For Overactive Bladder in Men, Start with Behavioral Strategies

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

A study in JAMA Internal Medicine reinforces the efficacy of behavioral strategies as first-line treatment for overactive bladder in men.

Some 200 men with urinary frequency and urgency were randomized to behavioral training alone, drug therapy alone, or combination therapy for 6 weeks. Behavioral training included pelvic-floor exercises and urge-suppression strategies, while drug therapy entailed an antimuscarinic and an alpha-blocker. (After this, men initially receiving monotherapy received combination therapy for an additional 6 weeks, and those initially receiving combination therapy continued to do so for 6 more weeks.)

At 6 weeks, voiding frequency had improved in all three groups. The improvement with combination therapy (from 11.8 to 8.2 voids daily) was similar to that with behavioral therapy alone (from 11.7 to 8.8) — but was superior to drug therapy alone (from 11.8 to 10.3).

The authors conclude, "When using a stepped approach, it is reasonable to begin with behavioral therapy alone."