Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials

Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, Magri V, Mourmouris P, Ouattara A, Perletti G, Philipraj J, Stamatiou K, Trinchieri A, Buchholz N · Archivio Italiano di Urologia e Andrologia · 2022 December 28

DOI 10.4081/aiua.2022.4.492

Objective

To investigate the efficacy of pharmacological and non-pharmacological treatments for neurogenic overactive bladder (OAB) symptoms associated with neurological diseases.

Conclusions

Anticholinergics were more effective than placebo in decreasing the number of daily voids in patients with Parkinson's disease, but no significant difference was found for incontinence episodes and nocturia. Mirabegron was more effective than placebo in increasing cystometric capacity in patients with multiple sclerosis, while tibial nerve stimulation and pelvic floor muscle training demonstrated efficacy for reducing specific OAB symptoms.

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Insights

Neurogenic overactive bladder can be moderately treated using a combination of different medical interventions, possibly resulting in fewer side effects.

The research approach involved analyzing data from PubMed and EMBASE to review the efficacy of treatments for neurogenic overactive bladder linked to neurological diseases. The databases were scrutinized for randomized controlled trials focusing on both pharmacological and non-pharmacological treatments. Articles were selected based on title and abstract screening and assessed for relevance through full-text examination. A total of 62 studies were chosen for their perspectives and evidence on interventions such as anticholinergics, mirabegron, cannabinoids, botulinum toxin, and various physiotherapy methods including acupuncture and pelvic floor muscle training. The meta-analysis results show that all explored treatments exhibit a moderate degree of effectiveness; no single therapy displayed clear superiority over others. Anticholinergics effectively decreased daily voids in Parkinson's disease patients, while mirabegron improved bladder capacity in patients with multiple sclerosis. Treatments like transcutaneous tibial nerve stimulation and pelvic floor muscle training also showed improvement in certain symptoms. Symptom scores, bladder diary parameters, and the number of incontinence incidences didn't significantly change across most treatments. It is postulated that combining different pharmacological and non-pharmacological treatments might optimize results while potentially reducing side effects from medication dosage reductions.