I see many young and older men with complaints of overactive symptoms of urgency and frequency. The older men may have benign prostatic hyperplasia (BPH) and the younger men seem to have no underlying pathology. Whatever the cause, these are distressing symptoms that affect the quality of life for all of these men. Drug therapy is usually recommended at first with behavioral therapy added usually as an afterthought. But based on a recently published research in JAMA by Burgio and colleagues, clinicians should consider a more effective stepped approach to combination overactive bladder (OAB) therapy by first recommending behavioral therapy.1
In this 2-stage multisite randomized controlled trial of 204 men with overactive bladder symptoms, these researchers studied the effect of combined behavioral and drug therapy compared to each therapy alone. Men received behavioral therapy over a 6-week period during three clinic visits. Behavioral therapy included bladder training, including skills and strategies for postponing urination, controlling urgency with suppression strategies, and using the pelvic floor muscles to prevent urgency incontinence. Drug therapy in this study consisted of two drugs: an antimuscarinic (sustained-release tolterodine, 4 mg, daily) and an α-blocker (tamsulosin, 0.4 mg, daily before bed).
Results indicated that the combination of behavioral and drug therapy yielded significantly greater short-term (12 weeks) reductions in voiding frequency compared with drug therapy alone but not compared with behavioral therapy alone. Behavioral therapy yielded better 6-week outcomes than drug therapy. In addition, nocturia and urinary urgency, as well as other secondary outcomes including patient-perceived improvement and satisfaction were improved with combination therapy. As expected, behavioral therapy alone had the least adverse effects. Behavioral therapy has been shown to be effective in women with lower urinary tract symptoms (LUTS) but this study adds to the evidence of the effectiveness of this treatment in men.
I recommend clinicians start prescribing behavioral therapy at the time of diagnosis in men with OAB symptoms. SUFU’s OAB Clinical Care Pathway and Roadmap is a great resource for clinicians and patients alike. A quick Google search can also provide downloadable patient education PDFs on bladder training for controlling urgency and frequency as well as instructions on pelvic floor muscle exercises.
Written by: Diane Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practitioner (NP), Co-Director, Penn Center for Continence and Pelvic Health Director, Clinical Trials, Division of Urology, Adjunct Professor of Urology in Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Published Date: February 13th, 2020
1. Burgio, Kathryn L., Stephen R. Kraus, Theodore M. Johnson, Alayne D. Markland, Camille P. Vaughan, Peng Li, David T. Redden, and Patricia S. Goode. "Effectiveness of Combined Behavioral and Drug Therapy for Overactive Bladder Symptoms in Men: A Randomized Clinical Trial." JAMA Internal Medicine (2020).
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