title: A double-blind crossover trial of baclofen--a new treatment for the unstable bladder syndrome. Randomized trial of transcutaneous tibial nerve stimulation to treat urge urinary incontinence in older women Preliminary results of a dose-finding study for botulinum toxin-A in patients with idiopathic overactive bladder: 100 versus 150 units. A urodynamic study of surface neuromodulation versus sham in detrusor instability and sensory urgency. Double-blind, placebo-controlled study of magnesium hydroxide for treatment of sensory urgency and detrusor instability: preliminary results. Intravesical resiniferatoxin for the treatment of women with idiopathic detrusor overactivity and urgency incontinence: A single dose, 4 weeks, double-blind, randomized, placebo controlled trial. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Prospective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women Efficacy of botulinum toxin-A for treating idiopathic detrusor overactivity: results from a single center, randomized, double-blind, placebo controlled trial. The Effect of Behavioral Therapy on Urinary Incontinence: A Randomized Controlled Trial Group treatments for sensitive health care problems: a randomised controlled trial of group versus individual physiotherapy sessions for female urinary incontinence Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. The Efficacy of Acupuncture in Treating Urge and Mixed Incontinence in Women: A Pilot Study Improving Urinary Incontinence in Overweight and Obese Women Through Modest Weight Loss Effect of weight loss on urinary incontinence in overweight and obese women: results at 12 and 18 months. Randomized, double-blind placebo-controlled trial with Bryophyllum pinnatum versus placebo for the treatment of overactive bladder in postmenopausal women. Bladder base/trigone injection is safe and as effective as bladder body injection of onabotulinumtoxinA for idiopathic detrusor overactivity refractory to antimuscarinics. Vaginal weight cone versus assisted pelvic floor muscle training in the treatment of female urinary incontinence. A prospective, single-blind, randomized trial Randomized, double-blind, sham-controlled evaluation of the effect of functional continuous magnetic stimulation in patients with urgency incontinence. Is sensory testing during lead placement crucial for achieving positive outcomes after sacral neuromodulation? Comparison of electric stimulation and oxybutynin chloride in management of overactive bladder with special reference to urinary urgency: a randomized placebo-controlled trial. Results of a prospective, randomized, multicenter study evaluating sacral neuromodulation with InterStim therapy compared to standard medical therapy at 6-months in subjects with mild symptoms of overactive bladder. An alternative intervention for urinary incontinence: retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. Refractory idiopathic urge urinary incontinence and botulinum A injection. Evaluation of a new disposable "tampon like" electrostimulation technology (Pelviva®) for the treatment of urinary incontinence in women: a 12-week single blind randomized controlled trial. Investigation of the clinical efficacy and safety of pregabalin alone or combined with tolterodine in female subjects with idiopathic overactive bladder. Outcome of a randomized, double-blind, placebo controlled trial of botulinum A toxin for refractory overactive bladder. Behavioral therapy for urinary incontinence in India. Efficacy and tolerability of mirabegron, a β(3)-adrenoceptor agonist, in patients with overactive bladder: results from a randomised European-Australian phase 3 trial. Repeated botulinum toxin type A injections for refractory overactive bladder: medium-term outcomes, safety profile, and discontinuation rates. Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. A double-blind placebo-controlled trial on the effects of 25 mg estradiol implants on the urge syndrome in postmenopausal women Terodiline with bladder retraining for treating detrusor instability in elderly people. The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: a randomized controlled trial. OnabotulinumtoxinA for the Treatment of Patients with Overactive Bladder and Urinary Incontinence: Results of a Phase 3, Randomized, Placebo Controlled Trial Side effects, feasibility, and adherence to treatment during home-managed electrical stimulation for urinary incontinence: a Norwegian national cohort of 3,198 women. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. Weight loss: a novel and effective treatment for urinary incontinence. Effect of intravaginal electrical stimulation on pelvic floor muscle strength Satisfaction and patient experience with sacral neuromodulation: results of a single center sample survey. Prospective randomised controlled trial comparing trigone-sparing versus trigone-including intradetrusor injection of abobotulinumtoxinA for refractory idiopathic detrusor overactivity. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Acupuncture for Overactive Bladder: A Randomized Controlled Trial A prospective, randomized controlled trial of inpatient versus outpatient continence programs in the treatment of urinary incontinence in the female Vaginal electrical stimulation of the pelvic floor: A randomized feasibility study in urinary incontinent elderly women A prospective randomised double-blind controlled trial evaluating the effect of trans-sacral magnetic stimulation in women with overactive bladder Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Randomized controlled trial of foot reflexology for patients with symptomatic idiopathic detrusor overactivity Botulinum toxin a versus placebo for refractory detrusor overactivity in women: a randomised blinded placebo-controlled trial of 240 women (the RELAX study). Neuromodulative treatment of overactive bladder--noninvasive tibial nerve stimulation. Randomized double-blind, active-controlled phase 3 study to assess 12-month safety and efficacy of mirabegron, a β(3)-adrenoceptor agonist, in overactive bladder. Increasing patient preparedness for sacral neuromodulation improves patient reported outcomes despite leaving objective measures of success unchanged. The effect of weight loss on changes in health-related quality of life among overweight and obese women with urinary incontinence Conservative treatment of female urinary incontinence with functional magnetic stimulation. A multicenter, double-blind, randomized, placebo-controlled trial of the β3-adrenoceptor agonist solabegron for overactive bladder. Pelvic Static Magnetic Stimulation to Control Urinary Incontinence in Older Women: A Randomized Controlled Trial Effectiveness of pelvic floor muscle exercise therapy supplemented with a health education program to promote long-term adherence among women with urinary incontinence. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. Caffeine reduction education to improve urinary symptoms. Efficacy of physical therapeutic modalities in women with proven bladder overactivity. Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics. Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder. Unilateral versus bilateral sacral neuromodulation in patients with chronic voiding dysfunction. Extracorporeal magnetic stimulation is of limited clinical benefit to women with idiopathic detrusor overactivity: a randomized sham controlled trial. A randomized trial of behavioral management for continence with older rural women. Sustained improvement of subjective quality of life in older community-dwelling people after treatment of urinary incontinence. Evaluation of a simple, non-surgical concept for management of urinary incontinence (minimal care) in an open-access, interdisciplinary incontinence clinic. Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial Sacral Root Neuromodulation in the Treatment of Refractory Urinary Urge Incontinence: A Prospective Randomized Clinical Trial Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. A phase III, randomized, double-blind, parallel-group, placebo-controlled, multicentre study to assess the efficacy and safety of the β₃ adrenoceptor agonist, mirabegron, in patients with symptoms of overactive bladder. The safety and efficacy of botulinum toxin-A in the management of bladder oversensitivity: a randomised double-blind placebo-controlled trial. What predicts and what mediates the response of urge urinary incontinence to biofeedback? Percutaneous tibial nerve stimulation effects on detrusor overactivity incontinence are not due to a placebo effect: a randomized, double-blind, placebo controlled trial. Effect of heat- and steam-generating sheet on daily activities of living in patients with osteoarthritis of the knee: randomized prospective study
abstract: Forty patients with the unstable bladder syndrome have been treated in a double-blind crossover trial of baclofen 5 mg qds versus placebo . Baclofen significantly improved diurnal and nocturnal frequency of micturition and the severity of incontinence . Considerable improvement was also obtained with placebo Introduction The aim of this study was to examine the efficacy of transcutaneous electrical tibial nerve stimulation ( TTNS ) to treat urge urinary incontinence ( UUI ) in older women . Material and methods The study design was a r and omized clinical trial conducted on 51 elderly women ( > 60 years ) with UUI . All were treated with 12 weeks of bladder retraining and pelvic floor muscle exercises , and 25 were r and omly selected to receive TTNS in addition to the st and ard therapy . The cases were evaluated at the baseline and after the end of therapy by 3-day bladder diary , quality of life question naires ( QoL ) , and subjective response . Results Of the patients , 68.0 % in TTNS group reported cure or improvement vs. 34.6 % in the control group ( P = 0.017 ) . TTNS showed significant improvement in most areas of QoL and in UUI parameters when compared with the control group . Conclusion TTNS is efficacious to treat UUI in older women AIMS To evaluate the clinical outcomes of two different doses of BTX-A in patients with I-OAB . METHODS This investigator initiated , r and omized trial was design ed to evaluate clinical differences in outcomes for 100 versus 150 U BTX-A in patients with I-OAB . Patients with OAB-Wet and OAB-Dry were r and omized to receive 100 or 150 U BTX-A intra-detrusor injection . For patients with OAB-Wet , the primary outcome of interest was change in daily UUI episodes , and for those with OAB-Dry the primary outcome measure was change in number of daily voids as determined by 3-VD . Statistical comparisons were made both pre- and post-injection and also between different treatment groups to assess the superiority of one dose versus the other . RESULTS Forty-four patients enrolled in the study ; 10 OAB-Dry and 12 OAB-Wet patients received 100 U and another 10 OAB-Dry and 12 OAB-Wet patients received 150 U. No significant differences in outcome measure were noted between those receiving 100 versus 150 U. Patients with OAB-Wet tended to be completely dry more frequently if they received the 150 U dose , but this was not statistically significant . No differences in urodynamics outcomes were noted between the groups . QOL was significantly improved in both groups with no difference between the different doses . CONCLUSIONS In patients with I-OAB , preliminary results indicate that 100 U BTX-A and 150 U BTX-A are equivalent in terms of symptom reduction and QOL improvement PURPOSE We studied the effect of surface neuromodulation on cystometric pressure and volume parameters in women with detrusor instability or sensory urgency .  Electrical current was delivered to the suprapubic region and third sacral foramina via a transcutaneous electrical nerve stimulator with sham neuromodulation control . MATERIAL S AND METHODS A consecutive series of women with proved detrusor instability or sensory urgency were r and omized to 3 surface neuromodulation groups .  Volume and pressure parameters were the main outcomes of transcutaneous electrical nerve stimulation applied during second cystometric fill . RESULTS Sham transcutaneous electrical nerve stimulation did not alter the outcome measures . However , neuromodulation delivered across the suprapubic and sacral skin effected a reduction in mean maximum height of detrusor contraction . A current which inhibits motor activity was not superior to that which inhibits sensory perception in reducing detrusor pressure . Response in sensory urgency was poor . CONCLUSIONS Results from our sham controlled study suggest that short-term surface neuromodulation via transcutaneous electrical nerve stimulation may have a role in the treatment of detrusor instability . Future studies must examine the clinical effect of long-term surface neuromodulation In a prospect i ve , r and omised , double-blind , placebo-controlled study 40 women with sensory urgency or detrusor instability r and omly received either magnesium hydroxide ( group A ) or placebo ( group B ) . Pre- and post-treatment symptoms , frequency-volume charts and cystometry results were compared . Eleven of 20 patients receiving magnesium ( 55 % ) reported a subjective improvement of their urinary symptoms , compared with five patients taking placebo ( 20 % ) . In both study groups there was no statistically significant difference in pre- and post-treatment urodynamic parameters in those reporting symptomatic improvement . Magnesium was well tolerated by patients in group A , and no side effects were reported . These results suggest that magnesium hydroxide may be beneficial for detrusor instability or sensory urgency in women AIMS To assess the hypothesis that resiniferatoxin ( RTX ) can be useful in women with urgency incontinence and idiopathic detrusor overactivity ( IDO ) , we conducted a prospect i ve , double-blind , r and omized , placebo-controlled , parallel trial comparing the effects of RTX and placebo . MATERIAL S AND METHODS Fifty-eight patients were r and omly assigned to receive a single intravesical dose of 100 ml of either RTX 50 nM or placebo .  Safety and efficacy were evaluated over 4 weeks . The primary efficacy endpoints were voiding symptoms evaluated through the voiding diary . Secondary efficacy endpoint was urodynamic response . Quality of life was measured by the Kings ' Health Question naire RESULTS Although improving trends were seen in both groups after the instillations , no statistically significant differences were found between the groups in any of the clinical or urodynamic parameters .  RTX instillations were well tolerated with few and self-limited side-effects . CONCLUSION A single 50 nM intravesical dose of RTX was not better than placebo for the treatment of women with IDO and urgency incontinence BACKGROUND Overactive bladder ( OAB ) syndrome with urinary incontinence ( UI ) is prevalent in the population and impairs health-related quality of life ( HRQOL ) . OBJECTIVE To assess the impact on efficacy , safety , and HRQOL of onabotulinumtoxinA ( BOTOX ( ® ) , Allergan , Inc. ) treatment in patients with OAB with UI . DESIGN , SETTING , AND PARTICIPANTS This pivotal , multicentre , double-blind , r and omised , placebo-controlled , phase 3 study enrolled patients with idiopathic OAB with ≥ 3 urgency UI episodes over 3 d and ≥ 8 micturitions per day who were inadequately managed by anticholinergics . INTERVENTION OnabotulinumtoxinA at a 100U dose ( n=277 ) or placebo ( n=271 ) , administered as 20 intradetrusor injections of 0.5 ml . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Co- primary end points were change from baseline in the number of UI episodes per day and proportion of patients reporting positive treatment response on the treatment benefit scale ( TBS ) at week 12 . Additional end points included other OAB symptoms ( episodes of urinary urgency incontinence , micturition , urgency , and nocturia ) and HRQOL ( Incontinence Quality of Life [ I-QOL ] , King 's Health Question naire [ KHQ ] ) . Safety assessment s included adverse events ( AEs ) , postvoid residual ( PVR ) urine volume , and initiation of clean intermittent catheterisation ( CIC ) . RESULTS AND LIMITATIONS OnabotulinumtoxinA significantly decreased UI episodes per day at week 12 ( -2.95 for onabotulinumtoxinA versus -1.03 for placebo ; p<0.001 ) . Reductions from baseline in all other OAB symptoms were also significantly greater following onabotulinumtoxinA compared with placebo ( p ≤ 0.01 ) . Patients perceived a significant improvement in their condition , as measured by patients with a positive treatment response on the TBS ( 62.8 % for onabotulinumtoxinA versus 26.8 % for placebo ; p<0.001 ) . Clinical ly meaningful improvements from baseline in all I-QOL and KHQ multi-item domains ( p<0.001 versus placebo ) indicated positive impact on HRQOL . AEs were mainly localised to the urinary tract . Mean PVR was higher in the onabotulinumtoxinA group ( 46.9 ml versus 10.1 ml at week 2 ; p<0.001 ) ; 6.9 % of onabotulinumtoxinA patients versus 0.7 % of placebo patients initiated CIC . CONCLUSIONS OnabotulinumtoxinA 100 U was well tolerated and demonstrated significant and clinical ly relevant improvements in all OAB symptoms , patient-reported benefit , and HRQOL in patients inadequately managed by anticholinergics . TRIAL REGISTRATION Clinical Trials.gov : NCT00910520 The purpose of this study is to compare the effectiveness of oxybutynin , functional electrostimulation ( FES ) , and pelvic floor training ( PFT ) for treatment of women with detrusor overactivity . Sixty-four subjects were r and omized to oxybutynin ( n = 22 ) , FES ( n = 21 ) , or PFT ( n = 21 ) . Women were evaluated before and after completion of 12 weeks of treatment by subjective response , voiding diary , and urodynamic test . There was subjective symptomatic improvement in 77 % of the women treated with oxybutynin , 52 % with FES , and 76 % with PFT .  Urgency resolved in 64 % of women treated with oxybutynin , 52 % with FES , and in 57 % with PFT .  Urodynamic evaluation was normal in 36 % treated with oxybutynin , 57 % with FES , and 52 % with PFT .  Maximum detrusor involuntary contraction pressure decreased in all groups ( p < 0.05 ) . All treatments were equally effective . Subjective reduction of urge-incontinence episodes was associated with symptomatic improvement PURPOSE We evaluated the use of botulinum toxin-A in treating patients with idiopathic detrusor overactivity refractory to anticholinergics . MATERIAL S AND METHODS This double-blind , placebo controlled trial r and omized participants to intradetrusor injections of 200 U botulinum toxin-A ( 16 patients ) or placebo ( 18 patients ) . The primary outcome measure was change in maximum cystometric capacity . Secondary outcome measures included changes in overactive bladder symptoms , post-void residual , maximum detrusor pressure during filling cystometry and reflex detrusor volume . Quality of life was assessed using the Incontinence Impact Question naire short form 7 and Urogenital Distress Inventory short form 6 . Followup occurred at 4 and 12 weeks after injection , at which point the study was unblinded . Further followup in the botulinum toxin-A group occurred at 24 weeks . RESULTS Significant increases in maximum cystometric capacity were observed at 4 weeks ( difference 144.69 ml , 95 % CI 100.95 to 215.75 , p < 0.0001 ) and 12 weeks ( difference 95.71 ml , 95 % CI 47.47 to 172.45 , p = 0.001 ) in patients treated with botulinum toxin-A compared to placebo . Botulinum toxin-A reduced frequency ( p < 0.001 , p = 0.003 ) and urgency urinary incontinence ( p = 0.03 , p = 0.008 ) episodes at 4 and 12 weeks , respectively . Urgency was reduced at 4 weeks ( p = 0.005 ) in the botulinum toxin-A group . In patients receiving botulinum toxin-A , post-void residual increased at 4 weeks ( p = 0.024 ) but became insignificant by 12 weeks ( p = 0.406 ) . Of these patients 6 required intermittent self-catheterization . Significant improvements in quality of life were observed following botulinum toxin-A. The extension study suggests that the beneficial effects of botulinum toxin-A are maintained for at least 24 weeks . CONCLUSIONS Botulinum toxin-A at 200 U is safe and effective for idiopathic detrusor overactivity and the beneficial effects persist for at least 24 weeks OBJECTIVE To evaluate the effect of a low‐intensity behavioral therapy program on urinary incontinence in older women . METHODS A r and omized clinical trial for community‐dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted . Women were r and omly assigned to a behavioral therapy group ( n = 77 ) or a control group ( n = 75 ) . The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules . The control group received no instruction but kept urinary diaries for 6 weeks . After this period , the control group underwent the behavioral therapy protocol . Using per‐ protocol analyses , t and χ2 tests were used to compare the treatment and control groups , and paired t tests were used to evaluate the efficacy of behavioral therapy for all women ( treatment and control groups before and after behavioral therapy ) . RESULTS Women in the treatment group experienced a 50 % reduction in mean number of incontinent episodes recorded on a 7‐day urinary diary compared with a 15 % reduction for controls ( P = .001 ) . After behavioral therapy , all women had a 40 % decrease in mean weekly incontinent episodes ( P = .001 ) , which was maintained over 6 months ( P < .004 ) . Thirty ( 31 % ) women were 100 % improved ( dry ) , 40 ( 41 % ) were at least 75 % improved , and 50 ( 52 % ) at least 50 % improved . There were no differences in treatment efficacy by type of incontinence ( stress , urge , mixed ) or group assignment ( treatment , control ) . CONCLUSION A low‐intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first‐line treatment for urinary incontinence in older women Background The aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms , quality of life , and costs , and to investigate the effect of patient preference on uptake and outcome of treatment . Methods A pragmatic , multi-centre r and omised controlled trial in five British National Health Service physiotherapy departments . 174 women with stress and /or urge incontinence were r and omised to receive treatment from a physiotherapist delivered in a group or individual setting over three weekly sessions . Outcome were measured as Symptom Severity Index ; Incontinence-related Quality of Life question naire ; National Health Service costs , and out of pocket expenses . Results The majority of women expressed no preference ( 55 % ) or preference for individual treatment ( 36 % ) . Treatment attendance was good , with similar attendance with both service delivery models . Overall , there were no statistically significant differences in symptom severity or quality of life outcomes between the models . Over 85 % of women reported a subjective benefit of treatment , with a slightly higher rating in the individual compared with the group setting . When all health care costs were considered , average cost per patient was lower for group sessions ( Mean cost difference £ 52.91 95 % , confidence interval ( £ 25.82 - £ 80.00 ) ) . Conclusion Indications are that whilst some women may have an initial preference for individual treatment , there are no substantial differences in the symptom , quality of life outcomes or non-attendance . Because of the significant difference in mean cost , group treatment is recommended . Trial Registration Trial Registration number : IS RCT N PURPOSE This 5-year , prospect i ve , multicenter trial evaluated the long-term safety and efficacy of sacral neuromodulation in patients with refractory urge incontinence , urgency frequency and retention . MATERIAL S AND METHODS A total of 17 centers worldwide enrolled 163 patients ( 87 % female ) . Following test stimulation 11 patients declined implantation and 152 underwent implantation using InterStim .  Of those treated with implantation 96 ( 63.2 % ) had urge incontinence , 25 ( 16.4 % ) had urgency frequency and 31 ( 20.4 % ) had retention . Voiding diaries were collected annually for 5 years . Clinical success was defined as 50 % or greater improvement from baseline in primary voiding diary variable(s ) . RESULTS Data for all implanted cases were reported . For patients with urge incontinence mean leaking episodes per day decreased from 9.6 + /- 6.0 to 3.9 + /- 4.0 at 5 years . For patients with urgency frequency mean voids per day decreased from 19.3 + /- 7.0 to 14.8 + /- 7.6 , and mean volume voided per void increased from 92.3 + /- 52.8 to 165.2 + /- 147.7 ml . For patients with retention the mean volume per catheterization decreased from 379.9 + /- 183.8 to 109.2 + /- 184.3 ml , and the mean number of catheterizations decreased from 5.3 + /- 2.8 to 1.9 + /- 2.8 . All changes were statistically significant ( p < 0.001 ) . No life threatening or irreversible adverse events occurred . In 102 patients 279 device or therapy related adverse events were observed . At 5 years after implantation 68 % of patients with urge incontinence , 56 % with urgency frequency and 71 % with retention had successful outcomes . CONCLUSIONS This long-term study demonstrates that InterStim therapy is safe and effective for restoring voiding in appropriately selected cases refractory to other forms of treatment PURPOSE The propose of this pilot study was to examine the feasibility of recruiting women into a clinical trial design ed to examine the efficacy of acupuncture in treating urge and mixed urinary incontinence ( UI ) and the feasibility of performing the planned study procedures . We also sought to determine if there was preliminary evidence to suggest that acupuncture may be effective in reducing UI and improving general health-related and disease-specific quality of life and if a sham acupuncture needle is an effective placebo intervention . DESIGN This pilot study was a double-blinded , r and omized , clinical trial . Subjects were r and omly assigned to a true or sham ( placebo control ) acupuncture group . Both true and sham acupuncture treatments were performed twice a week for 6 weeks . All subjects were evaluated at the completion of the 6-week intervention and 4 weeks later . SAMPLE The sample consisted of 9 women between the ages of 44 and 66 years with urge or mixed urge and stress UI at least twice a week for a minimum of 3 months . MEASURES Subjects completed a 1-week bladder diary at baseline and at 1 and 4 weeks postacupuncture to assess the impact of acupuncture on incontinence episodes . Quality of life was measured at baseline and at 1 and 4 weeks postacupuncture using the Medical Outcomes Short-Form ( general health- related quality of life ) and the Incontinence Impact Question naire and Urogenital Distress Inventory ( incontinence-specific quality of life ) . RESULTS It was feasible to recruit subjects and perform the planned study procedures . Subjects r and omized to the true acupuncture group had a mean 63.30 % ( median = 65.99 % ) reduction in daytime accidents/day at 1 week postacupuncture and 67.47 % reduction ( median = 75.76 % ) at 4 weeks postacupuncture . In contrast , the mean reduction in daytime accidents was 18.88 % ( median = 19.64 % ) at 1 week and 16.67 % ( median = 0 % ) at 4 weeks post – sham acupuncture . There were no significant group differences in changes in the scores on the quality -of-life measures . Subjects ' perceptions about whether they had received the true or sham acupuncture were not significantly better than one would expect by chance . CONCLUSIONS The findings of this pilot study support the need for additional research examining the efficacy of acupuncture in the treatment of UI in women , the feasibility of performing study procedures , and the use of a sham needle as placebo in acupuncture studies OBJECTIVE : To examine the relationship between magnitude of weight loss and changes in urinary incontinence frequency . METHODS : Overweight and obese women ( N=338 ) with 10 or more urinary incontinence episodes per week were assigned r and omly to an intensive 6-month behavioral weight loss program followed immediately by a 12-month weight maintenance program ( intervention ; n=226 ) or to a structured education program ( control ; n=112 ) . The intervention and control groups were combined to examine the effects of the magnitude of weight loss on changes in urinary incontinence assessed by 7-day voiding diary , pad test , and self-reported satisfaction with change in urinary incontinence . RESULTS : Compared with participants who gained weight ( reference ) , those who lost 5 % to less than 10 % or 10 % or more of their body weight had significantly greater percent reductions in urinary incontinence episodes and were more likely to achieve at least a 70 % reduction in the frequency of total and urge urinary incontinence episodes at 6 , 12 , and 18 months . Satisfaction was also related to magnitude of weight loss ; approximately 75 % of women who lost 5 % to less than 10 % of their body weight reported being moderately or very satisfied with their changes in urine leakage . CONCLUSION : Weight losses between 5 % and 10 % of body weight were sufficient for significant urinary incontinence benefits . Thus , weight loss should be considered as initial treatment for incontinence in overweight and obese women . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00091988 . LEVEL OF EVIDENCE : PURPOSE Initial weight loss improves urinary incontinence in overweight and obese women . In this study we examined the longer term effects of a weight loss intervention on urinary incontinence . MATERIAL S AND METHODS Overweight and obese women ( mean + /- SD age 53 + /- 10 years ) with 10 or more urinary incontinence episodes weekly were r and omized to an 18-month behavioral weight loss intervention ( 226 ) or control group ( 112 ) . Outcome measures were collected at 12 and 18 months . RESULTS At baseline women had a mean body mass index of 36 + /- 6 kg/m(2 ) and reported a mean of 24 + /- 18 incontinence episodes weekly . Of the patients 86 % completed 18-month measurements . The percent weight loss in the intervention group averaged 8.0 % , 7.5 % and 5.5 % at 6 , 12 and 18 months , respectively , vs approximately 1.5 % in the control group ( all values p < 0.001 ) . Compared with controls at 12 months the intervention group reported a greater percent reduction in weekly stress urinary incontinence episodes ( 65 % vs 47 % , p < 0.001 ) , and a greater proportion achieved at least a 70 % decrease in weekly total and stress urinary incontinence episodes . At 18 months a greater proportion of women in the weight loss intervention group had more than 70 % improvement in urge incontinence episodes but there were no significant differences between the groups for stress or total urinary incontinence . The intervention group also reported greater satisfaction with changes in urinary incontinence than the control group at 6 , 12 and 18 months . CONCLUSIONS Weight loss intervention reduced the frequency of stress incontinence episodes through 12 months and improved patient satisfaction with changes in incontinence through 18 months . Improving weight loss maintenance may provide longer term benefits for urinary incontinence INTRODUCTION Overactive bladder syndrome ( OAB ) is a chronic disorder that often requires long-term treatment . There is a growing interest in new substances . In vitro experiments of Bryophyllum pinnatum ( BP ) on porcine bladder muscle have shown a muscle-relaxing effect . In this clinical trial we evaluated BP versus placebo regarding efficacy and safety . MATERIAL S AND METHODS Prospect i ve , double-blind r and omized , placebo-controlled study with 20 patients ( 10 BP , 10 placebo ) ; medication over 8 weeks ; dosage 3 × 2 capsules BP 50 % ( 350 mg)/day or placebo ( lactose ) . Primary aim : reduction of the micturition frequency/24h . Secondary aim : change in quality of life , alterations of parameters in the bladder diary and adverse events ( AE ) . Statistical analysis was performed with IBM SPSS Statistics 20 . The groups were compared using Fisher 's exact test and the Mann-Whitney test ; the visits using the Wilcoxon signed ranks test . RESULTS Both groups did not differ significantly in demographical data . For the primary endpoint , a trend in the reduction of the micturition frequency/24h in the BP group was found : 9.5±2.2 before and 7.8±1.2 after BP versus 9.3±1.8 before and 9.1±1.6 after placebo , p=0.064 . From visit 2 to visit 4 , micturition frequency/24h improved in 8/10 patients in the BP group ( p=0.037 ) . In the placebo group , micturition frequency/24h improved in 5/9 patients ( p=0.89 ) . Improvement of the QoL did not differ between the two groups . The incidence of AE was similar in both groups , no SAE occurred . CONCLUSION The successful safety outcome and positive trend for efficacy permits BP to be further evaluated as a favorable treatment option for OAB PURPOSE The purpose of this study was to evaluate the efficacy and safety of onabotulinumtoxinA injections at bladder base/trigone and compare with injections at bladder body or bladder body/trigone for the treatment of idiopathic detrusor overactivity ( IDO ) refractory to antimuscarinics . MATERIAL S AND METHODS A single blind , r and omized , paralleled , actively controlled trial was performed in patients with urodynamically proven IDO who failed antimuscarinic therapy . Patients were r and omly assigned to receive intravesical injections of 100 U of onabotulinumtoxinA into three different bladder sites . All treatments were evaluated by voiding diary variables , urgency severity score , urodynamic studies , and patient perception of bladder condition . Long-term success rates over 12 months were also determined . RESULTS Among the patients , 37 were r and omized to injections in the bladder body , 35 into the bladder body/trigone , and 33 into the bladder base/trigone . Successful results were reported in 76 ( 72 % ) patients at 3 months : 26 ( 70 % ) in the bladder body group , 26 ( 74 % ) in the bladder body/trigone group , and 24 ( 73 % ) in the bladder base/trigone group . There were no significant differences in success rates , changes in urgency and urgency incontinence episodes , urodynamic variables , or long-term success rates among the three subgroups . The incidence of adverse events was similar among three groups . No vesicoureteral reflux was noted in all patients with or without involving trigone injection . CONCLUSION Intravesical onabotulinumtoxinA injection is an effective treatment for IDO regardless of the bladder injection site . Bladder base/trigone injection is as safe and effective as bladder body injections with or without trigone involvement Introduction and hypothesisVaginal weight cone ( VWC ) versus assisted pelvic floor muscle training ( APFMT ) in the treatment of urinary incontinence ( UI ) in women . Methods One hundred three incontinent women were r and omly distributed into two groups : group G1 ( n = 51 ) treated with VWC and G2 ( n = 52 ) , APFMT . The following parameters were performed initially and after treatment : ( 1 ) clinical question naire , ( 2 ) visual analogue scale ( VAS ) , ( 3 ) 60-min pad test , and ( 4 ) subjective and objective assessment of pelvic floor muscle ( PFM ) . Results There was a significant decrease in nocturia and urine loss after treatment in both groups ( p < 0.05 ) . In VAS , there was a significant improvement of all parameters in both groups ( p < 0.05 ) . The pad test showed significant decrease in both groups ( p < 0.05 ) . There was a significant increase of PFM strength in both groups ( p < 0.05 ) . Conclusion There was no difference between groups treated with VWC and APFMT AIMS To evaluate the effect of functional continuous magnetic stimulation ( FCMS ) on urgency incontinence in r and omized , sham-controlled manner . METHODS Thirty-nine patients with urgency incontinence , 16 males and 23 females ( aged 66.0 + /- 16.5 years ) , who were refractory to pelvic floor muscle training ( PFMT )  , were r and omly assigned either to the treatment schedule performing 10-week active treatment , followed by 4-week non-treatment interval and then by 10-week sham treatment ( A-S , n = 20 ) or to that performing the sham treatment first followed by 10-week active treatment ( S-A , n = 19 ) . RESULTS At 10 weeks , the number of leaks/week , the total score of the International Consultation on Incontinence- Question naire : Short Form ( ICIQ-SF ) , and maximum cystometric capacity ( MCC ) were significantly improved as compared with the initial levels ( P < 0.001 , P < 0.001 , and P = 0.003 , respectively ) in the former group , but not in the latter group . Four ( 20.0 % ) patients were cured in the A-S group , while no patient was cured in the S-A group . At the end of the A-S schedule ( 24 weeks of study ) , the effect of the active treatment was still maintained at a significantly improved level , as compared with the initial level . At the end of the S-A schedule , the number of leaks/week was significantly improved as compared with the initial level and with its 10-week level ( P < 0.001 and P = 0.049 , respectively ) , as well as ICIQ-SF total score ( P = 0.001 and P = 0.006 , respectively ) . MCC significantly increased from its initial level ( P = 0.030 ) . CONCLUSION Magnetic stimulation was effective on urgency incontinence in comparison to sham stimulation in this small patient group AIMS Motor and sensory responses help guide lead placement during staged neuromodulation procedures . However , eliciting sensory responses requires lighter anesthesia . We evaluated the impact of assessing sensory responses during quadripolar tined lead placement on outcomes in subjects with refractory voiding symptoms . METHODS Adults who had a sacral lead placed were identified from our prospect i ve neuromodulation data base and grouped by whether they had intraoperative sensory testing  or not  .  History , operative data , and implantable permanent generator ( IPG ) implant , lead revision and device explant rates were collected from medical records . Symptoms were evaluated with the Interstitial Cystitis Symptom Index/Problem Index ( ICSI-PI ) and scaled global response assessment s ( GRA ) for the first 24 months post IPG placement . Data were analyzed using Pearson 's Chi-square , Fisher 's Exact , or Wilcoxon rank test . RESULTS Of 141 subjects ( 82 % female ) , 86 ( 61 % ) had sensory testing and 55 ( 39 % ) did not .  Sensory and no sensory testing groups were not significantly different on demographics , urologic diagnosis , IPG implant rates ( 76/84 ; 90 % and 48/55 ; 87 % respectively ) or mean operative time ( 37.9 ± 13.9 minutes vs. 35.5 ± 11.6 ) . Within 4 years , 19/141 ( 13.5 % ) were revised and /or explanted . For explant alone , 11/86 ( 13 % ) in the sensory and only 3/55 ( 5.5 % ) in the no sensory group ( P = 0.16 ) were explanted . Overall , ICSI-PI scores improved over time ( P < 0.0001 ) and most reported improvement on the GRA at each time point , but no differences were seen between groups . CONCLUSIONS Intraoperative sensory testing during sacral lead placement does not necessarily improve IPG implantation rates or clinical outcomes of neuromodulation OBJECTIVES To compare the efficacy of electric stimulation ( ES ) , oxybutynin , and placebo in managing the symptom complex of overactive bladder ( OAB ) , particularly urgency . METHODS A r and omized placebo-controlled trial was conducted for 68 patients with OAB , placing emphasis on urinary urgency . The interventions for the 12-week treatment period , conducted by the physiotherapist , who was unaware of the progress and outcome , included a vaginal ES program using biphasic symmetric , pulsed current with a 10-Hz frequency , 400-micros pulse width , 10/5 duty cycle , and varying intensity ; and oxybutynin ( 2.5 mg ) or placebo three times per day . Identical preintervention and postintervention assessment s included the measurement of warning time , urodynamics , voiding diaries , and King 's Health Question naire . RESULTS Of the 68 women who completed this study , 24 were in the ES , 23 in the oxybutynin , and 21 in the placebo group . The between-group comparison showed that significant improvements in daily voided volume , pad count , number of urgency and nocturia episodes , and the domain 2 score and total score of the King 's Health Question naire existed between the ES and the other groups ( all P < or = 0.050 ) . The changes in warning time , maximal voided volume , number of urgency episodes , and frequency were significantly improved between oxybutynin and placebo ( all P < 0.013 ) . Additionally , a comparison of the voided volume in uroflowmetry between the ES and placebo groups revealed a greater difference after treatment ( P = 0.013 ) . The reduction rate of OAB was 58.4 % for the ES , 39.1 % for the oxybutynin , and 9.5 % for the placebo group ( P = 0.036 ) . CONCLUSIONS ES had the greatest subjective outcome for OAB and was the most effective of the three treatments . Oxybutynin was more effective than placebo AIMS This prospect i ve , r and omized , multicenter trial evaluated the 6-month success rate of sacral neuromodulation ( SNM ) with InterStim ® Therapy versus st and ard medical therapy ( SMT ) for overactive bladder ( OAB ) . METHODS Enrolled subjects discontinued OAB medications prior to and during baseline data collection and were r and omized 1:1 to SNM or SMT . Subjects had bothersome symptoms of overactive bladder ( OAB ) including urinary urge incontinence ( ≥2 leaks/72 hr ) and /or urgency-frequency ( ≥8 voids/day ) . Subjects failed at least one anticholinergic medication , and had at least one medication not yet attempted . The primary objective was to compare OAB therapeutic success rate at 6 months between SNM and SMT . RESULTS Overall , 147 subjects were r and omized ( 70 to SNM and 77 to SMT ) ; 93 % were female and mean age was 58 . The primary intent to treat analysis showed OAB therapeutic success was significantly greater in the SNM group ( 61 % ) than the SMT group ( 42 % ; P = 0.02 ) . In the as treated analysis , OAB therapeutic success was 76 % for SNM and 49 % for SMT ( P = 0.002 ) . The SNM group showed significant improvements in quality of life versus the SMT group ( all P < 0.001 ) and 86 % of SNM subjects reported improved or greatly improved urinary symptom interference score at 6 months , compared to 44 % for SMT subjects . The device-related adverse event rate was 30.5 % and the medication-related adverse event rate was 27.3 % . CONCLUSIONS This study demonstrates superior objective and subjective success of SNM compared to SMT . SNM is shown to be a safe and effective treatment for OAB patients with mild to moderate symptoms . Neurourol . Urodynam . 34:224 - 230 , 2015 . © 2014 Wiley Periodicals , This study was a r and omized controlled trial to investigate the effect of treating women with stress or mixed urinary incontinence ( SUI or MUI ) by diaphragmatic , deep abdominal and pelvic floor muscle ( PFM ) retraining .  Seventy women were r and omly allocated to the training ( n = 35 ) or control group ( n = 35 ) . Women in the training group received 8 individual clinical visits and followed a specific exercise program . Women in the control group performed self-monitored PFM exercises at home . The primary outcome measure was self-reported improvement . Secondary outcome measures were 20-min pad test , 3-day voiding diary , maximal vaginal squeeze pressure , holding time and quality of life . After a 4-month intervention period , more participants in the training group reported that they were cured or improved ( p < 0.01 ) . The cure/improved rate was above 90 % . Both amount of leakage and number of leaks were significantly lower in the training group ( p < 0.05 ) but not in the control group . More aspects of quality of life improved significantly in the training group than in the control group . Maximal vaginal squeeze pressure , however , decreased slightly in both groups . Coordinated retraining diaphragmatic , deep abdominal and PFM function could improve symptoms and quality of life . It may be an alternative management for women with SUI or MUI CONTEXT Previous research on urge urinary incontinence has demonstrated that multicomponent behavioral training with biofeedback is safe and effective , yet it has not been established whether biofeedback is an essential component that heightens therapeutic efficacy . OBJECTIVE To examine the role of biofeedback in a multicomponent behavioral training program for urge incontinence in community-dwelling older women . DESIGN Prospect i ve , r and omized controlled trial conducted from April 1 , 1995 , to March 30 , 2001 . SETTING University-based outpatient continence clinic in the United States . PATIENTS A volunteer sample of 222 ambulatory , nondemented , community-dwelling women aged 55 to 92 years with urge incontinence or mixed incontinence with urge as the predominant pattern . Patients were stratified by race , type of incontinence ( urge only vs mixed ) , and severity ( frequency of accidents ) . INTERVENTIONS Patients were r and omly assigned to receive 8 weeks ( 4 visits ) of biofeedback-assisted behavioral training ( n = 73 ) , 8 weeks ( 4 visits ) of behavioral training without biofeedback ( verbal feedback based on vaginal palpation ; n = 74 ) , or 8 weeks of self-administered behavioral treatment using a self-help booklet ( control condition ; n = 75 ) . MAIN OUTCOME MEASURES Reduction in the number of incontinence episodes as documented in bladder diaries , patients ' perceptions and satisfaction , and changes in quality of life . RESULTS Intention-to-treat analysis showed that behavioral training with biofeedback yielded a mean 63.1 % reduction ( SD , 42.7 % ) in incontinence , verbal feedback a mean 69.4 % reduction ( SD , 32.7 % ) , and the self-help booklet a mean 58.6 % reduction ( SD , 38.8 % ) . The 3 groups were not significantly different from each other ( P = .23 ) . The groups differed significantly regarding patient satisfaction : 75.0 % of the biofeedback group , 85.5 % of the verbal feedback group , and 55.7 % of the self-help booklet group reported being completely satisfied with treatment ( P = .001 ) . Significant improvements were seen across all 3 groups on 3 quality -of-life instruments , with no significant between-group differences . CONCLUSIONS Biofeedback to teach pelvic floor muscle control , verbal feedback based on vaginal palpation , and a self-help booklet in a first-line behavioral training program all achieved comparable improvements in urge incontinence in community-dwelling older women . Patients ' perceptions of treatment were significantly better for the 2 behavioral training interventions PURPOSE We compared 200 U intradetrusor botulinum toxin A vs placebo in women with refractory idiopathic urge incontinence . MATERIAL S AND METHODS This institutional review board approved , multicenter registered trial r and omized women with refractory urge incontinence , detrusor overactivity incontinence and 6 or greater urge incontinence episodes in 3 days to botulinum toxin A or placebo at a 2:1 ratio . Refractory was defined as inadequate symptom control after 2 or more attempts at pharmacotherapy and 1 or more other first line therapies for detrusor overactivity incontinence . The primary outcome measure was time to failure , as evidence d by a Patient Global Impression of Improvement score of 4 or greater at least 2 months after injection , or changes in treatment ( initiation or increase ) at any time after injection . Safety data , including increased post-void residual volume , defined as more than 200 ml irrespective of symptoms , was obtained at specified time points . RESULTS Approximately 60 % of the women who received botulinum toxin A had a clinical response based on the Patient Global Impression of Improvement . The median duration of their responses was 373 days , significantly longer than the 62 days or less for placebo ( p < 0.0001 ) . In the botulinum toxin A group increased post-void residual urine ( 12 of 28 women or 43 % ) and urinary tract infection in those with increased post-void residual urine ( 9 of 12 or 75 % ) exceeded expected ranges . Further injections were stopped after 43 patients were r and omized , including 28 to botulinum toxin A and 15 to placebo . CONCLUSIONS Local injection of 200 U botulinum toxin A was an effective and durable treatment for refractory overactive bladder . However , a transient post-void residual urine increase was experienced in 43 % of patients . Botulinum toxin A for idiopathic overactive bladder is still under investigation AIMS To test the null hypothesis that a novel disposable " tampon like " electrostimulation device ( Pelviva ( ® ) ) is no better than unsupervised pelvic floor muscle exercise for treatment of urinary incontinence in women . METHODS Pre/post-intervention assessor blinded , single center RCT . A total of 123 community dwelling self referred women with symptoms of stress , urge , or mixed incontinence were r and omly assigned to one of two 12-week duration treatments : Pelviva ( ® ) used for 30 min a day plus unsupervised pelvic floor muscle exercise or unsupervised exercises alone . Outcome measures included ICIQ-UI ( primary ) , ICIQ FLUTSex and global impression of severity and improvement ( secondary ) completed at recruitment , after 4 weeks of unsupervised exercise and immediately post-treatment . Diary of exercise frequency/type , overall impression , and usage of device was completed mid- and post-treatment . RESULTS Pelviva ( ® ) plus exercise produced significantly better outcome than unsupervised exercise alone : 5 points ( 45 % ) versus 1 point ( 10 % ) for ICIQ-UI ( P = 0.014 ) ; 67 % versus 33 % for leak frequency ( P = 0.005 ) ; 40 % versus 20 % for leak interference with life ( P = 0.018 ) . Incontinence was less bothersome during sex to a greater extent in the Pelviva ( ® ) group ( P = 0.026 ) . Women were enthusiastic about the device , found it comfortable/easy to use and experienced no adverse events . CONCLUSIONS The Pelviva ( ® ) device plus unsupervised exercise is more successful than unsupervised pelvic floor muscle exercise alone in treating urinary incontinence . The device is easy/comfortable to use , there are no apparent adverse incidents , and women can manage their incontinence in the privacy of their own home . The product will be launched 2013 AIMS To assess the efficacy and safety of pregabalin alone or in combination with tolterodine extended release ( ER ) in subjects with idiopathic OAB . METHODS This 26-week , multicenter , r and omized , double-blind , placebo-controlled , three-period crossover study enrolled women aged ≥ 18 years that were diagnosed with OAB and reported ≥ 8 micturitions/24 hr and ≥ 4 urgency episodes/week on 5-day bladder diary at baseline . Subjects were r and omized to 1 of 10 treatment sequences and received three of five treatments , each for 4 weeks with 4-week washout periods : st and ard-dose pregabalin/tolterodine ER ( 150 mg twice daily [BID]/4 mg once daily [ QD ] , n=102 ) , pregabalin alone ( 150 mg BID , n=105 ) , tolterodine ER alone ( 4 mg QD , n=104 ) , low-dose pregabalin/tolterodine ER ( 75 mg BID/2 mg QD , n=105 ) , and placebo ( n=103 ) . Subjects completed 5-day diaries at the end of treatment and washout periods . The primary endpoint was change from baseline to week 4 in mean voided volume ( MVV ) per micturition . The primary comparison was st and ard-dose pregabalin/tolterodine ER versus tolterodine ER alone ; secondary comparisons were pregabalin alone versus tolterodine ER alone and versus placebo . RESULTS Baseline-adjusted changes in MVV were significantly greater after treatment with st and ard-dose pregabalin/tolterodine ER ( 39.5 ml ) versus tolterodine ER alone ( 15.5 ml ; P<0.0001 ) , and with pregabalin alone ( 27.4 ml ) versus tolterodine ER alone ( P=0.005 ) and placebo ( 11.9 ml ; P=0.0006 ) . Treatments were generally well tolerated ; discontinuation rates due to adverse events were 4 % , 2 % , 5 % , 0 % , and 1 % with st and ard- and low-dose pregabalin/tolterodine ER , pregabalin , tolterodine ER , and placebo , respectively . CONCLUSIONS Pregabalin , alone or with tolterodine ER may offer an alternative treatment option for idiopathic OAB in women PURPOSE We determined the effectiveness of cystoscopic administration of botulinum-A toxin compared to placebo for the treatment of urinary incontinence in subjects with idiopathic overactive bladder . MATERIAL S AND METHODS Subjects were recruited from the Division of Urogynecology at the University of Rochester . Inclusion criteria were overactive bladder refractory to anticholinergic medications , multiple daily incontinence episodes and a 24-hour pad weight of 100 gm or greater . Subjects with low leak point pressures , increased post-void residual volume or neurological etiologies were excluded from study . Subjects were r and omized to placebo or to 1 of 2 doses of botulinum-A toxin . The detrusor was injected at 8 to 10 sites above the trigone . Evaluations were performed at baseline , and at 3 and 6 weeks after injection , and included bladder diaries , pad weights , quality of life question naires and urodynamic studies . RESULTS A total of 22 subjects participated in stage 1 of this 2-stage study . We report on the outcomes of stage 1 of this study . Because stage 2 is still ongoing and investigators remain blind to the doses of botulinum-A toxin , the 2 botulinum-A toxin groups were combined for this report . There were no differences in mean baseline measurements between the 2 groups . Statistically significant improvements in daily incontinence episodes , pads changed per day and quality of life question naires were seen in the botulinum-A toxin group with no changes in the placebo group . No change in nocturia , daily voiding frequency , peak flow or detrusor pressure was seen in either group . Of 15 subjects 4 ( 26 % ) receiving botulinum-A toxin had a post-void residual volume of 200 cc or greater and 1 subject required intermittent catheterization . Four subjects experienced a urinary tract infection , 2 ( 13 % ) in the botulinum-A toxin group and 2 ( 28 % ) in the placebo group ( not significant ) . CONCLUSIONS Botulinum-A toxin can significantly reduce urge urinary incontinence due to overactive bladder at 6 weeks . However , there is a risk of urinary retention requiring self-catheterization OBJECTIVE To ascertain the prevalence of urinary incontinence in a sample of women from northern India , and the impact of behavioral therapy to treat its occurrence and severity . METHODS A r and omized controlled trial conducted from 2005 - 2006 to test the null hypothesis that behavioral therapy would not have an effect on urinary incontinence . Following a prevalence study , a total of 198 women with urinary incontinence were r and omized into 2 groups : an intervention group ( behavioral therapy ) and a control group ( no therapy ) . RESULTS The prevalence of urinary incontinence was 11.6 % . After an 8-month follow-up period , 41 women ( 52.5 % ) in the intervention group had become continent , and severity had shifted from severe to mild in 19 women ( 24.4 % ) . In contrast , 11 women ( 12.8 % ) in the control group had become continent . In the intervention group , mean daytime voiding frequency decreased from 9.56 to 7.64 , mean nighttime voiding frequency decreased from 1.45 to 0.69 , and mean episodes of urine leakage decreased from 1.97 to 0.23 . CONCLUSION Behavioral therapy was effective in treating urinary incontinence , particularly in women with mild and moderate incontinence BACKGROUND Mirabegron , a β(3)-adrenoceptor agonist , has been developed for the treatment of overactive bladder ( OAB ) . OBJECTIVE To assess the efficacy and tolerability of mirabegron versus placebo . DESIGN , SETTING , AND PARTICIPANTS Multicenter r and omised double-blind , parallel-group placebo- and tolterodine-controlled  phase 3 trial conducted in 27 countries in Europe and Australia in patients ≥ 18 yr of age with symptoms of OAB for ≥ 3 mo . INTERVENTION After a 2-wk single-blind placebo run-in period , patients were r and omised to receive placebo , mirabegron 50 mg , mirabegron 100 mg , or tolterodine extended release 4 mg orally once daily for 12 wk . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients completed a micturition diary and quality -of-life ( QoL ) assessment s. Co- primary efficacy end points were change from baseline to final visit in the mean number of incontinence episodes and micturitions per 24h . The primary comparison was between mirabegron and placebo with a secondary comparison between tolterodine and placebo . Safety parameters included adverse events ( AEs ) , laboratory assessment s , vital signs , electrocardiograms , and postvoid residual volume . RESULTS AND LIMITATIONS A total of 1978 patients were r and omised and received the study drug .  Mirabegron 50-mg and 100-mg groups demonstrated statistically significant improvements ( adjusted mean change from baseline [ 95 % confidence intervals ] ) at the final visit in the number of incontinence episodes per 24h ( -1.57 [ -1.79 to -1.35 ] and -1.46 [ -1.68 to -1.23 ] , respectively , vs placebo -1.17 [ -1.39 to -0.95 ] ) and number of micturitions per 24h ( -1.93 [ -2.15 to -1.72 ] and -1.77 [ -1.99 to -1.56 ] , respectively , vs placebo -1.34 [ -1.55 to -1.12 ] ; p<0.05 for all comparisons ) . Statistically significant improvements were also observed in other key efficacy end points and QoL outcomes . The incidence of treatment-emergent AEs was similar across treatment groups . The main limitation of this study was the short ( 12-wk ) duration of treatment . CONCLUSIONS Mirabegron represents a new class of treatment for OAB with proven efficacy and good tolerability . TRIAL IDENTIFICATION : This study is registered at Clinical Trials.gov , identifier NCT00689104 BACKGROUND Efficacy and safety of botulinum toxin type A ( BoNTA ) injection is supported by level 1 evidence , but data regarding repeated injections are limited in patients with refractory overactive bladder ( OAB ) and idiopathic detrusor overactivity ( IDO ) . OBJECTIVES Describe medium-term outcomes and discontinuation rates for patients adopting repeated BoNTA as a management strategy for IDO . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve data from a single centre were collected from the first 100 patients . INTERVENTION Bladder injection of BoNTA ( predominantly 200 U onabotulinumtoxinA ; Allergan Ltd. , Marlow , Buckinghamshire , UK ) in an outpatient setting . MEASUREMENTS OAB symptoms , quality of life , discontinuation rates , interinjection interval , and adverse events were recorded . Data comparisons were performed using a generalised linear model or a chi-square test where appropriate . RESULTS AND LIMITATIONS Two hundred seven injections were performed in 100 patients . All patients had 1 injection , 53 had a total of 2 , 20 had 3 , 13 had 4 , 10 had 5 , 5 had 6 , 3 had 7 , 1 had 8 , 1 had 9 , and 1 had 10 injections . Statistics were applied up to five repeated injections . A statistically significant reduction in frequency , urgency , and urge urinary incontinence were seen following the first BoNTA injection compared to baseline . This improvement was maintained after repeated injections and was not statistically different when comparing differences between injections . Thirty-seven patients stopped treatment after the first two injections ; thereafter , dropouts were rare . The most common reasons for discontinuing treatment were poor efficacy ( 13 % ) and clean intermittent self-catheterisation (CISC)-related issues ( 11 % ) . The incidence of CISC after the first injection was 35 % . Bacteriuria was detected in 21 % of patients . The mean interinjection interval was 322 d. Limitations included the concurrent use of antimuscarinic drugs in some patients . CONCLUSIONS BoNTA can provide a safe and effective medium-term management option for patients with refractory IDO . The most common reasons cited for stopping treatment were poor efficacy and CISC-related issues PURPOSE Neuromodulation of sacral nerves has shown promising results in correcting  voiding dysfunction .  We report the results of a multicenter trial design ed to assess the efficacy of sacral nerve neuromodulation in patients presenting with refractory urinary urgency-frequency . MATERIAL S AND METHODS A total of 51 patients from 12 centers underwent baseline assessment , including a detailed voiding diary , urodynamic evaluation and percutaneous test stimulation of the sacral nerves at S3 and /or S4 . All patients enrolled in the study had undergone prior conventional treatment , such as pharmacotherapy , hydrodistention and surgical intervention , which failed . All patients demonstrated a satisfactory response to trial stimulation and were r and omly divided into a stimulation group ( 25 patients ) and a control group ( 26 ) . A sacral nerve stimulation device was implanted after 6 months in the control group . Patients were followed at 1 , 3 and 6 months , and at 6-month intervals for up to 2 years after implantation of a neuroprosthetic InterStim * system . dagger The study variables included the number of voids daily , volume voided per void and degree of urgency before void . RESULTS Compared to the control group , 6-month voiding diary results demonstrated statistically significant improvements ( p < 0.0001 ) in the stimulation group with respect to the number voids daily ( 16.9 + /- 9.7 to 9.3 + /- 5.1 ) , volume per void ( 118 + /- 74 to 226 + /- 124 ml . ) and degree of urgency ( rank 2.2 + /- 0.6 to 1.6 + /- 0.9 ) . Patients in the control group showed no significant changes in voiding parameters at 6 months . Significant improvements in favor of the stimulation group were noted in various parameters with respect to water cystometry and quality of life ( SF-36 ) . At 6 months after implant , neurostimulators were turned off in the stimulation group and urinary symptoms returned to baseline values . After reactivation of stimulation sustained efficacy was documented at 12 and 24 months . CONCLUSIONS Neuromodulation of the sacral nerves is an effective , safe therapy that successfully treats significant symptoms of refractory urgency-frequency The aim of this prospect i ve double-blind r and omized placebo-controlled trial was to determine the effect of systemic estrogen on the ' urge syndrome ' in postmenopausal women . The trial took place in a tertiary referral urogynecology unit . Postmenopausal women with the ' urge syndrome ' were r and omly allocated to receive a 25 mg 17β-estradiol implant or placebo implant . Serum estradiol levels and endometrial thickness were measured on entry to the trial and at 1 , 3 and 6 months . The following outcome measures were employed : videocystourethrography , frequency volume chart , visual analogue score of symptoms , and King 's Health Care Quality of life Question naire . Forty women were included . Subjectively there was a significant improvement in urgency in both groups and urge incontinence in the estradiol group , but no significant differences between the groups . Objective ly no significant differences were demonstrated between the groups . Nine women in the estradiol group had vaginal bleeding , and 5 had a hysterectomy during or after the study . Despite using numerous outcome measures to examine its effect , 25 mg estradiol implants did not produce a greater improvement in the ' urge syndrome ' than placebo and had a high complication rate OBJECTIVE --To compare terodiline with bladder retraining against placebo with bladder retraining in the treatment of detrusor instability in frail elderly patients . DESIGN --R and omised , double blind , parallel group study . Treatment lasted for six weeks . Frequency of micturition and episodes of incontinence recorded on diary chart by patients . SETTING --Incontinence clinic and a geriatric day hospital at two teaching hospitals . PATIENTS --37 frail but ambulant patients , mean ( range ) age 80.4 ( 70 - 89 ) years with urinary frequency and urge incontinence , due to detrusor instability . Two patients withdrew before the first assessment ( one in each group ) and one could not complete the diary chart ( placebo group ) . INTERVENTIONS --19 patients received bladder retraining and terodiline 25 mg daily and 18 bladder retraining and placebo . MAIN OUTCOME MEASURES --Change in urinary frequency and number of episodes of incontinence after six weeks ' treatment . Patient 's subjective evaluation of symptoms . RESULTS --Little difference was found in the results of treatment with terodiline and placebo . The change in episodes of incontinence per 24 hours was no different in the two groups ( 95 % confidence interval -0.6 to 1.2 ; p = 0.75 ) and the difference between treatments in the change in frequency of micturition per 24 hours ( -0.2 ) was not significant ( -1.1 to 1.2 ; p = 0.76 ) . Ten patients taking terodiline thought they had improved compared with seven receiving placebo ; this difference was not significant . CONCLUSION --Although the number of patients in each group was small and may have been insufficient to detect a drug effect , the possible benefit of terodiline is likely to be small BACKGROUND Urinary incontinence is one of the most prevalent health problems and a significant cause of disability and dependence in the elderly . Pelvic floor exercise is effective in reducing stress urinary incontinence , but few studies have investigated the effect of behavioral management on urge and mixed incontinence . OBJECTIVES To determine the effects of multidimensional exercise treatment on reducing urine leakage in elderly Japanese women with stress , urge , and mixed urinary incontinence . DESIGN R and omized controlled , follow-up trial . SETTING S Urban community-based study . PARTICIPANTS 127 community-dwelling women aged 70 and older with stress , urge , and mixed urinary incontinence were r and omly assigned to the intervention ( n=63 ) or the control group ( n=64 ) . METHODS Urine leakage and fitness data were collected at baseline , and after the intervention and follow-up . The intervention group received a multidimensional exercise treatment twice a week for 3-month . After treatment , the participants were followed for 7-month . RESULTS There were significant differences in changes of functional fitness and incontinence variables between the intervention and control groups . The intervention group showed urine leakage cure rates of 44.1 % after treatment and 39.3 % after follow-up ( χ(2)=21.96 , p<0.001 ) ; whereas , the control group showed no significant improvement . The multidimensional exercise treatment was significantly effective in decreasing all three types of urinary incontinence . However , the effects of the exercise treatment were greater on stress urinary incontinence than on urge or mixed urinary incontinence . At the 7-month follow-up , while cure rates of all three types of urinary incontinence were significantly maintained , a slight reversal was seen only in the urge and mixed urinary incontinence ( χ(2)=10.28 , p=0.008 ) . According to the logistic regression model , urine leakage volume ( adjusted odds ratio OR=0.69 , 95 % confidence interval CI=0.39 - 0.98 ) , compliance ( OR=1.03 , 95%CI=1.01 - 1.16 ) , and BMI reduction ( OR=0.67 , 95%CI=0.48 - 0.89 ) were significantly associated with the cure of urine leakage after intervention . The cure rate of urine leakage after the follow-up was significantly associated with compliance ( OR=1.13 , 95%CI=1.02 - 1.29 ) and BMI reduction ( OR=0.78 , 95%CI=0.60 - 0.96 ) . CONCLUSIONS The intervention group showed higher urine leakage cure rates than control group . This result suggests that multidimensional exercise strategies may be effective for all three types of urinary incontinence . BMI reduction and compliance to the intervention was the consistent predictor for the effectiveness of the exercise treatment Purpose : Overactive bladder affects 12 % to 17 % of the general population and almost a third experience urinary incontinence , which may severely impact health related quality of life . Oral anticholinergics are the mainstay of pharmacological treatment but they are limited by inadequate efficacy or side effects , leading to a high discontinuation rate . We report the results of the first large ( 557 patients ) , phase 3 , placebo controlled trial of onabotulinumtoxinA in patients with overactive bladder and urinary incontinence inadequately managed with anticholinergics . Material s and Methods : Eligible patients with overactive bladder , 3 or more urgency urinary incontinence episodes in 3 days and 8 or more micturitions per day were r and omized 1:1 to receive intradetrusor injection of onabotulinumtoxinA 100 U or placebo . Co‐ primary end points were the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients with a positive response on the treatment benefit scale at posttreatment week 12 . Secondary end points included other overactive bladder symptoms and health related quality of life . Adverse events were assessed . Results : OnabotulinumtoxinA significantly decreased the daily frequency of urinary incontinence episodes  vs placebo ( −2.65 vs −0.87 , p < 0.001 ) and 22.9 % vs 6.5 % of patients became completely continent . A larger proportion of onabotulinumtoxinA than placebo treated patients reported a positive response on the treatment benefit scale ( 60.8 % vs 29.2 % , p < 0.001 ) . All other overactive bladder symptoms improved vs placebo ( p ≤0.05 ) . OnabotulinumtoxinA improved patient health related quality of life across multiple measures ( p < 0.001 ) . Uncomplicated urinary tract infection was the most common adverse event . A 5.4 % rate of urinary retention was observed . Conclusions : OnabotulinumtoxinA 100 U showed significant , clinical ly relevant improvement in all overactive bladder symptoms and health related quality of life in patients inadequately treated with anticholinergics and was well tolerated AIM To analyze side effects , feasibility , and adherence to treatment during home-managed electrical stimulation for urinary incontinence in women . METHODS This was a prospect i ve study of 3,198 Norwegian women treated with home-managed electrical stimulation from 1992 to 1994 . Data were collected from both patients and physicians by question naires before and after treatment . RESULTS Eighty-nine percent of the patients found the stimulator easy or acceptable to use . Fifty percent had no or little discomfort from stimulator use . Nine percent found the stimulator very unpleasant , difficult , or impossible to use . Fifty-one percent had one or more side effects related to the treatment , most of them mild . A wide range of side effects was reported ; the majority of which related to local discomfort . Three hundred and six patients ( 12 % ) discontinued treatment . A total of 79 % of the patients recommended the treatment to other women with similar problems . CONCLUSIONS Home-managed electrical stimulation was practicable and well accepted . Half of the patients reported various degrees of side effects with treatment , but no serious events were reported PURPOSE The Overactive Bladder Innovative Therapy trial was a r and omized , multicenter , controlled study that compared the effectiveness of percutaneous tibial nerve stimulation to extended-release tolterodine . The reduction in overactive bladder symptoms along with global response assessment s was evaluated . MATERIAL S AND METHODS A total of 100 adults with urinary frequency were r and omized 1:1 to 12 weeks of treatment with weekly percutaneous tibial nerve stimulation or to 4 mg daily extended-release tolterodine . Voiding diaries and an overactive bladder question naire were completed at baseline and at the end of therapy to compare 24-hour voiding frequency , urinary urge incontinence episodes , voids causing waking , volume voided , urgency episodes and quality of life indices . Global response assessment s were completed by subjects and investigators after 12 weeks of therapy . RESULTS The global response assessment demonstrated that subject assessment of overactive bladder symptoms compared to baseline was statistically significant in the percutaneous tibial nerve stimulation arm with 79.5 % reporting cure or improvement compared to 54.8 % of subjects on tolterodine ( p = 0.01 ) . Assessment s by investigators were similar but did not reach statistical significance ( p = 0.05 ) . After 12 weeks of therapy objective measures improved similarly in both groups for reductions in urinary frequency , urge urinary incontinence episodes , urge severity and nighttime voids , as well as for improvement in voided volume . There were no serious adverse events or device malfunctions . CONCLUSIONS This multicenter , r and omized trial demonstrates that percutaneous tibial nerve stimulation is safe with statistically significant improvements in patient assessment of overactive bladder symptoms , and with objective effectiveness comparable to that of pharmacotherapy . Percutaneous tibial nerve stimulation may be considered a clinical ly significant alternative therapy for overactive bladder PURPOSE We evaluated the effect of weight loss on  urinary incontinence ( UI ) in overweight and obese women . MATERIAL S AND METHODS A r and omized , controlled clinical trial was conducted among overweight and obese women experiencing at least 4 UI episodes per week . Women were r and omly assigned to a 3-month liquid diet weight reduction program ( 24 in the immediate intervention group ) or a wait-list delayed intervention group ( 24 in the wait-list control group ) . Participants in the wait-list control group began the weight reduction program in month 3 of the study . All women were followed for 6 months after completing the weight reduction program . Wilcoxon tests were used to compare intergroup differences in change in weekly UI episodes and quality of life scores . RESULTS A total of 48 women were r and omized and 40 were assessed 3 months after r and omization . Median ( with 25 % to 75 % interquartile range [ IQR ] ) baseline age was 52 years ( IQR 47 to 59 ) , weight was 97 kg ( IQR 87 to 106 ) and UI episodes were 21 weekly ( IQR 11 to 33 ) . Women in the immediate intervention group had a 16 kg ( IQR 9 to 20 ) weight reduction compared with 0 kg ( IQR -2 to 2 ) in the wait-list control group ( p < 0.0001 ) . The immediate intervention group experienced a 60 % reduction ( IQR 30 % to 89 % ) in weekly UI episodes compared with 15 % ( IQR -9 % to 25 % ) in the wait-list control group ( p < 0.0005 ) and had greater improvement in quality of life scores . Stress ( p = 0.003 ) and urge ( p = 0.03 ) incontinent episodes decreased in the immediate intervention vs wait-list control group . Following the weight reduction program the wait-list control group experienced a similar median reduction in weekly UI episodes ( 71 % ) . Among all 40 women  mean weekly UI episodes decreased 54 % ( 95 % CI 40 % to 69 % ) after weight reduction and the improvement was maintained for 6 months . CONCLUSIONS Weight reduction is an effective treatment for overweight and obese women with UI . Weight loss of 5 % to 10 % has an efficacy similar to that of other nonsurgical treatments and should be considered a first line therapy for incontinence The aim of this study was to evaluate the effect of intravaginal electrical stimulation ( IES ) on pelvic floor muscle ( PFM ) strength in patients with mixed urinary incontinence ( MUI ) . Between January 2001 and February 2002 , 40 MUI women ( mean age : 48 years ) were studied . Urge incontinence was the predominant symptom ; 92.5 % also presented mild stress urinary incontinence ( SUI ) . Selection criteria were clinical history and urodynamics . Pre-treatment urodynamic study showed no statistical differences between the groups . Ten percent of the women in each group had involuntary detrusor contractions . Patients were r and omly distributed , in a double-blind study , into two groups . Group G1 ( n=20 ) , effective IES , and group G2 ( n=20 ) , sham IES , with follow-up at 1 month . The following parameters were studied : ( 1 ) clinical question naire , ( 2 ) examiner ’s evaluation of perineal muscle strength , ( 3 ) objective evaluation of perineal muscle by perineometry , ( 4 ) vaginal weight test , and ( 5 ) urodynamic study . The IES protocol consisted of three 20-min sessions per week over a 7-week period using a Dualpex Uro 996 at 4 Hz . There was no statistically significant difference in the demographic data of both groups . The number of micturitions per 24 h after treatment was reduced significantly in both groups . Urge incontinence , present in all patients before treatment , was reduced to 15 % in G1 and 31.5 % in G2 post-treatment . The subjective evaluation of PFM strength demonstrated a significant improvement in G1 . Objective evaluation of PFM force by perineometer showed a significant improvement in maximum peak contraction post-treatment in both groups . In the vaginal weight test , there was a significant increase in average number of cone retentions post-treatment in both groups . With regard to satisfaction level , after treatment , 80 % of the patients in G1 and 65 % of the patients in G2 were satisfied . There was no statistically significant difference between the groups . There was a significant improvement in PFM strength from both effective and sham electrostimulation , question ing the effectiveness of electrostimulation as a monotherapy in treating MUI PURPOSE We systematic ally assessed long-term satisfaction and patient experience with sacral nerve modulation therapy . MATERIAL S AND METHODS All patients who received sacral neuromodulation between 1990 and 2007 at our center and who still had the implant were included in the survey . All received a postal question naire regarding satisfaction and experiences with the system , such as side effects , complications , burden , impact on sexuality and defecation changes . RESULTS Of the 275 question naires sent 207 were returned for a 75 % response rate . The population was 83 % female . Overall treatment was done for overactive bladder syndrome , nonobstructive urinary retention , combined overactive bladder and retention , and pelvic pain in 55 % , 24 % , 20 % and 1 % of patients , respectively . Overall satisfaction with sacral neuromodulation was high at 90 % . No correlations were found between the satisfaction rate , and pretreatment age , gender , complaint type , sexual dysfunction or therapy duration . However , 56 % of patients reported side effects , such as pain at the internal nerve stimulator site and due to stimulation . However , 89 % of these patients did not seek further therapy . Of patients with additional defecation problems 47 % experienced relief of complaints . CONCLUSIONS This study shows a high satisfaction rate in patients with sacral neuromodulation . There was no relation between patient age , complaint type , therapy duration or side effects and the satisfaction rate . The number of side effects was limited but further analysis in prospect i ve cohorts should identify patients who are likely to have side effects or stop sacral neuromodulation treatment BACKGROUND Botulinum toxin A is effective for treatment of idiopathic detrusor overactivity ( IDO ) . The trigone is generally spared because of the theoretical risk of vesicoureteric reflux ( VUR ) , although studies assessing injection sites are lacking . OBJECTIVE Evaluate efficacy and safety of trigone-including versus trigone-sparing intradetrusor injections of abobotulinumtoxinA in patients with IDO . DESIGN , SETTING , AND PARTICIPANTS Twenty-two patients from one centre were r and omised to  trigone-including or trigone-sparing injections . INTERVENTION Injection of 500 U abobotulinumtoxinA diluted to 20ml into 20 trigone-including or trigone-sparing sites . MEASUREMENTS The primary outcome measure was total overactive bladder symptom score ( OABSS ) at 6 wk . The OABSS question naire was completed at 0 , 6 , 12 , and 26 wk . Baseline and postinjection urodynamic studies and micturating cystourethrograms were performed . Baseline values and subsequent time points were compared by t test . A mixed-effect model was used for repeated measures in time . RESULTS AND LIMITATIONS For symptom scores at baseline compared with scores at 6 wk postinjection , the mean total OABSS improved from 22.4 to 8.7 ( p<0.001 ) in the trigone-including group compared with 22.7 to 13.4 ( p<0.03 ) in the trigone-sparing group . The difference in mean change from baseline was 4.4 points in favour of the trigone-including group ( p=0.03 ) . The total OABSS at 12 and 26 wk and the urgency subscale scores at 6 , 12 , and 26 wk showed significant improvement in favour of the trigone-including group . Mean postvoid residual volumes and clean intermittent self-catheterisation rates between the two groups were similar . No patients developed VUR . Performing injections under general anaesthetic was a limitation , as tolerability under local anaesthetic was not assessed . A further limitation is the lack of a trigone-only arm . CONCLUSIONS Trigone-including injections are superior to trigone-sparing injections for the treatment of refractory IDO and did not cause VUR in this study Many patients have chronic , debilitating symptoms of voiding dysfunction that are refractory to conventional medical or surgical therapies . This multicenter , prospect i ve study evaluated the long-term effectiveness of sacral nerve stimulation using the implantable Medtronic InterStim therapy for urinary control in patients with otherwise intractable complaints of urinary urge incontinence , urgency-frequency , or retention . Each patient first underwent temporary , percutaneous sacral nerve test stimulation . If at least a 50 % reduction in target symptoms was documented for at least 3 days , patients received a permanent Medtronic InterStim sacral nerve stimulation system that includes a surgically implanted lead and neurostimulator . Regular follow-up was conducted with outcome data . We report here on patients who have been observed from 1.5 to 3 years postimplantation . The results demonstrate that after 3 years , 59 % of 41 urinary urge incontinent patients showed greater than 50 % reduction in leaking episodes per day with 46 % of patients being completely dry . After 2 years , 56 % of the urgency-frequency patients showed greater than 50 % reduction in voids per day . After 1 . 5 years , 70 % of 42 retention patients showed greater than 50 % reduction in catheter volume per catheterization . We conclude that the Medtronic InterStim therapy for urinary control system is an effective therapy with sustained clinical benefit for patients with intractable symptoms of urinary urge incontinence , urgency-frequency , or retention Objective : To compare acupuncture treatment for overactive bladder with urge incontinence with a placebo acupuncture treatment . Methods : Eighty-five women enrolled in this r and omized , placebo-controlled trial . Women were r and omly assigned to either receive an acupuncture treatment expected to improve their bladder symptoms , or a placebo acupuncture treatment design ed to promote relaxation . They underwent cystometric testing , completed a 3-day voiding diary , and completed the urinary distress inventory and incontinence impact question naire , vali date d quality -of-life inventories , before and after 4 weekly acupuncture treatments . The primary endpoint was number of incontinent episodes over 3 days . Secondary endpoints included voiding frequency and urgency , cystometric bladder capacity , maximum voided volume , and the urinary distress inventory and incontinence impact question naire symptom scores . Results : Seventy-four women completed all aspects of the study . Women in both treatment and placebo groups had significant decreases in number of incontinent episodes ( 59 % for treatment , 40 % for placebo ) without a significant difference in the change between the groups . Women in the treatment group had a 14 % reduction in urinary frequency ( P = .013 ) , a 30 % reduction in the proportion of voids associated with urgency ( P = .016 ) , and a 13 % increase in both maximum voided volume and maximum cystometric capacity ( P = .01 ) . Both groups also had an improvement in the urinary distress inventory and incontinence impact question naire scores ( 54 % decrease for treatment , 30 % decrease for placebo , P < .001 for the difference in change between the groups ) . Conclusion : Women who received 4 weekly bladder-specific acupuncture treatments had significant improvements in bladder capacity , urgency , frequency , and quality -of-life scores as compared with women who received placebo acupuncture treatments . Level of Evidence : Seventy-four patients presenting with a mixed pattern of urinary symptoms were r and omly allocated to undergo either inpatient or outpatient continence programs as initial treatment , without prior urodynamic investigation . Both programs consisted of physiotherapy , bladder retraining , fluid normalization , dietary advice and general support and advice .  Nine out of 39 in the outpatient group and 8 out of the 35 of the impatient group failed to complete the study . There was a significant decrease in frequency , nocturia , number of incontinent episodes and visual analog scores for both groups . In addition the out patients had a significant reduction in loss on pad testing , and a significantly greater improvement in their visual analog score . In each group 63 % were cured or improved to the extent that they did not require further treatment . Staff costs per outpatient were half those for an inpatient . We conclude that outpatient conservative treatment as detailed above is a successful first-line treatment of urinary incontinence in women . It is as successful and possibly better than inpatient treatment , and is significantly cheaper Background . To evaluate the effectiveness of intravaginal electrical stimulation ( ES ) of the pelvic floor for urinary incontinence in elderly women , and to determine whether ES of the pelvic floor is a preferable treatment for urinary incontinence in elderly women Overactive bladder ( OAB ) is a prevalent condition with 16 % of adults having one or more symptoms that significantly affect quality of life .  Transcutaneous electrical nerve stimulation and neuromodulators have had success in treating OAB but are expensive , invasive , and sometimes cumbersome . We developed an alternative neuromodulatory technique that involves electromagnetic stimulation of the sacral nerve roots with a portable electromagnetic device to produce trans-sacral stimulation of the S3 and S4 sacral nerve roots . The aim of this study was to evaluate the impact of this device on  OAB  symptoms in women with a prospect ively r and omised double-blind controlled study . Following a power analysis , women with symptoms of OAB were prospect ively recruited with ethical approval for r and omisation to an  active treatment ( n = 33 ) or placebo group ( n = 30 ) in a double-blind trial . The patient , at home , used the belt device daily for 20 min over 12 weeks . Outcome measures included a 3-day voiding diary , 1 h pad test , visual analogue score ( VAS ) for symptom impact ( 0–100 % ) , Kings Health Question naire ( KHQ ) and Australian Quality of Life question naire ( AQOL ) at baseline , 6 and 12 weeks . Overall , no difference was found between groups for any of the research questions . Specifically , we were unable to demonstrate any difference between the active and sham device groups in frequency , nocturia , urinary leakage , or quality of life , nor was there any evidence of a placebo effect . The quality of the data was high with the number of missing observations ( especially for disease specific KHQ and general AQOL ) being few . This attempt to promote trans-sacral electromagnetic neuromodulation with a specially created device was ineffective on the symptoms of OAB OBJECTIVES To compare the efficacy of pelvic floor muscle training ( PFMT ) , biofeedback-assisted PFMT ( BAPFMT ) , and electrical stimulation ( ES ) in the management of overactive bladder ( OAB ) .  METHODS The interventions for the 12-week treatment period , conducted by the physiotherapist who was unaware of the progress and outcome , included ( a ) a PFMT program tailored to the subject 's PERFECT ( power , endurance , repetitions , and fast [ 1-second ] contractions , with every contraction timed ) scheme , used for training at home ; ( b ) an electromyography BAPFMT program and home program tailored to the subject 's PERFECT scheme ; and ( c ) an ES program using biphasic symmetric probe current with 10-Hz frequency , 400-micros pulse width , 10/5 duty cycle , and varying intensity . Identical preintervention and postintervention assessment included King 's Health Question naire , as well as outcomes of urge incontinence and other urinary symptoms . RESULTS Of the 103 women who completed this study , 34 were in the PFMT group , 34 in the BAPFMT group , and 35 in the ES group . The changes in the three parameters of King 's Health Question naire revealed statistically significant differences , except for the total score , between ES and BAPFMT ( domain 7 , P = 0.003 ; domain 9 , P = 0.029 ; and total score , P = 0.952 ) . These same parameters were significantly different between ES and PFMT ( domain 7 , P = 0.007 ; domain 9 , P = 0.001 ; and total score P = 0.004 ) . The change in total score was significantly different between BAPFMT and PFMT ( P = 0.003 ) . The subjective improvement/cure rate of OAB was 51.4 % for ES , 50.0 % for BAPFMT , and 38.2 % for PFMT ( P = 0.567 ) . CONCLUSIONS ES had the greatest subjective reduction rate of OAB and was the most effective of the three treatments . BAPFMT was more effective than PFMT The aim of this study was to examine whether foot reflexology has beneficial effects on patients with idiopathic detrusor overactivity . One hundred and nine women with symptomatic idiopathic detrusor overactivity were r and omized into either foot reflexology treatment group or nonspecific foot massage control group . The primary outcome measure was the change in the diurnal micturition frequency . There was significant change in the number of daytime frequency in the reflexology group when compared with the massage group ( −1.90 vs −0.55 , p = 0.029 ) . There was also a decrease in the 24-h micturition frequency in both groups , but the change was not statistically significant ( −2.80 vs −1.04 p = 0.055 ) . In the reflexology group , more patients believed to have received “ true ” reflexology ( 88.9 vs 67.4 % , p = 0.012 ) . This reflects the difficulty of blinding in trials of reflexology . Larger scale studies with a better- design ed control group and an improved blinding are required to examine if reflexology is effective in improving patients ’ overall outcome BACKGROUND Emerging data suggest botulinum toxin is an effective treatment for detrusor overactivity ( DO ) , but large studies confirming efficacy and safety are lacking . OBJECTIVE Study the efficacy and safety of onabotulinumtoxinA ( onaBoNTA ) for the treatment of DO . DESIGN , SETTING , AND PARTICIPANTS A double-blind placebo-controlled  r and omised trial in eight UK urogynaecology centres was conducted between 2006 and 2009 . A total of 240 women with refractory DO were r and omised to active or placebo treatment and followed up for 6 mo . INTERVENTION Treatment consisted of 200 IU onaBoNTA or placebo injected into the bladder wall ( 20 sites ; 10 IU per site in 1ml saline ) . MEASUREMENTS Primary outcome was voiding frequency per 24h at 6 mo . Secondary outcomes included urgency and incontinence episodes and quality -of-life data . Intention-to-treat analysis was used with imputation of missing data . RESULTS AND LIMITATIONS A total of 122 women received onaBoNTA and 118 received the placebo .  Median ( interquartile range ) voiding frequency was lower after onaBoNTA compared with placebo ( 8.3 [ 6.83 - 10.0 ] vs 9.67 [ 8.37 - 11.67 ] ; difference : 1.34 ; 95 % confidence interval [ CI ] , 1.00 - 2.33 ; p=0.0001 ) . Similar differences were seen in urgency episodes ( 3.83 [ 1.17 - 6.67 ] vs 6.33 [ 4.0 - 8.67 ] ; difference : 2.50 ; 95 % CI , 1.33 - 3.33 ; p<0.0001 ) and leakage episodes ( 1.67 [ 0 - 5.33 ] vs 6.0 [ 1.33 - 8.33 ] ; difference : 4.33 ; 95 % CI , 3.33 - 5.67 ; p<0.0001 ) . Continence was more common after botulinum toxin type A ( BoNTA ; 31 % vs 12 % ; odds ratio [ OR ] : 3.12 ; 95 % CI , 1.49 - 6.52 ; p=0.002 ) . Urinary tract infection ( UTI ; 31 % vs 11 % ; OR : 3.68 ; 95 % CI , 1.72 - 8.25 ; p=0.0003 ) and voiding difficulty requiring self-catheterisation ( 16 % vs 4 % ; OR : 4.87 ; 95 % CI , 1.52 - 20.33 ; p=0.003 ) were more common after onaBoNTA . CONCLUSIONS This r and omised controlled trial of BoNTA for refractory DO , the largest to date , confirms efficacy and safety of the compound . UTI ( 31 % ) and self-catheterisation ( 16 % ) are common . A third of women achieved continence . TRIAL REGISTRATION The study received ethical committee approval from the Scottish Multicentre Research Ethics Committee ( reference : 04/MRE10/67 ) . The trial has a EudraCT number ( 2004 - 002981 - 39 ) , a clinical trial authorisation from the UK Medicines and Healthcare Regulatory Agency , and it was registered on Current Controlled Trials ( IS RCT N26091555 ) on May 26 , 2005 BACKGROUND Conservative treatment of overactive bladder employes behavioral or invasive neuromodulatory inhibition of miction reflex and administration of anticholinergic drugs . MAIN PURPOSE The aim of this study was to use non-invasive stimulation of the tibial nerve with the intention to achieve desired therapeutic effects without iatrogenic nerve damage using a superficial electrostimulation . METHODS All patients suffered from overactive bladder ( OAB ) without bladder outlet obstruction . OAB was examined by the Behavioral urge score BUS ( 0.0 - -the best and 1.0 - -the worst score ) , the International prostate symptom score IPSS ( 0 - -the best and 35 - -the worst score ) and the Incontinence quality of life question naire IQOL ( 0.0 - -the worst and 1.0 - -the best index ) . The patients were divided into 3 groups : Group I-- patients with electrode attached behind the medial ankle of the left lower extremity . The intensity of stimulation corresponded to 70 % of the maximum amplitude of response from musculus abductor hallucis . Frequency of stimulation was 1 Hz and duration of the square impulse was 0.1 ms . Surface stimulation lasted 30 minutes and was repeated once a week . Group II-- patients were treated by oral oxybutynin 5 mg t.i.d . Group III-- patients without treatment . The BUS , IPSS , and IQOL were repeated after the treatment . RESULTS The study included 28 females of average age 54 year ( range 45 to 63 ) . Mean IPSS was 17 ( range 12 to 21 ) , mean index of quality of life IQOL was 30 ( range 12 to 78 ) and mean BUS score was 0.68 ( range 0.50 to 0.86 ) . Group I with stimulation did achieve statistically significant changes following the treatment : decrease of mean IPSS from 17 + /- 3 points to 6 + /- 4 points after the treatment , increase in mean IQOL from 36 + /- 10 to 68 + /- 20 and decrease of mean BUS from 0.65 + /- 0.12 to 0.43 + /- 0.16 . Group II had similar statistically significant differences after the treatment of OAB . Group III noted no changes in the complaints . CONCLUSION Noninvasive stimulation had improved subjective symptom related to overactive bladder , had no adverse events and was well tolerated . ( Fig. 1 , Tab . 1 , Ref . 18 . ) BACKGROUND Despite several antimuscarinic treatment options for overactive bladder ( OAB ) , there is still a need for distinct treatment approaches to manage this condition . Mirabegron , a β(3)-adrenoceptor agonist , has demonstrated efficacy and tolerability for up to 12 wk in phase 3 trials . OBJECTIVE To assess the 12-mo safety and efficacy of mirabegron . DESIGN , SETTING , AND PARTICIPANTS Patients ≥ 18 yr of age with OAB symptoms for ≥ 3 mo . INTERVENTIONS After a 2-wk single-blind placebo run-in , patients with eight or more micturitions per 24h and three or more urgency episodes in a 3-d micturition diary were r and omized 1:1:1 to once-daily mirabegron 50 mg , mirabegron 100 mg , or tolterodine extended release ( ER ) 4 mg for 12 mo . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary variable : incidence and severity of treatment-emergent AEs ( TEAEs ) . Secondary variables : change from baseline at months 1 , 3 , 6 , 9 , and 12 in key OAB symptoms . RESULTS AND LIMITATIONS A total of 812 , 820 , and 812 patients  received mirabegron 50 mg , mirabegron 100 mg , and tolterodine ER 4 mg , respectively . Baseline demographic and OAB characteristics were similar across groups . TEAEs were reported in 59.7 % , 61.3 % , and 62.6 % of patients , respectively ; most were mild or moderate . Serious TEAEs were reported in 5.2 % , 6.2 % , and 5.4 % of patients , respectively . The most common TEAEs were similar across groups . Dry mouth was reported by 2.8 % , 2.3 % , and 8.6 % of patients , respectively . Adjusted mean changes from baseline to final visit in morning systolic blood pressure were 0.2 , 0.4 , and -0.5 mm Hg for mirabegron 50 mg , 100 mg , and tolterodine ER 4 mg , respectively . Mirabegron and the active control , tolterodine , improved key OAB symptoms from the first measured time point of 4 wk , and efficacy was maintained throughout the 12-mo treatment period . The study was not placebo controlled , which was a limitation . CONCLUSIONS The safety and tolerability of mirabegron was established over 1 yr , with sustained efficacy observed over this treatment period . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00688688 PURPOSE We assessed how a group shared appointment influenced patient preparedness for  sacral nerve stimulation  for refractory overactive bladder and /or urge urinary incontinence . We also evaluated subjective and objective outcomes . MATERIAL S AND METHODS Patients considering sacral nerve stimulation were prospect ively enrolled and invited to attend a group shared appointment . This 75-minute presentation included a question and answer period with an implanting surgeon and an implanted patient . Control patients received st and ard office counseling . A patient preparedness question naire was completed after the group shared appointment or office counseling . Response to treatment was determined using the postoperative satisfaction question naire , Patient Global Impression of Improvement ( PGI-I ) and voiding diaries . RESULTS In our study 36 women with a mean ± SD age of 61 ± 15 years underwent sacral nerve stimulation .  There was no significant difference in patient demographics between the 19 women who attended the group shared appointment and the 17 controls . Overall preparedness was greater in the shared appointment group ( p = 0.043 ) with better underst and ing of the purpose of ( p = 0.003 ) and alternatives to ( p = 0.043 ) sacral nerve stimulation . Significantly more women in the shared appointment group than controls felt completely prepared ( 78.9 % vs 29.4 % , p = 0.003 ) and completely satisfied ( 78.9 % vs 35.3 % , p = 0.003 ) with sacral nerve stimulation as well as very much better ( 68.4 % vs 17.6 % , p = 0.002 ) according to the PGI-I. There was no difference between the groups in the number of women with a 50 % or greater symptom reduction on voiding diary . CONCLUSIONS Participating in a group shared appointment before sacral nerve stimulation improved patient preparedness and perceived outcomes of treatment , although there was no difference in objective outcomes based on voiding diary Objective To estimate the effect of change in weight and change in urinary incontinence ( UI ) frequency on changes in preference-based measures of health-related quality of life ( HRQL ) among overweight and obese women with UI participating in a weight loss trial . Methods We conducted a longitudinal cohort analysis of 338 overweight and obese women with UI enrolled in a r and omized clinical trial comparing a behavioral weight loss intervention to an educational control condition . At baseline , 6 , and 18 months , health utilities were estimated using the Health Utilities Index Mark 3 ( HUI3 ) , a transformation of the SF-36 to the preference-based SF-6D , and the estimated Quality of Well-Being ( eQWB ) score ( a summary calculated from the SF-36 physical functioning , mental health , bodily pain , general health perceptions , and role limitations –physical subscale scores ) . Potential predictors of changes in these outcomes were examined using generalized estimating equations . Results In adjusted multivariable models , weight loss was associated with improvement in HUI3 , SF-6D , and eQWB at 6 and 18 months ( P < 0.05 ) . Increases in physical activity also were independently associated with improvement in HUI3 ( P = 0.01 ) and SF-6D ( P = 0.006 ) scores at 18 months . In contrast , reduction in UI frequency did not predict improvements in HRQL at 6 or 18 months . Conclusion Weight loss and increased physical activity , but not reduction in UI frequency , were strongly associated with improvements in health utilities measured by the HUI3 , SF-6D , and eQWB . These findings provide important information that can be used to inform cost – utility analyses of weight loss interventions OBJECTIVES To determine the efficacy and safety of functional magnetic stimulation ( FMS ) produced by the Pulsegen device compared with placebo in the treatment of women with urinary incontinence . METHODS Fifty-five women with urinary incontinence were r and omly assigned to the active FMS  group ( 30 patients ) or the placebo group ( 22 patients ) . Each patient in the active group received a Pulsegen device , which produced a pulsating magnetic field of B = 10 microT intensity and a frequency of 10 Hz . Patients were asked to wear the Pulsegen device day and night for 2 months . Clinical and urodynamic data were collected before and after FMS and analyzed using nonparametric statistics . RESULTS Compared with the placebo , the number of pads used was significantly lower ( P = 0.0031 ) after FMS , as was the pad weight ( P = 0.014 ) . In patients from the active group , a significant improvement in the power of the pelvic floor muscle contractions ( P = 0.0071 ) , as well as in the duration of the pelvic floor muscle contractions ( P = 0.038 ) , was observed . After FMS , a 56.3 % improvement in urinary incontinence symptoms was reported by patients in the active group , a significantly greater difference ( P = 0.00012 ) compared with the reported 26.3 % improvement in symptoms in the placebo group . CONCLUSIONS We believe that FMS represents a new method in the conservative treatment of urinary incontinence . Magnetic stimulation with the Pulsegen device is efficient and safe . It can be used at home and , because of its small size , wearing the device is not annoying for patients BACKGROUND β-Adrenoceptor agonists are effective in animal models of bladder dysfunction , and the human bladder primarily expresses the β3 receptor subtype . OBJECTIVE To evaluate the efficacy and tolerability of the highly selective and potent β3-adrenoceptor agonist solabegron in a clinical proof-of-concept study in incontinent women with overactive bladder ( OAB ) . DESIGN , SETTING , AND PARTICIPANTS This was a r and omized , double-blind trial in adult women with OAB ( one or more 24-h incontinence episodes and eight or more average 24-h micturitions ) . INTERVENTIONS Solabegron 50 mg ( n=88 ) , solabegron 125 mg ( n=85 ) , or placebo (n=85)-all twice daily-were administered . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary efficacy end point was percentage change from baseline to week 8 in the number of incontinence episodes over 24 h. Secondary end points included actual change and percentage change from baseline to week 4 and week 8 in micturitions per 24 h , urgency episodes per 24 h , and volume voided per micturition . Adverse events ( AEs ) were assessed , as well . RESULTS AND LIMITATIONS Solabegron 125 mg produced a statistically significant difference in percent change from baseline to week 8 in incontinence episodes over 24h when compared with placebo ( p=0.025 ) . Solabegron 125 mg treatment also showed statistically significant reductions from baseline to weeks 4 and 8 in micturitions over 24 h and a statistically significant increase from baseline to week 8 in urine volume voided . Solabegron was well tolerated , with a similar incidence of AEs in each treatment group . There were no significant treatment differences for mean changes from baseline to week 8 in systolic blood pressure ( BP ) , diastolic BP , mean arterial pressure ( MAP ) , or heart rate during the 24-h ambulatory measurement . CONCLUSIONS Solabegron significantly reduced the symptoms of OAB in women with moderate to severe OAB . Solabegron was safe , well tolerated , and did not demonstrate significant differences in AEs as compared to placebo . β3-Adrenoceptor agonists may represent a new therapeutic approach for treating OAB symptoms Objectives To determine the efficacy of non-invasive static magnetic stimulation ( SMS ) of the pelvic floor compared to placebo in the treatment of women aged 60 years and over with urinary incontinence for 6 months or more . Subjects and Methods A single-blinded r and omized , placebo-controlled , parallel-group trial . Subjects were excluded if they had an implanted electronic device , had experienced a symptomatic urinary tract infection , or had commenced pharmacotherapy for the same in the previous 4 weeks , or if they were booked for pelvic floor or gynecological surgery within the next 3 months . Once written consent was obtained , subjects were r and omly assigned to the active SMS group ( n=50 ) or the placebo group ( n=51 ) . Treatment was an undergarment incorporating 15 static magnets of 800–1200 Gauss anterior , posterior , and inferior to the pelvis for at least 12 hours a day for 3 months . Placebo was the same protocol with inert metal disks replacing the magnets . Primary outcome measure was cessation of incontinence as measured by a 24-hour pad test . Secondary outcomes were frequency and severity of symptoms as measured by the Bristol Female Lower Urinary Tract Symptoms question naire ( BFLUTS-SF ) , the Incontinence Severity Index , a Bothersomeness Visual Analog scale , and a 24-hour bladder diary . Data were collected at baseline and 12 weeks later . Results There were no statistically significant differences between groups in any of the outcome measures from baseline to 12 weeks . Initial evidence of subjective improvement in the treatment group compared to the placebo group was not sustained with sensitivity analysis . Conclusion This study found no evidence that static magnets cure or decrease the symptoms of urinary incontinence . Additional work into the basic physics of the product and garment design is recommended prior to further clinical trials research AIMS A longitudinal r and omized controlled trial ( RCT ) was conducted to evaluate the effectiveness of physiotherapeutic pelvic floor muscle exercise ( PFME ) therapy supplemented with a health education program to promote long-term adherence among women with stress , mixed , and urge urinary incontinence ( UI ) . METHODS Women ( n = 129 ) were evaluated by their general practitioner ( GP ) and r and omized in either the control group ( PFME therapy alone ) or one of the three experimental groups ( PFME therapy with one of the three health education program versions ) . Therapy consisted of 9 - 18 individual 30 min sessions with a specialized physiotherapist , over 14 - 22 weeks . Outcome measures were weekly frequency of wet episodes and adherence behavior . Women were assessed up to 1 year after therapy . RESULTS The health education program had no additional impact to individual contact during PFME therapy on treatment outcome , nor on adherence . However , the individual physiotherapeutic treatment protocol was very effective in reducing weekly frequency of wet episodes from 23 to 8 times a week immediately after therapy , and effects were maintained during the 1-year follow-up period . Adherence was very high ; most women followed the behavioral advice on average 6 days/week at posttest and still 4 - 5 days 1 year after therapy . Results were not different between incontinence types . Women who had relatively frequent wet episodes before and 1 year after therapy had higher adherence levels compared to women who had fewer weekly losses . CONCLUSIONS Results suggest that a st and ardized protocol checklist for physiotherapists covering all treatment aspects of PFME therapy , may optimize long-term treatment outcome and adherence behavior among patients , and outshines the addition of a health education program PURPOSE Treatment options for patients with overactive bladder refractory to anticholinergics are limited . We assessed the dose response across a range of doses of onabotulinumtoxinA ( BOTOX ® ) in patients with idiopathic overactive bladder and urinary urgency incontinence whose symptoms were not adequately managed with anticholinergics .  MATERIAL S AND METHODS In a phase 2 , multicenter , r and omized , double-blind study , 313 patients with idiopathic overactive bladder and urinary urgency incontinence experiencing 8 or more urinary urgency incontinence episodes a week and 8 or more micturitions daily at baseline received 50 , 100 , 150 , 200 or 300 U intradetrusor onabotulinumtoxinA , or placebo . Symptoms were recorded using a 7-day bladder diary . The primary efficacy variable was weekly urinary urgency incontinence episodes and the primary end point was week 12 . RESULTS Demographics and baseline characteristics were balanced across the treatment groups . Durable efficacy was observed for all onabotulinumtoxinA dose groups of 100 U or greater for primary and secondary efficacy measures , including the proportion of incontinence-free patients . When the dose response curves were analyzed , doses greater than 150 U contributed minimal additional or clinical ly relevant improvement in symptoms . This finding was also reflected in health related quality of life assessment s. Dose dependent changes in post-void residual urine volume were observed and the use of clean intermittent catheterization was also dose dependent . The only adverse events significantly greater with onabotulinumtoxinA than with placebo were urinary tract infection and urinary retention . CONCLUSIONS OnabotulinumtoxinA at doses of 100 U or greater demonstrated durable efficacy in the management of idiopathic overactive bladder and urinary urgency incontinence . A dose of 100 U may be the dose that appropriately balances the symptom benefits with the post-void residual urine volume related safety profile Caffeine reduction is an internationally accepted treatment strategy for patients with urinary symptoms . However , there is little trial evidence in support of a caffeine/urinary symptom effect . A prospect i ve r and omized trial was conducted among 95 consecutive adult patients with urinary symptoms presenting to two nurse continence advisers .  Frequency , urgency and leakage outcomes were tested 1 month postenrolment . Trial findings indicate that caffeine intake was reduced ( P<0.0001 ) in the experimental group and that urgency ( P=0.002 ) and frequency ( P=0.037 ) outcomes were significantly improved . Caffeine practice s and habits were surveyed and self-reports of caffeine effects indicate that urinary symptoms figured prominently as a reported effects but less so as a driver of caffeine reduction OBJECTIVE To assess the efficacy of physiotherapeutic treatment modalities in women with proven bladder overactivity . METHODS One hundred and twelve women received ambulatory urodynamics .  Based on both urodynamic variables of ambulatory cystometry ( ACM ) and the micturition diary , the Detrusor Activity Index ( DAI ) for each patient was calculated . After r and omization , 68 women with a DAI > or = 0.50 were defined as having proven bladder overactivity . In a single blinded RCT patients were r and omized over four treatment groups , i.e. lower urinary tract exercises ( LUTE ) ; office- and home-based functional electrostimulation ( FES ) ; office-based FES and LUTE ; no treatment . Patients treated received nine treatment sessions , once weekly . The primary outcome variable was the DAI , measured before r and omization and , as soon as possible within a maximum of 14 days after the end of the study period . RESULTS Intention to treat analysis in the group of 68 patients showed a statistically significant decrease of DAI-scores in the FES group ( p=0.032 ) in comparison with no treatment , while this decrease was not statistically significant in the LUTE group ( p=0.105 ) and the LUTE+FES group ( p=0.672 ) . CONCLUSIONS Our conclusion is that , based on the DAI , in the homogeneous set of 68 patients , only FES seemed to be effective PURPOSE In this prospect i ve , nonr and omized , ongoing study we evaluated the efficacy and safety of botulinum-A toxin injections in the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment , such as anticholinergic drugs . MATERIAL S AND METHODS A total of 23 men and 77 women with a mean age of 63 years ( range 24 to 89 ) with nonneurogenic overactive bladder , including urgency-frequency syndrome , and incontinence despite the administration of maximal doses of anticholinergics were consecutively treated with injections of 100 U botulinum-A toxin in the detrusor muscle at 30 sites under cystoscopic guidance . Micturition diary , full urodynamics , neurological status and urine probes were performed in all participants before treatment . Bladder biopsies were done only in cases of suspected bladder fibrosis or unclear findings . Special attention was given to reflex volume , maximal bladder capacity , detrusor compliance , post-void residual urine , urgency and frequency/nocturia . Clinical , urodynamic and quality of life assessment s were performed at baseline , and 4 , 12 and 36 weeks after botulinum-A toxin treatment . RESULTS Overall after 4 and 12 weeks 88 % of our patients showed significant improvement in bladder function in regard to subjective symptoms , quality of life and urodynamic parameters ( p < 0.001 ) . Urgency disappeared in 82 % of the patients and incontinence resolved in 86 % within 1 to 2 weeks after botulinum-A toxin injections . Mean frequency decreased from 14 to 7 micturitions daily ( -50 % ) and nocturia decreased from 4 to 1.5 micturitions . Mean maximal bladder capacity increased 56 % from 246 to 381 ml , mean detrusor compliance increased from 24 to 41 ml/cm H(2)O and pretreatment detrusor instability ( mean reflex volume 169 ml ) resolved in 74 % of patients . Mean volume at first desire to void increased from 126 to 212 ml and mean urge volume increased from 214 to 309 ml . There were no severe side effects except temporary urine retention in 4 cases . Only in 8 patients was the clinical benefit poor and analysis revealed preoperative low detrusor compliance . Mean efficacy duration + /- SD was at least approximately 6 + /- 2 months and then symptoms began to increase . CONCLUSIONS Our results show that intradetrusor botulinum-A toxin injections may be an efficient and safe treatment option in patients with severe overactive bladder resistant to all conventional treatments AIMS We assessed the effects of onabotulinumtoxinA ( BOTOX ® ) on clinical and urodynamic variables in patients with idiopathic overactive bladder ( OAB ) and urinary urgency incontinence ( UUI ) with or without detrusor overactivity ( DO ) , inadequately managed with anticholinergics . METHODS Three hundred thirteen patients with OAB were r and omized to double-blind intradetrusor injection with placebo ( n = 44 ) or 1 of 5 onabotulinumtoxinA doses ( 50 - 300 U ; n = 269 ) . Primary efficacy variable was change from baseline in UUI episodes/week at week 12 . Urodynamic assessment s at baseline and weeks 12 and 36 included maximum cystometric capacity ( MCC ) and volume at first involuntary detrusor contraction ( IDC ) . RESULTS 76.0 % of patients had baseline DO . Changes from baseline in MCC and volume at first IDC with onabotulinumtoxinA ≥100 U were superior to placebo at week 12 , generally decreasing by week 36 . Significant dose-dependent increases in MCC were observed for all onabotulinumtoxinA doses at week 12 , and for 150 , 200 , and 300 U at week 36 . Data suggested a dose-response relationship . At week 12 on diary , 15.9 % of placebo and 29.8 - 57.1 % of onabotulinumtoxinA 50 - 300 U recipients , respectively , did not demonstrate UUI . OnabotulinumtoxinA doses > 150 U were more commonly associated with post-void residual urine volumes > 200 ml . CONCLUSIONS Improvements in urodynamic parameters and clinical outcomes generally trended together following onabotulinumtoxinA treatment . This therapy improved key urodynamic parameters in patients with idiopathic OAB and UUI , with no differences in outcomes between those with and those without baseline DO . Therefore , successful idiopathic OAB treatment with onabotulinumtoxinA does not appear to be related to pretreatment finding of DO PURPOSE Bilateral sacral nerve neuromodulation has been proposed as a more effective treatment for  chronic voiding dysfunction .  However no comparison with the unilateral approach has been performed . We investigated the possible advantage of bilateral sacral neuromodulation . MATERIAL S AND METHODS In a prospect i ve r and omized crossover trial we investigated 33 patients who underwent bilateral implantation of a temporary test lead . Unilateral and bilateral test stimulation was continued for 4 to 6 days in all patients . Patients were r and omly assigned to start with bilateral or unilateral stimulation . Between the stimulation episodes a 2-day washout interval was scheduled . Voiding diaries were completed at baseline and during the entire stimulation period . Sacral x-rays were taken to confirm lead positioning or possible migration after implantation and at the end of the test stimulation period . After 10 days the temporary leads were removed and voiding diaries were analyzed . RESULTS After stimulation sacral x-ray revealed test lead migration in 8 patients , leaving 12 patients with urge incontinence and 13 with voiding difficulty and urinary retention  available for review . A statistically significant improvement in voiding parameters was seen during the test stimulation period . However no statistically significant improvement was seen due to bilateral stimulation compared to unilateral stimulation . Two patients with urinary retention only started voiding to completion during bilateral stimulation . CONCLUSIONS Bilateral is in general not superior to unilateral sacral neuromodulation . However , in some individuals bilateral stimulation may be more effective in relieving symptoms . Therefore , if unilateral percutaneous nerve evaluation fails , a bilateral test should be considered OBJECTIVES To observe the effect of both acute and medium-term magnetic stimulation of the pelvic floor on detrusor function amongst women with idiopathic detrusor overactivity ( IDO ) . METHODS Two separate studies were undertaken amongst women with a sole diagnosis of IDO . The first study assessed the acute effect of magnetic stimulation ( provided by Neocontrol ) on detrusor function during the filling phase of st and ard cystometry . Multiple filling cycles were performed with stimulation at a different key moment in each . This was done to establish that the device could influence the detrusor . Subsequently , a r and omized sham control trial was performed to assess clinical efficacy . A total of 20 treatments , each of 20 minutes duration , were administered over six weeks with follow-up six weeks thereafter . Half the patients received therapy from a genuine device , the others receiving fake treatment on an identical looking/sounding sham device . The sham device contained a deflector plate to de grade the magnetic field and was located in a separate room . Outcome measures included changes in a 24 hour fluid volume chart , urine loss ( 24 hour pad test ) and quality of life instruments . RESULTS Amongst 10 patients receiving stimulation during cystometry , volume at first involuntary detrusor contraction during filling rose from a median value of 240ml ( Inter-quartile range ( IQR ) 210 - 300 ) to 285ml ( IQR 231 - 320 ) , p = 0.03 and maximum detrusor pressure decreased from 40 cm water ( IQR 34 - 45 ) to 33 cm water ( IQR 25 - 41 ) , p<0.01 . The RCT was completed by 29 of 44 ( 66 % ) recruits . Of these , 15 of 29 ( 52 % ) received active treatment and 14 of 29 ( 48 % ) sham therapy . Active therapy significantly reduced the number of urge episodes per day , p<0.01 . With respect to baseline , actively treated patients experienced significant reduction in voids per day and quality of life but this trend did not reach significance when compared to the sham group , partly due to unexpected difficulty in recruitment which yielded an underpowered sample size for these outcome measures . CONCLUSIONS Magnetic stimulation reduces detrusor contractility in the acute phase of administration . Although the treatment was well tolerated and urge episodes reduced following prolonged therapy , no statistically significant improvement was observed in quality of life indices or measured 24 hour urinary loss . The treatment can not be recommended for women with IDO Urinary incontinence ( UI ) is a commonly underreported and underdiagnosed condition . The purpose of this trial was to implement and evaluate behavioral management for continence ( BMC ) , an intervention to manage symptoms of UI with older rural women in their homes . Participants were r and omized into BMC or a control group , and 178 were followed for between 6 and 24 months . The intervention involved self-monitoring , bladder training , and pelvic muscle exercise with biofeedback . The primary outcome variable-severity of urine loss-was evaluated by pad test . Secondary variables were episodes of urine loss , micturition frequency , voiding interval , quality of life , and subjective report of severity . Urine loss severity at baseline evaluation was not significantly different in the two groups . But using the generalized linear mixed model analysis , at the four follow-ups , severity of urine loss , episodes of urine loss , quality of life , and subjective report of severity were significantly different . At 2 years the BMC group UI severity decreased by 61 % ; the control group severity increased by 184 % . Self-monitoring and bladder training accounted for most of the improvement . The results support the use of simple strategies based on bladder diaries before implementing more complex treatments We aim ed to study the impact of conservative non-pharmacological , non-surgical management on quality of life in elderly incontinent patients . Community-dwelling patients age 60 years or older were r and omized to receive immediate or delayed conservative management . A number of questions relating to quality of life were administered at admission and then at 2 , 4 , 8 and 12 months . By 4 months , incontinence was cured in 25 % and improved in 63 % of patients . The frequency and severity of incontinence was reduced ( p < 0.001 ) , and deferment time was improved ( p < 0.01 ) . There were statistically significant improvements in subjective quality of life measures at 4 and 12 months involving depression ( p < 0.001 ) , isolation ( p < 0.03 ) , embarrassment ( p < 0.001 ) , laundry ( p < 0.001 ) and smell ( p < 0.02 ) when comparing these variables with initial assessment . This effect did not appear to be a placebo effect as evidence d by comparison with the delayed intervention group , and was sustained over 12 months . There are significant short- and long-term benefits to the quality of life of older patients with incontinence when treated by conservative measures . Intervention studies should measure and report quality of life as an outcome variable Our objective was to evaluate a new concept for assessment and treatment of urinary incontinence  in an open-access , interdisciplinary incontinence clinic . A st and ardized program for investigation and treatment of incontinence was based on minimal relevant investigations , primarily non-surgical treatment with a limited consumption of re sources ( " minimal care " ) . This was a prospect i ve observational study of 408 consecutive women examined and treated in the clinic . The main characteristics of the women were a high median age and a high prevalence of severe concomitant diseases with possible influence on lower urinary tract function . More than half of the patients had urge or mixed incontinence . Most of the patients were managed with conservative treatment . Fifteen percent were referred to in-hospital treatment , with 5 % to  incontinence surgery . In total 44 % felt cured or very much improved . Before and after treatment one third of the women completed quality -of-life questions and voiding charts , while 43 % completed the pad tests . Quality of life improved significantly . Objective ly leakage on pad test and voiding charts was significantly improved . The patients were in general very satisfied with clinic 's program . Almost one fourth of the women were followed up for 6 months after discharge . No significant deterioration in the subjective results were found compared to status at discharge . In conclusion , the results highlight the need for advice and treatment of patients with incontinence . The minimal care program and interdisciplinary structure in the incontinence clinic offer effective and low cost treatment for urinary incontinence . The open-access , interdisciplinary incontinence clinic model is recommended . Neurourol . Urodynam . 18:9 - 17 , 2000 We compared telemedicine with a conventional outpatient continence service ( CS ) in community-dwelling older women with urge or stress incontinence . After an initial biofeedback-assisted pelvic floor muscle training session , subjects were r and omized to behavioural training for eight weeks via the CS ( n = 27 ) or a telemedicine continence programme ( TCP ) ( n = 31 ) . Participants in both treatment groups experienced significant improvement in their symptoms , namely , a reduction in the number of daily incontinence episodes ( P<0.001 ) and voiding frequency ( P<0.001 ) , while the volume of urine at each micturition increased ( P<0.005 ) . Pelvic floor muscle strength as measured by the Oxford Score also improved ( P<0.005 ) . There were no significant differences in outcomes between the two groups . Thus our findings suggest that videoconferencing is as effective as conventional methods in the management of urinary incontinence Objectives : To compare the effectiveness of sacral root neuromodulation with that of conservative management in ameliorating symptoms of  refractory urinary urge incontinence  and enhancing quality of life , to assess the objective response to neuromodulation as revealed by urodynamic testing , and to delineate the long – term outcomes of neuromodulation . Methods : Forty – four patients with refractory urge incontinence were r and omized to undergo neuromodulation with an implantable impulse generator ( n = 21 ) or to continue their prior conservative management ( n = 23 ) . At 6 months the control group was eligible for crossover to implant . Patient evaluation included voiding diaries , quality of life question naires , urodynamic testing , and documentation of adverse events . Long – term follow – up evaluations were conducted at 6–month intervals up to 36 months . Results : At 6 months mean leakage episodes , leakage severity and pad usage in the implant group were significantly lower by 88 % ( p < 0.0005 ) , 24 % ( p = 0.047 ) and 90 % ( p < 0.0005 ) , respectively , than the corresponding control group mean values . Improvements in leakage episodes and pad usage of ≥90 % were attained by 75 and 85 % of the implant group , respectively , but none of the control group . One third of implant patients , but none of the control patients , achieved ≥50 % improvement in leakage severity . Over half of the implant patients ( 56 % ) were completely dry compared with 1 control patient ( 4 % ) . Implant patients , but not control patients , exhibited significant improvement with respect to two quality of life measures . Neuromodulation result ed in increases of 220 % ( p < 0.0005 ) and 39 % ( p = 0.013 ) , respectively , in urodynamically assessed bladder volume at first contraction and maximum fill . At 36 months the actuarial rate of treatment failure was 32.4 % ( 95 % CI , 17.0–56.0 % ) . Adverse events most frequently involved pain at the implant site , and the incidence of serious complications was low . Conclusions : Neuromodulation is markedly more effective than conservative management in alleviating symptoms of refractory urge incontinence . Quality of life and urodynamic function are also improved by neuromodulation . The effects of neuromodulation are long – lasting , and associated morbidity is low PURPOSE The Study of Urgent PC vs Sham Effectiveness in Treatment of  Overactive Bladder Symptoms ( SUmiT ) was a multicenter , double-blind , r and omized , controlled trial comparing the efficacy of percutaneous tibial nerve stimulation to sham through 12 weeks of therapy . The improvement in global response assessment , voiding diary parameters , and overactive bladder and quality of life question naires was evaluated . MATERIAL S AND METHODS A total of 220 adults with overactive bladder symptoms were r and omized 1:1 to 12 weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy .  Overactive bladder and quality of life question naires as well as 3-day voiding diaries were completed at baseline and at 13 weeks . Subject global response assessment s were completed at week 13 . RESULTS The 13-week subject global response assessment for overall bladder symptoms demonstrated that percutaneous tibial nerve stimulation subjects achieved statistically significant improvement in bladder symptoms with 54.5 % reporting moderately or markedly improved responses compared to 20.9 % of sham subjects from baseline ( p < 0.001 ) . All individual global response assessment subset symptom components demonstrated statistically significant improvement from baseline to 13 weeks for percutaneous tibial nerve stimulation compared to sham .  Voiding diary parameters after 12 weeks of therapy showed percutaneous tibial nerve stimulation subjects had statistically significant improvements in frequency , nighttime voids , voids with moderate to severe urgency and urinary urge incontinence episodes compared to sham . No serious device related adverse events or malfunctions were reported . CONCLUSIONS This pivotal multicenter , double-blind , r and omized , sham controlled trial provides level I evidence that percutaneous tibial nerve stimulation therapy is safe and effective in treating overactive bladder symptoms . The compelling efficacy of percutaneous tibial nerve stimulation demonstrated in this trial is consistent with other recently published reports and supports the use of peripheral neuromodulation therapy for overactive bladder OBJECTIVE To assess the efficacy and tolerability of mirabegron 25 mg and 50 mg once-daily vs placebo in patients with overactive bladder ( OAB ) . MATERIAL S AND METHODS Patients ≥18 years with OAB symptoms were recruited to a 2-week , single-blind , placebo run-in . Those with ≥8 micturitions per 24 hours and ≥3 urgency episodes were r and omized 1:1:1 to once-daily mirabegron 25 mg or 50 mg , or placebo for 12 weeks . Primary endpoints were changes to final visit in mean number of incontinence episodes and micturitions per 24 hours . Key secondary endpoints were changes to final visit in mean volume voided or micturition , change to week 4 in mean number of incontinence episodes and micturitions per 24 hours , changes to final visit in mean level of urgency , number of urgency incontinence episodes , and urgency ( grade 3 or 4 ) episodes per 24 hours . Patient-reported outcomes were assessed using the OAB- question naire , Patient Perception of Bladder Condition , and Treatment-Satisfaction-Visual Analog Scale . RESULTS Both mirabegron groups demonstrated statistically significant improvements in co primary endpoints vs placebo . Mirabegron 50 mg demonstrated significantly greater improvements vs placebo in the following : change to final visit in mean volume voided per micturition and change to week 4 in mean number of incontinence episodes per 24 hours . Statistically significant improvements vs placebo were demonstrated by mirabegron 50 mg in all patient-reported outcome scales with no increase in the incidence of treatment-emergent adverse events vs placebo . CONCLUSION Mirabegron 25 mg and 50 mg were associated with significant improvements in efficacy measures of incontinence episodes and micturition frequency . Mirabegron was well tolerated vs placebo OBJECTIVE To assess the safety and efficacy of botulinum toxin-A ( botn-A ) in the management of patients with bladder oversensitivity ( BO ) . PATIENTS AND METHODS Twenty-three consecutive patients with a diagnosis of BO refractory to anticholinergics were enrolled in this r and omised , double blind , placebo-controlled trial . Patients were r and omly allocated to receive intradetrusor injections of either botn-A ( 100 U Botox ) or saline ( placebo ) via a flexible cystoscopic approach . The study was design ed to have 90 % power to detect a change in the maximum cystometric capacity ( MCC ) of 30 % . It was calculated that a total cohort of 58 patients would be required .  Urodynamic assessment ( UDS ) , voiding diaries ( VD ) and quality of life ( QoL ) were assessed at baseline and at 4 and 12 weeks following intervention . RESULTS An interim analysis was performed and the trial halted after recruitment of 23 patients as a result of poorly perceived patient benefit . Data were analysed for 21 patients ( 10  botn-A ; 11 placebo ) . In the treatment arm , there was a significant increase in MCC ( mean rise 105 ml ; p = 0.009 ) . However , storage symptoms remained statistically unchanged following botn-A. Three patients in the treatment arm were required to perform clean intermittent self-catheterisation with no clinical improvement . The limitations of this trial include the small sample size and the unplanned interim analysis . CONCLUSIONS This is the first r and omised , double blind , placebo-controlled trial examining the effects of botn-A exclusively in patients with BO . A significant increase in MCC was observed but this did not translate to clinical benefit with no change observed in the symptoms and quality of life for the majority of patients AIMS To better target a behavioral approach for  urge urinary incontinence ( UUI )  and enhance its efficacy by ( 1 ) identifying predictors of response to biofeedback-assisted pelvic muscle training ( BFB ) , and ( 2 ) determining factors that mediate response . METHODS BFB ( four biweekly visits ) was administered to 183 women > 60 years ( mean = 73.6 ) . Before and after intervention , all underwent comprehensive evaluation and videourodynamic testing . Postulated predictors and mediators from four urodynamic domains , specified a priori , were correlated with reduction in UUI frequency . RESULTS Median UUI frequency decreased from 3.2/day to 1/day ( P = 0.0001 ) . UUI improved by ≥50 % in 55 % of subjects and by 100 % in 13 % of subjects . Frequent UUI predicted poor response ( P < 0.01 ) . Of the urodynamic parameters , only high amplitude and briskness of detrusor overactivity ( DO ) predicted decreased response ( P < 0.05 and P < 0.01 ) and these could be measured only in the 43 % of subjects with elicitable DO . Decreased DO elicitability was the only urodynamic variable that changed in concert with improvement and thus was a c and i date mediator . Response was neither predicted nor mediated by proprioception/warning , cystometric capacity , detrusor contractility , sphincter strength , or baseline DO elicitability . CONCLUSIONS Severe DO predicts poor response to BFB . Good response is mediated by reduction in DO elicitability . Other than baseline UUI frequency , there are no other clinical ly or urodynamically important predictors or mediators of BFB response in this population . BFB may be best for patients with less severe DO . Future research to enhance its efficacy might better focus on the brain than on the lower urinary tract PURPOSE This is a prospect i ve , double-blind , placebo controlled study , based on an original placebo technique , performed to evaluate the efficacy of percutaneous tibial nerve stimulation in female patients with detrusor overactivity incontinence . MATERIAL S AND METHODS A total of 35 female patients presenting with detrusor overactivity incontinence that did not respond to antimuscarinic therapy were r and omly assigned to percutaneous tibial nerve stimulation or to a control group . The  percutaneous tibial nerve stimulation group ( 18 patients ) was treated with 12 percutaneous tibial nerve stimulation sessions . The control group ( 17 patients ) received an original placebo treatment using a 34 gauge needle placed in the medial part of the gastrocnemius muscle . The sessions lasted for 30 minutes and were performed 3 times weekly as percutaneous tibial nerve stimulation sessions . All patients were evaluated with bladder diaries as well as quality of life scores before and after treatment . Patients showing a reduction in urge incontinence episodes greater than 50 % were considered responders . RESULTS Some patients ( 1 in the percutaneous tibial nerve stimulation group and 2 in the placebo group ) did not complete the study for reasons not related to the technique . Of 17 patients in the percutaneous tibial nerve stimulation group 12 ( 71 % ) and of 15 in placebo group 0 were considered responders according to the previously reported definition ( p < 0.001 ) . Improvement in the number of incontinence episodes , number of voids , voided volume and incontinence quality of life score were statistically significant in the percutaneous tibial nerve stimulation group but not in the placebo group . CONCLUSIONS Percutaneous tibial nerve stimulation can be considered an effective treatment for detrusor overactivity incontinence with 71 % of patients considered responders , while none of those treated with placebo was considered a responder . The relevance of a placebo effect seems to be negligible in this patient population Background Thermotherapy is widely known to be effective for osteoarthritis of the knee ( knee OA ) , but most treatment methods make use of dry heat . We developed a sheet that generates heat and steam simultaneously . In this prospect i ve r and omized study , we evaluated the effectiveness of this sheet . Methods Of 41 female patients with knee OA r and omized to use the heat/steam-generating sheet or the dry heat-generating sheet , 37 patients ( 20 using the heat/steam-generating sheet and 17 using the dry heat-generating sheet ) who used the sheets continuously for 4 weeks were studied . Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and Japan Orthopaedic Association ( JOA ) scores , which were applied at baseline and after 2 and 4 weeks of use . Results Significant improvement of the total WOMAC score was observed at 2 and 4 weeks ( compared to baseline ) in the heat/steam-generating sheet group , but no significant change was observed in the dry heat-generating sheet group . Among the JOA scores , the gait ability score was also improved significantly only in the heat/steam-generating sheet group . The effects were still seen 6 weeks after completion of treatment . Conclusions The present study provided evidence that the heat/steam-generating sheet that we developed is effective for alleviating pain and is especially superior in regard to improving stiffness and gait impairment in patients with knee OA . Furthermore , the effect persists for at least 6 weeks after application
target: Pelvic floor exercises are more effective in subjective and objective outcomes with biofeedback or verbal feedback .
  Weight loss with diet and exercise , caffeine reduction , 25 - 50 % reduction in fluid intake , and pelvic floor muscle exercises with verbal instruction and or biofeedback were all efficacious .
  Botulinum toxin A improves urge incontinence episodes , urgency , frequency , quality of life , nocturia , and urodynamic testing parameters .
  Acupuncture  improves quality of life and urodynamic testing parameters .
  Extracorporeal magnetic stimulation improves urodynamic parameters .
  Mirabegron improves daily incontinence episodes , nocturia , number of daily voids , and urine volume per void , whereas solabegron improves daily incontinence episodes .
  Short-term posterior tibial nerve stimulation is more efficacious than pelvic floor muscle training exercises and behavioral therapy for improving : urgency , urinary incontinence episodes , daily voids , volume per void , and overall quality of life .
  Sacral neuromodulation is more efficacious than antimuscarinic treatment for subjective improvement of overactive bladder and quality of life .
  Transvaginal electrical stimulation demonstrates subjective improvement in overactive bladder symptoms and urodynamic parameters .
  Multiple therapies , including physical therapy , behavioral therapy , botulinum toxin A , acupuncture , magnetic stimulation , mirabegron , posterior tibial nerve stimulation , sacral neuromodulation , and transvaginal electrical stimulation , are efficacious in the treatment of overactive bladder
background: The purpose of the study was to determine the efficacy and safety of nonantimuscarinic treatments for overactive bladder .