Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Peri‐operative pelvic floor muscle training reduces urinary incontinence for men undergoing radical prostatectomy (RP). A preoperative biofeedback session, combined with postoperative pelvic floor muscle training, and assisted sessions on a monthly basis only, is an effective low‐intensity programme to improve recovery of continence in patients undergoing RP. OBJECTIVE To evaluate the efficacy of preoperative biofeedback (BFB) combined with an assisted low‐intensity programme of postoperative perineal physiokinesitherapy in reducing the incidence, duration and severity of urinary incontinence (UI) in patients undergoing radical prostatectomy (RP). PATIENTS AND METHODS A prospective, single‐centre, randomized controlled clinical study was designed. The intervention group received a training session with BFB, supervised oral and written instructions on Kegel exercises and a structured programme of postoperative exercises on the day before open RP. After RP, patients received control visits, including a session of BFB, at monthly intervals only. The control group received, after catheter removal, only oral and written instructions on Kegel exercises to be performed at home. Patients received control visits at 1, 3 and 6 months after catheter removal. At each visit the number of incontinence episodes, the number of pads used and patient‐reported outcome measures (International Consultation on Incontinence Questionnaire on Urinary Incontinence [ICIQ‐UI], [ICIQ]‐Overactive Bladder [OAB], University of California, Los Angeles‐Prostate Cancer Index [UCLA‐PCI], International Prostate Symptom Score‐Quality of Life [IPSS‐QoL]) were assessed in both groups. All patients were followed‐up for a period of at least 6 months after catheter removal. The primary outcome was the recovery of continence, strictly defined as a ICIQ‐UI score of zero. RESULTS Overall, 34 consecutive patients were eligible and 32 were available for the final analysis: 16 patients for each study group. The two groups were homogeneous for all pre‐ and intraoperative features examined. In the intervention group, continence had been achieved by six, eight and 10 patients at 1‐, 3‐ and 6‐month follow‐ups, respectively, vs no patients (P= 0.02), one patient (P= 0.01) and one patient (P= 0.002) in the control group at each follow‐up, respectively. The analysis of the UCLA‐PCI and ICIQ‐OAB scores, the number of incontinence episodes per week and the number of pads per week showed significant differences in favour of patients in the intervention group at 3 and 6 months. Patients in the intervention group reported better IPSS‐QoL scores at all follow‐up times but the difference did not reach statistical significance. CONCLUSIONS Preoperative BFB combined with a postoperative programme of perineal physiokinesitherapy and assisted sessions on a monthly basis only, is a treatment strategy significantly more effective than the standard care in improving reco...

Thanks to its tolerability and safety/efficacy balance, mirabegron has potential to fill a need for new treatment options for OAB, and paves the way for further development of a completely new class of drugs aimed to treat this condition. However, the exact role of mirabegron in clinical practice has yet to be defined. Further studies are needed in order to clarify, together with post-launch information, critical safety issues and cost-effectiveness in head-to-head comparison with current standard treatments.

BoNT-A injection therapy appears effective and safe in medically refractory men with PBND, although repeated procedures are required for long-term sustained benefit. Randomized controlled trials are warranted in order to corroborate these results.

Overactive bladder (OAB) is a highly prevalent urinary syndrome with a profound impact on quality of life (QoL) of affected patients and their family because of its adverse effects on social, sexual, interpersonal, and professional function. Cost-of-illness analyses showed the huge economic burden related to OAB for patients, public healthcare systems, and society, secondary to both direct and indirect costs; however, intangible costs related to QoL impact are usually omitted from these analyses. Recently many novel treatment modalities have been introduced and the need to apply the modern methodology of health technology assessment to these treatment strategies was immediately clear in order to evaluate objectively their value in term of both improvement in length/quality of life and costs. Health utilities are instruments that allow a measurement of QoL and its integration in the economic evaluation using the quality-adjusted life-years model and cost-utility analysis. The development of suitable instruments for quantifying utility in the specific group of OAB patients is vitally important to extend the application of cost-utility analysis in OAB and to guide healthcare resources allocation for this disorder. Studies are required to define the cost-effectiveness of available pharmacological and nonpharmacological therapy options for this disorder.

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