Behavioral Versus Drug Treatment for Overactive Bladder in Men: The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial

Authors

  • Kathryn L. Burgio PhD,

    Corresponding author
    1. Department of Medicine
    • Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, Atlanta, Georgia
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  • Patricia S. Goode MSN, MD,

    1. Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, Atlanta, Georgia
    2. Department of Medicine
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  • Theodore M. Johnson II, MD, MPH,

    1. Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, Atlanta, Georgia
    2. Emory University, Atlanta, Georgia
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  • Lee Hammontree MD,

    1. Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, Atlanta, Georgia
    2. Department of Surgery
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  • Joseph G. Ouslander MD,

    1. Department of Clinical Biomedical Science, Charles E. Schmidt College of Biomedical Science, Florida Atlantic University, Miami, Florida
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  • Alayne D. Markland DO, MSc,

    1. Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, Atlanta, Georgia
    2. Department of Medicine
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  • Janet Colli MD,

    1. Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, Atlanta, Georgia
    2. Department of Surgery
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  • Camille P. Vaughan MD, MS,

    1. Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, Atlanta, Georgia
    2. Emory University, Atlanta, Georgia
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  • David T. Redden PhD

    1. Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, Atlanta, Georgia
    2. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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  • Presented at the International Continence Society Annual Scientific Meeting, San Francisco, California, September 2009, and the American Urological Association Annual Scientific Meeting, San Francisco, California, May/June 2010.

Address correspondence to Kathryn L. Burgio, Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, 11G, 700 South 19th Street, Birmingham, AL 35233. E-mail: kburgio@aging.uab.edu

Abstract

Objectives

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.

Design

The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial was a two-site randomized, controlled, equivalence trial with 4-week alpha-blocker run-in.

Setting

Veterans Affairs Medical Center outpatient clinics.

Participants

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.

Interventions

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).

Measurements

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.

Results

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 (< .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; = .05). The drug group showed greater reductions in maximum urgency scores (mean = −0.44 vs −0.12; = .02). Other between-group differences were nonsignificant.

Conclusion

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.

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