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 .
Botulinum toxin a versus placebo for refractory detrusor overactivity in women: a randomised blinded placebo-controlled trial of 240 women (the RELAX study).
BACKGROUND Emerging data suggest botulinum toxin is an effective treatment for detrusor overactivity ( DO ) , but large studies confirming efficacy and safety are lacking . OBJECTIVE Study the efficacy and safety of onabotulinumtoxinA ( onaBoNTA ) for the treatment of DO . DESIGN , SETTING , AND PARTICIPANTS A double-blind placebo-controlled  r and omised trial in eight UK urogynaecology centres was conducted between 2006 and 2009 . A total of 240 women with refractory DO were r and omised to active or placebo treatment and followed up for 6 mo . INTERVENTION Treatment consisted of 200 IU onaBoNTA or placebo injected into the bladder wall ( 20 sites ; 10 IU per site in 1ml saline ) . MEASUREMENTS Primary outcome was voiding frequency per 24h at 6 mo . Secondary outcomes included urgency and incontinence episodes and quality -of-life data . Intention-to-treat analysis was used with imputation of missing data . RESULTS AND LIMITATIONS A total of 122 women received onaBoNTA and 118 received the placebo .  Median ( interquartile range ) voiding frequency was lower after onaBoNTA compared with placebo ( 8.3 [ 6.83 - 10.0 ] vs 9.67 [ 8.37 - 11.67 ] ; difference : 1.34 ; 95 % confidence interval [ CI ] , 1.00 - 2.33 ; p=0.0001 ) . Similar differences were seen in urgency episodes ( 3.83 [ 1.17 - 6.67 ] vs 6.33 [ 4.0 - 8.67 ] ; difference : 2.50 ; 95 % CI , 1.33 - 3.33 ; p<0.0001 ) and leakage episodes ( 1.67 [ 0 - 5.33 ] vs 6.0 [ 1.33 - 8.33 ] ; difference : 4.33 ; 95 % CI , 3.33 - 5.67 ; p<0.0001 ) . Continence was more common after botulinum toxin type A ( BoNTA ; 31 % vs 12 % ; odds ratio [ OR ] : 3.12 ; 95 % CI , 1.49 - 6.52 ; p=0.002 ) . Urinary tract infection ( UTI ; 31 % vs 11 % ; OR : 3.68 ; 95 % CI , 1.72 - 8.25 ; p=0.0003 ) and voiding difficulty requiring self-catheterisation ( 16 % vs 4 % ; OR : 4.87 ; 95 % CI , 1.52 - 20.33 ; p=0.003 ) were more common after onaBoNTA . CONCLUSIONS This r and omised controlled trial of BoNTA for refractory DO , the largest to date , confirms efficacy and safety of the compound . UTI ( 31 % ) and self-catheterisation ( 16 % ) are common . A third of women achieved continence . TRIAL REGISTRATION The study received ethical committee approval from the Scottish Multicentre Research Ethics Committee ( reference : 04/MRE10/67 ) . The trial has a EudraCT number ( 2004 - 002981 - 39 ) , a clinical trial authorisation from the UK Medicines and Healthcare Regulatory Agency , and it was registered on Current Controlled Trials ( IS RCT N26091555 ) on May 26 , 2005
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 .