Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama 35233, USA.
J Am Geriatr Soc. 2011 Dec;59(12):2209-16. doi: 10.1111/j.1532-5415.2011.03724.x. Epub 2011 Nov 7.
To compare the effectiveness of behavioral treatment with that of antimuscarinic therapy in men without bladder outlet obstruction who continue to have overactive bladder (OAB) symptoms with alpha-blocker therapy.
The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial was a two-site randomized, controlled, equivalence trial with 4-week alpha-blocker run-in.
Veterans Affairs Medical Center outpatient clinics.
Volunteer sample of 143 men aged 42 to 88 who continued to have urgency and more than eight voids per day, with or without incontinence, after run-in.
Participants were randomized to 8 weeks of behavioral treatment (pelvic floor muscle exercises, urge suppression techniques, delayed voiding) or drug therapy (individually titrated, extended-release oxybutynin, 5-30 mg/d).
Seven-day bladder diaries and a validated urgency scale were used to calculate changes in 24-hour voiding frequency, nocturia, urgency, and incontinence. Secondary outcomes were global patient ratings and American Urological Association Symptom Index.
Mean voids per day decreased from 11.3 to 9.1 (-18.8%) with behavioral treatment and 11.5 to 9.5 (-16.9%) with drug therapy. Equivalence analysis indicated that posttreatment means were equivalent (P < .01). After treatment, 85% of participants rated themselves as much better or better; more than 90% were completely or somewhat satisfied, with no between-group differences. The behavioral group showed greater reductions in nocturia (mean = -0.70 vs -0.32 episodes/night; P = .05). The drug group showed greater reductions in maximum urgency scores (mean = -0.44 vs -0.12; P = .02). Other between-group differences were nonsignificant.
Behavioral and antimuscarinic therapy are effective when added to alpha-blocker therapy for OAB in men without outlet obstruction. Behavioral treatment is at least as effective as antimuscarinic therapy.
比较行为治疗与抗毒蕈碱药物治疗在继续接受α-受体阻滞剂治疗但仍有膀胱过度活动症（OAB）症状的无膀胱出口梗阻男性中的疗效。
退伍军人膀胱过度活动症治疗（MOTIVE）试验是一项为期 4 周的双盲、对照、等效性试验，试验中进行了α-受体阻滞剂导入期。
退伍军人事务部医疗中心门诊。
143 名年龄在 42 至 88 岁之间的志愿者，在导入期后继续有尿急和每天超过 8 次排尿，且伴有或不伴有尿失禁。
参与者被随机分为 8 周的行为治疗（盆底肌锻炼、抑制尿急技术、延迟排尿）或药物治疗（个体化滴定、延长释放奥昔布宁、5-30mg/d）。
使用 7 天膀胱日记和经过验证的尿急量表来计算 24 小时排尿频率、夜间多尿、尿急和尿失禁的变化。次要结局是患者总体评分和美国泌尿外科学会症状指数。
行为治疗组平均每天排尿次数从 11.3 次减少到 9.1 次（减少 18.8%），药物治疗组从 11.5 次减少到 9.5 次（减少 16.9%）。等效性分析表明，治疗后平均值等效（P<0.01）。治疗后，85%的参与者自我评估为“好很多”或“好”；超过 90%的参与者完全或部分满意，两组之间无差异。行为组夜间多尿（平均= -0.70 次/夜 vs -0.32 次/夜；P=0.05）的改善程度更大。药物组最大尿急评分（平均= -0.44 分 vs -0.12 分；P=0.02）的改善程度更大。其他组间差异无统计学意义。
在无膀胱出口梗阻的男性中，行为治疗和抗毒蕈碱药物治疗与α-受体阻滞剂联合应用治疗 OAB 是有效的。行为治疗与抗毒蕈碱药物治疗同样有效。
