Drugs plus biofeedback show promise for dysfunctional voiding

By Joanna Lyford, Senior medwireNews Reporter

Research shows that the use of α1-blockers in combination with uroflowmetry biofeedback is more effective than either treatment alone for improving urinary symptoms and quality of life in women with dysfunctional voiding and recurrent urinary tract infection (UTI).

The findings come from a randomised study undertaken by Daniele Minardi (Università Politecnica delle Marche, Ancona, Italy) and team, results of which are reported this month in the International Journal of Urology.

Minardi’s team recruited 155 nulliparous women who had suffered recurrent UTIs for at least 3 years, with at least three symptomatic episodes over a 12-month period. The women were randomly assigned to receive one of four regimens: (A) uroflowmetry biofeedback for 10 weeks; (B) an α1-antagonist drug taken daily for 3 months; (C) uroflowmetry biofeedback plus an α1-blocker; or (D) no treatment.

In all, 128 women completed the study and were included in the analysis. Their mean age was 25.3 years, the baseline prevalence of storage symptoms ranged from 61.1% to 78.4% across the groups and emptying symptoms ranged from 61.1% to 77.1%.

The women were followed up for 1 year. At the final assessment, the prevalence of storage symptoms had declined to 59.2%, 66.6% and 39.2% in treatment groups A, B and C, respectively, but was unchanged in group D, at 61.1%.

A similar pattern was seen for emptying symptoms, with the prevalence at 12 months being 55.5%, 63.3%, 39.2% and 61.1% in groups A, B, C and D, respectively.

In all three treatment groups, patients showed a significant increase in mean flow rate and voiding volume and a significant decrease in flow time and post-void residual, together with significant improvements in urodynamic parameters such as mean opening detrusor pressure and mean urethral closure pressure.

The combination of pharmacological and biofeedback approaches offered the greatest improvement in nearly all of the outcome parameters examined. The exception was UTIs, which fell in frequency by a similar magnitude in the three active treatment groups, from 100% to 21–26%, but was unchanged, at 94%, in group D.

Noting that there is a relative paucity of treatment options for women with predominant voiding symptoms, Minardi and co-authors describe as “interesting” the good results obtained in the present study not only on emptying but also on storage symptoms.

“We can suppose that they are partly due to patients being aware of the condition, and voiding frequency and liquid intake being adjusted and measuring voided volume; but pelvic floor therapy probably also has an indirect effect on storage symptoms”, they write, adding: “Further studies will be necessary to elucidate this issue.”

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