Population ageing has as consequence an increasing number of women older than 80 years with lower urinary tract symptoms (LUTS) who are referred for urodynamics to diagnose the cause of LUTS and to propose management. 
It is frequent that elderly people have a wide range of chronic conditions. Consequently they tend to take multiple medications in a day, including frequently one or more anticholinergic drugs (AC) resulting in cumulative anticholinergic burden (AB). AC (before availability of beta-3 agonist) were the first line treatment for overactive bladder. Main effect is to inhibit uninhibited detrusor contractions; adverse effects are urinary frequency, urgency with or without incontinence.
Aims of study were for the first time to search for the incidence of AB on urodynamic study for non-neurologic women older than 80 years.

Urodynamic tracings of 117 non-neurologic women older than 80 years who were referred for investigation of various LUTS were retrospectively analyzed. 
Each file comprised demographic data, medical history, bladder diary for three days and medications. Exclusion criteria were advanced cognitive impairment (MMSE ≤ 20), diabetes mellitus and/or severe mobility impairment.
Main complaint was assessed through history taking and defined as: stress urinary incontinence (SUI), mixed urinary incontinence (MUI), urge urinary incontinence (UUI) and OTHER (no urinary incontinence).  
AB was estimated using the Anticholinergic Drug Scale [1].
After urodynamic session, a urodynamic diagnosis (UD) was posed according to the ICS/IUGA recommendations. UD were detrusor overactivity with impaired contractility (DHIC), detrusor overactivity (DO), detrusor underactivity (DU), low bladder compliance (LBC). Some investigations were found “normal” (N) and other related to urethral dysfunction (intrinsic sphincter deficiency (ISD)). Some combined diagnoses were observed between DO, DU or DHIC with ISD.
As AC drugs modify detrusor contraction, an evaluation of detrusor contractility (parameter VBN k) was made using the VBN model [2-3] in order to analyze the effect of AB on that population. Parameters allowing k computation are initial bladder volume (Vini) with a voided volume >100 mL, maximum flow Qmax and detrusor pressure at maximum flow pdet.Qmax [3]. Thus files with an IF will be more accurately analyzed.

Mean age of the population was 83.9 years [range 80-93]. Eigthy one women (sub-group X) succeeded in intubated-flow (IF), but only 70 (sub-group Y) had a voided volume >100 mL and so, had evaluation of the VBN detrusor contractility parameter k. 
1- Occurrence of AB was similar in X (24 patients; 29.6%) and Y (20 patients; 28.6%). Similar repartition in intensity of AB was observed; AB=1: 7 (10%) in Y vs. 9 (11%) in X, AB >1 for 13 (19%) in patients in Y vs.15 (19%) in X.
2- Main complaints vs. AB were given in Table1 for sub-group Y. There was no significant difference of k value between main complaints in Y
3- Urodynamic diagnosis vs. AB was given in Table 2 for sub-group Y. In that sub-group k values were consistent with previous evaluations for a population older than 75 y with or without AC medication [3].

.The role of AC is to decrease detrusor contractility, so an expected observation is a predominance of symptomatology which could be a consequence of AC treatment.
In that population of older non neurologic women predominance of MUI, UUI and frequency-dysuria (88.5% in X and 95% in Y of patients included in OTHER) could be the consequence of treatment of some existing LUTS by AC. High AB is observed in women with MUI and UUI complaints. 
The high AB value for patients with SUI complaint results from a patient’s AB who had former AC treatment of detrusor overactivity; that women had still a high detrusor contractility (k = .340) while absence of non inhibited detrusor contraction during urodynamics.
Despite a small population, some trends can be proposed.
Looking at urodynamic diagnosis there is no significant difference in AB between UD with a trend to lower values for UD of DO-ISD and N. An intriguing result is the high AB for women with ISD diagnosis which is the consequence as for SUI complaint of a former treatment for three women of detrusor overactivity.
The last question is: is there a decrease of detrusor contractility associated with AB? The values of the VBN parameter of detrusor contractility are low which could also be explained by an important decrease in detrusor contractility with aging but k values are consistent with previous evaluation in a population older than 60 years without reference of AB [3].

For the first time incidence of anticholinergic burden (AB) on urodynamics is studied on an oldest non neurologic female population. High AB is associated with complaint of MUI, UUI and dysuria-frequency. The small samples of urodynamic diagnoses prevent to give reliable conclusion on incidence of AB on urodynamics’ conclusions. Prescription of AC remains low to avoid adverse events. Incidence of AB seems not very significant as the values of the VBN parameter of detrusor contractility are consistent with previous evaluations. Despite the controversy for the prescription of anti-cholinergic drugs in elderly, further studies should include larger populations.

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Valentini FA, Marti BG, Nelson PP, Zimmern PE, Robain G. Usefulness of an algebraic fitting of nomograms allowing evaluation detrusor contractility in women. Prog Urol. 2017 ; 27(4): 261-6. doi:10.1016/j.purol.2016.06.010.
Valentini FA, Marti BG, Robain G, Haddad R, Nelson PP. Detrusor contractility in post-menopausal women: impact of ageing, complaint and urodynamic diagnosis. Prog Urol 2021 . On line 26 Feb 2021 DOI 10.1016/j.purol.2021.02.001.