Behavioral therapy better than drug therapy for overactive bladder in men

Référence

Burgio KL, Kraus SR, Johnson TM 2nd, et al. Effectiveness of combined behavioral and drug therapy for overactive bladder symptoms in men. A randomized clinical trial. JAMA Intern Med 2020;180(3):411-419. doi:10.1001/jamainternmed.2019.6398

Sommaire

These investigators enrolled men with an average age of 64 years with urinary urgency and 9 or more voids per 24 hours, without evidence of outlet obstruction. The men (who all lived at home) were randomized, concealed allocation uncertain, to receive either 3 behavioral therapy visits, drug therapy with tolterodine 5 mg once daily and tamsulosin 0.4 mg at bedtime, or the combination for 6 weeks. The behavioral intervention consisted of pelvic floor muscle training, urge suppression, and fluid restriction at night and was administered over 3 visits. At 6 weeks, average voids over 24 hours decreased in all 3 groups, but combined behavioral/drug therapy and behavioral therapy alone were significantly better than drug treatment alone. Men who receive behavioral therapy can expect a reduction of approximately 3 voids per 24 hours. Nocturia decreased from an average 2.1 times per night to 1.3 with behavioral or combined therapy, but only to 1.8 with drug therapy (P <.001). The mean International Prostate Symptom Score decreased in all 3 groups, but decreased the most with combined behavioral and drug therapy (from 17.6 to 6.5; P <.001).