Management of overactive bladder (OAB) symptoms in men generally is limited to drug therapies (e.g., a-adrenergic receptor antagonists, antimuscarinic agents). However, in women, combined therapy (behavioural plus drug therapies) is more effective than drug therapy alone. To evaluate the effectiveness of combined therapy in men, researchers conducted a multisite study in more than 200 men (mean age, 64) with OAB symptoms (baseline mean voids/24 hours, 12; baseline nocturia, 2.1). Participants were randomised to one of three groups:
• Drug therapy alone: tolterodine (4 mg/daily) plus tamsulosin (0.4 mg/daily)
• Behavioural therapy alone: Three clinic visits focused on pelvic floor muscle and urge suppression training plus contraction-relaxation exercises
• Combination behavioural and drug therapy
After 6 weeks, urinary frequency improved more in the behavioural-therapy and combination-therapy groups than in the drug-therapy group (mean voids/24 hours, 8.8 and 8.2 vs. 10.2), and nocturia improved similarly (mean overnight voids, 1.3 and 1.3 vs. 1.8). Adverse effects were more common in the groups that received drug therapy (alone or combined) than in the group that received behavioural therapy only (≈67% vs. 14%, respectively).
These results favour starting with behavioural therapy. However, as is frequently the case with non-pharmacologic approaches to common somatic symptoms, access to this type of therapy can be limited, and the default approach is a prescription (or two).