Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. Neuromodulative treatment of overactive bladder--noninvasive tibial nerve stimulation. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. Do patient characteristics predict responsiveness to treatment of overactive bladder with antimuscarinic agents? OnabotulinumtoxinA for the Treatment of Patients with Overactive Bladder and Urinary Incontinence: Results of a Phase 3, Randomized, Placebo Controlled Trial Long‐term treatment with darifenacin for overactive bladder: results of a 2‐year, open‐label extension study [Posterior tibial nerve stimulation in the management of overactive bladder: a prospective and controlled study]. Neurogenic bladder treatment by doubling the recommended antimuscarinic dosage. Time to onset of improvement in symptoms of overactive bladder using antimuscarinic treatment Efficacy of botulinum toxin type A 100 units versus 200 units for treatment of refractory idiopathic overactive bladder Randomized, double‐blind, placebo‐ and propiverine‐controlled trial of the once‐daily antimuscarinic agent solifenacin in Japanese patients with overactive bladder Multicenter phase III trial studying trospium chloride in patients with overactive bladder. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. Efficacy of antimuscarinic therapy for overactive bladder with varying degrees of incontinence severity. Efficacy of physical therapeutic modalities in women with proven bladder overactivity. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study.
AIMS Electrostimulation is an established therapeutic option for neurogenic urinary disorders . The aim of this study was to investigate the efficacy of the noninvasive technique of transcutaneous posterior tibial nerve stimulation ( TPTNS ) in patients with multiple sclerosis ( MS ) and troublesome symptoms of an overactive bladder ( OAB ) . METHODS A multicentric study enrolled 70 MS patients , suffering from OAB for a 3-month study period . INTERVENTION Daily sessions of 20 min of TPTNS were provided . No change of associated treatments during the study period . The primary outcome measurement was Urgency and Frequency reported by bladder diary and symptom score performed before the treatment ( Day 0 , D0 ) and at D30 and D90 . The secondary outcomes measurements were continence , symptom score , quality of life , psychosocial burden at DO , D30 , and D90 and cystometry at baseline , with and without TPTNS and at D90 . RESULTS Clinical improvement of OAB was shown in 82.6 % and 83.3 % of the patients on D30 and D90 , respectively , with significant improvement of primary and secondary outcomes compared to baseline . The initial acute cystometric response to TPTNS was positive in 51.2 % of the patients ( increase of > 30 % of cystometric capacity and /or reflex volume ) , without correlation with TPTNS clinical efficiency . The procedure was well tolerated . CONCLUSIONS Chronic TPTNS appears to be effective in the management of severe OAB in MS , without compromising bladder emptying or inducing side effect . Treatment may be effective even in the absence of an acute cystometric effect . Additional works are required to demonstrate long-term efficacy of TPTNS PURPOSE Treatment options for patients with overactive bladder refractory to anticholinergics are limited . We assessed the dose response across a range of doses of onabotulinumtoxinA ( BOTOX ® ) in patients with idiopathic overactive bladder and urinary urgency incontinence whose symptoms were not adequately managed with anticholinergics .  MATERIAL S AND METHODS In a phase 2 , multicenter , r and omized , double-blind study , 313 patients with idiopathic overactive bladder and urinary urgency incontinence experiencing 8 or more urinary urgency incontinence episodes a week and 8 or more micturitions daily at baseline received 50 , 100 , 150 , 200 or 300 U intradetrusor onabotulinumtoxinA , or placebo . Symptoms were recorded using a 7-day bladder diary . The primary efficacy variable was weekly urinary urgency incontinence episodes and the primary end point was week 12 . RESULTS Demographics and baseline characteristics were balanced across the treatment groups . Durable efficacy was observed for all onabotulinumtoxinA dose groups of 100 U or greater for primary and secondary efficacy measures , including the proportion of incontinence-free patients . When the dose response curves were analyzed , doses greater than 150 U contributed minimal additional or clinical ly relevant improvement in symptoms . This finding was also reflected in health related quality of life assessment s. Dose dependent changes in post-void residual urine volume were observed and the use of clean intermittent catheterization was also dose dependent . The only adverse events significantly greater with onabotulinumtoxinA than with placebo were urinary tract infection and urinary retention . CONCLUSIONS OnabotulinumtoxinA at doses of 100 U or greater demonstrated durable efficacy in the management of idiopathic overactive bladder and urinary urgency incontinence . A dose of 100 U may be the dose that appropriately balances the symptom benefits with the post-void residual urine volume related safety profile BACKGROUND Conservative treatment of overactive bladder employes behavioral or invasive neuromodulatory inhibition of miction reflex and administration of anticholinergic drugs . MAIN PURPOSE The aim of this study was to use non-invasive stimulation of the tibial nerve with the intention to achieve desired therapeutic effects without iatrogenic nerve damage using a superficial electrostimulation . METHODS All patients suffered from overactive bladder ( OAB ) without bladder outlet obstruction . OAB was examined by the Behavioral urge score BUS ( 0.0 - -the best and 1.0 - -the worst score ) , the International prostate symptom score IPSS ( 0 - -the best and 35 - -the worst score ) and the Incontinence quality of life question naire IQOL ( 0.0 - -the worst and 1.0 - -the best index ) . The patients were divided into 3 groups : Group I-- patients with electrode attached behind the medial ankle of the left lower extremity . The intensity of stimulation corresponded to 70 % of the maximum amplitude of response from musculus abductor hallucis . Frequency of stimulation was 1 Hz and duration of the square impulse was 0.1 ms . Surface stimulation lasted 30 minutes and was repeated once a week . Group II-- patients were treated by oral oxybutynin 5 mg t.i.d . Group III-- patients without treatment . The BUS , IPSS , and IQOL were repeated after the treatment . RESULTS The study included 28 females of average age 54 year ( range 45 to 63 ) . Mean IPSS was 17 ( range 12 to 21 ) , mean index of quality of life IQOL was 30 ( range 12 to 78 ) and mean BUS score was 0.68 ( range 0.50 to 0.86 ) . Group I with stimulation did achieve statistically significant changes following the treatment : decrease of mean IPSS from 17 + /- 3 points to 6 + /- 4 points after the treatment , increase in mean IQOL from 36 + /- 10 to 68 + /- 20 and decrease of mean BUS from 0.65 + /- 0.12 to 0.43 + /- 0.16 . Group II had similar statistically significant differences after the treatment of OAB . Group III noted no changes in the complaints . CONCLUSION Noninvasive stimulation had improved subjective symptom related to overactive bladder , had no adverse events and was well tolerated . ( Fig. 1 , Tab . 1 , Ref . 18 . ) PURPOSE Overactive bladder affects 12 % to 17 % of the general population and almost a third experience urinary incontinence , which may severely impact health related quality of life . Oral anticholinergics are the mainstay of pharmacological treatment but they are limited by inadequate efficacy or side effects , leading to a high discontinuation rate . We report the results of the first large ( 557 patients ) , phase 3 , placebo controlled trial of onabotulinumtoxinA in patients with overactive bladder and urinary incontinence inadequately managed with anticholinergics . MATERIAL S AND METHODS Eligible patients with overactive bladder , 3 or more urgency urinary incontinence episodes in 3 days and 8 or more micturitions per day were r and omized 1:1 to receive intradetrusor injection of onabotulinumtoxinA 100 U or placebo . Co- primary end points were the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients with a positive response on the treatment benefit scale at posttreatment week 12 . Secondary end points included other overactive bladder symptoms and health related quality of life . Adverse events were assessed . RESULTS OnabotulinumtoxinA significantly decreased the daily frequency of urinary incontinence episodes vs placebo ( -2.65 vs -0.87 , p < 0.001 ) and 22.9 % vs 6.5 % of patients became completely continent . A larger proportion of onabotulinumtoxinA than placebo treated patients reported a positive response on the treatment benefit scale ( 60.8 % vs 29.2 % , p < 0.001 ) . All other overactive bladder symptoms improved vs placebo ( p ≤ 0.05 ) . OnabotulinumtoxinA improved patient health related quality of life across multiple measures ( p < 0.001 ) . Uncomplicated urinary tract infection was the most common adverse event . A 5.4 % rate of urinary retention was observed . CONCLUSIONS OnabotulinumtoxinA 100 U showed significant , clinical ly relevant improvement in all overactive bladder symptoms and health related quality of life in patients inadequately treated with anticholinergics and was well tolerated OBJECTIVE To determine clinical and demographic characteristics associated with antimuscarinic treatment response using a regression model . METHODS Adults with overactive bladder ( OAB ) symptoms for > 3 months and ≥ 1 urgency urinary incontinence ( UUI ) episode and ≥ 8 micturitions per 24 hours at baseline were r and omized to fesoterodine ( 8 mg ) , tolterodine extended-release ( 4 mg ) , or placebo in two 12-week , double-blind , head-to-head studies . Fesoterodine-treated patients received 4 mg/d during the first week and 8 mg/d thereafter . Patients completed 3-day bladder diaries and the Overactive Bladder Question naire at baseline and week 12 . Pooled data for changes from baseline to week 12 in winsorized UUI episodes , micturitions , and urgency episodes per 24 hours and Overactive Bladder Question naire Symptom Bother and health-related quality of life scores were analyzed posthoc using a regression model that selects outcome predictors from baseline values and patient characteristics while retaining baseline values and treatment , with stepwise inclusion of significant covariates and assessment of treatment interactions . Logistic regression was used for analysis of diary-dry rates . RESULTS Younger age , lack of previous antimuscarinic treatment , shorter duration of OAB diagnosis , and female gender were common predictors of larger changes in outcomes from baseline to week 12 . Baseline measures often interacted with treatment , such that poorer baseline outcomes were predictive of larger treatment differences . Longer duration since OAB diagnosis predicted greater treatment differences for UUI episodes and in diary-dry rate , and increased age predicted greater treatment differences for micturitions . CONCLUSION Symptom severity and duration , age , gender , and previous antimuscarinic pharmacotherapy impact the response to antimuscarinic treatment Purpose : Overactive bladder affects 12 % to 17 % of the general population and almost a third experience urinary incontinence , which may severely impact health related quality of life . Oral anticholinergics are the mainstay of pharmacological treatment but they are limited by inadequate efficacy or side effects , leading to a high discontinuation rate . We report the results of the first large ( 557 patients ) , phase 3 , placebo controlled trial of onabotulinumtoxinA in patients with overactive bladder and urinary incontinence inadequately managed with anticholinergics . Material s and Methods : Eligible patients with overactive bladder , 3 or more urgency urinary incontinence episodes in 3 days and 8 or more micturitions per day were r and omized 1:1 to receive intradetrusor injection of onabotulinumtoxinA 100 U or placebo . Co‐ primary end points were the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients with a positive response on the treatment benefit scale at posttreatment week 12 . Secondary end points included other overactive bladder symptoms and health related quality of life . Adverse events were assessed . Results : OnabotulinumtoxinA significantly decreased the daily frequency of urinary incontinence episodes  vs placebo ( −2.65 vs −0.87 , p < 0.001 ) and 22.9 % vs 6.5 % of patients became completely continent . A larger proportion of onabotulinumtoxinA than placebo treated patients reported a positive response on the treatment benefit scale ( 60.8 % vs 29.2 % , p < 0.001 ) . All other overactive bladder symptoms improved vs placebo ( p ≤0.05 ) . OnabotulinumtoxinA improved patient health related quality of life across multiple measures ( p < 0.001 ) . Uncomplicated urinary tract infection was the most common adverse event . A 5.4 % rate of urinary retention was observed . Conclusions : OnabotulinumtoxinA 100 U showed significant , clinical ly relevant improvement in all overactive bladder symptoms and health related quality of life in patients inadequately treated with anticholinergics and was well tolerated To examine , in a 2‐year , non‐comparative , open‐label extension study , the safety , tolerability and efficacy of darifenacin controlled‐release ( CR ) 7.5/15 mg once daily in patients with overactive bladder ( OAB ) who completed two 12‐week r and omized , double‐blind , placebo‐controlled ‘ feeder ’ studies UNLABELLED The aim of this study was to evaluate the efficacy of the Posterior Tibial Nerve stimulation in women with overactivity bladder symptoms and the impact in the quality of life using the Overactivity Bladder Question naire ( OABq ) . METHODS thirty seven women from female urology outpatient clinic of the Hospital das Clinicas de Campinas ( HC/UNICAMP ) were enrolled in this prospect i ve , controlled and r and omized clinical trial . The patients were r and omly placed in one of two groups : TREATMENT GROUP : patients were su bmi tted to tibial posterior nerve electrical stimulation ( n=21 ) and Sham group : patients had electrodes placed without electricity ( n = 16 ) . After informed consent the patients underwent a physiotherapeutic evaluation , that included voiding diary and the overactivity bladder question naire ( OABq ) . The treatment schedule included eight sessions of electrical stimulation in the posterior tibial nerve , twice a week . RESULTS there were significant changes in symptoms such as frequency and nocturia ( p=0,003 and p=0,001 ) . The urgency and quality of life was improved in both group after treatment . CONCLUSION The posterior tibial nerve electrical stimulation is an effective treatment in overactive bladder INTRODUCTION AND OBJECTIVES The dosage of the antimuscarinic drugs : Tolterodine ER or Trospium was increased to a higher-than-recommended dosage in patients where the manufacturer 's recommended dosage had failed . All patients were suffering from neurogenic detrusor overactivity incontinence .  Tolerability and success were evaluated in the present study . MATERIAL S AND METHODS Twenty-one patients with neurogenic detrusor overactivity were evaluated : 17 with spinal cord injury , 3 with multiple sclerosis , and 1 with a meningomyelocele . All patients catheterized themselves or were catheterized . If neurogenic detrusor overactivity continued and the medication was well tolerated , the dosage was doubled to either 8 mg of Tolterodine ER [ 2 x 4 mg ( n = 11 ) ] or 90 mg of Trospium [ 3 x 30 mg ( n = 10 ) ] . The follow-up was monitored by a bladder diary and urodynamic evaluation . RESULTS Sixteen patients significantly decreased their incontinence episodes from 8 - 12 episodes before to 0 - 2 episodes during the doubled treatment . The reflex volume increased from 202 + /- 68 to 332 + /- 50 ml ( P < 0.001 ) . Cystometric capacity enlarged from 290 + /- 56 to 453 + /- 63 ml ( P < 0.001 ) . One patient had to stop the medication because of intolerable side effects and five patients did not experience satisfactory benefit . CONCLUSION The increased dosage of Tolterodine or Trospium is an effective treatment in patients with neurogenic bladder To evaluate the time to onset of statistically significant and clinical ly meaningful effects of trospium chloride in patients with an overactive bladder ( OAB ) ABSTRACT Objective : To evaluate the efficacy and safety of a single intra detrusor injection of BoNTA comparing two different doses ( 100 U or 200 U ) in patients with idiopathic overactive bladder . Material s and Methods : A r and omized prospect i ve study evaluated the efficacy of BoNTA in management of refractory idiopathic overactive bladder and included 80 patients . All patients were assessed initially by taking a history , a physical examination , overactive bladder symptom score , urine analysis , routine laboratory investigations , KUB and pelviabdominal . OABSS was adjusted on all patients postoperative at 1,3,6,9 months also Urodynamic was done for all patients preoperative and postoperative at 3 , 6 , 9 months . Results : The mean age was 30.22±8.37 and 31.35±7.61 in group I and II respectively . There was no statistically difference between both groups in all parameters all over the study except at 9 months after treatment . Hematuria was observed 6 and 9 patients in group I and II respectively . Dysuria was observed in 6 and 15 patients in group I and II respectively . UTI was detected in 3 and 7 patients in group I and II respectively . Conclusion : A single-injection procedure of 100 U or 200 U BoNTA is an effective and safe treatment for patients with IOAB who failed anticholinergic regimens . OABSS and QoL were improved for 6 months ; 100 U injections seemed to have comparable results with 200 U. There was a significant difference at month 9 towards 200 U with more incidences of adverse events To compare solifenacin succinate ( 5 and 10 mg once‐daily ) to placebo and propiverine hydrochloride ( 20 mg once‐daily ) , respectively , in Japanese patients with overactive bladder syndrome ( OAB ) OBJECTIVES To study the efficacy and safety of trospium chloride in treating overactive bladder .  Trospium chloride is an anticholinergic agent with predominantly peripheral nonselective antimuscarinic activity and thus has potential therapeutic value in treating patients with overactive bladder . METHODS Patients with overactive bladder were r and omized on a 1:1 basis to either placebo or trospium chloride 20 mg twice daily in this 12-week , multicenter , parallel , double-blind , placebo-controlled study . The primary endpoint was the change in the average number of toilet voids per 24 hours . The secondary efficacy variables were changes in the average void urgency severity , volume per toilet void , urge frequency , number of daily urge urinary incontinence episodes , and daytime sleepiness . RESULTS A total of 658 patients were r and omized at 52 sites .  Trospium chloride significantly decreased the average number of daily toilet voids , average urgency severity , urge frequency , and urge urinary incontinence episodes and increased the average volume per void at weeks 1 , 4 , and 12 . All effects occurred by the end of week 1 and all improved and were sustained throughout the 12-week study . Adverse events included dry mouth and constipation . CONCLUSIONS Trospium chloride had significant and sustained effectiveness beginning at the end of week 1 and continuing through 12 weeks of treatment . Trospium chloride was also safe and generally well tolerated PURPOSE The Study of Urgent PC vs Sham Effectiveness in Treatment of  Overactive Bladder Symptoms ( SUmiT ) was a multicenter , double-blind , r and omized , controlled trial comparing the efficacy of percutaneous tibial nerve stimulation to sham through 12 weeks of therapy . The improvement in global response assessment , voiding diary parameters , and overactive bladder and quality of life question naires was evaluated . MATERIAL S AND METHODS A total of 220 adults with overactive bladder symptoms were r and omized 1:1 to 12 weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy .  Overactive bladder and quality of life question naires as well as 3-day voiding diaries were completed at baseline and at 13 weeks . Subject global response assessment s were completed at week 13 . RESULTS The 13-week subject global response assessment for overall bladder symptoms demonstrated that percutaneous tibial nerve stimulation subjects achieved statistically significant improvement in bladder symptoms with 54.5 % reporting moderately or markedly improved responses compared to 20.9 % of sham subjects from baseline ( p < 0.001 ) . All individual global response assessment subset symptom components demonstrated statistically significant improvement from baseline to 13 weeks for percutaneous tibial nerve stimulation compared to sham .  Voiding diary parameters after 12 weeks of therapy showed percutaneous tibial nerve stimulation subjects had statistically significant improvements in frequency , nighttime voids , voids with moderate to severe urgency and urinary urge incontinence episodes compared to sham . No serious device related adverse events or malfunctions were reported . CONCLUSIONS This pivotal multicenter , double-blind , r and omized , sham controlled trial provides level I evidence that percutaneous tibial nerve stimulation therapy is safe and effective in treating overactive bladder symptoms . The compelling efficacy of percutaneous tibial nerve stimulation demonstrated in this trial is consistent with other recently published reports and supports the use of peripheral neuromodulation therapy for overactive bladder PURPOSE We analyze the efficacy of tolterodine extended release ( ER ) for overactive bladder in patients with severe incontinence . MATERIAL S AND METHODS Patients with urinary frequency ( 8 micturitions or greater per 24 hours ) , urge incontinence ( 5 episodes or greater a week ) and symptoms of overactive bladder for 6 months or greater were r and omized to treatment with 4 mg tolterodine ER once daily or placebo for 12 weeks . Severe incontinence was defined as 21 episodes or greater per week at baseline . Changes in the number of incontinence episodes per week and micturition frequency after 12 weeks were compared between treatments . RESULTS A total of 986 patients were eligible for this post-hoc analysis . After 12 weeks tolterodine ER produced a significant absolute median reduction in incontinence episodes per week compared to placebo ( 9.0 vs 5.0 , p < 0.0001 ) . For patients with severe incontinence at baseline median absolute and percentage reductions in incontinence episodes per week were significantly greater with tolterodine ER than placebo ( 21.0 vs 9.5 , p < 0.0001 ; 67.6 % vs 29.8 % , p = 0.022 ) . Micturition frequency decreased ( p < 0.02 ) and volume voided per micturition ( p < 0.0001 ) increased significantly more with tolterodine ER compared with placebo in these patients . For patients with nonsevere incontinence at baseline median reductions in incontinence episodes per week were also significantly greater with tolterodine ER than placebo ( 6.0 vs 4.0 , p < 0.0001 ; 71.4 % vs 38.5 % , p = 0.026 ) . CONCLUSIONS Patients with more severe incontinence at baseline achieved greater absolute reductions in incontinence with tolterodine compared to those with less severe symptoms . The degree of improvement , as measured by percent change , was comparable across the entire range of baseline incontinence severity strata . Benefits of antimuscarinic therapy may be greater in these patients than previously reported OBJECTIVE To assess the efficacy of physiotherapeutic treatment modalities in women with proven bladder overactivity . METHODS One hundred and twelve women received ambulatory urodynamics .  Based on both urodynamic variables of ambulatory cystometry ( ACM ) and the micturition diary , the Detrusor Activity Index ( DAI ) for each patient was calculated . After r and omization , 68 women with a DAI > or = 0.50 were defined as having proven bladder overactivity . In a single blinded RCT patients were r and omized over four treatment groups , i.e. lower urinary tract exercises ( LUTE ) ; office- and home-based functional electrostimulation ( FES ) ; office-based FES and LUTE ; no treatment . Patients treated received nine treatment sessions , once weekly . The primary outcome variable was the DAI , measured before r and omization and , as soon as possible within a maximum of 14 days after the end of the study period . RESULTS Intention to treat analysis in the group of 68 patients showed a statistically significant decrease of DAI-scores in the FES group ( p=0.032 ) in comparison with no treatment , while this decrease was not statistically significant in the LUTE group ( p=0.105 ) and the LUTE+FES group ( p=0.672 ) . CONCLUSIONS Our conclusion is that , based on the DAI , in the homogeneous set of 68 patients , only FES seemed to be effective PURPOSE We report the long-term efficacy and safety of percutaneous tibial nerve stimulation with the Urgent ® PC Neuromodulation System for overactive bladder after 3 years of therapy . MATERIAL S AND METHODS Fifty participants in the r and omized , double-blind SUmiT ( Sham Effectiveness in Treatment of Overactive Bladder Symptoms ) Trial who met the primary effectiveness end point after 12 weekly percutaneous tibial nerve stimulation treatments were enrolled in this prospect i ve study to assess long-term outcomes with percutaneous tibial nerve stimulation . STEP ( Sustained Therapeutic Effects of Percutaneous Tibial Nerve Stimulation ) Study patients were prescribed a fixed schedule 14-week tapering protocol followed by a personal treatment plan aim ed at sustaining overactive bladder symptom improvement . Overactive bladder and quality of life question naires were completed every 3 months and 3-day voiding diaries were completed every 6 months . RESULTS A total of 29 patients completed the 36-month protocol and received a median of 1.1 treatments per month after a 14-week treatment tapering protocol . A Bayesian model estimated that 77 % ( 95 % CI 64 - 90 ) of patients maintained moderate or marked improvement in overactive bladder symptoms at 3 years . Compared to baseline , median voids per day decreased from 12.0 ( IQR 10.3 - 13.7 ) to 8.7 ( IQR 7.3 - 11.3 ) , nighttime voids per night decreased from 2.7 ( IQR 1.7 - 3.3 ) to 1.7 ( IQR 1.0 - 2.7 ) and urge incontinence episodes per day decreased from 3.3 ( IQR 0.7 - 6.0 ) to 0.3 ( IQR 0.0 - 1.0 ) ( all p < 0.0001 ) . All quality of life parameters remained markedly improved from baseline through 3 years ( all p < 0.0001 ) . One patient experienced 2 mild treatment related adverse events of bleeding at the needle site during followup . CONCLUSIONS Most STEP participants with an initial positive response to 12 weekly percutaneous tibial nerve stimulation treatments safely sustained overactive bladder symptom improvement to 3 years with an average of 1 treatment per month
Pelvic floor exercises are more effective in subjective and objective outcomes with biofeedback or verbal feedback .
Weight loss with diet and exercise , caffeine reduction , 25 - 50 % reduction in fluid intake , and pelvic floor muscle exercises with verbal instruction and or biofeedback were all efficacious .
Botulinum toxin A improves urge incontinence episodes , urgency , frequency , quality of life , nocturia , and urodynamic testing parameters .
Acupuncture  improves quality of life and urodynamic testing parameters .
Extracorporeal magnetic stimulation improves urodynamic parameters .
Mirabegron improves daily incontinence episodes , nocturia , number of daily voids , and urine volume per void , whereas solabegron improves daily incontinence episodes .
Short-term posterior tibial nerve stimulation is more efficacious than pelvic floor muscle training exercises and behavioral therapy for improving : urgency , urinary incontinence episodes , daily voids , volume per void , and overall quality of life .
Sacral neuromodulation is more efficacious than antimuscarinic treatment for subjective improvement of overactive bladder and quality of life .
Transvaginal electrical stimulation demonstrates subjective improvement in overactive bladder symptoms and urodynamic parameters .
Multiple therapies , including physical therapy , behavioral therapy , botulinum toxin A , acupuncture , magnetic stimulation , mirabegron , posterior tibial nerve stimulation , sacral neuromodulation , and transvaginal electrical stimulation , are efficacious in the treatment of overactive bladder
The purpose of the study was to determine the efficacy and safety of nonantimuscarinic treatments for overactive bladder .