Article type
Abstract
Background: Overactive bladder is a collective diagnosis for disturbances in the filling and emptying of the bladder. The patients’ quality of life is strongly affected by the condition and, if all basic treatments fail, instillation therapy is seen as a potential treatment option. A heterogenous population, unclear etiology of the condition and a variety of substances that are being marketed and installed make this research field difficult to synthesize.
Objectives: To assess the effects of instillation therapy for overactive bladder and make the heterogeneity of the research field more comprehensible.
Methods: The effect of instillation therapy was evaluated through a systematic review, according to Cochrane methodology, that included research on the following substances: dimethyl sulfoxide (DMSO), hyaluronic acid (HA), chondroitin sulfate (CS), the combination of HA + CS, polyhexanide, silver chloride, chlorhexidine. Several studies compare different substances with each other. However, due to scares and heterogenous data, a network meta-analysis would have resulted in very uncertain results. Instead, we focused on first addressing whether the instillations have an effect beyond placebo.
Results: Our results show that instillation therapy may have little or no effect on key outcomes such as urinary frequency, pain, infection, and health-related quality of life. We identified 16 relevant studies. However, only 7 of those have examined whether instillations provide any effect beyond placebo, which resulted in one to two studies per comparison and outcome.
Conclusions: As long as uncertainties about the effects persist, it is reasonable to continue to restrict the use of these treatments. Future studies should focus on demonstrating an effect beyond placebo instead of comparing treatments against each other. Given the heterogeneous population, studies should also identify subgroups where symptoms or suspected etiology differ. Studies on these subgroups can better answer whether a particular substance is better suited for a certain group of patients or symptoms.
Objectives: To assess the effects of instillation therapy for overactive bladder and make the heterogeneity of the research field more comprehensible.
Methods: The effect of instillation therapy was evaluated through a systematic review, according to Cochrane methodology, that included research on the following substances: dimethyl sulfoxide (DMSO), hyaluronic acid (HA), chondroitin sulfate (CS), the combination of HA + CS, polyhexanide, silver chloride, chlorhexidine. Several studies compare different substances with each other. However, due to scares and heterogenous data, a network meta-analysis would have resulted in very uncertain results. Instead, we focused on first addressing whether the instillations have an effect beyond placebo.
Results: Our results show that instillation therapy may have little or no effect on key outcomes such as urinary frequency, pain, infection, and health-related quality of life. We identified 16 relevant studies. However, only 7 of those have examined whether instillations provide any effect beyond placebo, which resulted in one to two studies per comparison and outcome.
Conclusions: As long as uncertainties about the effects persist, it is reasonable to continue to restrict the use of these treatments. Future studies should focus on demonstrating an effect beyond placebo instead of comparing treatments against each other. Given the heterogeneous population, studies should also identify subgroups where symptoms or suspected etiology differ. Studies on these subgroups can better answer whether a particular substance is better suited for a certain group of patients or symptoms.