Behavioral management including bladder training is the first choice of treatment for patients with overactive bladder syndrome (OABS) (1). However, there is still not enough knowledge about the proper content and best application methods of this treatment regimen. In order to explore this, we analyzed our patients’ records that were treated with bladder training (BT) in our Pelvic Floor Dysfunctions Rehabilitation Unit.

Data of female OABS patients’ allocated to bladder training between January, 2020-April 2021 were extracted from our rehabilitation unit database. In a routine scheme, a trained nurse supervised BT for 8 weeks. Some patients with insufficient response to treatment or who are willing to continue were continued to the same program as much as possible, until the desired 3-4 hours of micturition period is obtained. All patients were informed about OABS and were encouraged for life-style modifications. Patients were asked to void at pre-set intervals where duration of the interval was decided by the patient and the nurse as a shared decision. Then, the patients had weekly follow-up visits via phone calls led by the nurse to understand patient status during the week and to set a new voiding interval for the next week. Pre-set voiding interval was established as the longest possible duration for a patient without any urinary incontinence. All patients signed informed consents. Patients were asked to log a simple bladder diary for their urgency and incontinence episodes during this period. All patients’ age, duration of OABS symptoms, pre-treatment and post-treatment 3 day-bladder diary, Overactive Bladder-V8 Questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), patient reported symptom severity of the last 3 days by visual analog scale (VAS-symptom severity: 0-10) and 24 hours pad test parameters were extracted from their medical records. During the SARS-CoV2-19 pandemic, we preferred phone calls instead of face-to-face visits for patient safety, so after the hospital initiation visit; consecutive visits were actualized via phone calls.

Twenty-five female patients with OABS were treated with BT. Twenty-three patients had wet symptoms for OABS and 2 patients had dry OAB symptoms. Mean patient age was 47.40±12.13 years, mean BMI was 29.67±6.48 kg/m2 and mean symptom duration for OAB was 74.25±62.75 months. None of the patients were on any medication for OABS at the time BT started. Three (12%) patients could not complete the program due to compliance issues and their results were analyzed as ‘non-responder’ like an ITT analysis. Average initial voiding interval was 76.20±27.70 minutes at the beginning of the BT treatment. Patients mean voiding interval increased to 133.00±43.30 minutes at 8 weeks (p<0.001; Table-1). Six (24%) patients achieved a 3-hours micturition interval at 8 weeks. No adverse events were recorded during BT.

Our patients’ duration of voiding intervals almost doubled with 8 weeks of bladder training treatment (p<0.001; Table-1). Although this increase in voiding interval didn’t reflect on the voiding frequency at the same amount, bladder training was effective in reducing urgency, urinary incontinence and pad test results. 
The percentage of patients achieving ≥3 hours of voiding interval at 8 weeks was relatively low (26%). This might be due to the fact that severe OABS patients were involved in bladder training treatment or due to the relatively short duration of treatment. Weekly intense follow-up for bladder training might have positively affected the outcome and patients’ adherence to treatments. However, given the non-randomized and uncontrolled nature of our study, it is impossible to make a conclusion.

Bladder training is the first treatment of choice as it is essential for OABS patients to break the urgency-voiding loop. Strict monitoring of bladder training almost doubles the duration of voiding interval at 2 months for female OABS patients and effectively reduces urgency and urinary incontinence episodes. Identification of patient selection criteria is crucial for better outcomes of bladder training. Non-pharmacological treatment of OABS with bladder training is possible by phone calls even in pandemic conditions where hospital based options are avoided. Prospective randomized controlled trials are needed for the effectiveness of remote visits. Different telemedicine methods, like phone calls or video calls might have different outcomes.

C.K. Harding (Chair), M.C. Lapitan (Vice-chair), S. Arlandis, K. Bø, E. Costantini, J. Groen, A.K. Nambiar, M.I. Omar, V. Phé, C.H. van der Vaart Guidelines Associates: F. Farag, M. Karavitakis, M. Manso, S. Monagas, A. Nic an Riogh, E. O'Connor, B. Peyronnet, V. Sakalis, N. Sihra, L. Tzelves. Non-neurogenic Female LUTS. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2021. ISBN 978-94-92671-13-4