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Am J Obstet Gynecol. 2016 Jul;215(1):34-57. doi: 10.1016/j.ajog.2016.01.156. Epub 2016 Feb 4.

Nonantimuscarinic treatment for overactive bladder: a systematic review.

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Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address:
Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM.
Department of Obstetrics and Gynecology, University Hospitals, Case Western Reserve University, Cleveland, OH.
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX.
Department of Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA.
Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
Department of Obstetrics and Gynecology, University of South Carolina Greenville, Greenville, SC.
Department of Obstetrics and Gynecology, The Ohio State University-Wexner Medical Center, Columbus, OH.
Center for Evidence-Based Medicine, Brown University School of Public Health, Providence, RI.
The Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, PA.


The purpose of the study was to determine the efficacy and safety of nonantimuscarinic treatments for overactive bladder. Medline, Cochrane, and other databases (inception to April 2, 2014) were used. We included any study design in which there were 2 arms and an n > 100, if at least 1 of the arms was a nonantimuscarinic therapy or any comparative trial, regardless of number, if at least 2 arms were nonantimuscarinic therapies for overactive bladder. Eleven reviewers double-screened citations and extracted eligible studies for study: population, intervention, outcome, effects on outcome categories, and quality. The body of evidence for categories of interventions were summarized and assessed for strength. Ninety-nine comparative studies met inclusion criteria. Interventions effective to improve subjective overactive bladder symptoms include exercise with heat and steam generating sheets (1 study), diaphragmatic (1 study), deep abdominal (1 study), and pelvic floor muscle training exercises (2 studies). Pelvic floor exercises are more effective in subjective and objective outcomes with biofeedback or verbal feedback. Weight loss with diet and exercise, caffeine reduction, 25-50% reduction in fluid intake, and pelvic floor muscle exercises with verbal instruction and or biofeedback were all efficacious. Botulinum toxin A improves urge incontinence episodes, urgency, frequency, quality of life, nocturia, and urodynamic testing parameters. Acupuncture improves quality of life and urodynamic testing parameters. Extracorporeal magnetic stimulation improves urodynamic parameters. Mirabegron improves daily incontinence episodes, nocturia, number of daily voids, and urine volume per void, whereas solabegron improves daily incontinence episodes. Short-term posterior tibial nerve stimulation is more efficacious than pelvic floor muscle training exercises and behavioral therapy for improving: urgency, urinary incontinence episodes, daily voids, volume per void, and overall quality of life. Sacral neuromodulation is more efficacious than antimuscarinic treatment for subjective improvement of overactive bladder and quality of life. Transvaginal electrical stimulation demonstrates subjective improvement in overactive bladder symptoms and urodynamic parameters. Multiple therapies, including physical therapy, behavioral therapy, botulinum toxin A, acupuncture, magnetic stimulation, mirabegron, posterior tibial nerve stimulation, sacral neuromodulation, and transvaginal electrical stimulation, are efficacious in the treatment of overactive bladder.


frequency; overactive bladder; treatment; urgency; urinary incontinence

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