Overactive bladder syndrome (OAB) is highly prevalent among women and has a negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities.
To provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome.
The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. The risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions, and quality of evidence was assessed using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A meta-analysis was performed where appropriate.
Antimuscarinics and beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists being more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events. Onabotulinumtoxin-A (Onabot-A) was more effective than placebo across most outcomes, but with significantly higher rates of acute urinary retention/clean intermittent self-catheterisation (six to eight times) and urinary tract infections (UTIs; two to three times). Onabot-A was also significantly better than antimuscarinics in the cure of urgency urinary incontinence (UUI) but not in the reduction of mean UUI episodes. Success rates of sacral nerve stimulation (SNS) were significantly higher than those of antimuscarinics (61% vs 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% vs 10%). SNS was associated with 9% removal rate and 3% revision rate.
Overactive bladder is a manageable condition, with first-line treatment options including antimuscarinics, beta-3 agonists, and posterior tibial nerve stimulation. Second-line options include Onabot-A bladder injections or SNS. The choice of therapies should be guided by individual patient factors.
Overactive bladder is a manageable condition. All patients should be informed and advised on conservative treatment measures in the first instance. The first-line treatment options for its management include antimuscarinics or beta-3 agonists medication, and posterior tibial nerve stimulation procedures. The second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation procedure. The therapy should be chosen based on individual patient factors.
European urology. 2023 Jun 16 [Epub ahead of print]
Fawzy Farag, Vasileios I Sakalis, Serenella Monagas Arteaga, Néha Sihra, Markos Karavitakis, Salvador Arlandis, Kari Bø, Hanny Cobussen-Boekhorst, Elisabetta Costantini, Monica de Heide, Jan Groen, Benoit Peyronnet, Veronique Phé, Mary-Lynne van Poelgeest-Pomfret, Tine W L van den Bos, Huub van der Vaart, Christopher K Harding, Marie Carmela Lapitan, Muhammad Imran Omar, Arjun K Nambiar
Department of Urology, Sohag University Hospital, Sohag, Egypt., Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece., Department of Urology, University Hospital of San Agustín, Avilés, Spain., Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Department of Urology, Lefkos Stavros Clinic, Athens, Greece., Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain., Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway., Department of Urology, Radboud UMC, Nijmegen, The Netherlands., Department of Medicine and Surgery, University of Perugia, Perugia, Italy., Bekkenbodem4All, Tiel, The Netherlands., Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands., Department of Urology, University of Rennes, Rennes, France., Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France., World Federation of Incontinence and Pelvic Problems (WFIPP), Leiden, The Netherlands., Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands., Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK., College of Medicine/Philippine General Hospital/National institutes of Health, University of the Philippines Manila, Manila, Philippines., University of Aberdeen, Aberdeen, UK; European Association of Urology, Arnhem, The Netherlands., Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. Electronic address: .