Ring pessary for OAB as effective as nonsurgical therapies

By Joanna Lyford, Senior medwireNews Reporter

The use of a ring pessary appears to be an effective, well tolerated and inexpensive treatment for overactive bladder (OAB), say US researchers writing in International Urogynecology Journal.

Their study found that the cure rate was around 20% in women treated with a ring pessary, which is equivalent to cure rates associated with either behavioural therapy or anticholinergic medication.

However the device’s long-term efficacy remains to be determined, admit study authors Eddie Sze (State University of New York—Upstate Medical University, Syracuse) and Gerry Hobbs (West Virginia University School of Medicine, Morgantown).

The researchers identified 381 women who were evaluated for OAB at their clinic over a 42-month period, of whom 150 elected to use the ring pessary and 231 chose multicomponent behavioural therapy (comprising advice on timed voiding and pelvic floor muscle exercises).

The two treatment groups were similar with regard to demographical and clinical characteristics, including severity of OAB, note the authors.

At the end of the 6-month treatment period, cure rates were 19% with the ring pessary versus 20% with behavioural therapy, a nonsignificant difference.

Subgroup analysis indicated that the two treatments had equivalent efficacy in premenopausal and postmenopausal women and in women who had and had not already received treatment for their condition. Indeed, logistic regression analysis failed to identify any baseline predictor of treatment success.

The researchers say that the mechanism by which ring pessaries alleviate OAB is unclear, as is the precise pathophysiological pathway underlying OAB itself. “We believe that OAB probably has multiple causes, each of which may contribute to the condition by varying degrees, or be solely responsible for it, resulting in a variable response to each treatment”, they write, but add that the placebo effect may also contribute to the treatment response.

Noting that OAB is a challenging condition for both physicians and patients because it often does not respond to treatment, Sze and Hobbs conclude: “Our study showed that the ring pessary provides clinicians with a treatment alternative that is as efficacious as timed voiding with pelvic floor muscle exercises; is inexpensive, easy to manage, widely available, and applicable; and has minimal side effects”.

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