BLADDER TRAINING IN THE IMPROVEMENT OF OVERACTIVE BLADDER SYMPTOMS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Abstract

Background

Bladder training (BT) is characterized by a programmed voiding regimen with gradually adjusted voiding intervals and is commonly used in the conservative treatment of individuals with overactive bladder (OAB).

Objectives

To investigate and update the literature on the effectiveness of BT treatment alone and/or combined with other therapeutic strategies that can promote improvement in OAB symptoms and quality of life and report adverse events.

Methods

The systematic review was performed in eight databases, including PubMed, PEDro, SciELO, LILACS, Cochrane Library, Web of Science, EMBASE and CINAHL. After selecting the titles, abstracts and full texts retrieved. To assess the risk of bias of the studies, the Cochrane RoB 2 tool and the GRADE system were used to determine all the evidence of the studies analyzed. The protocol of this study is available in the PROSPERO systematic review protocol registry database with the registration number (PROSPERO CRD42022301522).

Results

The search generated a total of fourteen randomized controlled trials (RCTs) included in the review. The total participants were 2,319 (men and women) from 9 countries. The minimum age of the sample was 18 and the maximum age was 80 years. RCTs featured BT isolated (n=12), BT + intravaginal electrical stimulation (IVES) (n=2), BT + DT (drug treatment) (n=5), DT (n=7), BT + Biofeedback (BF) + IVES (n=1), PFMT + BF (n=1), BT + PFMT + behavioral education/therapy (n=2), BT + PTNS (percutaneous tibial nerve stimulation) or BT + TTNS (transcutaneous tibial nerve stimulation) (n=1). To the meta-analyses BT combined with IVES in the short-term follow-up period promoted improvement in nocturia (DM: 0.89, 95% CI: 0.59-1.20), urinary incontinence (DM: 1.93, 95% CI:1.32-2.55) and quality of life (DM: 4.87, 95% CI: 2.24-7.50). Three RCTs were considered with a "High" risk of bias, nine studies with "Some concerns," and two with a "Low" risk. In the GRADE system, the RCTs showed very low, of evidence to the GRADE system.

Conclusion

BT combined with IVES showed favorable results for treating OAB in the short-term follow-up period. Thus, the use usingined with IVES is recommended for treating individuals with OAB.

Implications

For individuals with OAB treated with BT + IVES there is a report of reduced episodes of nocturia, urinary incontinence and improved quality of life in the short-term follow-up period. The methodological quality of the studies was the best possible for the moment; aspects of the currently available RCTs were analyzed to update the current literature. Most of the data in this review comes from moderate-sized RCTs of very low to moderate methodological quality, verified by GRADE, in addition to heterogeneous risk of bias across RCTs. The findings corroborate the recommendations of the societies guiding conservative treatment for OAB. BT should be offered in combination with IVES as supplemental therapy in conservative treatment to increase treatment efficacy in the short-term follow-up period.