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| Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis |
Shi Qiu1,Siwei Bi1,Tianhai Lin1,Zhuheng Wu,Qi’an Jiang,Jiwen Geng,Liangren Liu,Yige Bao,Xiang Tu,Mingjing He,Lu Yang( ),Qiang Wei()
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| Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China |
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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.
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Received: 15 August 2017
Available online: 13 April 2019
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Corresponding Authors:
Lu Yang,Qiang Wei
E-mail: wycleflue@163.com;weiqiang163163@163.com
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Flow chart of study identification and selection procedure. OAB, overactive bladder; RCTs, randomized controlled trails.
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| Author | Publish year | Country | Intervention group 1 (sample size) | Intervention group 2 (sample size) | stimulation frequency | Stimulation duration (min/time) | Treatment duration (week) | Treatment frequency | | de Paula et al. [17] | 2017 | Brazil | PTENS (8) | Sham stimulation (8) | 10 Hz | 20 | 20 | Once a week | | Lordêlo et al. [18] | 2010 | Brazil | PTENS (21) | Scapular stimulation (16) | 10 Hz | 20 | 6 | Three times a week | | Sillén et al. [19] | 2014 | Sweden | PTENS and urotherapy (30) | Urotherapy (32) | 10 Hz | 20 | 12 | Twice daily | | Quintiliano et al. [20] | 2015 | Brazil | PTENS and placebo (13) | Antimuscainic (oxybutynin) and sham electric stimulation (15) | 10 Hz | 20 | 6 | Three times a week | | Marschall-Kehrel et al. [21] | 2009 | Germany | Antimuscarinic (propiverine) (87) | Placebo (84) | NA | NA | 8 | Twice daily | | Newgreen et al. [22] | 2016 | Netherlands | Antimuscarinic (Solifenacin) (73) | Placebo (73) | NA | NA | 12 | Once daily |
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The main characteristics of the included RCTs.
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Risk of bias assessments within studies.
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Risk of bias assessments for each study.
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Forest plot for pairwise meta-analysis. (A) Change in maximal voiding volume; (B) Voiding frequency; (C) Incontinence episodes; (D) Change in average voiding volume change; (E) Constipation. The size of the boxes corresponds to each study's weight. CI, confidential interval; PTENS, parasacral transcutaneous electrical nerve stimulation. IV, Inverse variance; M-H, Mantel-Haenszel.
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| Comparison | No. of participants | No. of trials | Pairwise meta-analysis mean difference/odd ratios (95% CI) | p-Value | Heterogeneity, I2 | Network meta-analysis, mean difference/odds ratios (95% CrI) | Quality of evidence | Downgraded reason | | Maximal voiding volume | | PTENS vs. urotherapy | 196 | 2 | NA | NA | NA | 37.46 (28.27, 45.24) | ⊕⊕○○ low | Inconsistency and imprecision | | Antimuscarinic vs. urotherapy | 307 | 2 | 20.49 (6.80, 34.17) | 0.1 | 64% | 21.03 (11.85, 29.97) | ⊕⊕⊕○ moderate | heterogeneity | | PTENS vs. antimuscarinic | 239 | 0 | NA | NA | NA | 58.50 (45.95, 69.52) | ⊕⊕○○ low | Heterogeneity and imprecision | | Voiding frequency | | PTENS vs. urotherapy | 196 | 2 | NA | NA | NA | 0.425 (-2.21, 2.76) | ⊕⊕○○ low | Inconsistency and imprecision | | Antimuscarinic vs. urotherapy | 307 | 2 | -0.80 (-1.29, -0.31) | 1 | 0 | 1.09 (-1.18, 3.40) | ⊕⊕○○ low | Inconsistency and imprecision | | PTENS vs. antimuscarinic | 239 | 0 | NA | NA | NA | 0.67 (-2.213, 3.71) | ⊕⊕○○ low | Heterogeneity and imprecision | | Incontinence episodes | | PTENS vs.urotherapy | 219 | 1 | NA | NA | NA | 0.13 (-4.88, 5.44) | ⊕⊕○○ low | Inconsistency and imprecision | | Antimuscarinic vs. urotherapy | 349 | 2 | -0.30 (-0.54, -0.05) | 0.81 | 0 | 0.23 (-3.41, 3.74) | ⊕⊕○○ low | Inconsistency and imprecision | | PTENS vs. antimuscarinic | 190 | 0 | NA | NA | NA | 0.09 (-6.79, 6.59) | ⊕⊕○○ low | Heterogeneity and imprecision | | Constipation | | PTENS vs. urotherapy | 29 | 1 | 0.21 (0.04, 1.12) | 0.51 | 0 | 0.38 (0.01, 6.85) | ⊕⊕⊕○ moderate | Heterogeneity | | Antimuscarinic vs. urotherapy | 23 | 0 | NA | NA | NA | 0.15 (0.25, 3.82) | ⊕⊕○○ low | Heterogeneity and imprecision | | PTENS vs. antimuscarinic | 36 | 1 | NA | NA | NA | 0.22 (0.01, 0.46) | ⊕⊕○○ low | Inconsistency and imprecision |
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Summary effect size of pairwise and network meta-analysis.
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