A pilot study of the use of fesoterodine in the management of men with refractory overactive bladder symptoms after surgery for bladder outlet obstruction

Objective: To assess the efficacy of long-acting fesoterodine on persistent lower urinary tract symptoms in men who have had previous surgical treatment for bladder outlet obstruction (BOO). Materials and methods: Seventeen patients with overactive bladder (OAB) secondary to BOO, persisting for 3 months after the obstruction was surgically relieved, were treated with fesoterodine. Follow up was performed at 2 months, 3 months, and 7 months. The primary endpoint was change in the International Prostate Symptom Score (IPSS). The secondary endpoints were change in the maximum flow rate (Qmax) and postvoid residual (PVR). Results: Patients receiving fesoterodine demonstrated trends for improvement in mean nocturia episodes (3.2-2.6, p=0.065), IPSS irritative subscore (6.2-2.0, p=0.066), and quality of life score (4.2-3.5, p=0.067) over 7 months of follow up. There was also a reduction in the mean IPSS score which was not significant over time (18.8-15.1, p=0.183). There was no significant change observed in Qmax or PVR. Six patients (33%) had significant side effects and did not complete the study. Conclusion: Patients with persistent OAB symptoms after surgical treatment of BOO displayed possible reductions in the IPSS, IPSS irritative subscore, and mean number of nocturia events after 7 months of follow up, as well as trends for an increased quality of life when treated with fesoterodine. Larger trials are needed to help characterize the utility of fesoterodine in the treatment of persistent lower urinary tract symptoms after surgical treatment of benign prostatic hyperplasia.