***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To verify whether the combination of transcutaneous electrical neural stimulation ( TENS ) with oxybutynin in the treatment of women with overactive bladder ( OAB ) would be more effective than isolated treatments . Methods We r and omized 75 women with OAB , in three groups : GI—30 min TENS , twice a week ; GII — daily slow release 10 mg oxybutynin ; and GIII — TENS + oxybutynin ( multimodal ) ; all for 12 weeks . Patients were evaluated with vali date d question naires International Consultation on Incontinence-Short Form ( ICIQ-SF ) , International Consultation on Incontinence-OAB ( ICIQ-OAB ) , Symptom bother , and 3-day Voiding diary at weeks 0 , 12 , and 24 . Results The groups were similar before treatment . After treatment , all groups significantly improved in OAB symptoms and quality of life ( QoL ) . At week 12 , ICIQ-OAB scores were 5.9 , 4.6 , and 2.9 , in groups I , II , and III , respectively , p = 0.01 . At week 24 , GI and GIII kept the scores of the end of treatment ( week 12 ) , while GII increased ICIQ-OAB from 4.6 to 9.2 , p = 0.0001 , ICIQ-SF from 9.8 to 13.3 , p = 0.0006 , and Symptom bother score from 3.4 to 7.0 , p = 0.0001 . Conclusions The multimodal treatment was more effective and TENS alone or in association presented longer lasting results for improvement of clinical symptoms of OAB and BACKGROUND Overactive bladder ( OAB ) syndrome with urinary incontinence ( UI ) is prevalent in the population and impairs health-related quality of life ( HRQOL ) . OBJECTIVE To assess the impact on efficacy , safety , and HRQOL of onabotulinumtoxinA ( BOTOX ( ® ) , Allergan , Inc. ) treatment in patients with OAB with UI . DESIGN , SETTING , AND PARTICIPANTS This pivotal , multicentre , double-blind , r and omised , placebo-controlled , phase 3 study enrolled patients with idiopathic OAB with ≥ 3 urgency UI episodes over 3 d and ≥ 8 micturitions per day who were inadequately managed by anticholinergics . INTERVENTION OnabotulinumtoxinA at a 100U dose ( n=277 ) or placebo ( n=271 ) , administered as 20 intradetrusor injections of 0.5 ml . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Co- primary end points were change from baseline in the number of UI episodes per day and proportion of patients reporting positive treatment response on the treatment benefit scale ( TBS ) at week 12 . Additional end points included other OAB symptoms ( episodes of urinary urgency incontinence , micturition , urgency , and nocturia ) and HRQOL ( Incontinence Quality of Life [ I-QOL ] , King 's Health Question naire [ KHQ ] ) . Safety assessment s included adverse events ( AEs ) , postvoid residual ( PVR ) urine volume , and initiation of clean intermittent catheterisation ( CIC ) . RESULTS AND LIMITATIONS OnabotulinumtoxinA significantly decreased UI episodes per day at week 12 ( -2.95 for onabotulinumtoxinA versus -1.03 for placebo ; p<0.001 ) . Reductions from baseline in all other OAB symptoms were also significantly greater following onabotulinumtoxinA compared with placebo ( p ≤ 0.01 ) . Patients perceived a significant improvement in their condition , as measured by patients with a positive treatment response on the TBS ( 62.8 % for onabotulinumtoxinA versus 26.8 % for placebo ; p<0.001 ) . Clinical ly meaningful improvements from baseline in all I-QOL and KHQ multi-item domains ( p<0.001 versus placebo ) indicated positive impact on HRQOL . AEs were mainly localised to the urinary tract . Mean PVR was higher in the onabotulinumtoxinA group ( 46.9 ml versus 10.1 ml at week 2 ; p<0.001 ) ; 6.9 % of onabotulinumtoxinA patients versus 0.7 % of placebo patients initiated CIC . CONCLUSIONS OnabotulinumtoxinA 100 U was well tolerated and demonstrated significant and clinical ly relevant improvements in all OAB symptoms , patient-reported benefit , and HRQOL in patients inadequately managed by anticholinergics . TRIAL REGISTRATION Clinical Trials.gov : NCT00910520 OBJECTIVE To determine the efficacy of intradetrusor injections of botulinum toxin A for non-neurogenic urinary urge incontinence . METHODS We conducted a six-month , r and omized , double-blind controlled trial involving women with urinary urge incontinence . Participants received intradetrusor injections of either botulinum toxin ( 100U in 10 mL ) via cystoscopy or a placebo control ( saline injection ) . The primary outcome was maximum bladder capacity at cystoscopy . Secondary outcomes included quality -of-life measures , 24-hour leakage rate , patients ' subjective assessment , and safety data . RESULTS There were 21 participants : 11 in the botulinum toxin ( treated ) group and 10 in the placebo ( control ) group . There were no significant differences between the groups at baseline . After six months the mean maximum bladder capacity at cystoscopy was 161.6 mL greater in the treated group than in the control group ( P = 0.018 ) . There were no differences in diary data or quality -of-life measures . The 24-hour pad test ( a measure of leakage ) after three months showed significant improvement in the treated group ( difference 272.12 g , P = 0.016 ) ; treated subjects also showed subjective benefit at three months ( difference 1.29 , P = 0.007 ) and at six months ( difference 1.16 , P = 0.01 ) . There was no significant difference in rates of urinary tract infection between groups . There was one serious adverse event ( a perioperative cardiac event ) in the botulinum toxin group . CONCLUSION Botulinum toxin increased bladder capacity at cystoscopy and reduced urinary incontinence on 24-hour pad testing in adult females with urinary urge incontinence . There was one adverse event in the group treated with botulinum toxin Aim : To evaluate the clinical outcomes of two different doses of BTX-A in patients with refractory idiopathic overactive bladder . Patients and Methods : Thirty nine patients with refractory idiopathic overactive bladder from 1/1/2008 till 30/3/2009 were evaluated in a tertiary care hospital . Patients were evaluated using urodynamic studies , voiding diary , UDI-6 and IIQ-7 question naires prior to being prospect ively r and omized ( alternate r and omization ) to the BTX-A applications and three months after treatment . Voiding diary and residual volume were followed two weeks later . All patients received intradetrusorial injections of BTX-A ( Botox , Allergan , Irvine , CA ) of 100u or 200u under cystoscopic control on an outpatient basis . The primary endpoint was assessed for the improvement of urodynamic parameters and adverse events at three months after the initial treatment . Secondary end points included urinary frequency , urgency and UUI episodes as assessed by voiding diary and QoL. Results : Eleven patients were enrolled to each arm of the study . There were no significant differences in demographic characteristics between the two groups . Urodynamic assessment at the end of the third month showed significant improvement in urodynamic variables in both groups . There was no statistically significant difference in urodynamic parameters and in the voiding diary between the two groups . QOL was significantly improved in both groups with no statistically significant difference between the different doses . Only three patients developed acute urinary retention . Conclusion : BTX-A at 100u and 200u appears to improve symptoms , urodynamic parameters and QoL with no statistical significance between the two groups BACKGROUND Patients with urgency urinary incontinence ( UUI ) due to overactive bladder ( OAB ) refractory to oral antimuscarinics have limited therapeutic options . OnabotulinumtoxinA appears to be an effective new treatment . OBJECTIVE Assess disease-specific quality -of-life outcomes and general health-related quality -of-life ( HRQOL ) outcomes following treatment with onabotulinumtoxinA in patients with idiopathic OAB and UUI inadequately managed with antimuscarinics . DESIGN , SETTING , AND PARTICIPANTS A phase 2 , r and omized , double-blind , placebo-controlled , dose-ranging study conducted at 40 sites from July 2005 to June 2008 with 313 patients ( 288 females ) with idiopathic OAB experiencing eight or more UUI episodes per week and eight or more micturitions per day at baseline , with follow-up of 36 wk . INTERVENTION Intradetrusor onabotulinumtoxinA ( 50 U , 100 U , 150 U , 200 U , or 300 U ) or placebo . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS HRQOL was assessed using the urinary Incontinence-Specific Quality -of-Life Instrument ( I-QOL ) , the King 's Health Question naire ( KHQ ) symptom component , and the Medical Outcomes Study 36-Item Short-Form Health Survey . Descriptive statistics were used for absolute scores/changes from baseline . Within-group changes from baseline were assessed using paired t tests . Change from baseline for each onabotulinumtoxinA group compared with placebo was analyzed using an analysis of covariance model . RESULTS AND LIMITATIONS OnabotulinumtoxinA treatment at doses≥100 U produced significantly greater improvements than placebo in the I-QOL total and subscale scores at all follow-up visits from week 2 through week 24 ( p<0.05 ) . OnabotulinumtoxinA doses≥100 U produced significantly greater improvements than placebo in the KHQ symptom score at a majority of follow-up visits . HRQOL instruments demonstrated low to moderate correlations ( Spearman correlation range : 0.01 - 0.51 ) with the symptoms of UUI recorded using daily diary data , with I-QOL demonstrating the highest correlations . A study limitation was that certain quality -of-life measures were exploratory and not vali date d. CONCLUSIONS A single onabotulinumtoxinA treatment with doses≥100 U result ed in statistically significant and clinical ly meaningful improvement in HRQOL by week 2 compared with placebo , and this improvement was sustained for ≤36 wk in patients with idiopathic OAB and UUI who were inadequately managed by oral antimuscarinics . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00168454 To compare the efficacy of tolterodine plus simplified bladder training  ( BT ) with tolterodine alone in patients with an overactive bladder Introduction and hypothesisMirabegron is a potent and selective β3-adrenoceptor agonist that may represent an alternative treatment option in place of antimuscarinics for patients with overactive bladder . Methods Patients completed a single-blinded , 2-week placebo run-in period followed by 12 weeks of r and omized ( n = 928 ) double-blinded treatment with  mirabegron oral controlled absorption system ( OCAS ) 25 , 50 , 100 , or 200 mg once-daily ( QD ) , placebo or tolterodine extended release ( ER ) 4 mg QD . The primary endpoint was change from baseline to end-of-treatment in mean number of micturition episodes/24 h. Secondary endpoints included changes in mean volume voided per micturition ; mean number of urinary incontinence , urgency urinary incontinence , and urgency episodes/24 h ; severity of urgency ; nocturia ; and quality of life measures . Safety parameters included vital signs , adverse events , laboratory tests , electrocardiogram measurements and post-void residual volume . Results Mirabegron 25 , 50 , 100 , and 200 mg result ed in dose-dependent reductions ( improvements ) from baseline to end-of-treatment in micturition frequency of 1.9 , 2.1 , 2.1 , and 2.2 micturitions/24 h respectively , versus 1.4 micturitions/24 h with placebo ( p ≤ 0.05 for the mirabegron 50- , 100- , and 200-mg comparisons ) . There was a statistically significant improvement with mirabegron compared with placebo for most secondary endpoints including quality of life variables . While there was a significant ( p < 0.05 ) increase from baseline in pulse rate in the mirabegron 100-mg and 200-mg groups , this was not associated with an increased incidence of cardiovascular ad 
    Output:
    
New evidence -based statements and expert opinion supplement the original guideline published in 2012 , which provided guidance for the diagnosis and overall management of OAB in adults .