Re: Effectiveness of Combined Behavioral and Drug Therapy for Overactive Bladder Symptoms in Men: A Randomized Clinical Trial
| Autor: | Theodore M. Johnson, Camille P. Vaughan, Alayne D. Markland, Kathryn L. Burgio, David T. Redden, Peng Li, Patricia S. Goode, Stephen R. Kraus |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Urinary urgency Urology MEDLINE Muscarinic Antagonists 01 natural sciences law.invention chemistry.chemical_compound 03 medical and health sciences Text mining Pharmacotherapy 0302 clinical medicine Randomized controlled trial law Internal medicine Internal Medicine medicine Nocturia Outpatient clinic Combined Modality Therapy Humans Benzhydryl compounds 030212 general & internal medicine 0101 mathematics Benzhydryl Compounds Original Investigation Urinary bladder business.industry Urinary Bladder Overactive 010102 general mathematics medicine.disease medicine.anatomical_structure chemistry Overactive bladder International Prostate Symptom Score Tolterodine medicine.symptom business medicine.drug |
| Zdroj: | JAMA Intern Med |
| ISSN: | 1527-3792 |
| Popis: | IMPORTANCE: First-line behavioral and drug therapies for overactive bladder (OAB) symptoms in men are effective but not usually curative. OBJECTIVE: To determine whether combining behavioral and drug therapies improves outcomes compared with each therapy alone for OAB in men and to compare 3 sequences for implementing combined therapy. DESIGN, SETTING, AND PARTICIPANTS: In this 3-site, 2-stage, 3-arm randomized clinical trial, participants were randomized to 6 weeks of behavioral therapy alone, drug therapy alone, or combined therapy followed by step-up to 6 weeks of combined therapy for all groups. Participants were recruited from 3 outpatient clinics and included community-dwelling men 40 years or older with urinary urgency and 9 or more voids per 24 hours. Data were collected from July 2010 to July 2015 and analyzed from April 2016 to September 2019. INTERVENTIONS: Behavioral therapy consisted of pelvic floor muscle training with urge suppression strategies and delayed voiding. Drug therapy included an antimuscarinic (sustained-release tolterodine, 4 mg) plus an α-blocker (tamsulosin, 0.4 mg). MAIN OUTCOMES AND MEASURES: Seven-day bladder diaries completed before and after each 6-week treatment stage were used to calculate reduction in frequency of urination (primary outcome) and other symptoms (ie, urgency, urgency incontinence, and nocturia). Other secondary outcomes included validated patient global ratings of improvement and satisfaction, Overactive Bladder Questionnaire score, and International Prostate Symptom Score. RESULTS: Of the 204 included men, 133 (65.2%) were white, and the mean (SD) age was 64.1 (11.1) years. A total of 21 men discontinued treatment and 183 completed treatment. Mean (SD) voids per 24 hours decreased significantly in all 3 groups from baseline to 6-week follow-up (behavioral therapy: 11.7 [2.4] vs 8.8 [2.1]; change, 2.9 [2.4]; percentage change, 24.7%; P |
| Databáze: | OpenAIRE |
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