Contributors to satisfaction with combined drug and behavioral therapy for overactive bladder in subjects dissatisfied with prior drug treatment

PURPOSE: To assess contributors to treatment satisfaction with a focused, self-administered behavioral intervention combined with tolterodine extended release (ER) in subjects from an open-label study who had reported dissatisfaction with antimuscarinic treatment for overactive bladder (OAB) before that study. METHODS: Cognitive debriefing interviews were conducted with a convenience sample of 15 participants 7 to 10 months after completing the open-label trial. Reasons that contributed to participants' satisfaction with tolterodine ER treatment combined with behavioral intervention were assessed in the context of their dissatisfaction with prior antimuscarinic treatment. Also assessed were participants' treatment expectations and experiences with specific aspects of study participation and the self-administered behavioral intervention. RESULTS: Among the 15 participants (median age, 57 years; 13 women, 2 men), 12 attributed dissatisfaction with prior antimuscarinics to lack of efficacy. Only 7 participants had positive expectations of tolterodine ER treatment, 5 did not expect it to work, and 3 did not know what to expect. Reasons given for satisfaction with combined treatment were improved OAB symptoms (n = 13), attention of clinic staff (n = 8), review of educational materials on OAB symptoms and treatment (n = 14), and keeping a bladder diary (n = 13). One-third of participants (n = 5) continued to take tolterodine ER for 7 to 10 months after completing the open-label study. CONCLUSION: In addition to antimuscarinic therapy, treatment satisfaction and OAB symptoms may be improved in many patients by using a focused educational pamphlet with verbal reinforcement that increases awareness of OAB causes, treatments, and strategies for improving bladder control, including behavioral interventions and keeping bladder diaries.