Using behavioral therapy first before drugs more effectively reduces voiding frequency in men with overactive bladder (OAB), according to new study findings published in JAMA Internal Medicine.

Kathryn L. Burgio, PhD, of Birmingham VA Medical Center in Birmingham, Alabama, and peers randomly assigned 204 men (mean age 64; 65% white) with 9 or more daily voids (with or without urge incontinence) to 6 weeks of behavioral training alone, drug therapy alone, or combined behavioral and drug therapy. Behavioral training included pelvic floor muscle exercises, urge suppression strategies, and fluid restriction for nocturia. Drug therapy included an antimuscarinic (sustained-release tolterodine, 4 mg, once daily) and an α-blocker (tamsulosin, 0.4 mg, once daily before bed). After the initial 6 weeks of treatment, participants receiving monotherapy were stepped up to combined behavioral and drug therapy for an additional 6 weeks.

According to Dr Burgio’s team, combination therapy appeared more effective over 6 weeks in reducing:

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  • voiding frequency (30.5% vs 24.7% behavioral therapy vs 12.7% drug therapy),
  • nocturia (0.9 vs 0.7 vs 0.4, respectively),
  • and mean urinary urgency score (0.2 vs −0.1 vs 0.1, respectively).

In intent-to-treat analyses, combining therapies significantly outperformed drug therapy alone, although not behavioral therapy alone, in reducing voiding frequency. Similar results were obtained at 12 weeks. These findings coincide with the success of combining therapies in women found in other studies.

Patient-perceived improvement (90%) and satisfaction (98%) were highest for the combination. Combining therapies, however, led to more adverse effects than behavioral therapy alone: 87% vs 48%, respectively. Twenty-one men overall discontinued treatment.

“When using a stepped approach, it is reasonable to begin with behavioral therapy alone, not just because of the better adverse effect profile but also because behavioral therapy yields better 6-week outcomes than drug therapy and, thus, results are achieved more quickly than starting with drug therapy alone,” Dr Burgio and colleagues stated.

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Burgio KL, Kraus SR, Johnson II TM, et al. Effectiveness of combined behavioral and drug therapy for overactive bladder symptoms in men: A randomized clinical trial [published online January 13, 2020]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.6398