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Does Conservative Management Really Benefit Patients with OAB?

  • Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)
  • Published:
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Abstract

The benefit that patients with overactive bladder (OAB) experience with conservative management is an important aspect in the evaluation of this therapy. The first-line options include behavioral interventions, and several techniques are available. Clinical research indicates amelioration of individual symptoms with these techniques, but few studies have shown a positive effect on health-related quality-of-life parameters. After failure of behavioral therapy or in combination with a training program, pharmacological therapy with anticholinergics is the next step. Extensive clinical research into different pharmacological compounds has shown significant effects on the symptomatic elements of OAB. The clinical relevance and the effects on quality-of-life parameters with pharmacological therapy have also been evaluated and show a significant effect on specific aspects. Recently, clinical research in conservative management of patients with OAB has focused more on evaluating patients' perceptions of their condition and the effects of treatment with patient-reported outcome instruments. Future studies should include these tools in the evaluation of any therapy in OAB.

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References

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  1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61:37–49.

    Article  PubMed  Google Scholar 

  2. Abrams P, Artibani W, Cardozo L, et al. Reviewing the ICS 2002 Terminology Report: the ongoing debate. Neurourol Urodyn. 2006;25:293.

    Article  Google Scholar 

  3. Coyne KS, Payne C, Bhattacharyya SK, et al. The impact of urinary urgency and frequency on health-related quality of life in overactive bladder: results from a national community survey. Value Health. 2004;7:455–63.

    Article  PubMed  Google Scholar 

  4. Donovan A, Bosch R, Gotoh M, et al. Symptom and quality of life assessment. In: AbramsP, CardozoL, KhouryS, WeinA, editors. Incontinence. Book 1. Basics and evaluation. International Continence Society; 2005.

  5. Milne JL. Behavioral therapies for overactive bladder: making sense of the evidence. J Wound Ostomy Continence Nurs. 2008;35:93–101.

    Article  PubMed  Google Scholar 

  6. Burgio KL. Current perspectives on management of urgency using bladder and behavioral training. J Am Acad Nurse Pract. 2004;16:4–7.

    PubMed  Google Scholar 

  7. Burgio KL. Behavioral treatment options for urinary incontinence. Gastroenterology. 2004;126:S82–9.

    Article  PubMed  Google Scholar 

  8. Wyman JF, Fantl JA, McClish DK, Bump RC. Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. Am J Obstet Gynecol. 1998;179:999–1007.

    Article  PubMed  CAS  Google Scholar 

  9. Burgio KL, Goode PS, Locher JL, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002;288:2293–9.

    Article  PubMed  Google Scholar 

  10. Burgio KL, Locher JL, Goode PS, et al. Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA. 1998;280:1995–2000.

    Article  PubMed  CAS  Google Scholar 

  11. Mattiasson A, Blaakaer J, Hoye K, Wein AJ. Simplified bladder training augments the effectiveness of tolterodine in patients with an overactive bladder. BJU Int. 2003;91:54–7.

    Article  PubMed  CAS  Google Scholar 

  12. Sampselle CM. Behavioral intervention: the first-line treatment for women with urinary incontinence. Curr Urol Rep. 2003;4:356–61.

    Article  PubMed  Google Scholar 

  13. Godec CJ. ‘Timed voiding’– a useful tool in the treatment of urinary incontinence. Urology. 1984;23:97–100.

    Article  PubMed  CAS  Google Scholar 

  14. Riesenhuber A, Boehm M, Posch M, Aufricht C. Diuretic potential of energy drinks. Amino Acids. 2006;31:81–3.

    Article  PubMed  CAS  Google Scholar 

  15. Creighton SM, Stanton SL. Caffeine: does it affect your bladder? Br J Urol. 1990;66:613–4.

    Article  PubMed  CAS  Google Scholar 

  16. Lee JG, Wein AJ, Levin RM. The effect of caffeine on the contractile response of the rabbit urinary bladder to field stimulation. Gen Pharmacol. 1993;24:1007–11.

    Article  PubMed  CAS  Google Scholar 

  17. Charach G, Greenstein A, Rabinovich P, et al. Alleviating constipation in the elderly improves lower urinary tract symptoms. Gerontology. 2001;47:72–6.

    Article  PubMed  CAS  Google Scholar 

  18. Dallosso HM, McGrother CW, Matthews RJ, Donaldson MM. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int. 2003;92:69–77.

    Article  PubMed  CAS  Google Scholar 

  19. Teleman PM, Lidfeldt J, Nerbrand C, et al. Overactive bladder: prevalence, risk factors and relation to stress incontinence in middle-aged women. BJOG. 2004;111:600–4.

    Article  PubMed  Google Scholar 

  20. Zhang W, Song Y, He X, et al. Prevalence and risk factors of overactive bladder syndrome in Fuzhou Chinese women. Neurourol Urodyn. 2006;25:717–21.

    Article  PubMed  Google Scholar 

  21. Wyman JF, Fantl JA. Bladder training in ambulatory care management of urinary incontinence. Urol Nurs. 1991;11:11–7.

    PubMed  CAS  Google Scholar 

  22. Shafik A, Shafik IA. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol. 2003;20:374–7.

    PubMed  Google Scholar 

  23. Wyman JF. Treatment of urinary incontinence in men and older women: the evidence shows the efficacy of a variety of techniques. Am J Nurs. 2003;103(Suppl):26–35.

    Article  Google Scholar 

  24. Burgio KL, Kraus SR, Menefee S, et al. Behavioral therapy to enable women with urge incontinence to discontinue drug treatment: a randomized trial. Ann Intern Med. 2008;149:161–9.

    PubMed  Google Scholar 

  25. Hines SH, Seng JS, Messer KL, et al. Adherence to a behavioral program to prevent incontinence. West J Nurs Res. 2007;29:36–56. discussion 7–64.

    Article  PubMed  Google Scholar 

  26. Herschorn S, Becker D, Miller E, et al. Impact of a health education intervention in overactive bladder patients. Can J Urol. 2004;11:2430–7.

    PubMed  Google Scholar 

  27. Klutke CG, Burgio KL, Wyman JF, et al. Combined effects of behavioral intervention and tolterodine in subjects dissatisfied with their overactive bladder medication. J Urol. 2009.

  28. Chancellor MB, Kianifard F, Beamer E, et al. A comparison of the efficacy of darifenacin alone vs. darifenacin plus a Behavioural Modification Programme upon the symptoms of overactive bladder. Int J Clin Pract. 2008;62:606–13.

    Article  PubMed  CAS  Google Scholar 

  29. Srikrishna S, Robinson D, Cardozo L, Vella M. Management of overactive bladder syndrome. Postgrad Med J. 2007;83(981):481–6.

    Article  PubMed  CAS  Google Scholar 

  30. Anderson RU, Mobley D, Blank B. et al Once daily controlled versus immeadiate release oxybutynin chloride for urge urinary incontinence. OROS Oxybutynin Study Group. J Urol. 1999;1611809–1812:1812.

    Google Scholar 

  31. Gleason D M, Susset J, White C, et al. Evaluation of a new once–daily formulation of oxybutynin for the treatment of urinary urge incontinence. Ditropan XL Study Group. Urology 1999. 54420–423.423.

  32. Dmochowski R R, Sand P K, Zinner N R., Transdermal Oxybutynin Study Group, et al. Comparative efficacy and safety of transdermal oxybutynin and oral tolterodine versus placebo in previously treated patients with urge and mixed urinary incontinence. Urology.2003. 62237–242.242.

  33. Gomelsky A, Dmochowski RR. Oxybutynin gel for the treatment of overactive bladder. Expert Opin Pharmacother. 2012;13(9):1337–43.

    Article  PubMed  CAS  Google Scholar 

  34. Mazur D, Wehnert J, Dorschner W, et al. Clinical and urodynamic effects of propiverine in patients suffering from urgency and urge incontinence. Scand J Urol Nephrol. 1995. 29289–294.294. [PubMed].

  35. Stoher M, Madersbacher H, Richter R, et al. Efficacy and safety of propiverine in SCI–patients suffering from detrusor hyperreflexia: a double–blind, placebo–controlled clinical trial. Spinal Cord. 1999. 37196–200.200. [PubMed].

  36. Ruscin JM, Morgenstern NE. Tolterodine use for symptoms of overactive bladder. Ann Pharmacother. 1999. 331073–1082.1082. [PubMed]

  37. Nilvebrant L, Andersson K-E, Gillberg P-G, et al. Tolterodine – a new bladder selective antimuscarinic agent. Eur J Pharmacol. 1997.

  38. Swift S, Garely A, Dimpfl T, Payne C, Tolterodine Study Group. A new once daily formulation of tolterodine provides superior efficacy an is well tolerated in women with overactive bladder. Int J Pelvic Floor Dysfunct. 2003. 1450–54.54.

  39. Van Kerrebroeck P, Kreder K, Jonas U, Tolterodine Study Group, et al. Tolterodine once-daily: superior efficacy and tolerability in the treatment of overactive bladder. Urology. 2001. 57414–421.421.

  40. Diokno AC, Appell RA, Sand PK, OPERA Study Group, et al. Prospective, randomised, double blind study of the efficacy and tolerability of the extended release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trial. Mayo Clin Proc. 2003. 78687–695.695.

  41. Appell RA, Sand P, Dmochowski R, Overactive Bladder: Judging Effective Control and Treatment Study Group, et al. Prospective randomized controlled trial of extended release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: results of the OBJECT Study. Mayo Clin Proc. 2001. 76358–363.363.

  42. Sussman D, Garely A. Treatment of overactive bladder with once-daily extended release tolterodine or oxybutynin: the antimuscarinic clinical effectiveness trial (ACET). Curr Med Res Opin. 2002. 18177–184.184.

  43. Hills CJ, Winter SA, Balfour JA. Tolterodine. Drugs. 1998. 55813–820.820.

  44. Jonas U, Hofner K, Madesbacher H. et al Efficacy and safety of two doses of tolterodine versus placebo in patients with detrusor overactivity and symptoms of frequency, urge incontinence, and urgency: urodynamic evaluation. World J Urol 1997. 15144–151.151.

  45. Millard R, Tuttle J, Moore K, et al. Clinical efficacy and safety of tolterodine compared to placebo in detrusor overactivity. J Urol. 1999. 1611551–1555.1555.

  46. Rentzhog L, Stanton SL, Cardozo LD, et al. Efficacy and safety of tolterodine in patients with detrusor instability: a dose ranging study. Br J Urol. 1998. 8142–48.48

  47. Abrams P, Freeman R, Anderstrom C, et al. Tolterodine, a new antimuscarinic agent: as effective but better tolerated than oxybutynin in patients with an overactive bladder. Br J Urol. 1998. 81801–810.810.

  48. Appell RA. Clinical efficacy and safety of tolterodine in the treatment of overactive bladder: a pooled analysis. Urology. 1997. 5090–96.96.

  49. Chapple C, Van Kerrebroeck P, Tubaro A, Haag-Molkenteller C, Forst HT, Massow U. Clinical efficacy, safety, and tolerability of once-daily fesoterodine in subjects with overactive bladder. Eur Urol. 2007;52(4):1204–12.

    Article  PubMed  CAS  Google Scholar 

  50. Chapple CR, Van Kerrebroeck PE, Jünemann KP, Wang JT, Brodsky M. Comparison of fesoterodine and tolterodine in patients with overactive bladder. BJU Int. 2008;102(9):1128–32.

    Article  PubMed  CAS  Google Scholar 

  51. Cardozo L, Hall T, Ryan J, Ebel Bitoun C, Kausar I, Darekar A, Wagg A. Safety and efficacy of flexible-dose fesoterodine in British subjects with overactive bladder: insights into factors associated with dose escalation. Int Urogynecol J. 2012 May 11.

  52. • Kelleher CJ, Dmochowski RR, Berriman S, Kopp ZS, Carlsson M. Sustained improvement in patient-reported outcomes during long-term fesoterodine treatment for overactive bladder symptoms: pooled analysis of two open-label extension studies. BJU Int. 2011 Nov 30. In this study, patient-reported outcomes were used to evaluate the benefit of patients with OAB using fesoterodine.

  53. Fusgen I, Hauri D. Trospium chloride: an effective option for medical treatment of bladder overactivity. Int J Clin Pharmacol Ther. 2000. 38223–234.234.

  54. Cardozo LD, Chapple CR, Toozs-Hobson P, et al. Efficacy of trospium chloride in patients with detrusor instability: a placebo controlled, randomized, double–blind, multicentre clinical trial. BJU Int. 2000. 85659–664.664.

  55. Madersbacher H, Stoher M, Richter R, et al. Trospium choride versus oxybutynin: a randomized, double blind, multicentre trial in the treatment of detrusor hyperreflexia. Br J Urol. 1995. 75452–456.456.

  56. Ikeda K, Kobayashi S. Effects of YM905, tolterodine and oxybutynin on M3 receptor mediated cytosolic free Ca2+mobilization in acutely dissociated cells of guinea pig urinary bladder smooth muscle and murine submandibular gland. Yamanouchi Pharmaceutical Co. Ltd. (1998). Registration No. D199803217–02.000. International Study ID905PH005.

  57. Cardozo L, Lisec M, Millard R. et al Randomised, double blind placebo controlled trial of the once daily antimuscarinic agent solifenacin succinate in patients with overactive bladder. J Urol. 2004;1721919–1924:1924.

    Google Scholar 

  58. Chapple CR, Arano P, Bosch JL, et al. Solifenacin appears effective and well tolerated in patients with symptomatic idiopathic detrusor overactivity in a placebo and tolterodine controlled phase II dose finding study. BJU Int. 2004. 9371–77.77.

  59. Chapple CR, Martinez–Garcia R, Selvaggi L, for the STAR Study Group, et al. A comparison of the efficacy and tolerability of solifenacin succinate and extended release tolterodine at treating overactive bladder syndrome: results of the STAR trial. Eur Urol. 2005. 48464–470.470.

  60. •• Luo D, Liu L, Han P, Wei Q, Shen H. Solifenacin for overactive bladder: a systematic review and meta-analysis. Int Urogynecol J. 2012 Feb 7. This is a very nice systematic review on the clinical efficacy of solifenacin based on the results of 5 RCTs.

  61. Haab F, Stewart L, Dwyer P. Darifenacin, an M3 selective receptor antagonist, is an effective and well tolerated once daily treatment for overactive bladder. Eur Urol. 2004. 45420–429.429.

  62. Chapple CR. Darifenacin is well tolerated and provides significant improvement in the symptoms of overactive bladder: a pooled analysis of phase III studies. J Urol. 2004;171:130 [abstract 487], (Suppl).

    Google Scholar 

  63. Bhide AA, Digesu GA, Fernando R, Khullar V. Use of mirabegron in treating overactive bladder. Int Urogynecol J. 2012 Mar 13.

  64. van Kerrebroeck P, Rezapour M, Cortesse A, Thüroff J, Riis A, Nørgaard JP. Desmopressin in the treatment of nocturia: a double-blind, placebo-controlled study. Eur Urol. 2007;52(1):221–9.

    Article  PubMed  Google Scholar 

  65. •• Wagg A, Compion G, Fahey A, Siddiqui E. Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience. BJU Int. 2012 Mar 12. This study looks at the persistence rate with anticholinergics in different age groups as an indirect indicator of patients benefit with this therapy.

  66. • Espuña-Pons M, Castro-Díaz D, Díaz-Cuervo H, Pérez M. Impact of Overactive Bladder Treatment on Associated Comorbidities. Actas Urol Esp. 2012 Feb 23. This is a study that indicates that OAB treatment can reduce associated comorbidities.

  67. •• Madhuvrata P, Cody JD, Ellis G, Herbison GP, Hay-Smith EJ. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2012 Jan 18;1:CD005429. This is a Cochrane review that allows to make a rational choice between the different anticholinergic therapies available.

  68. Coyne KS, Matza LS, Kopp Z, et al. The validation of the patient perception of bladder condition (PPBC): A single-item global measure for patients with overactive bladder. Eur Urol. 2006;49:1079–86.

    Article  PubMed  Google Scholar 

  69. Burgio KL, Goode PS, Richter HE, et al. Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: Validation of three global patient ratings. Neurourol Urodyn. 2006;25:411–7.

    Article  PubMed  Google Scholar 

  70. Piault E, Evans CJ, Espindle D, et al. Development and validation of the Overactive Bladder Satisfaction (OAB-S) Questionnaire. Neurourol Urodyn. 2008;27:179–90.

    Article  PubMed  Google Scholar 

  71. • Zinner N, Kobashi K, Koochaki P, Fix D, Egermark M. Patient satisfaction with the benefits of overactive bladder treatment: exploration of influencing factors and development of a satisfaction assessment instrument. Neurourol Urodyn. 2011;30(1):62–8. This is one of the few studies looking at patients satisfaction with OAB treatment with a validated instrument.

    Article  PubMed  Google Scholar 

  72. Renganathan A, Robinson D, Cardozo L, Srikrishna S, Cartwright R. Do women with overactive bladder have realistic expectations for therapy? Int Urogynecol J. 2010;21(4):409–14.

    Article  PubMed  Google Scholar 

  73. Wu JM, Fulton RG, Amundsen CL, Knight SK, Kuppermann M. Patient preferences for different severities of and treatments for overactive bladder. Female Pelvic Med Reconstr Surg. 2011;17(4):184–9.

    Article  PubMed  Google Scholar 

  74. Komesu YM, Sapien RE, Rogers RG, Ketai LH. Hypnotherapy for treatment of overactive bladder: a randomized controlled trial pilot study. Female Pelvic Med Reconstr Surg. 2011;17(6):308–13.

    Article  PubMed  Google Scholar 

  75. Hashim H, Al Mousa R. Management of fluid intake in patients with overactive bladder. Curr Urol Rep. 2009;10(6):428–33.

    Article  PubMed  Google Scholar 

  76. Arruda RM, Castro R, Sartori M, Girão MJ. Comparison between oxybutynin, functional electrical stimulation and pelvic floor training for treatment of detrusor overactivity in women: a review. Curr Opin Obstet Gynecol. 2009;21(5):412–4.

    Article  PubMed  Google Scholar 

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Disclosure

P. E. V. Van Keerebroeck has lectured for Astellas and Ferring, and his institution has received a grant from Medtronic.

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  1. Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Philip E. V. Van Kerrebroeck

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Van Kerrebroeck, P.E.V. Does Conservative Management Really Benefit Patients with OAB?. Curr Urol Rep 13, 348–355 (2012). https://doi.org/10.1007/s11934-012-0262-0

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