***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: The Authors carried out a r and om double-blind trial on 30 patients affected by idiopathic urge incontinence with oxybutynin chloride ( 15 mg/die ) and placebo for two 20 day therapeutical cycles . The 24 patients who completed the trial oxybutynin chloride induced statistically significant effects -- compared to placebo too -- both on the subjective symptoms ( reduction or disappearance of the urgency in 14 cases - 60.8 % - and of urge incontinence in 16 cases - 76.1 % ) and on the objective symptoms showed by cystomanometry ( increased bladder capacity at the FD and VSD in 14 and 15 cases , respectively ; absence of involuntary contraction in 9 cases and normal or reduced detrusor pressure at the VSD in 13 out of 16 cases ) . Improvements , though less significant , were also obtained with the placebo To evaluate the efficacy , tolerability and safety of a flexible‐dosing strategy with darifenacin , an M3‐selective receptor antagonist , in patients with symptoms of overactive bladder ( OAB ) 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 PURPOSE An extended release formulation of trospium chloride was recently developed for the once daily treatment of overactive bladder . We investigated the safety , efficacy and tolerability of 60 mg trospium chloride once daily . MATERIAL S AND METHODS Subjects with overactive bladder were r and omized 1:1 to receive 60 mg trospium chloride once daily or placebo in this 12-week multicenter , parallel , double-blind , placebo controlled trial . Primary end points were calculated changes in diary recorded daily urinary frequency and daily urgency urinary incontinence episodes . Secondary end points were urgency severity , volume voided per void and the number of urgency voids per day . Safety was assessed by clinical examination , adverse event monitoring , clinical laboratory values and resting electrocardiograms . RESULTS Overall 601 subjects were prescribed  trospium once daily ( 298 ) or placebo ( 303 ) . Trospium once daily treatment result ed in significant improvements over placebo in all primary and key secondary efficacy outcomes at weeks 1 through 12 . The most common adverse events were dry mouth  ( trospium 8.7 % vs placebo 3 % ) and constipation  ( trospium 9.4 % vs placebo 1.3 % ) . Central nervous system adverse events were rare ( headache with trospium 1.0 % vs placebo 2.6 % ) . No clinical ly meaningful changes in laboratory , physical examination or electrocardiogram parameters were noted . CONCLUSIONS Trospium once daily provided significant improvements in overactive bladder symptoms ( frequency , urgency urinary incontinence and urgency ) . Efficacy was similar to that seen previously with trospium chloride twice daily , while class effect anticholinergic adverse events occurred at comparatively low levels . Dry mouth was elicited at the lowest reported rate in the oral antimuscarinic drug class Aims of the study : The aim of this double-blind , r and omised , prospect i ve , multicentre trial was to evaluate the efficacy of propiverine in patients suffering from detrusor hyperreflexia caused by spinal cord injury in comparison to placebo . Study design : The treatment period of 14 days comprised visits at baseline ( V1 ) and after 14 days treatment ( V2 ) . Fifteen mg propiverine t.i.d . or placebo t.i.d . were administered as medication . The following efficacy parameters were adopted : the urodynamic parameters maximal cystometric bladder capacity , bladder volume on onset of the first as well as duration and amplitude of the maximum detrusor contraction , bladder compliance and residual urine , and subjective assessment of efficacy by physicians . For the evaluation of the safety of propiverine the incidence rate of adverse events by directly question ing as well as laboratory parameters were investigated . For biometrical evaluation t-test for independent groups was applied . Results : One hundred and thirteen patients were investigated .  The maximal cystometric bladder capacity increased significantly in the propiverine group , on average by 104 ml ( V1 : 262±132 ml . V2 : 366±143 ml , P<0.001 ) . The changes in bladder capacity during the first contraction and the maximum detrusor contraction in the verum group were both statistically significant . The bladder compliance documented a more pronounced increase under propiverine in comparison to placebo . Residual urine increased by 37±71 ml in the propiverine group , significantly more than in the placebo group ( P=0.01 ) . Sixty-three per cent of the patients expressed subjectively an improvement under propiverine in comparison with 23 % of the placebo group . Expected anticholinergic adverse events occurred : dryness of the mouth ( 37 % in the verum and 8 % in the placebo group ) , accommodation disorders ( 28 % and 2 % respectively ) . Nausea , constipation , headache , dizziness , tiredness and palpitations were reported in almost comparable incidence rates between 3 and 13 % in both treatment groups . Eight drop-outs were registered in the propiverine group ( five due to adverse events ) and three in the placebo group ( one due to adverse events ) . The laboratory parameters revealed no changes . Conclusion : Propiverine proved its efficacy in detrusor hyperreflexia with regard to the urodynamic parameters of the maximal cystometric bladder capacity and detrusor contractility . Anticholinergic adverse events such as dryness of the mouth and accommodation disorders were considered being tolerable . The increase in residual urine reflects the therapeutically desired effect of detrusor relaxation because the majority of patients normally practise intermittent catheterisation for bladder emptying OBJECTIVES To evaluate the efficacy and tolerability of a new extended-release ( ER ) , once-daily , capsule formulation of tolterodine , relative to placebo and the existing immediate-release ( IR ) , twice-daily , tablet formulation , for treatment of the overactive bladder . METHODS This was a double-blind , multicenter , r and omized , placebo-controlled trial . One thous and five hundred twenty-nine patients ( 81 % women ) with urinary frequency ( eight or more micturitions every 24 hours ) and urge incontinence ( five or more episodes per week ) were r and omized to oral therapy with tolterodine ER 4 mg once daily ( n = 507 ) , tolterodine IR 2 mg twice daily ( n = 514 ) , or placebo ( n = 508 ) for 12 weeks . Efficacy was assessed at the end of the treatment period on the basis of the micturition diary variables . Tolerability and safety were assessed by evaluating the adverse events , electrocardiogram parameters , laboratory values , and treatment withdrawals . RESULTS Tolterodine ER 4 mg once daily ( P = 0.0001 ) and tolterodine IR 2 mg twice daily ( P = 0.0005 ) both significantly reduced the mean number of urge incontinence episodes per week compared with placebo . The median reduction in these episodes as a percentage of the baseline values was 71 % for tolterodine ER , 60 % for tolterodine IR , and 33 % for placebo . The ER formulation was 18 % more effective than the IR formulation ( P < 0.05 ) . Treatment with both formulations of tolterodine was also associated with statistically significant improvements in all other micturition diary variables compared with placebo . For both formulations , the mean decreases in micturition frequency ( P < 0.0079 ) and pad usage ( P < 0.0145 ) were significant , and the mean volume voided per micturition increased ( P = 0.0001 ) . The rate of dry mouth ( of any severity ) was 23 % for tolterodine ER , 30 % for tolterodine IR , and 8 % for placebo . The overall dry mouth rate for patients taking tolterodine ER was 23 % lower than for tolterodine IR ( P < 0.02 ) , and the rate of severe dry mouth in the ER group was only 1.8 % . The rates of withdrawal were comparable for the two active groups and the placebo group . No safety concerns were noted . CONCLUSIONS Tolterodine ER 4 mg once daily is effective and well tolerated in the treatment of overactive bladder with no safety concerns . Tolterodine ER demonstrated an improved efficacy for reducing urge incontinence episodes and a lower frequency of dry mouth compared with the existing IR twice-daily formulation CONTEXT Urinary incontinence is a common condition caused by many factors with several treatment options . OBJECTIVE To compare the effectiveness of biofeedback-assisted behavioral treatment with drug treatment and a placebo control condition for the treatment of urge and mixed urinary incontinence in older community-dwelling women . DESIGN R and omized placebo-controlled trial conducted from 1989 to 1995 . SETTING University-based outpatient geriatric medicine clinic . PATIENTS A volunteer sample of 197 women aged 55 to 92 years with urge urinary incontinence or mixed incontinence with urge as the predominant pattern . Subjects had to have urodynamic evidence of bladder dysfunction , be ambulatory , and not have dementia . INTERVENTION Subjects were r and omized to 4 sessions ( 8 weeks ) of biofeedback-assisted behavioral treatment , drug treatment ( with oxybutynin chloride , possible range of doses , 2.5 mg daily to 5.0 mg 3 times daily ) , or a placebo control condition . MAIN OUTCOME MEASURES Reduction in the frequency of incontinent episodes as determined by bladder diaries , and patients ' perceptions of improvement and their comfort and satisfaction with treatment . RESULTS For all 3 treatment groups , reduction of incontinence was most pronounced early in treatment and progressed more gradually thereafter . Behavioral treatment , which yielded a mean 80.7 % reduction of incontinence episodes , was significantly more effective than drug treatment ( mean 68.5 % reduction ; P=.04 ) and both were more effective than the placebo control condition ( mean 39.4 % reduction ; P<.001 and P=.009 , respectively ) . Patient-perceived improvement was greatest for behavioral treatment ( 74.1 % " much better " vs 50.9 % and 26.9 % for drug treatment and placebo , respectively ) . Only 14.0 % of patients receiving behavioral treatment wanted to change to another treatment vs 75.5 % in each of the other groups . CONCLUSION Behavioral treatment is a safe and effective conservative intervention that should be made more readily available to patients as a first-line treatment for urge and mixed incontinence Oxybutynin hydrochloride ( 3 mg ) was compared with placebo by r and omised , double-blind crossover trial in 53 females with idiopathic detrusor instability . Symptoms were cured or markedly improved in 60 % of patients on oxybutynin and 2.3 % on placebo . During the first treatment period , oxybutynin reduced the frequency of voiding by 35 % , compared with 9 % for placebo . Oxybutynin gave a significantly greater improvement than placebo in volume at the first desire to void ( 70 ml increase versus 7.7 ml ) , maximum filling-phase detrusor pressure ( 17 cm H2O reduction versus no benefit ) and cystometric capacity ( 104 ml increase versus 7.0 ml ) . A marked  oxybutynin carry-over effect was seen during the second treatment period . Side effects from the 3 mg dose of oxybutynin caused 7.5 % of subjects to discontinue therapy This study evaluated the efficacy , tolerability , and safety of darifenacin , an M3 selective receptor antagonist ( M3 SRA ) , in patients with overactive bladder ( OAB ) . In a multicenter , double-blind , placebo-controlled dose-ranging study , 439 adult OAB patients ( 85.4 % female ) were r and omized  to darifenacin controlled-release tablets 7.5 mg ( n = 108 ) , 15 mg ( n = 107 ) or 30 mg ( n = 115 ) qd , or placebo ( n = 109 ) for 12 weeks . Darifenacin significantly reduced the median number of incontinence episodes/week ( −68.7 , −76.5 , and −77.3 % from baseline at 7.5 , 15 , and 30 mg , respectively , vs −46 % with placebo , all p < 0.01 ) and dose relatedly improved micturition frequency , frequency and severity of urgency , nocturia , and bladder capacity . Darifenacin was well tolerated . Adverse events were commonly mild to moderate dry mouth and const 
    Output:
    
The proposed generally applicable transparent network meta-analytic approach summarizes adverse events in an easy to grasp way allowing straightforward benchmarking of antimuscarinics for treating OAB in clinical practice .
Most currently used antimuscarinics seem to be equivalent first choice drugs to start the treatment of OAB except for oral oxybutynin dosages of ≥ 10 mg/d which may have more unfavorable adverse event profiles