An overactive bladder online self-management program with embedded avatars: a randomized controlled trial of efficacy. Impact of a health education intervention in overactive bladder patients. Transcutaneous posterior tibial nerve stimulation in pediatric overactive bladder: A preliminary report. Management of refractory overactive bladder in children by transcutaneous posterior tibial nerve stimulation: A controlled study. Estimating a preference-based single index from the Overactive Bladder Questionnaire. Results of a prospective, randomized, multicenter study evaluating sacral neuromodulation with InterStim therapy compared to standard medical therapy at 6-months in subjects with mild symptoms of overactive bladder. Phase III, randomised, double‐blind, placebo‐controlled study of the β3‐adrenoceptor agonist mirabegron, 50 mg once daily, in Japanese patients with overactive bladder Patient-reported outcomes in patients with overactive bladder treated with mirabegron and tolterodine in a prospective, double-blind, randomized, two-period crossover, multicenter study (PREFER) Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Psychometric validation of an overactive bladder symptom and health-related quality of life questionnaire: The OAB-q Coping strategies and health care-seeking behavior in a US national sample of adults with symptoms suggestive of overactive bladder. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. OnabotulinumtoxinA for the Treatment of Patients with Overactive Bladder and Urinary Incontinence: Results of a Phase 3, Randomized, Placebo Controlled Trial Indirect treatment comparison (ITC) of medical therapies for an overactive bladder. Time to onset of improvement in symptoms of overactive bladder using antimuscarinic treatment
OBJECTIVE To determine whether an avatar-based , online , self-management program is an effective therapeutic approach for women with overactive bladder ( OAB ) . OAB is a highly prevalent symptom complex that significantly impacts health-related quality of life ( HRQOL ) . Behavioral interventions can produce substantial improvement in symptoms and HRQOL . Online education programs offer patients with OAB an alternative to face-to-face self-management instruction . Evidence suggests that avatars ( digital humans ) embedded into online programs may help persuade and motivate patients to adopt healthy behaviors . METHODS In a 12-week , r and omized , controlled trial , women ( aged > 55 years ) with symptoms of OAB for at least 3 months were r and omized to 2 versions of a 3-part , online , self-management program . After collecting the baseline metrics , the intervention group viewed a generic avatar coach with a self-avatar peer mentor design ed to resemble the participant , and the control group viewed the identical online program with voice only . Participants viewed part 1 at week 1 and parts 2 and 3 at week 6 . Participants completed daily bladder diaries throughout the 12-week period and OAB-related outcome measures at weeks 1 , 6 , and 12 . RESULTS Forty-one women completed the study ( mean age = 61 years , st and ard deviation = 6 ) . The analysis of covariance of week-12 outcome measures with the baseline as covariates demonstrated significant improvements in the intervention group in OAB question naire HRQOL ( P = .02 ; large effect ) , 24-hour frequency ( P < .001 ; large effect ) , night-time urination ( P < .001 ; large effect ) , urgency ( P < .001 ; large effect ) , and urge incontinence ( P < .001 ; large effect ) . CONCLUSION An avatar-based intervention embedded into an online self-management program improved OAB HRQOL and symptoms in women OBJECTIVE To assess a st and ardized and simple educational intervention in overactive bladder ( OAB ) patients to improve compliance with anticholinergic medication , increase the use of concomitant behavioral treatments , and improve patients ' perception of bladder symptoms . MATERIAL S AND METHODS This is a 16-week open-label r and omized trial of tolterodine combined with an education intervention for the experimental group versus tolterodine alone ( no intervention ) for the control group . The setting was in family medicine and urology clinics in Ontario . The participants were male and female adults with OAB symptoms . Both groups received tolterodine prescriptions . The intervention patients received printed information and an explanation about OAB , medication use , and behavioral treatments ( kegel exercise , bladder stretching , fluid regulation ) . The primary outcomes were medication compliance and persistence at 16 weeks . Secondary outcomes were use of behavioral treatments and self-reported severity of symptoms . RESULTS More patients in the intervention group ( experimental ) purchased their prescriptions ( p<0.05 ) . Compliance rate was greater for the intervention group ( 39 % ) , versus the control group ( 31 % ) at 16 weeks although the difference was not significant ( p>0.05 ) . Significantly more patients started and /or continued non-drug treatments in the intervention group ( 82 % ) compared to the control group ( 53 % ) ( p<0.05 ) . Furthermore , more patients in this group reported improvement in severity of bladder symptoms ( p<0.05 ) . CONCLUSIONS The simple education intervention result ed in a greater , but not significant , increase in compliance with medication compared to the control group . It also result ed in a significantly increased use of behavior modification therapies and better self-perception of treatment outcome BACKGROUND Non-neurogenic overactive bladder ( OAB ) is a common problem in children that may affect their quality of life . Various methods of neuromodulation have been reported to treat refractory lower urinary tract dysfunction . Since most of these techniques are invasive , they are less applicable in children . OBJECTIVE To evaluate the efficacy of transcutaneous PTNS in treatment of OAB in children , in a r and omized clinical setting . STUDY DESIGN This study was single-blinded , prospect i ve , sham controlled r and omized trial . 40 children with non-neurogenic OAB refractory to behavioural and anticholinergic therapy were r and omized either to test group or sham group . Neuromodulation was performed using two self-adhesive electrodes cephalad to medial malleolus . In test group the stimulation was given with voltage pulse intensity of 0 to 10 mA , pulse width of 200 μs and frequency of 20 Hz . In sham group patch electrodes were applied to simulate the test group but no stimulation was given . In both groups , weekly session of 30 min was given for a period of 12 weeks . The OAB symptoms , severity of incontinence , number of voids daily ( NV ) , average voided volume ( AVV ) and maximum voided volume ( MVV ) were evaluated before and after treatment . RESULTS On assessment of subjective improvement of OAB symptoms , 66.66 % patients reported cure and 23.81 % patients reported significant improvement of symptoms in test group whereas in sham group only 6.25 % patients reported significant improvement . In test group 71.42 % patients reported complete improvement in incontinence whereas in sham group only 12.5 % patient reported complete improvement . The AVV , MVV and NV improved significantly in test group ( p < 0.001 ) as compared to sham group ( Table ) . DISCUSSION The present study is unique as none of the earlier studies in children were sham controlled . It is also first PTNS study in which patch electrodes were used ; therefore it is completely noninvasive . This technique provides better patient acceptability and compliance . This study proved that , there is a definite effect of PTNS as compared to placebo because when patients from sham group were treated actively , they responded well . The present study has few limitations as it has relatively short follow-up period of 12 weeks . Relapse of OAB symptoms and maintenance schedule of PTNS need to be assessed further . CONCLUSION Transcutaneous PTNS is superior to placebo in treatment of non-neurogenic overactive bladder in children . In view of its effectiveness and acceptability we believe that transcutaneous PTNS should be part of pediatric urology armamentarium for treatment of OAB OBJECTIVE To assess the objective efficacy of transcutaneous posterior tibial nerve stimulation in children presenting with overactive bladder resistant to well conducted treatment . MATERIAL AND METHOD This was a r and omized , double-blind , controlled study on 20 children with OAB . All patients were previously treated with anticholinergic drugs associated with detrusor rehabilitation , diet advice , bladder-voiding hygiene and constipation treatment , with poor clinical results . Patients were r and omized into two groups : -Group A : treatment with PTNS ( n = 11 ) . -Group B : sham treatment  ( n = 9 ) . The program lasted 12 consecutive weeks with two 30-minutes sessions a week . Each patient underwent pre-stimulation urodynamic testing to vali date bladder overactivity followed by a post-stimulation testing . Pre- and post-stimulation urodynamic parameters were compared in order to objective ly evaluate the treatment 's efficacy . The patients noted their incontinence episodes for 7 consecutive days in a diary before the beginning of the program , in the middle and at the end of it : this led to computing an incontinence score ( score ranged from 0 to 13 , from good to poor ) . The difference between the pre-stimulation and post-stimulation score enabled to express clinical results in terms of poor ( less than a 3-point decrease ) , medium ( a 3 to 5-point decrease ) , good ( 6 to 8-point decrease ) , very good ( final score ranged between 0 and 3 ) . Children were question ed regarding their impression of being stimulated or not . RESULTS In Group A , there were five very good clinical results ( 45 % ) , one medium ( 10 % ) and five poor results ( 45 % ) . In group B , nine very good results ( 66 % ) and three poor results ( 33 % ) were noted . Regarding urodynamic testing , volume voided during urgency ( 184 mL to 265 mL ) , maximal cystomanometry volume ( 215 mL to 274 mL ) and volume at the onset of the first overactive detrusor contraction ( ODC ) ( 48 mL to 174 mL ) were significantly increased in Group A ( p = 0.002 , p = 0.024 and p = 0.001 ) and maximal bladder pressure during ODC had decreased ( 61 to 46 ) ( p = 0.042 ) . 85 % children in group A thought they were being stimulated vs. 70 % in group B. CONCLUSION Even though we noticed urodynamics improvements in group A , which objective ly supports the efficacy of TCTPNS , clinical results remained the same between the two groups . In spite of the small size of our sample , this underlines the placebo effect of any type management in this pediatric population . Study ing precisely the maximal useful voltage and duration of stimulation should then be relevant in order to yield maximal benefits from this easy-to-use procedure OBJECTIVES The aim of the study is to estimate a preference-based single index for calculating quality -adjusted life years for patients with overactive bladder ( OAB ) , based on a survey of the UK general population using the 5-dimensional health classification system OAB-5D , derived from the vali date d Overactive Bladder Question naire ( OAB-q ) . METHODS An interview valuation survey of members of public in the South Yorkshire , UK was undertaken using the time-trade-off method . Each respondent was r and omly allocated to one of 14 blocks , and valued seven states each plus the " pits " state , so that a total of 99 states were valued . A number of multivariate regression models were estimated for predicting a total of 3125 health state values defined by the classification . Models were compared and selected using a set of criteria , including overall diagnosis by adjusted R-squared , the sign and significance of individual parameter estimates , the relative size of coefficients within a given dimension and predictive ability . RESULTS The mean model was recommended for use in economic evaluation . CONCLUSION This will permit the cost-effectiveness of new interventions to be assessed in patients with OAB using existing and future OAB-q data sets AIMS This prospect i ve , r and omized , multicenter trial evaluated the 6-month success rate of sacral neuromodulation ( SNM ) with InterStim ® Therapy versus st and ard medical therapy ( SMT ) for overactive bladder ( OAB ) . METHODS Enrolled subjects discontinued OAB medications prior to and during baseline data collection and were r and omized 1:1 to SNM or SMT . Subjects had bothersome symptoms of overactive bladder ( OAB ) including urinary urge incontinence ( ≥2 leaks/72 hr ) and /or urgency-frequency ( ≥8 voids/day ) . Subjects failed at least one anticholinergic medication , and had at least one medication not yet attempted . The primary objective was to compare OAB therapeutic success rate at 6 months between SNM and SMT . RESULTS Overall , 147 subjects were r and omized ( 70 to SNM and 77 to SMT ) ; 93 % were female and mean age was 58 . The primary intent to treat analysis showed OAB therapeutic success was significantly greater in the SNM group ( 61 % ) than the SMT group ( 42 % ; P = 0.02 ) . In the as treated analysis , OAB therapeutic success was 76 % for SNM and 49 % for SMT ( P = 0.002 ) . The SNM group showed significant improvements in quality of life versus the SMT group ( all P < 0.001 ) and 86 % of SNM subjects reported improved or greatly improved urinary symptom interference score at 6 months , compared to 44 % for SMT subjects . The device-related adverse event rate was 30.5 % and the medication-related adverse event rate was 27.3 % . CONCLUSIONS This study demonstrates superior objective and subjective success of SNM compared to SMT . SNM is shown to be a safe and effective treatment for OAB patients with mild to moderate symptoms . Neurourol . Urodynam . 34:224 - 230 , 2015 . © 2014 Wiley Periodicals , To evaluate the efficacy and safety of the β3‐adrenoceptor agonist mirabegron , in a Japanese population with overactive bladder ( OAB ) Background The PREFER study was an assessment of medication tolerability , treatment preference and symptom improvement during treatment with mirabegron ( M ) and tolterodine ( T ) extended release ( ER ) in patients with overactive bladder ( OAB ) . In this analysis of PREFER , patient-reported outcomes ( PROs ) were assessed during treatment . Methods PREFER was a two-period , 8-week crossover , double-blind , phase IV study ( NCT02138747 ) of treatment-naïve adults with OAB ≥3 months r and omized to 1 of 4 treatment sequences ( M/T ; T/M ; M/M ; T/T ) , separated by a 2-week washout . Tolterodine ER was dosed at 4 mg for 8 weeks and mirabegron was dosed at 25 mg for 4 weeks then increased to 50 mg for the next 4 weeks . At each visit , PROs related to treatment satisfaction , quality of life and symptom bother were assessed using the OAB Satisfaction ( OAB-S ; 3 independent scales/5 single-item overall assessment s ) , OAB-q ( total health-related QoL [ HRQoL ] and subscales [ Sleep , Social , Coping , Concern ] and Symptom Bother scale ) and Patient Perception of Bladder Condition ( PPBC ) question naires . Responder rates were reported for OAB-q subscales based on a minimal important difference ( MID ; ≥ 10-point improvement ) and OAB-S Medication Tolerability score ≥ 90 . Results In total , 358 r and omized patients received ≥1 dose of double-blind study medication and completed ≥1 post-baseline value ( OAB-S scale , OAB-q , PPBC ) : M/T ( n = 154 ) , T/M ( n = 144 ) , M/M ( n = 30 ) or T/T ( n = 30 ) . At end of treatment ( EoT ) , mirabegron and tolterodine ER were associated with similar mean improvements in 7 of the 8 OAB-S scores investigated , OAB-q scales and PPBC . A higher percentage of patients achieved clinical ly relevant improvements ( MID ) in OAB-q scales and OAB-S Medication Tolerability score during treatment with mirabegron than tolterodine ER . Conclusions On average , patients with OAB experienced improvements in treatment satisfaction , HRQoL and symptom bother that were of a similar magnitude during treatment with mirabegron or tolterodine ER . However , during mirabegron treatment , patients were more likely to achieve clinical ly relevant improvements in tolerability and HRQoL ( as measured by the MID for the OAB-q or an OAB-S Medication Tolerability score ≥ 90 ) than during tolterodine ER treatment . Trial registration NCT02138747 ; registered May 13 , 2014 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 Objective : Overactive bladder ( OAB ) is characterized by symptoms of urinary frequency and urgency , with and without incontinence , and has been shown to have significant impact on health-related quality of life ( HRQL ) . Currently , no OAB-specific question naires exist to evaluate all symptoms of OAB ; thus we sought to evaluate the psychometric properties of a newly developed OAB HRQL question naire . Methods : The 33-item , self-administered OAB-q contains a symptom bother and HRQL scale . Both the OAB-q and SF-36 were completed by participants from two sources : ( 1 ) a community sample who screened positive for OAB in a r and om-digit dial telephone survey and participated in a clinical validation study ( n = 254 ) ; and ( 2 ) a clinical study of patients ' seeking treatment for OAB symptoms ( baseline assessment ) ( n = 736 ) . Item and exploratory factor analysis were performed to assess the subscale structure of the question naire . Psychometric evaluation was conducted to assess reliability and validity . Results : Seventy-four percent of the sample were women with mean age of 58.5 . Participants with continent and incontinent symptoms reported significantly greater symptom bother and HRQL impact than normal participants . Significant differences were present among all patient groups in all OAB-q subscales ( p < 0.0001 ) except sleep where the impact of continent and incontinent OAB was similar , but significantly worse than normal participants ( p < 0.0001 ) . Internal consistency was high with the subscale Cronbach α-values ranging from 0.86 to 0.94 . Conclusion : The OAB-q is a reliable and valid instrument that discriminates between normal and clinical ly diagnosed continent and incontinent OAB participants . The OAB-q demonstrates that both continent and incontinent OAB symptoms cause significant symptom bother and have a negative impact on HRQL BACKGROUND Although millions of individuals have symptoms suggestive of overactive bladder ( OAB ) , few ever seek or receive medical treatment for their condition . OBJECTIVE The purpose of this study was to describe coping strategies and health care-seeking behavior in a community-based sample of adults with symptoms suggestive of OAB . METHODS A cross-sectional household telephone survey of an age- and sex-stratified sample of adults was conducted . The survey consisted of general health-related questions as well as questions related to OAB symptoms . A total of 4896 adults completed the interview Respondents were considered to have OAB if they reported > or = 1 symptom of urinary urgency , frequency , or urge incontinence . A follow-up question naire was then mailed to a sub sample of the telephone interview respondents . The mailed question naire contained questions related to type and severity of OAB symptoms , coping strategies , medical care/treatment , feelings/beliefs about OAB , and quality of life . Half of the phone respondents with urinary incontinence ( n = 638 ) and a r and om sample of all other phone respondents received the mailed question naire ( n = 873 ) ; 1,034 question naires were returned . RESULTS Of the respondents with OAB , 69.6 % tried > or = 1 nonmedical coping strategy .  Respondents with incontinent OAB were significantly more likely than those with continent OAB or those with no OAB ( controls ) to use nonmedical coping strategies ( incontinent OAB , 76.1 % ; continent OAB , 59.0 % ; controls , 31.9 % ; P < 0.001 ) . Fewer than half of the respondents with OAB ( 43.5 % ) had spoken with a provider about OAB in the previous 12 months . Medical consultation was associated with sex , type and severity of OAB , number of nonmedical coping strategies tried , number of OAB information sources consulted , inclination to try new OAB medications , and feelings/beliefs about OAB . In 90 % of patient-provider discussion s about OAB , the patient initiated the topic . CONCLUSIONS Individuals manage symptoms suggestive of OAB primarily by using nonmedical coping strategies rather than consulting health care providers . Results of this study support the need for improved clinical recognition of OAB and increased patient-provider communication about this condition BACKGROUND Overactive bladder ( OAB ) syndrome with urinary incontinence ( UI ) is prevalent in the population and impairs health-related quality of life ( HRQOL ) . OBJECTIVE To assess the impact on efficacy , safety , and HRQOL of onabotulinumtoxinA ( BOTOX ( ® ) , Allergan , Inc. ) treatment in patients with OAB with UI . DESIGN , SETTING , AND PARTICIPANTS This pivotal , multicentre , double-blind , r and omised , placebo-controlled , phase 3 study enrolled patients with idiopathic OAB with ≥ 3 urgency UI episodes over 3 d and ≥ 8 micturitions per day who were inadequately managed by anticholinergics . INTERVENTION OnabotulinumtoxinA at a 100U dose ( n=277 ) or placebo ( n=271 ) , administered as 20 intradetrusor injections of 0.5 ml . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Co- primary end points were change from baseline in the number of UI episodes per day and proportion of patients reporting positive treatment response on the treatment benefit scale ( TBS ) at week 12 . Additional end points included other OAB symptoms ( episodes of urinary urgency incontinence , micturition , urgency , and nocturia ) and HRQOL ( Incontinence Quality of Life [ I-QOL ] , King 's Health Question naire [ KHQ ] ) . Safety assessment s included adverse events ( AEs ) , postvoid residual ( PVR ) urine volume , and initiation of clean intermittent catheterisation ( CIC ) . RESULTS AND LIMITATIONS OnabotulinumtoxinA significantly decreased UI episodes per day at week 12 ( -2.95 for onabotulinumtoxinA versus -1.03 for placebo ; p<0.001 ) . Reductions from baseline in all other OAB symptoms were also significantly greater following onabotulinumtoxinA compared with placebo ( p ≤ 0.01 ) . Patients perceived a significant improvement in their condition , as measured by patients with a positive treatment response on the TBS ( 62.8 % for onabotulinumtoxinA versus 26.8 % for placebo ; p<0.001 ) . Clinical ly meaningful improvements from baseline in all I-QOL and KHQ multi-item domains ( p<0.001 versus placebo ) indicated positive impact on HRQOL . AEs were mainly localised to the urinary tract . Mean PVR was higher in the onabotulinumtoxinA group ( 46.9 ml versus 10.1 ml at week 2 ; p<0.001 ) ; 6.9 % of onabotulinumtoxinA patients versus 0.7 % of placebo patients initiated CIC . CONCLUSIONS OnabotulinumtoxinA 100 U was well tolerated and demonstrated significant and clinical ly relevant improvements in all OAB symptoms , patient-reported benefit , and HRQOL in patients inadequately managed by anticholinergics . TRIAL REGISTRATION Clinical Trials.gov : NCT00910520 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 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 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 BACKGROUND Overactive bladder syndrome ( OAB ) is a chronic and prevalent condition which has a negative impact on Quality of Life . The National Institute of Clinical Excellence issued two documents which give slightly varying algorithms of pharmacotherapy for OAB , offering mirabegron as a possible treatment in certain circumstances . In the absence of trials involving a direct comparison of therapies , an indirect comparison can provide useful information on the difference in treatment effects between competing interventions . OBJECTIVE To compare effectiveness of available medical therapies for OAB using Bucher indirect treatment comparison ( ITC ) model . METHODS A systematic literature search identified r and omised controlled trials ( RCT ) assessing effectiveness of drugs for OAB versus placebo . Then indirect comparisons of the treatments effects were made , preserving the r and omisation of the originally assigned patient groups , using Bucher method . MAIN RESULTS 25 RCTs met inclusion criteria . In keeping with ITC method validity , four assessment s were undertaken of mirabegron against anticholinergics , which were number of incontinence episodes , micturition episodes , urgency episodes in 24 h and volume of micturition . This indirect treatment analysis suggests that mirabegron is as effective as anticholinergics in managing of OAB , except for solifenacin which appears to be superior . CONCLUSIONS These findings suggest that work looking into treatment choice should be individualized to patient characteristics rather than fitting patients to a treatment . Further work is required to identify what patient characteristics may be crucial and indicate that studies exploring the most effective sequence of managing treatment naïve patients and those with refractory disease To evaluate the time to onset of statistically significant and clinical ly meaningful effects of trospium chloride in patients with an overactive bladder ( OAB )
No significant difference was found between other treatments .
Conclusion Compared with antimuscarinic drugs , PTENS was associated with significant better efficacy considering MVV , but more constipation events in de novo OAB children .
Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy .
Objective To compare these managements focusing on the efficacy and safety to treat overactive bladder ( OAB ) in children through network meta- analysis ( NMA ) .