Among community-dwelling women aged over 80 referred for urodynamics: Is there an incidence of anticholinergic burden on conclusions of the examination?

Introduction: An increasing number of women over 80 years of age, treated with one or more anticholinergic drug (ACh), are referred for urodynamics (UDS). As ACh drugs are mainly prescribed in case of overactive bladder symptoms, we studied the effect of anticholinergic burden (AB) on urodynamic diagnoses dependent on detrusor contractility. Methods: UDS records for non-neurological women in a large database obtained from one institution were retrospectively analyzed. The data reviewed included medical history, 3-day bladder diary, and current medications. The main complaints were incontinence: stress (SUI), mixed (MUI), urge (UUI). AB was estimated using the Anticholinergic Drug Scale (each ACh drug was scored from 1 to 3; AB was the score sum). Detrusor contractility, which can be influenced by ACh medications, was evaluated using the VBN detrusor contractility K parameter and the PIP1 index. Results: Over 7 years, 97/189 women (mean age 83.9 (80–97) years) had an interpretable intubated-flow, with 92 having measurable k parameter and PIP1 index. AB was observed for 29 (31%) with similar score levels (1 for 15.2%, >1 for 16.3%); high AB (≥ 3) was noted among women with MUI, UUI and dysuria-frequency complaints. No significant difference in k and PIP1 values was observed between women with and without AB. Conclusion: To our knowledge this is the first report on the effect of anticholinergic burden on UDS in an older community-dwelling non-neurological female population. Given our results, it may not be necessary to stop anticholinergic medications ahead of a UDS investigation in this age group.