MICKEY KARRAM, MD STEVE KLEEMAN, MD Dr. Karram is director of urogynecology at Good Samaritan Hospital in Cincinnati, Ohio, and professor of obstetrics and gynecology at the University of Cincinnati. Dr. Kleeman is assistant director of the division of urogynecology and reconstructive surgery at Good Samaritan Hospital in Cincinnati.
We lack a complete understanding of how all the parts of this process interact and why. Most of the medications in use affect only 1 part of the complex process that governs urine storage and elimination.
In controlled trials, patients on placebo have experienced 30% improvement—or greater—in their symptoms. This would seem to suggest that education, behavioral retraining, and attention from physicians are responsible for some of the improvement. Indeed, in a recent systematic review of 32 trials involving 6,800 participants, Herbison et al8 found significant but relatively small differences between anticholinergic medications and placebo for many of the outcomes studied. Obviously, we have more to learn about the intricacies of this condition before we can eliminate it completely.
