Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis

Shi Qiu; Siwei Bi; Tianhai Lin; Zhuheng Wu; Qi'an Jiang; Jiwen Geng; Liangren Liu; Yige Bao; Xiang Tu; Mingjing He; Lu Yang; Qiang Wei

doi:10.1016/j.ajur.2019.04.001

Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis

Asian J Urol. 2019 Oct;6(4):330-338. doi: 10.1016/j.ajur.2019.04.001. Epub 2019 Apr 13.

Authors

Shi Qiu¹, Siwei Bi¹, Tianhai Lin¹, Zhuheng Wu¹, Qi'an Jiang¹, Jiwen Geng¹, Liangren Liu¹, Yige Bao¹, Xiang Tu¹, Mingjing He¹, Lu Yang¹, Qiang Wei¹

Affiliation

¹ Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China.

Abstract

Objective: To compare these managements focusing on the efficacy and safety to treat overactive bladder (OAB) in children through network meta-analysis (NMA).

Methods: We searched PubMed, Embase, the Cochrane Library Central Register of Controlled Trials (CENTRAL) and the reference lists up to May 1st, 2017. Data from eligible randomized controlled trails (RCT) studies including three different treatment options were extracted. The primary outcome was maximal voiding volume (MVV). We performed pairwise meta-analyses by random effects model and NMA by Bayesian model. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to assess the quality of evidence contributing to each network estimate.

Results: Six RCTs (462 patients) comparing three different interventions fulfilled the inclusion criteria. A low risk of bias was shown for the majority of the study items. The results of NMA showed that compared with antimuscarinic drugs, Parasacral transcutaneous electrical nerve stimulation was associated with significant improvement in the MVV (mean difference [MD] = 58.50, 95% confidential interval [CI]: 45.95-69.52), followed by urotherapy group (MD = 21.03, 95% CI: 11.85-29.97). When it comes to the constipation, antimuscarinic drugs exerted significant benefit than PTENS (odds ratio [OR]: 0.22, 95% CI: 0.01-0.46). No significant difference was found between other treatments.

Conclusion: Compared with antimuscarinic drugs, PTENS was associated with significant better efficacy considering MVV, but more constipation events in de novo OAB children. Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy. Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy.

Keywords: Anticholinergics; Meta-analysis; Overactive bladder; Parasacral transcutaneous electrical nerve stimulation.