title: Behavioral versus drug treatment for overactive bladder in men: the Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial.
abstract: OBJECTIVE
  To compare the effectiveness of behavioral treatment with that of antimuscarinic therapy in men without bladder outlet obstruction who continue to have overactive bladder (OAB) symptoms with alpha-blocker therapy.
  
  
  METHODS
  The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial was a two-site randomized, controlled, equivalence trial with 4-week alpha-blocker run-in.
  
  
  METHODS
  Veterans Affairs Medical Center outpatient clinics.
  
  
  METHODS
  Volunteer sample of 143 men aged 42 to 88 who continued to have urgency and more than eight voids per day, with or without incontinence, after run-in.
  
  
  METHODS
  Participants were randomized to 8 weeks of behavioral treatment (pelvic floor muscle exercises, urge suppression techniques, delayed voiding) or drug therapy (individually titrated, extended-release oxybutynin, 5-30 mg/d).
  
  
  METHODS
  Seven-day bladder diaries and a validated urgency scale were used to calculate changes in 24-hour voiding frequency, nocturia, urgency, and incontinence. Secondary outcomes were global patient ratings and American Urological Association Symptom Index.
  
  
  RESULTS
  Mean voids per day decreased from 11.3 to 9.1 (-18.8%) with behavioral treatment and 11.5 to 9.5 (-16.9%) with drug therapy. Equivalence analysis indicated that posttreatment means were equivalent (P < .01). After treatment, 85% of participants rated themselves as much better or better; more than 90% were completely or somewhat satisfied, with no between-group differences. The behavioral group showed greater reductions in nocturia (mean = -0.70 vs -0.32 episodes/night; P = .05). The drug group showed greater reductions in maximum urgency scores (mean = -0.44 vs -0.12; P = .02). Other between-group differences were nonsignificant.
  
  
  CONCLUSIONS
  Behavioral and antimuscarinic therapy are effective when added to alpha-blocker therapy for OAB in men without outlet obstruction. Behavioral treatment is at least as effective as antimuscarinic therapy.
authors.affiliation: Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama 35233, USA. kburgio@aging.uab.edu
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Burgio
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Goode
authors.forename: Theodore M
authors.initials: TM
authors.lastname: Johnson
authors.forename: Lee
authors.initials: L
authors.lastname: Hammontree
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Ouslander
authors.forename: Alayne D
authors.initials: AD
authors.lastname: Markland
authors.forename: Janet
authors.initials: J
authors.lastname: Colli
authors.forename: Camille P
authors.initials: CP
authors.lastname: Vaughan
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
mesh_terms: D001521:Behavior Therapy; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use*; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000628:therapy*; D014728:Veterans
chemical_list: D008333:Mandelic Acids; D018727:Muscarinic Antagonists; C005419:oxybutynin