***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Forty patients with the unstable bladder syndrome have been treated in a double-blind crossover trial of baclofen 5 mg qds versus placebo . Baclofen significantly improved diurnal and nocturnal frequency of micturition and the severity of incontinence . Considerable improvement was also obtained with placebo In 25 neurological patients with detrusor hyperreflexia terodiline reduced the number of total micturitions during daytime . Bladder capacity was increased and amplitude of the bladder contractions was reduced . An increase in residual urine was also observed . Mild anticholinergic side-effects were measured on pupillary motility and on heart rate variation . It is concluded that terodiline is a useful alternative in treatment of patients with detrusor hyperreflexia Eighteen women ( median age 54 years , 36 - 79 ) with urinary motor urge ( n = 13 ) or sensory urge ( n = 5 ) incontinence were treated for three 2-week periods with emepronium carrageenate ( EC ) ( Cetiprin Novum ) in daily doses of 500 and 1000 mg and placebo . Subjectively the women experienced an increased ability to control micturition , i.e. less urge , during EC treatment . Only mild and mainly anticholinergic side effects were recorded , most frequently dryness of the mouth . As regards side effects , the evaluation of objective effects were complicated by a tendency towards carry-over effect to placebo . Placebo in the first treatment periods were analysed solely ; no effects of placebo could be demonstrated . Compared with the reference period , decreases in the total number of micturitions ( approx . 20 % ) and in the number of urge incontinence episodes ( approx . 75 % ) were seen . As compared with placebo , a significant increase ( approx . 25 % ) in the average micturition volume could be demonstrated . The percentage urinary excretion of emepronium  decreased with increasing oral intake and with advancing age . Probably , an initial daily dosage of 500 mg EC will do well in younger women ( less than 50 years ) , whereas elder patients may need 1000 mg . Further dosage recommendations are given In a multicentre placebo-controlled double-blind study 61 patients with spinal cord injuries and detrusor hyperreflexia were treated : 20 mg trospium chloride was given twice daily over a period of 3 weeks . Pre- and posttreatment urodynamic measurements demonstrated large improvements in maximum cystometric capacity ( mean = 138.1 ml ) , decreased maximum detrusor pressure ( mean = -37.8 cm H2O ) and an increase in compliance ( mean = 12.1 ml/cm H2O ) in the treatment group . Urodynamic parameters in the placebo group remained substantially unchanged . Comparisons between the two groups revealed highly significant differences for these parameters ( all , p less than 0.001 ) . No effect on maximum flow rate and residual urine was detected in either group . The incidence of spontaneously reported side-effects was extremely low and comparable for both groups A controlled double-blind crossover study is reported in which quantitative urodynamic data and qualitative information are combined to evaluate the treatment of detrusor incontinence using thiphenamil HCl in patients with detrusor instability . Patients placed on the treatment protocol were r and omized to placebo or thiphenamil 400 mg q.i.d . Two weeks of thiphenamil HCl or placebo administration were followed by 1 week of washout followed by a cross-over to an additional 2 weeks of placebo or thiphenamil HCl administration . Of the 23 patients 7 dropped out at various stages of the study . The mean age of patients studied was 44 + /- 14 years old . Throughout the study , patients were asked to complete a formalized diary card of the amount and time of voiding and the incidence of incontinence . Three urodynamics studies were done in the following sequence : pretreatment , postwashout , and posttreatment . Parameters of bladder capacity , sensations , stability and pressure/flow were obtained . In addition , resting urethral closure pressures were recorded . The results show that the frequency of incontinence , which was based on the patients ' responses , decreased significantly ( 0.01 less than p less than 0.025 ) . There was an insignificant decrease in the number of voidings and increase in the amount voided each time . Patients on thiphenamil reported that their pads were significantly drier from baseline ( p = 0.01 ) . In response to questions comparing problems caused by urine loss during baseline and thiphenamil treatment , analysis shows a significant decrease of problems due to loss of urine ( p = 0.01 ) when the patient was taking the drug compared to the placebo . ( ABSTRACT TRUNCATED AT 250 WORDS Idiopathic detrusor instability is a common cause of lower urinary tract symptoms at all ages and in both sexes . Treatment initially is conservative and often includes drug therapy . Terodiline has the theoretical advantage of being a drug with anticholinergic and calcium channel blocking effects . Theoretically , by using a drug with dual action the beneficial effect of reduced detrusor overactivity might occur at a dosage below that likely to lead to the troublesome side effects experienced by patients who take pure anticholinergic agents . A total of 70 female patients completed a study characterized by extremely strict inclusion criteria and a tight protocol . Other novel elements to the study were the extensive use of urinary diaries for symptom evaluation , st and ardized urodynamic studies agreed upon by the participating centers and the dose titration design of the trial . Terodiline has been demonstrated to be a safe , well tolerated and effective drug in the treatment of idiopathic detrusor instability . Drug treatment led to significant decreases in urinary frequency and incontinence episodes . Pre-micturition symptoms , such as urgency , were markedly reduced and the voided volume was significantly increased . Although there were consistent trends towards greater improvement in the urodynamic measurements , when the terodiline and placebo groups were compared these did not reach statistical significance , partly due to a large improvement in the placebo group . Nevertheless , terodiline has been shown to be a useful drug for conservative management of patients with detrusor instability Fifty-one patients ( aged 20 to 68 years ) entered a 6-week double-blind trial of Bromocryptine , a dopamine agonist . All patients complained of the complex : frequency , nocturia , urgency and urge incontinence which was due to demonstrable bladder instability . No significant improvement in either symptoms or cystometric findings was seen in the Bromocryptine treated as compared with the control group . A high incidence of nausea was noted in the treated groups . The results of this study suggest that Bromocryptine does not have a therapeutic role in the treatment of idiopathic bladder instability Detrusor instability occurs in approximately 10 % of the adult population , producing troublesome symptoms . The pharmacotherapy currently available is usually only partially effective and can not be adequately evaluated except under " blind " conditions because of the significant component attributable to placebo effects . The results of the present study revealed no advantage result ing from treatment with flavoxate , as assessed both subjectively and objective ly . We suggest that this therapy does not appear to be beneficial in the medical management of detrusor instability PURPOSE We evaluated the efficacy , patient acceptability and side effect profile of tolterodine , a new antimuscarinic agent for treating bladder overactivity . MATERIAL S AND METHODS In our r and omized , placebo controlled , parallel group study 123 , 129 and 64 patients 18 years old or older with proved detrusor overactivity ( idiopathic detrusor instability or detrusor hyperreflexia ) were r and omized to receive 1 or 2 mg . tolterodine , or placebo , respectively , twice daily for 12 weeks . Main outcome measures were number of voids per 24 hours , urine volume per void and episodes of urge incontinence per 24 hours on a frequency-volume chart with detailed recording of side effects . RESULTS After 12 weeks of treatment mean number of voids per 24 hours plus or minus st and ard deviation decreased from 11.2 + /- 3.1 to 9.0 + /- 2.6 with the 2 mg . dosage ( p = 0.0045 versus placebo ) . At this dose mean urine volume per void increased from 155 + /- 52 to 190 + /- 70 ml . ( p < 0.0001 versus placebo ) , while mean number of incontinence episodes per 24 hours decreased from 3.6 + /- 4.0 to 1.8 + /- 3.1 ( p = 0.19 versus placebo ) . Similar efficacy was observed in patients receiving the 1 mg . dose . Severe dry mouth was reported by only 2 , 1 and 2 % of patients given the 1 and 2 mg . dose , and placebo , respectively . There was no clinical or electrocardiographic evidence of significant cardiac adverse events . CONCLUSIONS Tolterodine administration result ed in a significant decrease in the frequency of voiding and improved voided volume but it was seldom associated with troublesome or severe side effects In a placebo-controlled , r and omized , double-blind , cross-over study , terodiline ( 50 mg/d ) was compared with emepronium ( 600 mg/d ) in 20 patients with motor urge incontinence . Evaluation of clinical efficacy was based on changes in micturition pattern , flow measurements , residual urine , cystometry and patient preferences , and safety on adverse reactions , blood chemistry , urine examinations and ECG . The number of voluntary micturitions decreased from a mean of 21.5 per 48 h on placebo by 1.6 on terodiline and 2.8 on emepronium .  Involuntary micturitions decreased from 3.6 per 48 h by 1.3 on both treatments ( p less than 0.05 ) . The maximal flow rate decreased from a mean of 24.5 ml/sec to 19.6 ml/sec on emepronium and increased to 25.4 ml/sec on terodiline .  Residual urine decreased from a mean of 54 ml to 49 ml on terodiline and increased to 60 ml on emepronium .  Volume at first desire to void in the supine position increased on emepronium by 44 ml ( p less than 0.05 ) and on terodiline by 3 ml , on the upright position by 11 ml and 18 ml , respectively . Bladder capacity increased in the supine position on emepronium by 32 ml and decreased on terodiline by 8 ml , in the upright position increased by 9 ml and 5 ml , respectively . The bladder pressure at first desire to void in the supine position increased on emepronium by 2 cmH2O , and decreased on terodiline by 2 cmH2O . The intravesical pressure at strong desire to void decreased on emepronium by 6 cmH2O and on terodiline by 7 cmH2O , in the upright position by 2 cmH2O and 1 cmH2O , respectively . 39 % of the patients preferred terodiline , 39 % emepronium and 22 % placebo . ( ABSTRACT TRUNCATED AT 250 WORDS Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . The aim of this study was to investigate the efficacy and tolerance of capsaicin , a neurotoxin for C-fiber afferents , applied intravesically in the treatment of detrusor hyperreflexia . Eleven male and nine female patients who had spinal cord lesions caused by multiple sclerosis ( 12 ) or trauma ( eight ) result ing in detrusor hyperreflexia with urge incontinence and pollakiuria were r and omized to receive one intravesical instillation of either 30 mg capsaicin in 100 ml 30 % ethanol or 100 ml 30 % ethanol alone . The patients were evaluated clinical ly ( voiding diary ) and urodynamically ( maximum cystometric capacity , maximum detrusor pressure , first and normal desire to void ) before and 30 days after the instillation . On day 30 , the 10 patients who received capsaicin had significant decreases in 24-h voiding frequency from 9.3+/-6.1 to 6.7+/-3.8 ( P=0.016 ) and leakages from 3.9+/-1.6 to 0.6+/-0.8 ( P=0.0008 ) ; their maximum cystometric capacity increased from 169+/-68 to 299+/-96 ml ( P=0.01 ) and maximum detrusor pressure decreased from 77+/-24 to 53+/-27 cm H2O . There were no significant changes in the control group . In seven subjects in each group , instillation triggered immediate side effects ( suprapubic pain , sensory urgency , flushes , hematuria , autonomic hyperreflexia ) that resolved within 2 weeks . Intravesical capsaicin significantly improves clinical and 
    Output:
    
Data regarding treatment effects of anticholinergic drugs are consistent with a high therapeutic efficacy and characteristic side effects .
Therapeutic efficacy and side effect patterns of terodiline , an agent with anticholinergic and calcium antagonistic properties , were comparable to those of anticholinergic agents .
Of the investigated alternative drug regimens , the papaverine‐like smooth muscle relaxant flavoxate was reported to be ineffective .
Published trials support anticholinergic drugs as efficacious therapy for urinary urge incontinence , with predictable side effects .