Cholinergic Antagonists Combined with Electrical Stimulation or Bladder Training Treatments for Overactive Bladder in Female Adults: A Meta-Analysis of Randomized Controlled Trials

Short-term effect of magnetic stimulation added to bladder training in women with idiopathic overactive bladder: A prospective randomized controlled trial

OBJECTIVE

To evaluate the efficacy of magnetic stimulation (MStim) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB).

MATERIAL AND METHODS

Seventy-six women with idiopathic OAB were randomized into two groups using the random numbers generator as follows: Group 1 received BT alone (n: 38), and Group 2 received BT + MStim (n: 38). MStim was performed with MStim therapy armchair (Novamag NT60), 2 days a week, 20 min a day, a total of 12 sessions for 6 weeks. Women were evaluated in terms of incontinence severity (24-h pad test), 3-day voiding diary (frequency of voiding, incontinence episodes, nocturia, and number of pads), symptom severity (OAB-V8), QoL (IIQ-7), positive response and cure-improvement rates, and treatment satisfaction (Likert scale) at the baseline and the end of treatment (sixth week).

RESULTS

A statistically significant improvement was found in incontinence severity, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters for two groups at the end of the treatment compared to the baseline values (p < 0.05). At the end of treatment; incontinence severity, incontinence episodes, nocturia, number of pads, symptom severity, and QoL were significantly improved in Group 2 compared to Group 1 (p < 0.05). No difference was found between the two groups in terms of frequency of voiding (p > 0.05). The positive response and cure-improvement rates, and treatment satisfaction were significantly higher in Group 2 than in Group 1 (p < 0.05).

CONCLUSION

MStim added to BT is more effective than BT alone in women with idiopathic OAB.

Efficacy of non‐pharmacological interventions in females with overactive bladder: A systematic review and network meta‐analysis

AIMS AND OBJECTIVES

To compare and rank the effectiveness of non-pharmacological interventions for symptoms of Overactive Bladder (OAB) in network meta-analysis.

BACKGROUND

Overactive Bladder affects many patients, which often generates bothersome symptoms and debilitates the quality of life. Non-pharmacological therapies have been widely used in OAB. However, due to insufficient evidence, it remains unclear which strategies are most suitable for OAB.

METHODS

We integrated randomised controlled trials (RCTs), which were searched up to 1 January 2021, from 8 databases (PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc). Studies that met the eligible criteria were assessed the risk of bias. Then, network meta-analyses were conducted by STATA, R, and OpenBUGS. The review followed PRISMA statement.

RESULTS

A total of 24 studies comprising 2347 patients with OAB were included in this review, most of which were low to moderate risk of bias. The results of network meta-analysis implied that electric stimulation (ES) was the most effective intervention to reduce voided frequency and nocturia frequency of OAB.

CONCLUSIONS

Electric stimulation ranked the best in the management of OAB, and future studies should pay more attention to ES.

Efficacy of non-pharmacological interventions in patients with overactive bladder: A protocol for systematic review and network meta-analysis

Background

Some meta‐analyses have proved the superiority of non‐pharmacological interventions in overactive bladder (OAB), but the best choice is still controversial.

Aim

To assess the most effective interventions in female with OAB.

Methods

Studies for relevant randomized controlled trials which compare different kinds of non‐pharmacological interventions in females with OAB will be retrieved from 8 databases including PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Database, VIP Database and China Biology Medicine disc, from inception to 1 January 2021. After screening titles and abstracts, detailed data including participates, interventions and outcomes will be extracted according to the eligible criteria. Then, Cochrane risk‐of‐bias tool will be used to assess the quality of the literature. The pairwise meta‐analysis will be conducted by STATA. Network meta‐analysis will be performed to compare and rank the effects of different non‐pharmacological interventions, in terms of alleviation of symptoms, by OpenBUGS, R and STATA.

Results

This network meta‐analysis will present the best available evidence about non‐pharmacological interventions for OAB to both relieve symptoms and improve life quality.

Electric nerve stimulation for overactive bladder: an umbrella review

Numerous systematic reviews and meta-analyses have reported the effect of electrical nerve stimulation (ENS) on overactive bladder (OAB). However, these results are contradictory. We conducted an umbrella review to summarize the evidence and evaluate the effectiveness of ENS for OAB by using an umbrella review methodology from multiple perspectives with sufficient methodological quality. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and PsycINFO databases and two Chinese databases (CNKI and CBM) to identify articles written in English or Chinese that were published up to 15 February 2021. Two authors of this review independently selected the studies, assessed their quality, and extracted the data from all the included studies. We performed a quality assessment of eligible reviews using the AMSTAR 2.0 tool and estimated the summary effect size, 95% confidence intervals, 95% prediction intervals and heterogeneity. Ten systematic reviews and meta-analyses covering 89 randomized controlled trials and 16 prospective cohort studies with a total population of 5004 participants that investigated the effect of ENS for OAB in terms of 17 different outcomes were identified. ENS seems effective and safety for OAB, with our results showing weak evidence of clinical efficacy and no evidence of side effects. To recommend ENS as a practical treatment option for OAB, however, more high-quality research is needed.

Advances in pharmacotherapy for the treatment of overactive bladder

Purpose of review

To present the current literature on the pharmacologic management of overactive bladder, including combination therapies, agents still in clinical development, and special considerations related to individuals with cognitive decline, frailty and cardiovascular risk.

Recent Findings

Combination therapy is shown to be more effective than monotherapy, without additional side effects. Preliminary studies on novel treatment methods, including new medications, as well was novel use of established medications, demonstrates improved efficacy with a favorable side effect profile. Investigation into new target pathways may be an area for future pharmacologic development. Special consideration should be given when prescribing anti-muscarinic medication in the frail adult population. Overactive bladder has been associated with frailty and anti-muscarinic medications have been associated with the worsening cognitive decline.

Summary

Combination therapy is a safe and effective alternative to patients with refractory overactive bladder. Caution should be taken in prescribing medications for the frail older adult, and alternative first- and third-line treatments should be considered. Future studies should involve long term data on safety and outcomes stratified by age with objective measurements of cognition and frailty.