Intravaginal prasterone for urinary urgency in postmenopausal women without urodynamic detrusor overactivity

OBJECTIVES: Symptoms of an overactive bladder are frequently reported in women with genitourinary syndrome of menopause. Despite a frequent association with detrusor overactivity, urodynamic assessment does not always reveal this condition, which suggests a leading role for increased bladder mucosal sensitivity due to hormone deprivation in producing urinary symptoms. The present study assessed the effects of intravaginal prasterone on urgency symptoms in those patients receiving treatment for concurrent vulvovaginal atrophy.

STUDY DESIGN: This was an observational cohort study on 21 women with genitourinary syndrome of menopause, including urgency symptoms, without detrusor overactivity on urodynamic assessment. Patients received intravaginal prasterone 6.5 mg daily and were reassessed at 12 weeks.

MAIN OUTCOME MEASURES: Urinary symptoms and their impact on the quality of life were evaluated through the Urogenital Distress Inventory (UDI-6) and Overactive Bladder short-form (OAB-Q SF) questionnaires; secondary outcomes included urinary frequency and prevalence of urgency or incontinence as recorded in a voiding diary, and scores on a visual analogue scale (VAS) for vaginal discomfort.

RESULTS: A significant improvement in urinary symptoms was observed in the scores on both the UDI-6 (57.1 +/- 20.7 vs 30.2 +/- 22.7, p < 0.001) and the OAB-Q SF (61.3 +/- 19.7 vs 35.7 +/- 22, p < 0.001); a significant improvement was also reported in terms of better quality of life, diminished VAS scores, and a reduction in incontinence and daily and nocturnal frequency.

CONCLUSIONS: Women complaining of urgency related to genitourinary syndrome of menopause with no urodynamic evidence of detrusor overactivity may benefit from treatment with intravaginal prasterone.