What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women?: A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel

Fawzy Farag; Vasileios I.  Sakalis; Serenella Monagas Arteaga; Néha  Sihra; Markos Karavitakis; Salvador Arlandis; Kari Bø; Hanny  Cobussen-Boekhorst; Elisabetta  Costantini; Monica  de Heide; Jan  Groen; Benoit Peyronnet; Veronique Phé; Mary Lynne van Poelgeest-Pomfret; Tine W.L.  van den Bos; Huub  van der Vaartq; Christopher K.  Harding; Marie Carmela M. Lapitan; Muhammad Imran Omar; Arjun K. Nambiar

doi:10.1016/j.eururo.2023.05.014

What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women? A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel

Fawzy Farag, Vasileios I. Sakalis, Serenella Monagas Arteaga, Néha Sihra, Markos Karavitakis, Salvador Arlandis, Kari Bø, Hanny Cobussen-Boekhorst, Elisabetta Costantini, Monica de Heide, Jan Groen, Benoit Peyronnet, Veronique Phé, Mary Lynne van Poelgeest-Pomfret, Tine W.L. van den Bos, Huub van der Vaartq, Christopher K. Harding, Marie Carmela M. Lapitan, Muhammad Imran Omar, Arjun K. Nambiar^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Context
Overactive bladder syndrome (OAB) is highly prevalent among women and has negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities.
Objectives
To provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome.
Evidence Acquisition and methods
The Medline, Embase and Cochrane controlled trials databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. Risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions and quality of evidence was assessed using modified GRADE criteria. Meta-analysis was performed where appropriate.
Evidence Synthesis
Antimuscarinics and Beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events.
Onabotulinumtoxin-A was more effective than placebo across most outcomes, but with significantly higher rates of AUR/CISC (6-8 times) and UTIs (2-3 times). Onabot-A was also significantly better than antimuscarinics in cure of UUI but not in reduction of mean UUI episodes.
SNS success rate were significantly higher than antimuscarinics (61% vs. 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% VS. 10%). SNS was associated with 9% removal rate and 3% revision rate.
Conclusions and Patient Summary
Overactive bladder is a manageable condition, with first line treatment options including antimuscarinics, beta-3 agonists and PTNS. Second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation. The choice of therapies should be guided by individual patient factors.

Original language	English
Pages (from-to)	302-312
Number of pages	11
Journal	European Urology
Volume	84
Issue number	3
Early online date	11 Aug 2023
DOIs	https://doi.org/10.1016/j.eururo.2023.05.014
Publication status	Published - Sept 2023

Keywords

Anticholinergics
Female lower urinary tracts symptoms
onabotulinum toxin
overactive bladder
sacral neuromodulation
Systematic Review
urgency incontinence

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Farag, F., Sakalis, V. I., Arteaga, S. M., Sihra, N., Karavitakis, M., Arlandis, S., Bø, K., Cobussen-Boekhorst, H., Costantini, E., de Heide, M., Groen, J., Peyronnet, B., Phé, V., van Poelgeest-Pomfret, M. L., van den Bos, T. W. L., van der Vaartq, H., Harding, C. K., Lapitan, M. C. M., Omar, M. I., & Nambiar, A. K. (2023). What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women? A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel. European Urology, 84(3), 302-312. https://doi.org/10.1016/j.eururo.2023.05.014

What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women? A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel. / Farag, Fawzy; Sakalis, Vasileios I.; Arteaga, Serenella Monagas et al.
In: European Urology, Vol. 84, No. 3, 09.2023, p. 302-312.

Research output: Contribution to journal › Article › peer-review

Farag, F, Sakalis, VI, Arteaga, SM, Sihra, N, Karavitakis, M, Arlandis, S, Bø, K, Cobussen-Boekhorst, H, Costantini, E, de Heide, M, Groen, J, Peyronnet, B, Phé, V, van Poelgeest-Pomfret, ML, van den Bos, TWL, van der Vaartq, H, Harding, CK, Lapitan, MCM, Omar, MI & Nambiar, AK 2023, 'What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women? A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel', European Urology, vol. 84, no. 3, pp. 302-312. https://doi.org/10.1016/j.eururo.2023.05.014

Farag F, Sakalis VI, Arteaga SM, Sihra N, Karavitakis M, Arlandis S et al. What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women? A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel. European Urology. 2023 Sept;84(3):302-312. Epub 2023 Aug 11. doi: 10.1016/j.eururo.2023.05.014

Farag, Fawzy ; Sakalis, Vasileios I. ; Arteaga, Serenella Monagas et al. / What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women? A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel. In: European Urology. 2023 ; Vol. 84, No. 3. pp. 302-312.

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title = "What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women?: A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel",

abstract = "ContextOveractive bladder syndrome (OAB) is highly prevalent among women and has negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities.ObjectivesTo provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome.Evidence Acquisition and methodsThe Medline, Embase and Cochrane controlled trials databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. Risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions and quality of evidence was assessed using modified GRADE criteria. Meta-analysis was performed where appropriate.Evidence SynthesisAntimuscarinics and Beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events.Onabotulinumtoxin-A was more effective than placebo across most outcomes, but with significantly higher rates of AUR/CISC (6-8 times) and UTIs (2-3 times). Onabot-A was also significantly better than antimuscarinics in cure of UUI but not in reduction of mean UUI episodes.SNS success rate were significantly higher than antimuscarinics (61% vs. 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% VS. 10%). SNS was associated with 9% removal rate and 3% revision rate.Conclusions and Patient SummaryOveractive bladder is a manageable condition, with first line treatment options including antimuscarinics, beta-3 agonists and PTNS. Second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation. The choice of therapies should be guided by individual patient factors. ",

keywords = "Anticholinergics, Female lower urinary tracts symptoms, onabotulinum toxin, overactive bladder, sacral neuromodulation, Systematic Review, urgency incontinence",

author = "Fawzy Farag and Sakalis, {Vasileios I.} and Arteaga, {Serenella Monagas} and N{\'e}ha Sihra and Markos Karavitakis and Salvador Arlandis and Kari B{\o} and Hanny Cobussen-Boekhorst and Elisabetta Costantini and {de Heide}, Monica and Jan Groen and Benoit Peyronnet and Veronique Ph{\'e} and {van Poelgeest-Pomfret}, {Mary Lynne} and {van den Bos}, {Tine W.L.} and {van der Vaartq}, Huub and Harding, {Christopher K.} and Lapitan, {Marie Carmela M.} and Omar, {Muhammad Imran} and Nambiar, {Arjun K.}",

year = "2023",

month = sep,

doi = "10.1016/j.eururo.2023.05.014",

language = "English",

volume = "84",

pages = "302--312",

journal = "European Urology",

issn = "0302-2838",

publisher = "Elsevier",

number = "3",

}

TY - JOUR

T1 - What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women?

T2 - A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel

AU - Farag, Fawzy

AU - Sakalis, Vasileios I.

AU - Arteaga, Serenella Monagas

AU - Sihra, Néha

AU - Karavitakis, Markos

AU - Arlandis, Salvador

AU - Bø, Kari

AU - Cobussen-Boekhorst, Hanny

AU - Costantini, Elisabetta

AU - de Heide, Monica

AU - Groen, Jan

AU - Peyronnet, Benoit

AU - Phé, Veronique

AU - van Poelgeest-Pomfret, Mary Lynne

AU - van den Bos, Tine W.L.

AU - van der Vaartq, Huub

AU - Harding, Christopher K.

AU - Lapitan, Marie Carmela M.

AU - Omar, Muhammad Imran

AU - Nambiar, Arjun K.

PY - 2023/9

Y1 - 2023/9

N2 - ContextOveractive bladder syndrome (OAB) is highly prevalent among women and has negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities.ObjectivesTo provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome.Evidence Acquisition and methodsThe Medline, Embase and Cochrane controlled trials databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. Risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions and quality of evidence was assessed using modified GRADE criteria. Meta-analysis was performed where appropriate.Evidence SynthesisAntimuscarinics and Beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events.Onabotulinumtoxin-A was more effective than placebo across most outcomes, but with significantly higher rates of AUR/CISC (6-8 times) and UTIs (2-3 times). Onabot-A was also significantly better than antimuscarinics in cure of UUI but not in reduction of mean UUI episodes.SNS success rate were significantly higher than antimuscarinics (61% vs. 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% VS. 10%). SNS was associated with 9% removal rate and 3% revision rate.Conclusions and Patient SummaryOveractive bladder is a manageable condition, with first line treatment options including antimuscarinics, beta-3 agonists and PTNS. Second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation. The choice of therapies should be guided by individual patient factors.

AB - ContextOveractive bladder syndrome (OAB) is highly prevalent among women and has negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities.ObjectivesTo provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome.Evidence Acquisition and methodsThe Medline, Embase and Cochrane controlled trials databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. Risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions and quality of evidence was assessed using modified GRADE criteria. Meta-analysis was performed where appropriate.Evidence SynthesisAntimuscarinics and Beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events.Onabotulinumtoxin-A was more effective than placebo across most outcomes, but with significantly higher rates of AUR/CISC (6-8 times) and UTIs (2-3 times). Onabot-A was also significantly better than antimuscarinics in cure of UUI but not in reduction of mean UUI episodes.SNS success rate were significantly higher than antimuscarinics (61% vs. 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% VS. 10%). SNS was associated with 9% removal rate and 3% revision rate.Conclusions and Patient SummaryOveractive bladder is a manageable condition, with first line treatment options including antimuscarinics, beta-3 agonists and PTNS. Second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation. The choice of therapies should be guided by individual patient factors.

KW - Anticholinergics

KW - Female lower urinary tracts symptoms

KW - onabotulinum toxin

KW - overactive bladder

KW - sacral neuromodulation

KW - Systematic Review

KW - urgency incontinence

U2 - 10.1016/j.eururo.2023.05.014

DO - 10.1016/j.eururo.2023.05.014

M3 - Article

SN - 0302-2838

VL - 84

SP - 302

EP - 312

JO - European Urology

JF - European Urology

IS - 3

ER -