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    Patients Shouldn't Accept Urinary Incontinence!

    Many people make assumptions about urinary incontinence that just aren't so, says expert Michael B. Chancellor, MD.

    "Incontinence is not a natural act of aging, it is not just a geriatric problem, and it is not a problem only for women," explained Dr. Chancellor, who is director of neurology and urinary incontinence programs at the University of Pittsburgh School of Medicine. He led a course for fellow urologists about new drug treatments for overactive bladder at the annual meeting of the American Urological Association in Atlanta last week.

    "These are common myths held by the public, and unfortunately by some in the medical field too," Chancellor stated. "Public information about the problem is hampered by the fact that only about 15 percent of people who suffer from urinary incontinence admit the problem to their doctor or to their family."

    But people suffering from this condition shouldn't just run to the drug store and buy adult diapers, said Dr. Chancellor. Two recent medications have changed the way urologists treat incontinence, and another may be on the way.

    Tolterodine, (Detrol) and extended-release oxybutynin (Ditropan XL) have both proven to be effective in treating symptoms of urinary frequency, urgency and urge incontinence. Unlike previous drugs, these two formulations appear to have fewer side effects. According to Dr. Chancellor, more than half of patients taking incontinence drugs in the past tended to quit because the side effects, especially dry mouth, were so disagreeable. The dropout rate with the newer drugs is much lower: closer to 10 percent.

    Another new therapy designed to treat overactive and painful bladder is resiniferatoxin or RTX. This drug is a new, improved version of the extract of red pepper called capasaicin, which has proven to be an effective treatment for topical pain but which causes too much burning when used directly in the bladder. Even though RTX is 1,000 times stronger than capasaicin, said Dr. Chancellor, it causes minimal irritation and burning, sensations that have prevented the latter drug from being adopted as a direct-to-the-bladder treatment.

    "This may represent the next revolution of treatment of bladder incontinence or painful bladder symptoms," Dr. Chancellor stated. RTX, designed to be put directly into the bladder, deadens the nerves that cause bladder pain and spasm. In addition, studies so far indicate that it can be used just once every three or four months with no systemic side effects.

    "In three or four years, if RTX receives FDA approval, these patients could be coming to see the urologist only a few times a year, for treatment in the office," said Dr. Chancellor. He explained that during such an office visit, the doctor would insert a catheter into the bladder and put in an ounce of RTX.

    "The patient would hold the medication in for 30 minutes, and that would take out the bladder pain and spasm for three to four months," Dr. Chancellor said.

    RTX has been in clinical trials in Europe since 1998, and similar trials in the U.S. began in January 2000.



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