For OAB in Men, Try Behavioral Therapy First, Researchers Say

By Megan Brooks

January 22, 2020

NEW YORK (Reuters Health) - For men with overactive bladder, behavioral therapy alone may be the best first step in addressing the problem, researchers say.

In a randomized controlled trial, they found that combining behavioral and drug therapy led to greater improvement in OAB symptoms compared to drug therapy alone, but not compared to behavioral therapy alone.

"When using a stepped approach, it is reasonable to begin with behavioral therapy alone, not just because of the better adverse effect profile but also because behavioral therapy yields better 6-week outcomes than drug therapy and, thus, results are achieved more quickly than starting with drug therapy alone," Dr. Kathryn Burgio from University of Alabama at Birmingham and colleagues said in JAMA Internal Medicine.

"A stepped approach starting with behavioral therapy alone allows patients to evaluate its effect before discussing with their clinicians the advantages and disadvantages of adding drugs with accompanying adverse effects for a small degree of additional improvement," they add.

Prior research has shown that combining behavioral and drug therapy improves outcomes in women with OAB, but less is known about the effects in men with OAB.

To investigate, the research team randomly assigned 204 men aged 40 and older with OAB and an average of nine voids or more every 24 hours to six weeks of behavioral training alone, drug therapy alone, or combined behavioral and drug therapy.

Behavioral training included pelvic floor muscle training with urge suppression strategies, and fluid restriction for nocturia. Drug therapy included an antimuscarinic (sustained-release tolterodine, 4 mg, once daily) and an alpha-blocker (tamsulosin, 0.4 mg, once daily before bed). Following the first six weeks of treatment, men receiving monotherapy were stepped up to combined behavioral and drug therapy for another six weeks.

In intent-to-treat analyses, after six weeks of treatment, average voids per day were significantly lower with combined therapy compared with drug therapy alone (8.2 vs 10.3; P<0.001) but not significantly lower compared with behavioral therapy alone (8.2 vs 8.8; P=0.19).

Average voids per day were also lower for behavioral therapy alone compared with drug therapy alone (8.8 vs 10.3; P<0.001).

At 12 weeks, after all men received combined therapy, outcomes tended to be better for men who initially received combined therapy, but there were no significant group differences.

In email to Reuters Health, Dr. Burgio said, "Although behavioral treatments are recommended as a first-line therapy for these symptoms, they are not as readily available in clinical practices. Knowing that there is benefit to combining behavioral and drug therapies provides a rationale for providers to integrate behavioral components into practice, giving patients more options in shared decision-making."

"Behavioral therapy can be implemented by nurses, nurse practitioners, and physical therapists and has potential for widespread application in a variety of outpatient settings," the research team notes in their paper.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCE: JAMA Internal Medicine, online January 13, 2020.