TReating Incontinence for Underlying Mental and Physical Health

Launched by UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · May 2, 2022

Keywords

ClinConnect Summary

The TRIUMPH study is looking into how different medications can help older women who experience sudden and frequent urges to urinate, a condition known as urgency-predominant urinary incontinence. Specifically, the trial will compare two types of treatments: one called anticholinergic bladder therapy and another called beta-3-adrenergic agonist bladder therapy. They want to see which approach works better for improving not just bladder control, but also cognitive and overall functional health in women aged 60 and older who can walk to the bathroom independently.

To participate in this study, women must be 60 years or older, have experienced urinary incontinence for at least three months, and have at least two episodes of urgency incontinence within a week. It's important that they have normal or mildly impaired cognitive function and can provide informed consent. Participants will be randomly assigned to one of the two medication groups or a group that does not receive any medication. Throughout the study, they'll be monitored for changes in their urinary symptoms and overall health. If you or someone you know meets these criteria and is interested in helping researchers learn more about this common issue, this study might be a good opportunity.

Gender

FEMALE

Eligibility criteria

• Inclusion Criteria:
• • Aged 60 years or older at the time of enrollment
• • Female sex at birth, without surgical or hormonal gender re-assignment therapy
• • Able to walk to the bathroom and use the toilet without assistance
• • Report urinary incontinence starting at least 3 months prior to screening
• • Report that at least half of incontinence episodes occur with a sudden or strong sensation of urgency
• • Report 2 or more urgency incontinence episodes over a 7-day period
• • Willing to provide informed consent and adhere to study procedures throughout the length of the study
• Exclusion Criteria:
• • Prior clinician diagnosis of dementia, or a Montreal Cognitive Assessment (MOCA) score of 17 or lower on screening cognitive evaluation
• • Current use of anticholinergic, beta-3-adrenergic agonist, or other medication designed to improve urgency incontinence symptoms, or use in the past 1 month
• • Initiation, discontinuation, or dose change of dementia medications (such as donepezil, galantamine, memantine, rivastigmine) in the past 1 month (but candidates on stable doses are eligible)
• • Initiation, discontinuation, or dose change of other drugs with strong anticholinergic effects (based on the Beers List) in the past 1 month (but candidates on stable doses are eligible)
• • Initiation, discontinuation, or dose change of other drugs that can affect urinary frequency, including diuretics, in the past 1 month (but candidates on stable doses are eligible)
• • Current urinary tract infection (UTI) based on screening urinalysis and culture (but candidates can re-present for re-screening after undergoing treatment for UTI)
• • History of allergy or sensitivity to either of the study medications or an ingredient in the placebo or study medication capsule
• • Severe hepatic impairment (Child-Pugh score B or greater) or renal impairment (creatinine clearance \<30 mL/min) as a contraindication to both study medications
• • Current bladder obstruction or urinary retention (defined by symptoms suggesting difficulty emptying the bladder in addition to postvoid residual urine volume greater than 150 cc by portable bladder ultrasound)
• • Uncontrolled hypertension (based on measured systolic blood pressure greater than 180 or diastolic blood pressure greater than 110 mmHg) as a contraindication to beta-3-adrenergic therapy
• • Self-reported history of gastric retention, uncontrolled narrow angle glaucoma, myasthenia gravis, severe ulcerative colitis, or toxic megacolon as contraindications for anticholinergic bladder therapy
• • Use of drugs with adverse interactions with one of the study medications in the past 1 month, including potent CYP3A4 inhibitors, hepatic enzyme metabolism inducers, narrow therapeutic index drugs metabolized by CYP2D6, or intention to start taking one of these medications during the study treatment period
• • History of bladder surgery, invasive intra-vesical therapy, or bulk bladder injections in the past 3 months (more remote surgery will not be exclusionary), or intention to undergo one of these procedures in the study treatment period
• • Use of other specialized incontinence therapy (electrostimulation, pelvic physiotherapy, formal behavioral therapy overseen by certified practitioners) in the past 3 months (more remote therapy will not be exclusionary), or intention to undergo one of these procedures in the study treatment period
• • Inability to sign informed consent or complete questionnaires, interviews, or study testing in English
• • Other condition that would prevent the participant from completing study procedures, in the opinion of the investigators (e.g., uncontrolled psychosis)