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Clinical Question
Is behavioral therapy, drug therapy, or the combination more effective in men with frequent urination due to overactive bladder?
Bottom line
Behavioral training—consisting of sequential introduction of pelvic floor exercises, suppressing urge, and fluid restriction before bedtime—is more effective than combination drug therapy with tolterodine (Detrol, Detrusitol) and tamsulosin (Flomax) for men's overactive bladder without evidence of obstruction. Combination behavioral and medication therapy may be more effective for men with prostate-related symptoms in addition to frequent urination. 1b-
Reference
Study design: Randomized controlled trial (single-blinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
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).
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA