Behavioral therapy as good as drugs to treat overactive bladder

During the American Urological Association (AUA) 2010 Annual Scientific Meeting, researchers from the University of Alabama at Birmingham reported that a comprehensive behavioral therapy program is as effective as drug therapy for treating overactive bladder (OAB) in men without significant bladder outlet obstruction.

First, the details.

• 143 men with OAB were assigned to a treatment group for 8 weeks.
  • Behavioral therapy
    • Pelvic floor muscle exercises
    • Delayed voiding
    • Self-monitoring with bladder diaries
    • Urge-suppression techniques
  • Drug therapy: Individually titrated, extended-release oxybutynin (Ditropan) 5 to 30 mg daily to help reach the most effective and tolerable dose.
• OAB was defined as urgency and frequent urination (greater than 8 times per day), with/without incontinence, and without significant obstruction.
• All participants had persistent OAB symptoms after 4 weeks of alpha-blocker therapy before the study.
• Bladder diaries completed by patients were used to calculate changes in 24-hour urinary frequency, excessive urinating at night, and involuntary urination.

And, the results.

• Behavioral treatment and drug therapy demonstrated significant reductions in number of voids per day, from 11 to 9.
• After treatment, voiding frequencies were the same.
  • 36% of the behavioral treatment group and 30% those getting drug therapy had 8 or fewer voids per day.
• Nocturia was reduced by 0.7 episodes per night in the behavior group vs 0.3 episodes in the drug group—a significant difference.
• There was no difference in the perception of improvement, at the end of treatment.
  • 56% receiving behavioral therapy reported being “completely satisfied” vs 43% receiving drug therapy.

The bottom line?

The authors concluded, “Behavioral treatment with pelvic floor muscle training, delayed voiding; and urge-suppression techniques are effective for reducing frequency of voiding in men with OAB, and yield outcomes at least as good as drug therapy.”

Lack of side effects is a plus for behavioral therapy, but it takes effort to learn the techniques, and follow-up to ensure the techniques are being used properly.

Most important, behavior therapy is an alternative to drug treatment for men with overactive bladder.

6/4/10 15:31 JR