NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
This publication is provided for historical reference only and the information may be out of date.
Structured Abstract
Objectives:
The Vanderbilt Evidence-based Practice Center systematically reviewed evidence on treatment of overactive bladder (OAB), urge urinary incontinence, and related symptoms. We focused on prevalence and incidence, treatment outcomes, comparisons of treatments, modifiers of outcomes, and costs.
Data:
We searched PubMed, MEDLINE®, EMBASE, and CINAHL.
Review Methods:
We included studies published in English from January 1966 to October 2008. We excluded studies with fewer than 50 participants, fewer than 75 percent women, or lack of relevance to OAB. Of 232 included publications, 20 were good quality, 145 were fair, and 67 poor. We calculated weighted averages of outcome effects and conducted a mixed-effects meta-analysis to investigate outcomes of pharmacologic treatments across studies.
Results:
OAB affects more than 10 to 15 percent of adult women, with 5 to 10 percent experiencing urge urinary incontinence (UUI) monthly or more often. Six available medications are effective in short term studies: estimates from meta-analysis models suggest extended release forms (taken once a day) reduce UUI by 1.78 (95 percent confidence interval (CI): 1.61, 1.94) episodes per day, and voids by 2.24 (95 percent CI: 2.03, 2.46) per day. Immediate release forms (taken twice or more a day) reduce UUI by 1.46 (95 percent CI: 1.28, 1.64), and voids by 2.17 (95 percent CI: 1.81, 2.54). As context, placebo reduces UUI episodes by 1.08 (95 percent CI: 0.86, 1.30), and voids by 1.48 (95 percent CI: 1.19, 1.71) per day. No one drug was definitively superior to others, including comparison of newer more selective agents to older antimuscarinics.
Current evidence is insufficient to guide choice of other therapies including sacral neuromodulation, instillation of oxybutynin, and injections of botulinum toxin. Acupuncture was the sole complementary and alternative medicine treatment, among reflexology and hypnosis, with early evidence of benefit. The strength of the evidence is insufficient to fully inform choice of these treatments. Select behavioral interventions were associated with symptom improvements comparable to medications. Limited evidence suggests no clear benefit from adding behavioral interventions at the time of initiation of pharmacologic treatment.
Conclusions:
OAB and associated symptoms are common. Treatment effects are modest. Quality of life and treatment satisfaction measures suggest such improvements can be important to women. The amount of high quality literature available is meager for helping guide women’s choices. Gaps include weak or absent data about long-term followup, poorly characterized and potentially concerning harms, information about best choices to minimize side effects, and study of how combinations of approaches may best be used. This is problematic since the condition is chronic and a single treatment modality is unlikely to fully resolve symptoms for most women.
Contents
Suggested citation:
Hartmann KE, McPheeters ML, Biller DH, Ward RM, McKoy JN, Jerome RN, Micucci SR, Meints L, Fisher JA, Scott TA, Slaughter JC, Blume JD. Treatment of Overactive Bladder in Women. Evidence Report/Technology Assessment No. 187 (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I). AHRQ Publication No. 09-E017. Rockville, MD: Agency for Healthcare Research and Quality. August 2009.
This report is based on research conducted by the Vanderbilt University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290-2007-10065-I). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov - 2
Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, Tennessee 37203-1738.
- Review What Are the Short-term Benefits and Potential Harms of Therapeutic Modalities for the Management of Overactive Bladder Syndrome in Women? A Review of Evidence Under the Auspices of the European Association of Urology, Female Non-neurogenic Lower Urinary Tract Symptoms Guidelines Panel.[Eur Urol. 2023]Review What Are the Short-term Benefits and Potential Harms of Therapeutic Modalities for the Management of Overactive Bladder Syndrome in Women? A Review of Evidence Under the Auspices of the European Association of Urology, Female Non-neurogenic Lower Urinary Tract Symptoms Guidelines Panel.Farag F, Sakalis VI, Arteaga SM, Sihra N, Karavitakis M, Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, et al. Eur Urol. 2023 Sep; 84(3):302-312. Epub 2023 Jun 17.
- Superiority of fesoterodine 8 mg vs 4 mg in reducing urgency urinary incontinence episodes in patients with overactive bladder: results of the randomised, double-blind, placebo-controlled EIGHT trial.[BJU Int. 2014]Superiority of fesoterodine 8 mg vs 4 mg in reducing urgency urinary incontinence episodes in patients with overactive bladder: results of the randomised, double-blind, placebo-controlled EIGHT trial.Chapple C, Schneider T, Haab F, Sun F, Whelan L, Scholfield D, Dragon E, Mangan E. BJU Int. 2014 Sep; 114(3):418-26. Epub 2014 Jul 1.
- Treatments for overactive bladder: focus on pharmacotherapy.[J Obstet Gynaecol Can. 2012]Treatments for overactive bladder: focus on pharmacotherapy.Geoffrion R, UROGYNAECOLOGY COMMITTEE. J Obstet Gynaecol Can. 2012 Nov; 34(11):1092-1101.
- Review Which anticholinergic drug for overactive bladder symptoms in adults.[Cochrane Database Syst Rev. 2012]Review Which anticholinergic drug for overactive bladder symptoms in adults.Madhuvrata P, Cody JD, Ellis G, Herbison GP, Hay-Smith EJ. Cochrane Database Syst Rev. 2012 Jan 18; 1:CD005429. Epub 2012 Jan 18.
- Review Botulinum toxin injections for adults with overactive bladder syndrome.[Cochrane Database Syst Rev. 2011]Review Botulinum toxin injections for adults with overactive bladder syndrome.Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D. Cochrane Database Syst Rev. 2011 Dec 7; (12):CD005493. Epub 2011 Dec 7.
- Treatment of Overactive Bladder in WomenTreatment of Overactive Bladder in Women
- Preventing Alzheimer's Disease and Cognitive DeclinePreventing Alzheimer's Disease and Cognitive Decline
- Health Literacy Interventions and Outcomes: An Updated Systematic ReviewHealth Literacy Interventions and Outcomes: An Updated Systematic Review
- Enabling Medication Management Through Health Information TechnologyEnabling Medication Management Through Health Information Technology
- Bioterrorism Preparedness and ResponseBioterrorism Preparedness and Response
Your browsing activity is empty.
Activity recording is turned off.
See more...