Hypothesis: According to the International Continence Society (ICS), overactive bladder (OAB) is a multifactorial clinical syndrome associated with intrinsic and extrinsic factors, and is defined as the presence of symptoms of urinary urgency, daytime voiding frequency and/or nocturia, with urinary incontinence (OAB-wet) or without (OAB-dry), in the absence of urinary tract infection or other detectable disease.  OAB generates public health costs and tends to directly affect individuals' quality of life, self-esteem, interpersonal relationships, and may contribute to social isolation The aim of this study will be to investigate and update the literature on whether BT can promote improvement of symptoms of individuals with OAB, quality of life improvement and report adverse events.

Methods: A systematic review was carried out in eight databases, PubMed, PEDro, SciELO, LILACS, Cochrane Library, Web of Science, EMBASE, CINAHL. After selecting the titles, abstracts and full texts retrieved. Fourteen randomized controlled trials (RCTs) were included. To assess the risk of bias in the studies, the Cochrane RoB 2 tool was used and the GRADE system was used to assess the quality of evidence of the analyzed studies.

Results: BT isolated (n=12), BT + intravaginal electrical stimulation (IVES) (n=2), BT + DT (drug treatment) (n=5), DT (n=7), BT + Biofeedback (BF) + IVES (n=1), PFMT isolated (pelvic floor muscle training) (n=3), PFMT + BF (n=1), BT + PFMT + education/behavioral therapy (n=2), BT + PTNS (percutaneous tibial nerve stimulation) and BT + TTNS (transcutaneous tibial nerve stimulation) (n=1). BT + IVES, which at short term promoted improvement in nocturia (MD: 0.89, CI 95% CI: 0.59-1.20), urinary incontinence (MD: 1.93, 95% CI: 1.32-2.55) and quality of life (MD: 4.87, 95% CI: 2.24-7.50).

Implications for Practice: The larger number of countries and the choice of RCTs in this review emphasized the strength of the BT recommendation for the treatment of individuals with OAB. For individuals with OAB treated with BT there is now a report of reduced episodes of nocturia, urinary incontinence and improved quality of life at short-term follow-up. It is recommended as first-line conservative therapy that BT should be used as supplemental therapy, in particular combined with IVES in OAB in the short-term follow-up period. 


Implications for Research: The methodological quality of the studies was the best possible for the moment analyzed aspects of the currently available RCTs to update the current literature (choice of outcome, duration of follow-up, method of reporting and data), most of the data in this review comes from moderate sized RCTs of very low to moderate methodological quality, verified by GRADE. The findings of this study, corroborated with the recommendations of the societies guiding conservative treatment for OAB. BT should be offered in combination with IVES (another therapeutic strategy), as a supplementary therapy in conservative treatment to increase treatment efficacy in the short-term follow-up period.
This is a systematic review of randomized controlled trials (RCTs) to analyze the effectiveness of bladder training (BT) in improving symptoms of overactive bladder (OAB). A review of RCTs was conducted in order to obtain studies with the highest and best level of scientific evidence. Based on the available data, BT combined with IVES showed favorable results, favoring the use of BT as a supplementary therapy for OAB.

BT combined IVES showed favorable results for the treatment of OAB at short-term follow-up period. Thus, the use of BT combined with IVES is recommended as a useful conservative therapeutic strategy for the treatment of individuals with overactive bladder.
Register: PROSPERO CRD42022301522.