Outcomes of combined behavioural, physical and pharmacological therapy compared to a monotherapy approach for overactive bladder syndrome: A systematic review and meta‑analysis

Overactive bladder (OAB) syndrome is a prevalent condition characterised by urinary urgency, frequency and nocturia, and is often accompanied by incontinence. OAB is typically managed through pharmacological interventions, such as antimuscarinics or β3‑adrenoceptor agonists, and behavioural therapies, such as bladder training and pelvic floor muscle exercises. However, the effectiveness of combined pharmacological and behavioural approaches remain uncertain. Therefore, the present systematic review and meta‑analysis aimed to evaluate the outcomes of combined therapies for the management of OAB. A systematic search was conducted across the PubMed, ScienceDirect and Cochrane Library databases for studies published between January, 2000 and December, 2023. Eligible studies included randomised controlled trials and cohort studies reporting on outcomes of combined pharmacological and behavioural therapies (≥8 weeks) in adult patients with OAB. Data on study design, patient demographics, treatment regimens, follow‑up duration, outcome measures and adverse effects were extracted. The quality of the studies was evaluated using established assessment tools. The present study analysed four studies comprising 830 participants. The results of the meta‑analysis indicated no significant differences between combination therapy and monotherapy in reducing voiding frequency [mean difference (MD), 0.35; 95% confidence interval (CI), ‑0.23 to 0.93; P=0.24] and nocturia episodes (MD, 0.04; 95% CI, ‑0.18 to 0.27; P=0.70). However, combined therapies demonstrated greater symptom improvement and adherence in individual studies, particularly for the urgency and quality of life variables. Adverse events were mild and primarily related to pharmacological agents. Although the results of the meta‑analysis suggest comparable efficacy between the combined and single therapies in reducing voiding frequency and nocturia episodes, combined therapies exhibit potential benefits in overall symptom relief, treatment adherence and quality of life. Future research is required to investigate the long‑term effects of combined therapies and explore strategies to enhance adherence to treatment.