Update on Treatments for Overactive Bladder

Management of overactive bladder (OAB), a problem with bladder storage that causes a sudden urge to urinate, often involves behavioral strategies such as fluid schedules, timed voiding, and bladder-holding techniques aided by strengthening the pelvic floor. These strategies are not always adequate, however, necessitating the use of medical treatment to control symptoms of OAB.

Several presentations discussed promising treatment approaches for OAB and presented the outcomes of their use in older adult patients.

Antimuscarinics. Antimuscarinic drugs are the current mainstay of pharmacological treatment for OAB. These drugs are though to act through antagonism of muscarinic M3 receptions at the neuromuscular junctions in the muscles that control the bladder. However, these drugs should be used with caution in older adults, because the risk of adverse events is higher in this patient population. Chunhou Liao (Department of Urology, Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan) and Hann-Chorng Kuo (Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan) reported on a study to evaluate the use of antimuscarinics as first-line treatment in older adults with OAB, using an elevated post-void residual urine volume of >100 mL as inclusion criteria. A total of 126 patients aged 65-90 years (mean age, 75.5 years) were enrolled in the study. Overall, symptoms of OAB improved with antimuscarinic treatment at 1 month and 3 months after treatment initiation. Quality of life also improved significantly with treatment. Adverse events included dry mouth, constipation, dysuria, and dizziness; however, the more serious side effect of cognitive impairment was not seen in any of the patients. The researchers concluded that antimuscarinics can be used safely as a first-line treatment for OAB in older adults.

Tibial Nerve Stimulation (TNS). TNS is a minimally invasive technique used to regulate the nerve impulses in the bladder. The treatment is typically initiated with a trial to determine whether the electrical stimulation of the tibial nerve elicits a sensory response or a motor response. However, the extent to which either of these responses predicts a successful outcome with the treatment approach is a matter of debate. A team of researchers from Brazil, led by Aline Teixeira Alves (University of Brasilia), conducted a study to compare the two intensity levels of TNS in terms of their effects on urinary symptoms and quality of life in older women (aged 60 years or older). Participants were randomly assigned to two groups, one of which was evaluated using the sensory response criteria and the other of which was evaluated using the motor response criteria. When outcomes of participants in the two groups were compared, no significant differences were seen in the majority of outcome measures. Participants in both groups showed significant improvement in symptoms and in quality of life. However, participants for whom the sensory threshold was used showed a greater improvement in incontinence symptoms. The authors conclude that both sensory and motor responses may be used as indicators of treatment outcome, but sensory responses may be superior for predicting improvement in incontinence symptoms.