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Combining behavioral, drug therapy improves overactive bladder symptoms
A combination of behavioral and drug therapy was more effective in improving symptoms of overactive bladder in men than drug therapy alone but not behavioral therapy alone, according to a study published in JAMA Internal Medicine.
“While behavioral and drug therapies reduce symptoms, most patients are not completely cured with either modality alone,” Kathryn L. Burgio, PhD, a professor in the department of medicine at the University of Alabama at Birmingham, and colleagues wrote.
Previous research showed that combined therapy improved outcomes in women, but the potential effects in men were not clear, the researchers explained.
Burgio and colleagues conducted a three-site, two-stage, three-arm, parallel-group randomized control study of men aged at least 40 years with overactive bladder.
At baseline, researchers asked participants to complete a “bladder diary” where they recorded every void and urinary urgency episode for 1 week. To be included in the study, men had to have an average of nine voids or more every 24 hours in the baseline diary.
Participants were randomly assigned to receive drug therapy, behavioral therapy or combined behavioral and drug therapy for 6 weeks. All participants then received combined therapy for another 6 weeks.
Participants assigned to drug therapy alone received a daily antimuscarinic agent and an alpha-blocker. After 3 weeks of treatment, an interventionist called participants to determine whether they experienced any potential adverse effects. If necessary, the dose of antimuscarinic was lowered. Participants completed bladder diaries after each stage of treatment.
Those assigned to behavioral therapy alone received training during three clinical visits over 6 weeks on pelvic floor exercises and relaxation techniques that aim to reduce urgency, postpone urination and prevent urine loss. They also completed daily bladder diaries.
Participants assigned to combination therapy received both interventions simultaneously, with the same visit schedule as the behavioral therapy group throughout the study period.
A total of 204 men with a mean age of 64.1 years were included in the study — 183 completed treatment.
Participants in all three groups experienced significant decreases in mean voids per 24 hours from baseline to the end of week 6. Voids decreased by 24.7% (11.7 [2.4] vs. 8.8 [2.1]) in the behavioral therapy group, 12.7% (11.8 [2.5] vs. 10.3 [2.7]) in the drug therapy group, and 30.5% (11.8 [2.4] vs. 8.2 [2.3]) in the combined group.
In intent-to-treat analyses, the post-treatment mean frequency of voids was significantly lower in the combined treatment group compared with that of the drug therapy alone group (8.2 [2.3] vs. 10.3 [2.7]; P < .001) but not the behavioral therapy alone group (8.2 [2.3] vs. 8.8 [2.1]; P = .19).
After all groups completed combined therapy through week 12, the greatest improvement in mean voids per 24 hours from baseline occurred in the combined therapy group, with a 32.2% decrease (11.8 [2.4] vs. 8.0 [2.2]). The other groups also experienced drops in mean voids every 24 hours, with decreases of 31.6% (11.7 [2.4] vs. 8.0 [2.2]) in the behavioral group and 27.1% (11.8 [2.5] vs. 8.6 [2.3]) in the drug therapy group.
The findings suggest that when using a stepped approach to combined treatment, behavior therapy should be implemented first because it was associated with greater improvements at 6 weeks and had the lowest adverse events score, according to the researchers.
“A stepped approach starting with behavioral therapy alone allows patients to evaluate its effect before discussing with their clinicians the advantages and disadvantages of adding drugs with accompanying adverse effects for a small degree of additional improvement,” they wrote. – by Erin Michael
Disclosures: Burgio, reported receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the Department of Veterans Affairs. Please see the study for all other authors’ relevant financial disclosures.