Urinary Incontinence with Atypical Leakage Features, Symptom Response to Short-term Solifenacin Trial.

introduction and hypothesisA subset of women with stress urinary incontinence (SUI) exhibit atypical features that may suggest hidden storage dysfunction or bladder overactivity. As urodynamic studies (UDS) are invasive and not always accessible, this study was aimed at examining whether a short solifenacin trial could improve symptoms and help treat women with SUI who present atypical leakage patterns.

methodsFifty women (39-60 years old) suffering from clinically diagnosed SUI with atypical features were treated with solifenacin 5 mg daily over the course of 4 weeks. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) and the Overactive Bladder Symptom Score (OABSS) were used to measure changes in symptoms. The primary outcome measures were changes in total scores and achievement of clinically meaningful improvement (≥ 4-point reduction in ICIQ-UI-SF; ≥ 3-point reduction in OABSS).

resultsThe mean age of the participants was 51.9 ± 4.9 years. Mean ICIQ-UI-SF scores decreased from 15.4 ± 2.7 to 6.7 ± 2.4 (p < 0.001; Cohen's d = 2.4), and OABSS scores from 5.4 ± 2.2 to 2.0 ± 1.3 (p < 0.001; Cohen's d = 1.8). Clinically significant improvement was observed in 92% (according to ICIQ-UI-SF) and 80% (according to OABSS) of patients (p < 0.001).

conclusionsSolifenacin therapy resulted in statistically and clinically significant improvement of UI and storage symptoms among women with SUI exhibiting atypical features and managed without baseline UDS. These results suggest that a pharmacological trial may be a practical, non-invasive first-line approach for this SUI phenotype, may be consistent with a cough-induced detrusor overactivity-like mechanism, but cannot confirm it in the absence of urodynamic study.