[Comparisons of efficacy and safety of tolterodine and oxybutynin in children with idiopathic overactive bladder]. Efficacy, safety and tolerability of fesoterodine for overactive bladder syndrome. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. Once daily trospium chloride is effective and well tolerated for the treatment of overactive bladder: results from a multicenter phase III trial. Tolerability of 5 mg solifenacin once daily versus 5 mg oxybutynin immediate release 3 times daily: results of the VECTOR trial. Bladder base/trigone injection is safe and as effective as bladder body injection of onabotulinumtoxinA for idiopathic detrusor overactivity refractory to antimuscarinics. Results of a randomized phase III trial of mirabegron in patients with overactive bladder. Tolterodine: superior tolerability than and comparable efficacy to oxybutynin in individuals 50 years old or older with overactive bladder: a randomized controlled trial. Efficacy and safety of transdermal oxybutynin in patients with urge and mixed urinary incontinence. Tolterodine reduces the number of urge incontinence episodes in patients with an overactive bladder. Safety and efficacy of mirabegron as ‘add‐on’ therapy in patients with overactive bladder treated with solifenacin: a post‐marketing, open‐label study in Japan (MILAI study) Efficacy and safety of flexible dose fesoterodine in men and women with overactive bladder symptoms including nocturnal urinary urgency. OnabotulinumtoxinA for the Treatment of Patients with Overactive Bladder and Urinary Incontinence: Results of a Phase 3, Randomized, Placebo Controlled Trial OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. Efficacy and safety of combinations of mirabegron and solifenacin compared with monotherapy and placebo in patients with overactive bladder (SYNERGY study) Phase III, randomised, double‐blind, placebo‐controlled study of the β3‐adrenoceptor agonist mirabegron, 50 mg once daily, in Japanese patients with overactive bladder Clinical Efficacy and Safety of Tolterodine Compared to Oxybutynin and Placebo in Patients with Overactive Bladder Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics. Simplified bladder training augments the effectiveness of tolterodine in patients with an overactive bladder Tolterodine: as effective but better tolerated than oxybutynin in Asian patients with symptoms of overactive bladder.
OBJECTIVE To compare the efficacy and safety of tolterodine and oxybutynin in the treatment of idiopathic overactive bladder in children . METHODS A total of 204 children with idiopathic overactive bladder were r and omly divided into three groups ( n=68 each ) : placebo , tolterodine-treated and oxybutynin-treated . The efficacy and safety were evaluated two weeks after treatment . RESULTS The effective rate was 25 % in the placebo group , 89 % in the tolterodine-treated group , and 92 % in the oxybutynin-treated group . The effective rate in the two treatment groups was significantly higher than that in the placebo group ( P<0.05 ) . There was a similar efficacy between the two treatment groups . The incidence of adverse events in the tolterodine-treated group ( 28 % ) was significantly lower than that in the oxybutnin-treated group ( 57 % ) ( P<0.05 ) . CONCLUSIONS Tolterodine has a similar efficacy to oxybutynin in the treatment of idiopathic overactive bladder in children , with better safety in pharmacotherapy PURPOSE We evaluated the efficacy , tolerability and safety of the new antimuscarinic agent fesoterodine relative to placebo for overactive bladder syndrome . MATERIAL S AND METHODS This was a r and omized , double-blind , placebo controlled , multicenter trial performed in the United States . Overall 836 subjects with urinary frequency , urinary urgency or urgency urinary incontinence were r and omized to placebo ( 274 ) , 4 mg fesoterodine ( 283 ) or 8 mg fesoterodine ( 279 ) once daily for 12 weeks . The primary efficacy end point was the change in the number of micturitions per 24 hours . Co- primary end points were the change in the number of urgency urinary incontinence episodes per 24 hours and the treatment response . Secondary efficacy end points were other bladder diary variables , such as the change in mean voided volume per micturition , number of continent days and number of urgency episodes per 24 hours . Tolerability and safety were assessed by evaluating adverse events , electrocardiograms , post-void residual urine volume , laboratory parameters and treatment withdrawals . RESULTS Treatment with 4 or 8 mg fesoterodine result ed in statistically significant and clinical ly relevant improvements from baseline to end of treatment for the primary and co- primary end points compared with placebo ( p < 0.05 ) . Results for most secondary end points , including mean voided volume per micturition , number of continent days and number of urgency episodes per 24 hours , were also significantly improved vs placebo . The adverse events reported more frequently with fesoterodine than with placebo were dry mouth , constipation and urinary tract infection . CONCLUSIONS The 2 doses of fesoterodine were well tolerated and they statistically significantly improved overactive bladder symptoms 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 An extended release formulation of trospium chloride was recently developed for the once daily treatment of overactive bladder . We investigated the safety , efficacy and tolerability of 60 mg trospium chloride once daily . MATERIAL S AND METHODS Subjects with overactive bladder were r and omized 1:1 to receive 60 mg trospium chloride once daily or placebo in this 12-week multicenter , parallel , double-blind , placebo controlled trial . Primary end points were calculated changes in diary recorded daily urinary frequency and daily urgency urinary incontinence episodes . Secondary end points were urgency severity , volume voided per void and the number of urgency voids per day . Safety was assessed by clinical examination , adverse event monitoring , clinical laboratory values and resting electrocardiograms . RESULTS Overall 601 subjects were prescribed  trospium once daily ( 298 ) or placebo ( 303 ) . Trospium once daily treatment result ed in significant improvements over placebo in all primary and key secondary efficacy outcomes at weeks 1 through 12 . The most common adverse events were dry mouth  ( trospium 8.7 % vs placebo 3 % ) and constipation  ( trospium 9.4 % vs placebo 1.3 % ) . Central nervous system adverse events were rare ( headache with trospium 1.0 % vs placebo 2.6 % ) . No clinical ly meaningful changes in laboratory , physical examination or electrocardiogram parameters were noted . CONCLUSIONS Trospium once daily provided significant improvements in overactive bladder symptoms ( frequency , urgency urinary incontinence and urgency ) . Efficacy was similar to that seen previously with trospium chloride twice daily , while class effect anticholinergic adverse events occurred at comparatively low levels . Dry mouth was elicited at the lowest reported rate in the oral antimuscarinic drug class PURPOSE Although antimuscarinic treatment is indicated for overactive bladder , many patients discontinue it because of dry mouth . Of available antimuscarinics oxybutynin is associated with the highest dry mouth rate . We compared the safety and tolerability of 5 mg solifenacin vs 15 mg oxybutynin immediate release . MATERIAL S AND METHODS At 12 Canadian centers a total of 132 patients with overactive bladder symptoms ( greater than 1 urgency episode per 24 hours , and 8 or greater micturitions per 24 hours ) were r and omized to 5 mg solifenacin once daily or 5 mg oxybutynin 3 times daily for 8 weeks . The primary end point was the incidence and severity of dry mouth reported after direct question ing . Efficacy end points ( 3-day diary documented changes in urgency , frequency , incontinence , nocturia and voided volume ) , and changes on the Patient Perception of Bladder Condition scale and the Overactive Bladder Question naire were evaluated secondarily . RESULTS Of patients on solifenacin vs oxybutynin immediate release 35 % vs 83 % reported dry mouth ( p < 0.0001 ) . Of patients reporting dry mouth severity was grade d moderate by 13 % and 42 % of those on solifenacin and oxybutynin immediate release , and severe by 13 % and 28 % , respectively ( p = 0.001 ) . Patients in each group showed improvements in efficacy end points , and Patient Perception of Bladder Condition scale and Overactive Bladder Question naire scores from baseline to treatment end . CONCLUSIONS Significantly fewer patients on 5 mg solifenacin once daily reported dry mouth vs those receiving 5 mg oxybutynin immediate release 3 times daily . Significantly fewer patients on solifenacin reported moderate/severe dry mouth . Significantly fewer patients on solifenacin withdrew from study due to dry mouth and there were significantly fewer overall adverse events .  Solifenacin and oxybutynin immediate release were efficacious in decreasing efficacy end points , and improved Patient Perception of Bladder Condition scale and Overactive Bladder Question naire results from baseline to treatment end PURPOSE The purpose of this study was to evaluate the efficacy and safety of onabotulinumtoxinA injections at bladder base/trigone and compare with injections at bladder body or bladder body/trigone for the treatment of idiopathic detrusor overactivity ( IDO ) refractory to antimuscarinics . MATERIAL S AND METHODS A single blind , r and omized , paralleled , actively controlled trial was performed in patients with urodynamically proven IDO who failed antimuscarinic therapy . Patients were r and omly assigned to receive intravesical injections of 100 U of onabotulinumtoxinA into three different bladder sites . All treatments were evaluated by voiding diary variables , urgency severity score , urodynamic studies , and patient perception of bladder condition . Long-term success rates over 12 months were also determined . RESULTS Among the patients , 37 were r and omized to injections in the bladder body , 35 into the bladder body/trigone , and 33 into the bladder base/trigone . Successful results were reported in 76 ( 72 % ) patients at 3 months : 26 ( 70 % ) in the bladder body group , 26 ( 74 % ) in the bladder body/trigone group , and 24 ( 73 % ) in the bladder base/trigone group . There were no significant differences in success rates , changes in urgency and urgency incontinence episodes , urodynamic variables , or long-term success rates among the three subgroups . The incidence of adverse events was similar among three groups . No vesicoureteral reflux was noted in all patients with or without involving trigone injection . CONCLUSION Intravesical onabotulinumtoxinA injection is an effective treatment for IDO regardless of the bladder injection site . Bladder base/trigone injection is as safe and effective as bladder body injections with or without trigone involvement PURPOSE Many patients with overactive bladder discontinue pharmacotherapy due to suboptimal efficacy or side effects . Mirabegron , a β3-adrenoceptor agonist , may offer an effective and well tolerated alternative treatment for overactive bladder . MATERIAL S AND METHODS A r and omized , double-blind , placebo controlled trial was conducted in the United States and Canada . After a 2-week placebo run-in period , adults with overactive bladder symptoms for 3 or more months were r and omized 1:1:1 to receive placebo , 50 or 100 mg mirabegron once daily for 12 weeks . Efficacy data were collected via patient completed diaries and quality of life assessment s. Co- primary efficacy end points were changes from baseline to final visit in mean number of incontinence episodes per 24 hours and micturitions per 24 hours . Key secondary micturition and incontinence end points were also evaluated . Safety assessment s included treatment emergent adverse events , laboratory assessment s , vital signs , electrocardiograms and post-void residual volume . RESULTS Compared to placebo , 50 and 100 mg mirabegron groups demonstrated statistically significantly greater mean decreases ( 95 % CI ) from baseline for incontinence episodes ( -1.13 [ -1.35 , -0.91 ] , -1.47 [ -1.69 , -1.25 ] and -1.63 [ -1.86 , -1.40 ] ) and micturitions ( -1.05 [ -1.31 , -0.79 ] , -1.66 [ -1.92 , -1.40 ] and -1.75 [ -2.01 , -1.48 ] ) per 24 hours ( p < 0.05 ) . Significant improvements in all key secondary end points were observed for both mirabegron doses vs placebo . The incidence of frequently reported treatment emergent adverse events ( hypertension , urinary tract infection , headache , nasopharyngitis ) was similar in the mirabegron and placebo groups . Dry mouth was reported for 1.5 % , 0.5 % and 2.1 % of patients in the placebo , 50 and 100 mg mirabegron groups , respectively . CONCLUSIONS Once daily mirabegron in a 50 or 100 mg dose is an effective treatment for overactive bladder symptoms with a low occurrence of side effects PURPOSE We compared the tolerability and clinical efficacy of tolterodine with those of oxybutynin in patients with an overactive bladder using an upward oxybutynin dose titration strategy analogous to that used in routine clinical practice in the United Kingdom and Republic of Irel and . MATERIAL S AND METHODS In a r and omized double-blind trial 378 male and female patients 50 years old or older with symptoms of overactive bladder ( a urinary frequency of 8 or more voids per 24 hours with urgency and /or urge incontinence , that is 1 or more urge incontinence episodes per 24 hours ) received 10 weeks of treatment with 2 mg . tolterodine twice daily/or an initial dose of 2.5 mg . oxybutynin twice daily , increasing to 5 mg . twice daily after 2 weeks of treatment . The main outcome measures were changes in voiding diary variables combined with detailed tolerability-safety assessment s. RESULTS Patients treated with tolterodine had significantly fewer adverse events ( 69 % versus 81 % , p = 0.01 ) , notably dry mouth ( 37 % versus 61 % , p < 0.0001 ) , as well as a lower incidence of dose reduction ( 6 % versus 25 % , p < 0.0001 ) than those in the oxybutynin group . Each agent had comparable efficacy for improving urinary symptoms .  Tolterodine and oxybutynin caused a significant decrease ( p = 0.0001 ) in the mean number of voids per 24 hours ( -1.7 or -15 % and -1.7 or -15 % , respectively ) , urge incontinence episodes per 24 hours ( -1.3 or -54 % and -1.8 or -62 % , respectively ) and mean voided volume per void ( 33 ml . or 22 % and 34 ml . or 23 % ) after 10 weeks of treatment . CONCLUSIONS Tolterodine is as effective as oxybutynin for improving the symptoms of overactive bladder but it has superior tolerability . The combination of these qualities makes tolterodine the preferred pharmacological therapy for the long-term treatment of this condition PURPOSE We evaluated the efficacy and safety of an oxybutynin transdermal delivery system ( TDS ) in a general population of patients with overactive bladder and urge or mixed urinary incontinence . MATERIAL S AND METHODS Following symptom stabilization or treatment withdrawal 520 adult patients were r and omized to 12 weeks of double-blind daily treatment with 1.3 , 2.6 or 3.9 mg . oxybutynin TDS or placebo administered twice weekly , followed by a 12-week open-label , dose titration period to assess efficacy and safety further . Evaluations included patient urinary diaries , incontinence specific quality of life and safety . RESULTS A dose of 3.9 mg . daily oxybutynin TDS significantly reduced the number of weekly incontinence episodes ( median change -19.0 versus -14.5 , p = 0.0165 ) , reduced average daily urinary frequency ( mean change -2.3 versus -1.7 , p = 0.0457 ) , increased average voided volume ( median change 24 versus 6 ml . , p = 0.0063 ) and significantly improved quality of life ( Incontinence Impact Question naire total score , p = 0.0327 ) compared with placebo . Average voided volume increased in the daily 2.6 mg . group ( 19 ml . , p = 0.0157 ) but there were no other significant differences between 1.3 and 2.6 mg . oxybutynin TDS and placebo . The most common adverse event was application site pruritus  ( oxybutynin TDS 10.8 % to 16.8 % , placebo 6.1 % ) . Dry mouth incidence was similar in both groups ( 7.0 % versus 8.3 % , p not significant ) . In the open-label period a sustained reduction of nearly 3 incontinence episodes per day was reported for all groups . CONCLUSIONS Doses of 2.6 and 3.9 mg . oxybutynin TDS daily improve overactive bladder symptoms and quality of life , and are well tolerated . Transdermal oxybutynin is an innovative new treatment for overactive bladder OBJECTIVE To evaluate the efficacy , safety and tolerability of tolterodine compared to placebo in patients with an overactive bladder . STUDY DESIGN A double-blind , multi-centre phase III study in France and Belgium 251 patients with overactive bladder symptoms , and urodynamically verified detrusor overactivity , were r and omised to receive 4-week treatment with either placebo or tolterodine 1 or 2 mg twice daily ( bd ) . Efficacy was evaluated from patient micturition diaries . Safety and tolerability endpoints were also evaluated . RESULTS After 4-week treatment , the number of incontinence episodes/24h decreased significantly relative to placebo in the tolterodine 1 and 2 mgbd groups ( P=0.045 and P=0.0089 , respectively ) . Both dosages of tolterodine increased volume voided per micturition compared with placebo ( P=0.055 and P=0.056 , respectively ) , although significant decreases in micturition frequency were not apparent . Tolterodine was safe and well tolerated , few patients were withdrawn due to adverse events . Dry mouth , mainly of mild-to-moderate intensity , was the most common adverse event . No clinical ly relevant changes in blood pressure or laboratory safety variables were reported . CONCLUSION Tolterodine is effective , safe and well tolerated for the treatment of symptoms of an overactive bladder , particularly urge incontinence To examine the safety and efficacy of mirabegron as ‘ add‐on ’ therapy to solifenacin in patients with overactive bladder ( OAB ) PURPOSE Awakening from sleep to urinate is the hallmark of nocturia , a condition that impacts several facets of health related quality of life and for which current therapy is suboptimal . Given the paucity of prospect i ve data on antimuscarinics for the management of nocturia , we investigated the efficacy and safety of flexible dose fesoterodine for the treatment of nocturnal urgency in subjects with nocturia and overactive bladder . MATERIAL S AND METHODS Subjects with 2 to 8 nocturnal urgency episodes per 24 hours began a 2-week , single-blind , placebo run-in followed by 1:1 r and omization to 12 weeks of double-blind treatment with fesoterodine ( 4 mg daily for 4 weeks with an optional increase to 8 mg ) or placebo using predefined criteria for nocturnal urgency episodes , nocturnal urine volume voided and total 24-hour urine volume voided . The primary end point was change from baseline to week 12 in the mean number of micturition related nocturnal urgency episodes per 24 hours . RESULTS Overall 963 subjects were r and omized from 2,990 screened , and 82 % of subjects treated with fesoterodine and 84 % of those treated with  placebo completed the study . Significant improvements in the primary end point ( -1.28 vs -1.07 ) , in nocturnal micturitions per 24 hours ( -1.02 vs -0.85 ) and in nocturnal frequency urgency sum ( -4.01 vs -3.42 ) were observed with fesoterodine vs placebo ( all p ≤0.01 ) . Health related quality of life measures ( overactive bladder question naire Symptom Bother -20.1 vs -16.5 , sleep 22.3 vs 19.9 and other domains ; all p < 0.05 ) were improved with fesoterodine . CONCLUSIONS To our knowledge this is the first prospect i ve study to assess antimuscarinic efficacy for reducing nocturnal urgency . Flexible dose fesoterodine significantly reduced nocturnal urgency episodes vs placebo in subjects with overactive bladder 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 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 We determined the safety and efficacy of each of 2 doses of botulinum toxin type A ( BTX-A ) ( 200 or 300 U BOTOX ) injected into the detrusor for urinary incontinence caused by neurogenic detrusor overactivity of predominantly spinal cord origin . MATERIAL S AND METHODS A total of 59 patients with urinary incontinence caused by neurogenic detrusor overactivity ( due to spinal cord injury in 53 and multiple sclerosis in 6 ) requiring clean intermittent self-catheterization were r and omized to receive a single dose into the detrusor of BTX-A ( 200 U or 300 U ) or placebo . Changes in daily frequency of urinary incontinence episodes were monitored via a patient bladder diary during 24 weeks . Key urodynamic assessment s ( maximum cystometric capacity , reflex detrusor volume and maximum detrusor pressure during bladder contraction ) were used to provide objective measures of the treatment effect on bladder function . The impact of treatment on quality of life was assessed using the Incontinence Quality of Life question naire . RESULTS There were significant posttreatment decreases in incontinence episodes from baseline in the 2 BTX-A groups ( p < /=0.05 ) but not in the placebo group . In addition , more patients who received BTX-A reported no incontinence episodes during at least 1 posttreatment evaluation period . Positive treatment effects were also reflected by significant improvements in bladder function in the BTX-A groups , as assessed by urodynamics and in patient quality of life . Benefits were observed from the first evaluation at week 2 to the end of the 24-week study . No safety concerns were raised . CONCLUSIONS Intramuscular injections of BTX-A into the detrusor can provide rapid , well tolerated , clinical ly significant decreases in the signs and symptoms of urinary incontinence caused by neurogenic detrusor overactivity during a 24-week study period 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 To evaluate the potential of solifenacin 5 mg combined with mirabegron 25 or 50 mg to deliver superior efficacy compared with monotherapy , with acceptable tolerability , in the general overactive bladder ( OAB ) population with urinary incontinence ( UI ) To evaluate the efficacy and safety of the β3‐adrenoceptor agonist mirabegron , in a Japanese population with overactive bladder ( OAB ) Abstract : This study compared the clinical efficacy ( determined from micturition diaries ) and safety of 12 weeks ’ treatment with either tolterodine 2 mg twice daily , oxybutynin 5 mg three times daily or placebo in patients with an overactive bladder . A total of 277 patients were r and omized and treated at 25 centers . Both tolterodine and oxybutynin significantly increased volume voided/micturition compared to placebo . Both treatment groups evoked greater decreases in micturitions per 24 hours and incontinence episodes per 24 hours compared to placebo  ; however , only tolterodine was significantly better than placebo in reducing micturition frequency .  Tolterodine and oxybutynin were equivalent in their effectiveness .  Tolterodine was significantly better tolerated than  oxybutynin when adverse events ( particularly frequency and intensity of dry mouth ) , dose reduction and patient withdrawals were considered . Oxybutynin is an effective drug whose frequent adverse effects limit its clinical usefulness . Tolterodine has equivalent efficacy to oxybutynin , but with less severe adverse effects . This will allow patients to receive more effective treatment for their condition , with better compliance 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 PURPOSE In this prospect i ve , nonr and omized , ongoing study we evaluated the efficacy and safety of botulinum-A toxin injections in the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment , such as anticholinergic drugs . MATERIAL S AND METHODS A total of 23 men and 77 women with a mean age of 63 years ( range 24 to 89 ) with nonneurogenic overactive bladder , including urgency-frequency syndrome , and incontinence despite the administration of maximal doses of anticholinergics were consecutively treated with injections of 100 U botulinum-A toxin in the detrusor muscle at 30 sites under cystoscopic guidance . Micturition diary , full urodynamics , neurological status and urine probes were performed in all participants before treatment . Bladder biopsies were done only in cases of suspected bladder fibrosis or unclear findings . Special attention was given to reflex volume , maximal bladder capacity , detrusor compliance , post-void residual urine , urgency and frequency/nocturia . Clinical , urodynamic and quality of life assessment s were performed at baseline , and 4 , 12 and 36 weeks after botulinum-A toxin treatment . RESULTS Overall after 4 and 12 weeks 88 % of our patients showed significant improvement in bladder function in regard to subjective symptoms , quality of life and urodynamic parameters ( p < 0.001 ) . Urgency disappeared in 82 % of the patients and incontinence resolved in 86 % within 1 to 2 weeks after botulinum-A toxin injections . Mean frequency decreased from 14 to 7 micturitions daily ( -50 % ) and nocturia decreased from 4 to 1.5 micturitions . Mean maximal bladder capacity increased 56 % from 246 to 381 ml , mean detrusor compliance increased from 24 to 41 ml/cm H(2)O and pretreatment detrusor instability ( mean reflex volume 169 ml ) resolved in 74 % of patients . Mean volume at first desire to void increased from 126 to 212 ml and mean urge volume increased from 214 to 309 ml . There were no severe side effects except temporary urine retention in 4 cases . Only in 8 patients was the clinical benefit poor and analysis revealed preoperative low detrusor compliance . Mean efficacy duration + /- SD was at least approximately 6 + /- 2 months and then symptoms began to increase . CONCLUSIONS Our results show that intradetrusor botulinum-A toxin injections may be an efficient and safe treatment option in patients with severe overactive bladder resistant to all conventional treatments To compare the efficacy of tolterodine plus simplified bladder training  ( BT ) with tolterodine alone in patients with an overactive bladder BACKGROUND This double-blind , multicenter study compared the efficacy and tolerability of tolterodine ( Pharmacia , Los Angeles , USA ) with that of oxybutynin ( Alza , Palo Alto , USA ) in Asian patients with overactive bladder . METHODS Two-hundred- and -twenty-eight adults with overactive bladder symptoms were r and omized to receive tolterodine 2 mg twice daily ( bid ) ( n = 112 ) or oxybutynin 5 mg bid ( n = 116 ) . After 8 weeks ' treatment , changes in micturition diary variables , patients ' perception of treatment benefit , and tolerability endpoints were determined . RESULTS The mean ( + /- SD ) number of micturitions/24 h decreased by 2.6 + /- 2.9 ( -21 % ) with tolterodine and 1.8 + /- 4.2 ( -15 % ) with oxybutynin ( both P = 0.0001 vs baseline ) . The mean number of incontinence episodes/24 h decreased by 2.2 + /- 2.3 ( -85 % ) in the tolterodine group and by 1.4 + /- 1.8 ( -58 % ) in the oxybutynin group ( both P = 0.0001 vs baseline ) . Patient perception of treatment benefit was over 70 % in each treatment group . Adverse events were significantly lower in the tolterodine group compared with oxybutynin-treated patients ( 55 % vs 82 % ; P = 0.001 ) . Dry mouth was reported by significantly fewer patients on tolterodine , compared with oxybutynin ( 35 % vs 63 % ; P = 0.001 ) and withdrawals due to adverse events were lower in the tolterodine group than with those treated with oxybutynin ( 10 % vs 16 % ) . There were no safety concerns . CONCLUSIONS Tolterodine 2 mg bid is equally or more effective than oxybutynin 5 mg bid in the treatment of Asian patients with overactive bladder , and shows significantly better tolerability . This may enhance compliance during long-term treatment
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 .