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Digital Assistant Helps Ease an Overactive Bladder

Heidi Splete


Move over, Alexa and Siri. A digital conversation agent called CeCe helped reduced symptom severity and improved quality of life in adults with an overactive bladder (OAB) in an 8-week study.

People with an OAB have higher rates of anxiety, depression, and loneliness and spend up to 2.5 times more on their healthcare than those with similar comorbidities but without the condition, according to David Sheyn, MD, assistant professor of urology and reproductive biology at Case Western Reserve University in Cleveland, Ohio, and corresponding author of the study.

Although behavior therapies are known to be effective for an OAB, "the treatments are limited by issues related to adherence, accessibility, and cost," said Sheyn, who is also a faculty member in urology at University Hospitals in Cleveland, Ohio. "CeCe overcomes these barriers by providing an at-home option for pelvic floor therapy, as well as providing an interactive user interface that keeps the patient engaged with their treatment."

Rates of an OAB are likely to increase as the population ages, Sheyn said, and "many patients have concerns about possible dementia risks and costs associated with pharmacotherapy."

Sheyn and colleagues developed CeCe, which provides instruction to users on bladder training and pelvic floor exercises, as well as education about bladder health.

In research published in Urogynecology, Sheyn and colleagues studied 29 White women aged 30 years and older (median age, 61 years) who had primary complaints of urinary urgency with or without incontinence, urinary frequency (defined as more than seven voids per day), and nocturia (more one void per night).

Participants received access to CeCe over an 8-week period and used the tool for up to 10 minutes a day.

Overall, the women in the study reported improved quality of life in relation to an OAB and less generalized anxiety, Sheyn's group found. Patients also reported significant decreases in urinary frequency from baseline to week 8 (seven voids vs five voids; P = −.04), nocturia (two vs one; P = .03), and urge urinary incontinence (two vs none; P = .04).

Alcohol consumption also decreased significantly from a median use of 24 ounces per week at the start of the study to 14 ounces at the end of the trial (P = .02).

The findings were limited by several factors, including the small and racially homogenous study population, the relatively short study period, and the reimbursement of patients for participating, which may have affected adherence, the researchers noted.

"The take-home message is that digital therapeutics can be an effective adjunct to other OAB therapies and can be instituted by clinicians in the primary care setting, as well as by incontinence specialists," Sheyn told Medscape Medical News. "There is tremendous potential for this intervention both as a primary treatment and an adjunct, especially in populations who may have restricted access to pelvic floor therapists and urogynecologists."

Digital Options Have Real Advantages

Noninvasive therapies such as behavioral therapy or neuromodulation can be beneficial when implemented with adequate training, reinforcement, and follow-through but can be difficult to achieve in clinical practice because of limited resources, according to Noel Deep, MD, chief medical officer and staff physician at Aspirus Langlade Hospital in Antigo, Wisconsin, who also is a general internist in private practice. A digital option that can guide patients at home could be more efficient.

"The study findings have great promise for rural physicians like me to add to our arsenal of available treatment options for our patients," Deep, who was not involved in the study, said.

However, before recommending a tool like CeCe, Deep said he would want to see results from the tool on a wider swath of women with diverse backgrounds and adherence over longer periods, "given the poor adherence to nonpharmacological behavioral and lifestyle modifications frequently encountered in clinical practice."

The study was funded by Renalis. Sheyn disclosed research support from Renalis and consulting fee from Caldera. Other coauthors disclosed relationships with multiple companies including Collamedix, Boston Scientific, AbbVie, and Renalis. Deep had no financial conflicts to disclose.

Heidi Splete is a medical journalist based in the Washington, DC, area. She has been writing for more than 20 years on a range of medical and health topics for clinician and general audiences.



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