Sacral neuromodulation augments efficacy of antimuscarinics in OAB

By Joanna Lyford, Senior medwireNews Reporter

The addition of sacral neuromodulation to antimuscarinic pharmacotherapy offers significant benefits over antimuscarinics alone in the treatment of women with idiopathic overactive bladder (OAB), study findings show.

After 3 months, combination therapy not only improved voiding symptoms but also resulted in improvements in anxiety and depression, report Hua Tang (The Second Hospital of Sanming, Yong’an, Fujian Province, China) and fellow authors writing in Urology Journal.

There has been relatively little research into the combined use of drugs and sacral nerve stimulation (SNS) for the treatment of OAB. To investigate, Tang et al randomly assigned 240 women with idiopathic OAB to receive treatment with an M2/M3 muscarinic receptor antagonist alone or in combination with intermittent percutaneous SNS.

The groups were stratified by OAB subtype; 92 had dry OAB (urinary frequency and urgency) while the remainder had wet OAB (urinary frequency and urgency with urgency incontinence). None of the women had obstructive disease on urodynamic study.

At the end of the 3-month trial, both treatment groups exhibited significant improvements in urological parameters, including daily average single voided volume, the daily maximum volume of a single urination, first desire to void and maximum cystometric capacity.

For each of these endpoints, combination therapy was significantly better than antimuscarinic therapy alone.

Both groups also showed numerical although not statistically significant improvements in daily average urination frequency and maximum flow rate.

With regard to psychosocial outcomes, scores on the self-rating depression and anxiety scales improved significantly in both groups at 3 months as compared with baseline; again, patients in the combination treatment group showed a significantly greater improvement than those receiving drug therapy alone.

These results indicate that combined treatment improved patients’ quality of life to a significantly greater extent than antimuscarinics alone, say the study authors.

Similar results were seen in patients with wet and drug OAB, they add, and there was no obvious recurrence after 12 months of follow-up.

“[T]he results need further validation by larger trials,” they conclude.

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