Behavioral versus drug treatment for overactive bladder in men: the Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial.

Abstract

OBJECTIVES:

To compare the effectiveness of behavioral treatment with that of antimuscarinic therapy in men without bladder outlet obstruction who continue to have overactive bladder (OAB) symptoms with alpha-blocker therapy.

DESIGN:

The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial was a two-site randomized, controlled, equivalence trial with 4-week alpha-blocker run-in.

SETTING:

Veterans Affairs Medical Center outpatient clinics.

PARTICIPANTS:

Volunteer sample of 143 men aged 42 to 88 who continued to have urgency and more than eight voids per day, with or without incontinence, after run-in.

INTERVENTIONS:

Participants were randomized to 8 weeks of behavioral treatment (pelvic floor muscle exercises, urge suppression techniques, delayed voiding) or drug therapy (individually titrated, extended-release oxybutynin, 5-30 mg/d).

MEASUREMENTS:

Seven-day bladder diaries and a validated urgency scale were used to calculate changes in 24-hour voiding frequency, nocturia, urgency, and incontinence. Secondary outcomes were global patient ratings and American Urological Association Symptom Index.

RESULTS:

Mean voids per day decreased from 11.3 to 9.1 (-18.8%) with behavioral treatment and 11.5 to 9.5 (-16.9%) with drug therapy. Equivalence analysis indicated that posttreatment means were equivalent (P < .01). After treatment, 85% of participants rated themselves as much better or better; more than 90% were completely or somewhat satisfied, with no between-group differences. The behavioral group showed greater reductions in nocturia (mean = -0.70 vs -0.32 episodes/night; P = .05). The drug group showed greater reductions in maximum urgency scores (mean = -0.44 vs -0.12; P = .02). Other between-group differences were nonsignificant.

CONCLUSION:

Behavioral and antimuscarinic therapy are effective when added to alpha-blocker therapy for OAB in men without outlet obstruction. Behavioral treatment is at least as effective as antimuscarinic therapy.

• Authors: Kathryn L Burgio, Patricia S Goode, Theodore M Johnson, Lee Hammontree, Joseph G Ouslander, Alayne D Markland, Janet Colli, Camille P Vaughan, David T Redden
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 59 Issue 12 Pg. 2209-16 (Dec 2011) ISSN: 1532-5415 [Electronic] United States
• PMID: 22092152 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: © 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

Chemical References

• Mandelic Acids
• Muscarinic Antagonists
• oxybutynin

Topics

• Behavior Therapy
• Humans
• Male
• Mandelic Acids (therapeutic use)
• Middle Aged
• Muscarinic Antagonists (therapeutic use)
• Urinary Bladder, Overactive (drug therapy, therapy)
• Veterans