Combination therapy studies of third-line treatments were rare and centered on medication with PTNS .
Combination therapy , with certain first , second , and third-line OAB therapies , appears to be efficacious .
AIMS Overactive bladder ( OAB ) affects over 17 % of the population and significantly effect the health-related quality of life .
The treatments for OAB include first line ( lifestyle modification , pelvic floor muscle training ) , second line ( anticholinergic or beta-3 agonist medications ) , and third line therapies ( intradetrusor botulinum toxin injection , sacral neurostimulation [ SNM ] , or percutaneous tibial nerve stimulation [ PTNS ] ) .
For those with urinary incontinence secondary to OAB , complete continence is the goal of therapy , though cure rates are only 5 % to 40 % .
The use of combination therapies can be employed in refractory OAB , however , the efficacy of pooled modalities is relatively unknown .
Our objective was to determine the volume of data supporting combination therapy in treating OAB .
Combined Tolterodine and Vaginal Estradiol Cream for Overactive Bladder Symptoms After Randomized Single-Therapy Treatment
Objectives The aims of this study were to compare 12-week outcomes of single-therapy tolterodine ( Detrol LA ) extended release to intravaginal estrogen ( Estrace ) for overactive bladder ( OAB ) symptoms and characterize 24- and 52-week outcomes in women undergoing combined therapy . Methods A single-site r and omized , open-label trial in women with urinary frequency , urgency , nocturia , and /or urgency urinary incontinence symptoms was performed . Fifty-eight participants were r and omized to oral tolterodine extended release daily or intravaginal estradiol cream nightly for 6 weeks then twice per week . The primary outcome was change in Overactive Bladder Question naire ( OAB-q ) symptom bother score at 12 weeks . Secondary outcomes included the Health-Related Quality of Life Question naire ( HRQL ) of the OAB-q and a 3-day bladder diary . At 12 weeks , subjects were offered addition of the alternative therapy with follow-up at 24 and 52 weeks . Results There was no difference in symptom bother score improvement between the tolterodine and intravaginal estradiol groups baseline to 12 weeks ( 20.6 ± 21.7 , −15.8 ± 23.3 , respectively , P = 0.45 ) . There was a significant within-group decrease in symptom bother score from baseline to 12 weeks ( tolterodine , P < 0.0001 , and intravaginal estradiol , P = 0.002 ) . Secondary outcome improvement within groups was noted in the HRQL total , urinary incontinence episodes , and median voiding frequency ( all P ⩽ 0.03 ) in the tolterodine group and in the HRQL total score ( P = 0.03 ) in the intravaginal estradiol group , with no differences between groups . Combined therapy outcomes at 24 and 52 weeks compared with single therapy at 12 weeks revealed significant improvement in symptom bother score in the intravaginal estradiol + tolterodine group at 24 and 52 weeks ( 20.0 ± 23.9 , P = 0.008 ; −16.7 ± 23.3 , P = 0.02 , respectively ) . Conclusions Significant within-group improvement in OAB-q symptom bother was noted in both the intravaginal estradiol and tolterodine groups for OAB symptoms , with no difference between groups . Greater improvement from 12-week single therapy to 24 and 52 weeks of combined therapy was noted in the group originally assigned to intravaginal estradiol . The role of combined medical therapy for OAB symptoms needs further investigation
Combination therapy studies of third-line treatments were rare and centered on medication with PTNS .
Combination therapy , with certain first , second , and third-line OAB therapies , appears to be efficacious .
AIMS Overactive bladder ( OAB ) affects over 17 % of the population and significantly effect the health-related quality of life .
The treatments for OAB include first line ( lifestyle modification , pelvic floor muscle training ) , second line ( anticholinergic or beta-3 agonist medications ) , and third line therapies ( intradetrusor botulinum toxin injection , sacral neurostimulation [ SNM ] , or percutaneous tibial nerve stimulation [ PTNS ] ) .
For those with urinary incontinence secondary to OAB , complete continence is the goal of therapy , though cure rates are only 5 % to 40 % .
The use of combination therapies can be employed in refractory OAB , however , the efficacy of pooled modalities is relatively unknown .
Our objective was to determine the volume of data supporting combination therapy in treating OAB .